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HomeMy WebLinkAboutMiscellaneous - 53 WOODSTOCK STREET 4/30/2018ten, MAM ;� . x � r a. �� . _ nF",a{M� aN'°,w �I'��1 Mt��anta '�t.°a; .U. ,.. Sp WW Elmr... R dh'nx0' ROBERT J. SWAJIAN & ASSOCIATES, INC. INSURANCE ADJUSTERS 1820 TURNPIKE STREET - STE. 207 N. ANDOVER, MA 01845 TELEPHONE (978) 655-4994 FAX (978) 655-3571 1nfo@RJSAssodates.biz FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Inspector of Buildings Town Hall North Andover, Ma 01845 RE: Insured: Loss Location: Date of Loss: Policy Number: Board of Health or Some Karen Maheu 53 Woodstock Street 10/30/17 NXAR03 11Q MA ZONAL WNP(NaNf 14URAN([ DNTiT[ Z of,•gklp, gra 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 or file number. ADJUSTERS TITLE: 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. b E. Swa'ian October 31, 2017 Location Nob R 1 aloocis4ct s t Date NaR,� TOWN OF NORTH ANDOVER 3?o��t`•o •,hOL op Certificate of Occupancy $ + ; : Building/Frame Permit Fee $ Foundation Permit Fee $ s�C usE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector .7 r 07/09/99 12:23 25.00 PAID Div. Public Works M 'r a U W z F W _ z � C - _ O C - cc, I U ti z Z ^ G T W - != U C � W G M •( �. C C G U a W F W _ W_ _ O C - C U U L _3 ass 06/28/1999 20:12 9786856471 ALL UNDER ONE ROOF 67 (Policy Provisions: wC 00 00 00 (NM ONLY) , WC 00 00 00 A) 29 vM INFORMATION PAGE - WCIP wz WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY' HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115 NCCI Company Number. Company Cods: 6 PAGE 01 THE HARTFORD suffix ai�tEj LARS RENEWAL POLICY NUMBER: Previous Policy Number; 1. Named insured and Mailing Address: NORMAN GAY DBA ALL UNDER ONE (No., Street. Town, State, Zip Code) ROOF/FEST IN PEACE FEIN Nmnber: 028349269 70 NOR HFFERSON ANDOVER, MA01845 State Identification Numbw(s); The Named Insured Is: INDIVIDUAL Business of Named Insured: ROOFING Other Wor"oes not aho*Wn above: 70 JEFFERSON ST. , NORTH ANDOVER, MA 01845 2. Policy Period: From 11/09/98 To 11/09/99 12:01 a.m., Standard time at the Insured's mailing address, Produce's Name: MASS WORK COMP A R DIRECT LENNOX INSURANCE AGENCY PO BOX 462 LYNNFIELD, MA 01940 PrOdvaell's Code: 083477 Issulng Oifke; THE HARTFORD 4801 NORTH WEST LOOP 410, SUITE 200 SAN ANTONIO 0) 85zTX 78229 -79gi roe Policy is not binding uniass Counierscgned Dy aur authorized representative. ?h47 7 &,­,.A� Auriwdzed RepreswjWw Foran WC 00 00 01 A Printed in U.S.A. Profen Date: 10 / 09 / 98 Page 1 (Continued on next page) ORIGINAL Poilcy E*atlon Date: 1.1/09/99 x �¢ w a G DC c° cn p U z z c° c°G v U w ce O � w�' ro w 1:4 0 w u W W to 0� V) O F w 7 m H W A w z .5 0 CO c c � o � C N O C v V ad C m cc :moo o� m EQ '_.2 oCC OL o m C.3 $ CD c mm m Cy�H vs 3 m� d � a c H M N m h m cg O :mom cc.i H Z Q W. y m CD m c 3 x :a+ -o I- o o H c/) cya _ m W G '0 LL m •• C .y V m p m C CL m 40:5 x v s a�Cc O W :Q V O CLCD m ma y H OC r.1 CD v U as C/) c W a!