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Home My WebLink AboutMiscellaneous - 543 FOREST STREET 4/30/2018 (2) 543 FOREST STREET 210/106.B-0045-0000.0 ` 1 L � � � U C.1 � � �� I i f w i I LocationD ' No JAZ 0 Date r NCRTy TOWN OF NORTH ANDOVER . ' p Certificate of Occupancy $ Building/Frame Permit Fee `tth Foundation Permit Fee $ s�CHus Other Permit Fee $ } ' Sewer Connection Fee $ =' Water Connection Fee $ TOTAL $ Building Inspector 11:39 25:40 iPAID f a ° iv. Public Works I s3 0 '�EaJtIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. tf�c�--' 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE — ZONE SUB DIV. LOT NO. �I i LOCATION �� PURPOSE OF BUILDING OWNER'S NAMED -o `y3 `e / NO. OF STORIES SIZE OWNER'S ADDRESS_I^M/'`. j �® / am+y 5 BASEMENT OR SLAB _ ARCHITECT'S NAME " -e— SIZE SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 3.t1 O R C3'/'4 A,- SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW N I/ +c SIZE OF FOOTING X IS BUILDING ADDITION ♦ Ap MATERIAL OF CHIMNEY IS BUILDING ALTERATION a 1 S• i�11� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQ REMENTS OF CODE Ti/'n(� IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY � )� P ,•�L IS BUILDING CONNECTED TO TOWN SEWER �V IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST �► i�A .� PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST Ppfi SQ. FT. EST. BLDG. COST PER ROOM P!11GE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED Je BUILDING INSPECTOR OIGNAPRI/I OWNER OR AUTHORIZED AGENT F AE OWNERTEL # PERMIT GRANTED CONTR.TEL.# ` f Jr? • ^��T� 19 j13 H.LC.AI BUILDING RECORD 1 OCCUPANCY 12 _ INGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED.-THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH - CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 1/7 FIN. ATTIC AREA N_O BM'T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE -I— WOOD SHINGLES EARTH __ _ ASPHALT SIDING HARDV✓'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRI N MASON Y- ATTIC STIRS. & FLOOR i- BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME �u SUPERIOR I-1 POOR ADEQUATE NONE 5 ROOF 10 PLUMBING L GABLE HIP BATH Q FIX.) GAMBREL MANSARD TOILET RM. 12 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. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G A, UNIT HEATERS 7 NO. OF ROOMS GAS " OIL B'M'T2nd _ ELECTRIC ti 1st 13rd I NO HEATING 1 ffAbbAW1lUSE fT5 UNIFORM APPUCATION FOR PERMIT TO 00 Pt_UMUINU (Print or Type) NORTH ANDOVER, , Mass. Date Building permit Locatlon Fo S -tS Owner's Name 'rl New Renovation Replacement ❑ Plan: Submitted: Yea❑ No �iXTU ES • A M a W < « s s w s 0 M N 3 O s M S a1 < � at O M L O � 16 x s 33 " o ee 0 I-U o Ya '� � sa _ � KoNJ " � r � < : s = 3 • M o o y s M La s a e s s a<i eAe[M[NT I IST FLOOR iN0FLOON 111110 FLOOR ITM !•LOOK aTH FLOOR 111TH FLOOR. 1TH FLOOR on - 1 p� Check one: Certificate Installing Company Name 0 r �1 IJ, �- 13 Cow Address _ `b C F'fF d q �E ►- ❑Partnership [ S • 5 c o -t A4 D 1 `l® Firm/Co. Business Telephone & Name of Licensed Plumber D lq n /q 4 INSURANCE COVERAGE: ec one I have a current liability Insurance policy or Resubstantial equivalent, Yea No ❑ It you have checked y", please Indicate the type coverage by checking the appropriate box A Ilablilly Insurance policy Other type of kdemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee des not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and (hat my signature on this permit application waives this requirement. Check one: Owner 13 Agent C)a ure o et a Ormer s en I hereby certify that all of the details and information I have submitted for entered)In above eppReatlon are bus and accurate to the best of my knowted a and that tall plumbing work and InstaNatlona performed under the permit issued for this appNcatlon will be In compliance with all p^WInen provlslona of •Massachusetts State Plumbing Code and Chapter 1 V B �V Title 5ignor ure of Umnsed Plumber Gtyfrown license Number Type of Plumbing License: Master ❑ APPI'MTO(OFFICE USE ONLY) Journeyman Date-. . . . NI- .'n 83 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CHUS This certifies that has permission to perform . . . , plumbing in the buildings of . . . . . . . . . . . . ... . . . at. ter. ` . . . . . .,.North Andover,Mass. Fee 3-�. Lic. No/S. . PLUMBING INSPECTOR " --9` 96 44:44 35.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File n' t n ...ti,r,�a,r;n„[+x s+««. .