\ CIO o C 'c N �r m z O CD O E CD 0 z O O y CD .E C� i CO C CO O C.) m r.1 m LU _0 LLJ Ir W W Ir W Location Noy AYE Date /0-/e- i'af ,.ORT" TOWN OF NORTH ANDOVER Certificate of Occupancy $ } x Building/Frame Permit Fee $ Ss�cMusEt Foundation Permit Fee $ Other Permit Fee vk:E- $S Sewer Connection Fee $ WaterzConnection Fee $ 1. TO'T'AL $ ' Lt v2's rl Building Iris ctot' 6 6 4 0 Div. Public Works PERIIIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. L� /PAGE 1 %4AP 440. LOT NO. " 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. OCATION PURPOSE 01111 6 v ^ ,�.�.�-VtR'S NAME OWI) / NO. OF STORIES I E OWNER'S ADDRESS / BASEMENT OR SLAB -- ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD ALDER'S NAME SPAN DISTANCE TO NEAREST BUILDING �Q DIMENSIONS OF SILLS -_ --- DISTANCE FROM STREET fZ POSTS DISTANCE FROM LOT LINES — SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE JS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 I ELECTRIC .METEPS MUST BE ON OUTSIDE OF BUILDING e ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 11 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR D� ATE FILED SIGNATURE OFIOWNEPWt / 1THORIZED AGENT FEE O`a'r PERMIT GRANTED 1 3 PROPERTY INFORMATION LAND COST -Egg BLDG. COST _L1 o EST. BLDG. COOT PERS EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 'NV1d lO1d S30V1d3U SIHl 'a3SOdWl2l3dnS '013 's3ovu -V'J 'S3H0210d HlIM 'SONIa11n9 30 SNOISN3WIa lOVX3 aNV S3N1-1 101 WOMA 3ONV1Sla aNV 101 d0SNOISN3Wia lOVX3 MOHS1SnW N01103S SIHI V" ZI I AONVdn70o I aNOD3b ONIaiinv + 0NIIV3H ON _I PIC I +'1 P"L 1,W.9 JIa0313 110 SWOOM 40 'ON L SVO S831V3H LINtI O.1.H 1NVIOVS ONINOIl10NOJ SIV SOdVA SO S.1.M lOH _ _ S8313V8 DOOM 'S10J '8 'sm 1331S WV31S 'NSnj SIV lOH 03JSOj DVNanj SS313dId _ 'S10J V 'SW9 a39W11 1SIof OoOM ONIMM ll I ONIWVIId 9 OOVO 3111 aoo13 3111 _ S38n1XIj NS300W ON1300a 110b _ a3MOHS 11V1S 13AV80 8 "1 ON19wnld ON 31V1S ANIS N3HJ11A S30NIHS DOOM ASO1VAV1 S310NIHS 11VHdSV 13SO1J S31VM 03HS 1Vlj 13S9wVO ('X13 it 'WS _T3, —Io1 OSVSNVW — Xld E) H—IV 9 dlH I I 319V0 ONsawnld OI dooa 9 ov �I 3a01 3dns a00d ONIIlIM 3WVSj NO 3NO1S UNOSVW NO 3NO1S A19 a30NIJ So ':)NO:) _I soo13 g 'sals JI11V 3WVS3 NO AJIS9 ASNOSVW NO AJIS9 — _ C r —VSj 9 3111 'HdSV too lWOJ NO OJJn1S ASNOSVW NO OJJn1S ONIOIS 'AM ON -MIS SOIS39SV O.r;kOaVH ONIOIS 11VHdSV S310NIHS tfOOM HAV3 313aJNOJSOSV10,AOa0 Moll 6 II S71VM b N3HJ11A NS300W S3JVld 3alj V3aV JI11V 'Nlj V3aV .1.W.9 'Nlj WOOS OV3H 1.W f! 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CJ w� N O :mom C � L p � N O O � = C N A N L� CLP L O O 'cya V y O co 'F Z ' c � o CL Q m y °� c m : mz 3 a +� o H o N m $ I -- C* Lys C .a ►. t LL m C �+ P -N -a.c O C L2 cm LD m p m = C y a 0. 0:5 _ Cp m L N -_ s *- a0m CL N N C O 7 rm C: cm m 0 a c 'c N 0 z 0 NE Cl E 0 0 0 M� M U J o z LL coL 0 o � Z o Q O � y c z co cm CO O CO .y O O CU) o O i O CD L �Q o crj V J -O c Z � z_ C� y O C C CO) CDz G z Z OL t ry)M1y !V" '>; � t :eY,,,.}'13a '::'19GJohZAyYtcLiag�.hi�L1�.1�.1,r. ,L:i 1,t .-i:�.:•a. °a•7 4� „IYa..A..!.er- n.2i 1 iiil ily�„f,,,Z a};,�';�;R✓�,4:�iitt4�,�t✓iu Ta14a..r,�Att.s�'i4ilc:it,�..F�l....•P.tuu, Stove SDCCif i0tions &. Clearances r Performance Overall Maximum Heating Maximum EBiciencv Emissions Burn'lime Cubic Firebox Capacity BTU's/Hour (DEQ) (Cord Wood) Volume Wood Fuel ' Size Capacity EPA Phase 11 Model 1196 Approved Model 996 EPA Il Approved Model 796 EPA Phase 11 Approved 1,500- 72,300 Cord Wood 70.3% 7.4 Gr./Hr. 12 Hours 2.5 Cu. Ft. 2,250 Sq. Ft. 43,600 EPA 'rest 1,8000 SSq. Pt. 70.300 Cord Mood 73.6% 5.5 Gr./Hr. 9 Hours 1.7 Cu. Ft. Sq. 600- 64.200 Cord Wood 68% 3.0 Gr./Hr. 8 Hours 1.3 Cu. Fr. 1.200 Sq. Ft. 44,400 EPA esr 22” 30 lbs: 20" 20 lbs. 17" 16 lbs. � lox.ld 1196* V l Pedestal 315/8" i�C <ll tlllt ('� R) ComholiN ' 1 Please refer to clearances listed on rhe right. A= Unit to Sidewall B = knit to Backwall C = Unit to Adjacent Wall D = Chimney to Sidewall E = ChinmeN. to Backwall F = Chimney to adjacent Wall G= Hearth Extension in Front H= Hearth Extension to Sides 1 = Hearth Extension to Back Singlewall Connector Residential. Installation 16" 15" 9 1/2" 27 1/2" 17 1/2" 20 1/2" 16" 6" 6^ Mobile Home, Alcove or Reduced Clearance Installation 16" 10" 7 1/2" 27" 12" 18" 16" 6" 6" Alcove Specifications Maximum Depth 48" Maximum Height 84" Minimum Width 61 1/4" Height Pedestal 32 3/4" Black Legs 27 3/4" Brass & Cast Legs 291/8" `.Yidth 29 1/41 Depth 20 1/2" Flue Diameter 6" Unit Weight (Pedestal) 51011)s. Stove Construction Stove Top 5/16" Unibody 3/16" Unit Weight (Pedestal) 305" Stove Construction Stove Top 1/4" Unibody 3/16" 4� PLt'F. TOP FLIT 1, l l(.96* Iod�I t/ _I )p 1-11cC (11;15I1) I ICil�il(I�C' IO (olllhll`tlhlc Please refer to clearances listed on the right. A = Unit to Sidewall B = Unit to Backwall C = Unit to Adjacent Wall D = Chimney to Sidewall E = Chinmey- to Backwall F = Chimney to adjacent Wall G = Hearth Extension in Front H= Hearth Extension to Sides I = Hearth Extension to Back Singlewall Connector Residential Installation 14" 14 1/2" 11" 231/2" 15 1/2" 19 1/2" 16" 6" 6" H Mobile Home, Alcove or Reduced Clearance Installation 14" 9 1/2" 7 1/2" 23" 10" 15 1/2" 16" 6" 6" Alcove Specifications Maximum Depth 48" Maximum Height 84" Minimum Width 53 1/2" Height 45' Flue Pedestal 32 1/2" Black Legs 27 1/2" Brass & Cast Legs 28 7/8" Height Top Flue Pedestal 32,5/8" Black Legs 27 5/8" Brass & Cast Legs 29" NVidth 25 5/8" Depth 19 3/8" 4+51_ Fill(' 0011'011(0 TO LOI llhll�hhlc' , Singlewall Connector Please refer to clearances Residential listed on the right. Installation A = Unit to Sidewall 14" B = Unit to Backwall 17 1/2" C = Unit to Adjacent Wall 11" D = Chimney to Sidewall 23 1/2" E = Chimney to Backwall 15 1/2" F = Chimney to Adjacent Wall 16 1/2" G= Hearth Extension in Front 16" H= Hearth Extension to Sides 6" I = Hearth Extension to Back 6" Mobile Home, Alcove or Reduced Clearance installation 16" 14" 7 1/2" 25" 10" 12" 16" 6" 6" Alcove Specifications Maximum Depth 48" Maximum Height 84" Minimum Width 57 1/2" Flue Diameter 6" Unit \irei ht (Pedestal) 325 lbs. g Stove Construction Stove Top 1/4" Unibodv 3/16" I , , 45' FLUE (Ext.) TOP FLUE (Flush) Nodd 796* IOP FltIc Clcilralt (,� lO (_l:)II bohh1c Please refer to clearances listed on the right. A = Unit to Sidewall B = Unit to Backwall C = Unit to adjacent Wall D = Chimney to Sidewall E = Chinmev to Backwall F = Chimney to adjacent Wall G = Hearth Extension in Front H = Hearth Extension to Sides 1 = Hearth Extension to Back Singlewall Connector Residential Installation 10" 16 1/2" 9 1/2" 19" 17 1/2" 17 1/2" 16" 6" 6" Mobile Home, Alcove or Reduced Clearance Installation 11" 8 1/2" 7 1/2" 19 1/2" 9" 15" 16" 6" 6" Alcove Specifications Maximum Depth 48" Maximum Height 84" Minimum Width 46" Height 45' Flue Pedestal 315/8" Black Legs 26 5/8" Brass & Cast Legs 28" Height Top Flue Pedestal 31 3/4" Black Legs 26 3/4" Brass & Cast Legs 28 1/8" Width 23 5/8" Depth 45' Flue 15 3/4" Top Flue 163/8" j}!