�w..e.-w.:dr✓«*,.r: f Location 'No. f Date �i�`2 P� ,NORTH TOWN OF NORTH ANDOVER p Certificate of Occupancy $ �" • s +' Building/Frame Permit Fee $ Foundation Permit Fee $ ?Y'. SSACMUSE �h , Other Permit Fee , T{ � •w } Sewer Connection F ® $� GO Water Connection e QQ` O . TOTAL a i�Zlldlng Inspector } �' 9-663 Div. Public Works PERIfIT NO. C] APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER MASS. V PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP :DATE (BOOK :PAGE ZONE I SUB DIV. LOT NO. LOCATION a' PURPOSE OF BUILDING OWNER'S NAME O" / !q-S NO. OF STORIES SIZE OWNER'S ADDRESS ®`J,a5_f rJ.' D� /,�� EMENT OR SLAB ARCHITECT'S NAME 'SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME / ® SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION � .� e��j�` � IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM IrO/REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER w IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST ti SEE BOTH SIDES EBT. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED a, BUILDING INSPCCT+OR I ! SIGNATURE F O OR AUTfKORIZED AGENT P •-V_ /� F E A FrO � OWNER TEL.# PERMIT GRANTED ONTR.TELJ (ZdU 19 CONTR.LIC.#®i >� H.I.C.# BUILDING RECORD - 1 OCCUPANCY 12 SINGLE FAMILY _ NOkIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY QFFICES _ 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 a 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ y. 1/2 1/1 FIN. ATTIC AREA NO B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDSB 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMMON VERT. SIDING ,SPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME r BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I- I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 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. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING NORTH Town o 0 over No. 100 0 dover, Mass., — 19 Y� C 0C.1c NE wick 0,q'4.r ED C, BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THISCERTIFIES THAT............................... .................S�b ..... ...................................................... Foundation Fffills/f &AsFm - r__ hars permission to anxt.................................!?.TbUildingson ........:��5�3....... ........ ;?................ Rough to be occupied as... ........... �F 47 ., .............. ..................................... Chimney provided that the person"accepting*this'*per*m'K'.shall. ....in every respect conform to the terms of the application an 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations.Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ................... .................................../ Service L6iNd.INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. om»rroouvea/,� `��ccae� DEPARINENT OF PUBLIC SAFETY _- CONSTRUCTION SUPERVISOR LICENSE Nuiber: Expires: Birthdate: CS 036113 07/31/1997 07/31/1939 Restricted To: 00 JOHN J HORGAN W;,y D , 78 LOCKNOOD RO COMwisMCWER LYNN, NA 01904 f HOME IMPROVEMENT CONTRACTOR Registration 108575 ` Type -. INDIVIDUAL Expiration 06/19/96 Y John J. Horgan 78 Lockwood Road �,ararn MA.01904 4 :.ADMINISTRATOR r ' Vonce use only The Commonwealth of Massachusetts Permit No. Department of Public Safety Occupancy aFee Chocked BOARD OF FIR 3� (leave blank) E PREVENTION REGULATIONS 527 CMR 12:00 L3 to 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) DATE Z a(a - City or Town of I . 4t�,tXUVk_1(1 To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) �y3 r .5 7 5 � Owner or Tenant Lb UG, Owner's Address S/ Is this permit in conjunction with la/building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building llok✓4_L l A-c Utility Authorization No. Existing Service Amps VoltsOverhead ❑ Undgrd ElNo.of Meters New Service Amps Volts Overhead O Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -:;Z4 7'19,V— CU/r, No.of Lighting OutletsNo.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures —I n-Swimming Pool Above Q Generators KVA d. No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners FIRE ALARMS No.of Zones Total No.of Detection and No.of Ranges No.of Air Cond. Tons Initiating Devices Heat Total Total No.of Sounding Devices No.of Disposals No.of Pumps Tons KW No.of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local E] Municipal Other No.of Dryers Heating Devices KW Connection It 11` )s No.of Water Heaters KW No.of No.of Low Voltage Wirings i! Signs Ballasts No.Hydro Massage Tubs No.of Motors Total HP OTHER: INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws, I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE ndYBOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work$ (Expiration Date) Work to Start t/ a� �� Inspection Date Requested: Rough G- Final Signed under the penalties of egury FIRM NAME =Q k, r A,, LIC. NO. 7'4�� Licensee SA-Vt`L Signature �?f 'S LIC. NO. Address 3Y Wd J A--) .,�„y tha 0101dY Bus. 'el. Nlt.Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re uired by Massachusetts General Laws,and that my signature on this permit application waives this requirement. . Owner Agent (Please cfyeg onC, Telephone No. PERMIT FEE$ 'v (Signature of Owner or Agent) F+iY't},'+�k' '�Ro'•��1�—_ur 'yr.•Y-r�yy.'. -..�.f}�.+.w�y�y .�' t�� f='"+iy;�ypl_�,cA?, �3 X25 Date. .. - 14 F 40RTH_q TOWN OF NORTH ANDOVER VI PERMIT FOR MW INSTALLATIOI ' Oq S i, This certifies that . . . . . . . r' has permission fo iallation f. FAVA ?� ., in the buildings of . . . . .�'.�,. , ; , , , , at 21,4146;t., a. . North Andover, Maw Fe (�-5,.(* Lic. NA.P. .V 7. GAS INSPECTOR CA WHITE:Applican64--CANARY: Bbilding Dept PINK:_Treasurer GOLD Flle, c Office Use Onty .ger.. un>' �IImm�n Eel i Af fi iaE zZ#u52 Permit No. Occn anc & Fee Checked :jjqX rpar mrnt of �ithlSL.-*�fP� P i 3I9Q (leave blank). y BOARD OF FIRE PREVENTION REGULATIONS 527 Cld 12:fl0 APPLICATION` FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accardance.with the:Massaeiusetts `iectncai Cede, 527 CMR t2:o0 (PLEASEPRINT IN INK,OR TYPE ALL INFORMATION), Date 1 �- (Nx or-Town of NORTH ANDO R To the Inspector of Wires: The uders'igned applies for a`perm.it to ,perform the electrical Nark described below: Lacano�.;(S-treet & Num,ber) Owner or. Tenant'' Cwrter" Address Is,tttis per rttt to ccnlurctton with a building permit: Yes No — (Check Appreort�ta Box) R:�rccse cf-9utldina. Utility Authcr'ization No. ; y Am' s:_J Overread '_ Unagrnd r Mo of titeters existing Sarvlce /ct New Sarvice Amos_J Vats Overneae Un'ac, na No of itite*ers Numeer of Feeders�anc Amcacity ` r local cr -an Nature of ?rcoosed E'ec.ri- I `vccx• N Totai �`. No. at ransformers ' N6. or grang Cutiecs No. ...'=cc _s;.. KVA r �. xc Abover- n _ ` No. at gnung ores �.; Swimming �aot grna: — cmc _ Generators KVA Na. of Emergency Cighttng,.t , No. a =ec'ep«ac:e Outlets' a 1 No. ,t Cil urners ` 3arery Units No. af.$w,tcn Outlets j No. ar Gas _- rners I. FIRE..�WRMS Na of cones I Tptal Va. at Cetecuon and :V o. of Ranges I No. ct Air Cane_ tons intnattng:Oevlces at 6 t a I Total No: of Oisoosals i �o Pt �u„. s° -ons KW' No f Soun.alnq,0evtces .NO.of Sait'Contained :;;,• {iy Oe ec::oruScunaing 'Jevites No. at 0isnwasners - !. ScaceiArea Jeatirg t Muntciaat No. at Driers ”' .Heating Cev:ces. K local _ 'Cpnnec an _Otha( ; Na.,aT No. or No. of'Water Heaters f(�tI Sims 9adasts +'/ _ Low Voltage rr:nc . No. Hvara Massage;Tuns. I. Na. of �Aarcrs Total 40;. 1tVSURANCc CCvEaAGE: ' rsu'ant t0 the featl temencs of t Pass cn sa s general Laws + 1-have a current;LiaOtilty.TnSUtanCB.Policy inG!C.al,ng C mp:etea Opera ICns ,e-overage or is;sups anciat,ecuivalent...Y,E� _ NO l -:.nave suQmtttec valid - of Cf.Same to the Ottice:'`!ES = �-�NO it you.nave-cnecxel a��`!ES. please��naicate ne,.tyos of coverage y -CheCxing..the aot]f nate pax - i` IN 8CNO= OTHEa _ ,(F!ease, cec:fy). {' (Explranon Datet a Esumaceo Value of•E!ectncal Nork`5` r Insciec::on Oate �acues5ac Roug^ F nal worx ;a Start Signea uncer ;na,Penaities ot.pe.lury � iRNA`'NANI E LIC. ,VO. r� UC:: Licensee Signature, t Sus. ;at, No. ACCress Alt. TeL No. OWNER'S INSURANCE'WAIVER:.I am aware that the c:censee noes not nave one nsuran,ce coverage or its supstannai eaurvalent as e Agent', A �� auirea by Massachusetts Generat laws. aria ; s aerntt aooticauon waives reau�remenc..Owner nal my signature on a✓"' (P!ease cnecx ones -elean ne.No. - PEAMIT,FEE S- (Signature of Owner v Agenn "" r` _,f a Date.. za y 552 NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING i� b A This certifies that C r has permission to perform ...... ...... . .. .0.:....a.. . .. .....:. . .. ........ o wiring in the building of .� �/L ....... �1.11�. ..... .... ......... ..... ` at...: .: ... ..: ... ........::............ � !