�` IIl1C �IC'ilr(1(IIC It) Coll bolihlc� Please refer to clearances listed on the right. A = Unit to Sideyvall B = Unit to Backwall C = Unit to Adjacent Wall D = Chimney to Sidewall E = Chinmev to Backwall F = Chimney to adjacent Wall G = Hearth Extension in Front H = Hearth Extension to Sides I = Hearth Extension to Back Singlewall Connector Residential Installation 10" 19 1/2" 9 1/2" 19" 17 1/2" 16" 16" 6" 6" Mobile Home, Alcove or Reduced Clearance Installation 11" 13" 7 1/2" 19 1/2" 91, 11" 16" 6" 6" Alcove Specifications Maximum Depth 48" Maximum Height 84" Minimum Width 46" Flue Diameter 6 ' Unit Weight (Pedestal) 305" Stove Construction Stove Top 1/4" Unibody 3/16" 4� PLt'F. TOP FLIT BACKWALL Pardlf I WOII 110dialioll Please refer to clearances listed for the appropriate unit on the left. A = Unit to Sidewall B = Unit to Backwall D = Chimney to Sidewall E = Chinmey to Backwall G = Hearth Pad Extension in Front of Unit H= Hearth Pad Extension to Sides of Unit 1 = Hearth Pad Extension to Back of Unit Corner In�fallo foil Please refer to clearances listed for appropriate unit on the left. �5 C = Unit to Adjacent V\'all F = Chinmev to Adjacent Wall G = Hearth Pad Extension in Front of Unit H = Hearth Pad Extension to Sides of Unit 1 = Hearth Pad Extension to Back of Unit BACKWALL _ O Alt ov!c' lw4dl )fim f I Please refer to clearances listed for the appropriate unit on the left. A = Unit to Sidewall B = Unit to Backwall D = Chimney to Sidewall E = Chinmev to Backwall G = Hearth Pad Extension in Front of Unit H= Hearth Pad Extension to Sides of Unit I = Hearth Pad Extension to Back of Unit \pprovc'cl Douhlcwilll Coal odor: Components required for mobile home, alcove and reduced clearance residential installations. DURAVENT Model DVL with DURA -PLUS chimney SECURITY Model DP with SECURITY Model ASHT or 52100 chimney AMERI-TEC Model DCC with Model HS chimney METAL ­EAB Model DW with Model TG chimney In addition to the chimney systems above, the model 796 & 996 can utilize the following chimneys. OLIVER MaCLEOD ' Provent" Model PV with Model 3103 chimney SELKIRK METAL.BESTOS Model DS with Model SSII chimney GSWJAKES EVANS Superpipe 2100 * The Dimensions & Clearances on this page are for reference only, refer to Owner's Manual for exact specifications prior to installation. Installation, floor plan, types and dryness of fuel, insulation of home, chimney draft and outside temperatures Will effect stove performance. Six E y ti y� Fr-��'S .rte`-� _ �• - °,I. V ' �4 Jti 4 fi wjW. -a e t �� n i Model 796 Top Flue is . cleanest Ga,i tion c, small sto even ested at 3 grams.- I ideal for heating small = homes or just a room" two in large homes. It he from 600 to 1,200 squ feet with a burn time of to 8 hours. The 796 0 �- _ pedestal is right at home M!c tis cheery dining roo WOOD STOVE INSTALLAHON CHECKLIST - c Permit A building permit is required for the .installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove ..�` A. New Used 40 B. Type/radiant 600"26 drillA-, Circulating J C. Manufacturer _Lab. No. -7 li Name/Model No 216 74 7 0 Collar size �� { Dimensions/Height 11) 1 Length 04-1Width J 5 1 Chimney A. New Existing B. Size (flue area) 22 C. Other appliances attached to flue (Number and flue size) 14� sT D. Prefab (Manufacturer—name and type) /--- E. Masonry/Lined .Flue liner Unlined � tYOs6manufanuror) •; �. F. Height (refer to diagrams) `� t�i�L cap//,,/( n 1 OVEF, ICI 7 -}2 MIN 3' M(K '01 !0"FiRlo" Z `.11'y• CHIMNEY HEIGHT Hearth (non-combustible�j_ _ S -� �- A A. Materials � ' L �� � `� `�' B. Sub -floor construction C. Minimum dimensions (refer to diagram) / f Clearances and Wail Protection (see sieve installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE W CORNER HEARTH WALL/CENTER WOOD STOVE 1NSTALLAHON CHECKLIST �'-'.'•f1I1' IdU: Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove ..�` A. New ✓ Used /)0 B. Type/radiant 001W&M 0A Circulating f C. Manufacturer 19 1411.14 _Lab. No. Name/Model No. 1 Cr,llar size Dimensions/ Height J2 1� Length /9 ��� j� Width V 5 Chimney r A. New Existing B. Size (flue area) C. Other appliances attached to flue (Number and flue size) D. Prefab (Manufacturer—name and type) ,4---- E. Masonry/Lined Flue liner Unlined type 8 manuraccurer) F. Height (refer to diagrams) _cap aVEfL IC' 2r MIK 3 Mtn io CHIMNEY HEIGHT Hearth (non-ccmbustibl A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) �T Clearances and Wall Protection tsee stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER HEARTH W WALL/CENTER 13 I nd, CHIMNEY HEIGHT Hearth (non-ccmbustibl A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diagram) �T Clearances and Wall Protection tsee stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE CORNER HEARTH W WALL/CENTER 13 Location 3 )G0 r� S,�aC No. Date v0 TOWN OF NORTH ANDOVER �. . 0.i N4A Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ --30s�cwust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 Check # ()0,0 15 8 u 1 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/Inspector-of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �� 53 wo"Sncic S-1. #151F VO 10 1-3 Map Number Parcel Number AIoRiM- �uav��.. 1.3 Zoning Information: 1.4 Property Dimensions: 13050 t -D Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record k0a J-, MANCV L/ .5.3 Wo-op.svoc.tc 57', Name (P w' t) Address for Service: �-w`—j u— 'f' ® 8 S�ture Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constrvtsor. Jnr ,,i License Number LoU� L (�{j + Address 115 lo4- 9' �q " ¢,� �C)7 f Expiration `ate Situ Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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) 0 Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief s�cription of Proposed Work: (oo F A M v4L (_ ��� �� o ea SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building �. (a) Building Permit Fee Multiplier 2 Electrical r� (b) Estimated Total Cost of Construction 3 Plumbing A1114 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 IAZ_ .T` f✓]'A l ,,/� as Owner/Authorized Agent of subject property Hereby authorize V !