/ ..,North Andover,Mass. Fee.. : . U.:. LiC. y�C..... o ELECTRICAL INSPECTOR44'. WHITE:Applicant CANARY: Building Dept. PINK:Treasurer a . . Location Y � No. Date TOWN OF NORTH AN-DOVER �.. MORTM Certificate of Occupancy $ 'Ss,cMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ b Check # ,� 15555 Building Inspector 4 � � l l ' 1 l TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �� ,� � 'Y':� �y _.,. R"'�'Si ax5r: •5, yr �,yy .. .�.s: � � F �. ^n Y'ret" „' `"wr x :" »a.ar ,4r .: +ir BUILDING PERMIT NUMBER /� 69-9 DATE ISSUED: SIGNATURE: . Building Commissionevl for of B Idin s Date SECTION 1-SITE INFORMATION I 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: AIJ00U&IL /-4116.5 OIY4$ Map Number Parcel Number ' 1.3 Zoning Information: G 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided �v 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1.7 Water Supply M.G.L.C.40. 54) P Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT c 2.1 Owner of Record �9 OUGLA5 1-13 raRjs T 6T Name(Pri Address for Service: 1 4— I I �449 - 6V/ r Signa a Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ G o i U�e,y Licensed Construction Supervisor: � License Number P a. ,86'1 313 CWiT5 7dX .4)/1 6 3,0 31�' wn Address 4A - KO 'll �7, 7✓ 6 Expiration Date i ature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number 213 Address Expiration Date �^ S' re Telephone !d0 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......X No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building 0 Repair(s) ❑ _[_Alterations(s)i ❑ ,Addition 0 Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: S Niw 1319CK 1MC< RQYJ 4)ejg, SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be bFTCIALUSE 01�ILyx s Completed by permit a licant r "4 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinE Building Permit fee(a)X (b) 4 Mechanical HVAC ; 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 1 d QSL 457 'f;4.12 L as Owner/Authorized Agent of subject property Hereb, autho ' e— &X, 49S A)00ID13041-J, to act on My e all t ers relative to work authorized by this building permit application. Si at e Owne Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 40 0 Q&L 4,S 5&Q L_ 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 04G6,0s' �L Print Nam f)yj Si ati o O r/A en Date rt z z . NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TUVMERS 1 ST2 ND 3RD SPAN DUvIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U .- LOT RELEASE FORM ' • INSTRUCTIONS: This form is used to verify that all necessary ry 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_ LiJ�L.oS ',�,p PHONE_ LOCATION: Assessor's Map Number /O (06 PARCEL_ SUBDIVISION LOT (S) STREET_�� ST. NUMBER ' *****************************************OFFICIAL USE ONLY*********************************** RECO MENDATIONS O TOWN AGENTS: CONSERVATION ADMINIST TOR DATE APPROVED DATE REJECTED COMMENTS ;fs ------------ W ; I /vp TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED G� DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED r COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9197 jm North Andover Building Department Tel: 978-688_954 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition tion of Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid.waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) i Signatureof P rmit Applicant Date NOTE: Demolition permit from tf a Town of North Andover must this project through the Office of the Building Inspector be obtained for I IQ r The Commonwealth of Massachusetts • Department of Industrial Accidents ' r < Office or"Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit F . Please Print Name: " .91C Location: 3/ 3 City c' �'S� 'A,.. �f/ 3� 0 Phone am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers'compensation for my employees working on this job. Company name: Address City: Phone#• Insurance ce Co. o(i n P cv �orxt�nv-name: - . Address it Phone#• Instar nce Co. o i Failure to secure c&mmge as required under section 25A or MGL 1:52 can lead to the impUSition of criminal pence,of a fine up to$1,500.00 and/or one years'imprisonment as*wen as civil penalties in the form of a STOP WORK ORM and a tine of si oo.00 a d understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage veriffr,�ion.day against me. I I do herby certify under the pains and penalties of perjury that the Information provided above.is hue and caffect Signature Date Print name- R 6G&n�2 y Phone# 99, 25 3� Official use only do not write in this area to be completed by city or town official, Building Dept E]Check if immediate response is required Building Dept EJ 0 Licensing Board! Contact person: Phone p Selectman's ice # 0 Health Department Ofher R,1W WORKMAN'S CoMpENSATION t^ Sent By: TOWN OF MARBLEHEAD MA; 781 631 2617; May-8-02 12:28PM; Page 112 � II9Vr, ,. q. the Sm d° i � 5 ..��(�4 � i ��Y1 ��.:'�' rLy� �' �" rfS y�•� i 1F t 'i+ 4'M 'hsa �� `.1 Y'�� .'�' + .� i� !I, �� Y w.�5�:'V'�,� �a'�{.�k;u,S �,�`y'+f"7k f• )r PRNJ N „4�`� �� Al _7'f'F � � ia� �1 r �� ' � �J I � d•�,�y,�,r +k,: �� ,� ) �,: -r �:' '�, ,� ,?,;,k�^raw•�,g`�w�Y�d �Y. .`R+,; r. 1 r�p r �.�& 'L� a :��:Y'bty. dij � � w,• j r v' v 1',,+� '�Td�a'�/i .,eY ',�' r'Ty'�v'" 4pC '��•,� I ��n'b?� s` ,:w y��,��qy / y�4� ''. ... y��{ ` ��J ��r♦ °a t �.y" 4r.G. rw 0{i x','"¢".'r r '''�, .;c,, i' � �.'0� '�+�. .V '� iV�� . 1 � SII J 4f Nbi-th N. : . Do t zee .o#Ypett► ' for esLatalia ✓fie �anvirwmcuea�/ o� /�aaaac�u�ael�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 115758 Expifation 4/10704 'k �l�ype Individual µ RICHARD E WOODBURY 3 Kr' RICHARD W00D133.URY' r� 111 SANDOWN RD. CHESTER,NH 03036 Administrator v. 1'RD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR t; ..� Es i Nurtiber CSi '066763 � Birthdate jO�JT�/1943 L.a.._4rf _ Expires609101/2003 Tr.no: 3275 r 4 Restctefl 51G RICHARD 1 WOODBURY PQ„BOX 313 x.. CHESTER, NH 03,036 Administrator NORTH Town ove r 1 .. 110 . ......... No. d C%p Z- L A O dover, Mass., S^C -a vow COCKICMEWICK ADRATE D S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic_System c BUILDING INSPECTOR THIS CERTIFIES THAT........ .V .. .. a.. .........s.�..l4... .............. .............................................................. Foundation t. has permission to erect...6.Y8..................... buildings on ..�r...'.'y3..FAV O!V 8 ...:................................. Rough to be occupied as... ...S e11I^ �-l�O,r 4�1��►.. ..�. ...Ava.r`. Vit./ �...�C!!o ti/� ney provided that the person accepting this permit shall in every respect conform to the terms of the application on file i�,Wt nal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Iteration and Construction Buildings in the Town of North Andover. IDi M�S*� / PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .........00to.�.................................. ................................ Service 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 Street No. SEE REVERSE SIDE smoke Det. i R `° 3775 Date.15..... -.61-1. NORTH ' TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACMUS� This certifies that .1. ........................................................... 3 f has permission to perform ... �. . . ..... ..��!"'.... . ....: �- � 1 � wiring in the building of . ... .... ...................... .............. A . _ ..... ..... ......... I at............`.�•.......... ...............`.................r.............. . ,North Andover,Mass. 40 Fee. ...��......... Lic.Non��'�/.. ........ � *�c� ,...................................... ELECTRICALINSPECTOR Check # �' Official Use Only Permit No. 37 75 ; 4 a -e 4�` s"+ Occupancy&Fee Checked N 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) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number � 7 T`O�415 Owner or Tenant j��U6��C � '�L Owner's Address cs�/� Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building )ye til 46" Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Pci LL V1?c=`—T 1A ►" i i Total No.of Lighting Outlets No.of Hot fuse No.of Transformers INA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and 4-0- of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Sell Contained No.of Dishwashers Space/Area Heating 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 Ballases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws 1 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 yg�ffave checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) 4� 4� (Expiration Date) Estimated Value of Electrical Work$ j ` C Work to Start Inspection Date Resquested Rough `C *-4-final Signed under the nalties o eryury:� FIRM NAME �L�C f Co LIC.NO. '' C1' Lkensee CJMA1 Lll1_ Signature . � LIC.NO. l �4 / ] No 2 7t- 29 Address f� uE � AIt 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 Mptiirement Owner Agent (Please Check one) i Telephone No. PERMIT=f EE $ j (Signature of Owner or Agent)