� %[ie_.. to act on My behaI in tters re ive to work authorized by this building permit application iature oTlYkAmeY 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 attire of Owner/Aeent Date .., NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS i sr 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIlv1NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE L°c9►,,��rvLr t�AV, MVv S 70 r"C v\ o 0 e F� S�CQ st FORM U - LOT RELEASE FORM IDOo r r C M1Aq-e 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 eco -f, m4Hco LOCATION: Assessor's Map Number. SUBDIVISION STREET `{.5_ F PHONE 7?_8-W4'b1k?9 PARCEL LOT (S) l ST. NUMBER 53 ************************************OFFICIAL USE ONLY*********************************** RECQIMENDATIONS OF TOWN AGENTS: �v �" CONSERVATION ADMINI RATOR DATE APPROVED a DATE REJECTED COMM TOWN PLANNER COM DATE APPROVED DATE REJECTED 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 INSPECTO Revised 9\97 jm TE IIS W 00 Z LO iO d- 0 S80'15'50"E S82`1 4'45"E 0 d- 0 W 0 0 D S T 0 C K S T R E E T r�'fP�IVYilJ7V � :^r �C �oAt This plan is for the use of the Building Inspector P LOT PLAN of the Town determinationaofNo. zoni zoningover, for compliance. e purpose' of 53 WOODSTOCK ST., NO.ANDOVER, MA This property is in the R4 zone. Scale: 1 "=30' — Aug.9,2002 This plan is the result of an as—built construction survey performed, and monumentation found on NEW ENGLAND ENGINEERING SERVICES, INC. 8/06/02, based upon plan #3698 in the Essex 60 BEECHWOOD DRIVE North District Registry of Deeds. NORTH ANDOVER, MASSACHUSETTS °�" .l�f is (978) 686-1768 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: -TD © ,e o� j T,4 (Location of Facility) t//- 6� L. Signature of Permit Applicant 001//Z ZQ-2- Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of I'14assachusetts Department of Industrial Accidents Office or Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name: Location: City Phone 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' �brnl�tty trams: Address for my employees working on this job. it r: Phone*: Insurance: oo. Pout # Failure to secure coverage as iris ad uridar 3ec6on 25A or MGL 1,52 can teal to the imposition of criminal penalties ora fine up to $1.500.00 and/or one years' impris as t as civil penalties in the.form of a STOP MRM ORUM and a fire of ($1100-00) a day against me. t understand that a copy stat t m t be forrnxded to the office of InveStigAons of the DSA for coverage verification. I do herby certify and t ns and les that the irrlormadw provided above is true ani- correct Signature Date 0 / 2 16 2 Print name Q6t�rrll.7' ��Phone #9 %9-- ¢�g �97 1 Official use only do not write in this area to be completed by city or town official' p.Oheak if immediate response is requb-ed Building Dept Contact person: Phone ?1W WORKMAN'S COMPENSATION El Building dept '. p Licensing Board El Selectman's office D Health Department D Other ZW� I N 0 z TV —TI r� 4L NS �x Cl) m M C/) U) O co 0 .. v y d d O CA O CA d C2 CD CD CD C/!• CD O C = H p --1 CA CL O 5. m CO) rL CD CL C-) m 0 CD O.w .+ = .d.► m N '71 fid, d G m CCD N C y fmm'�C-Dq a C4 0 m t o ` j O N CO! Q O CD m r a VJ = m O y :� m C")� OT CD lJC (� a .W _a N ['� O i V_ o� A CA _ mW su CA y O cCD 0 , 0 N � O CD "4 a� d W . :tib =o: M )psi 0 0 c Z OX G ~ OZ- Mn b M y w oGGCL � ry b A) �r1 C�7 n w G C" w G'j. G ` G G CL P) 0 G C) b c O %� G tz O O M )psi 0 0 c