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No. l Date Z--
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $Fj- 3 -/ 0 12-
Building/Frame
1ZBuilding/Frame Permit Fee $ 1'2 20, �
_
Foundation Permit Fee $ %��b-SZ-
bier Permit Fee
4�4, > J�? Seonnection Fee
OIn Water Connection Fee
O TOTAL
60,
r ? �N
$ a3 -10-1z
11-6
$
d�-�- Building Inspector
Div. Public Works
Location �%/iVT '�IC��F-lf� ox?
No. ��S -, Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Jp,It r� $PAI®er Connection Fee $
MARVta(grigeection Fee $
TOTAL �/ $ /S� n
No. k4c&ve; '7A x
Building Inspector
502-) Div. Public Works
Location
No.
�' SPJ Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee,
Other Permit Fee ,
r luUV r Connection Fee
" a� �� Water o nectlon Fee
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ltil�[' k Building Inspector
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE �3/S A;2
JOB LOCATION SS Z°r /D ���/1 7� i✓GL . R- I
Number Street Address Section of town
'.'HOMEOWNER" X73-9�`2Y
Name Home Phone Work Phone
PRESENT MAILING ADDRESS
ity/Town
W(�- //��/ C Dz
tate
018,36
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 HOMEOWNER:
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 dwell-
ing, attached or detached structures accessory 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. Such "homeowner" shall submit
to the Building Official, on a form acceptable to the Bulding 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
..North Andover Building Department minimum inspection procedures and
requirements and that he/she will comply with said procedures and
requirements.
1./7 �.
HOMEOWNER'S SIGNATURE__
°..APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.
SUBDIVISION
w
FO(UI U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
/
ASSESSORS MAP 2�/&
SUBDIVISION LOT(S) X002 L0 -r
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
STREET IIL11, h2y-o rn a -g -a_ I I2A,r�
APPLICANT LJ, EA PHONE 373 - 9V,,,?
DATE OF APPLICATION /'p
TOWN USE BELOW THIS LINE
PLANNING BOARD Qw-i i
o)- W4
TOWN U NER
CONSERVATION. COMMISSION
f,n T.T C,?I T, TT TTCIT.T A n ixTT T.T
UA'i'E APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVEDO
111it1L 111 vrA1r11S1".LLUr "ATV REJEC'I'Ell
DEPARTMENT `OF PUBLIC WORKS 30 aC'CJoo
DRIVEWAY PER11IT01-1
SEWER/WATER CON ECTIONS
FIRE DEPT.Pe7d2
/RECEIVED BY BUILDING INSPECTION
w DATE
oaw( 6� 4.',e --Is ed0%ecrk'
6,A '-rb i nd��-!l rr/6.1 QKW
/Z!#%/ "%
/ 7,/,TO/'7/
This form shall be signed by the agents of the Planning and Health Boards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
-..
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location 5�) ✓ �2iLl�r,`y ..� .� .�.�'`,'
No. 5 S '(_ Date
E
NORTH TOWN OF NORTH ANDOVER
O�
x,,90, 14O
,w • O
p Certificate of Occupancy $
+�
Building/Frame Permit Fee $
;.
CNU ndation Permit Fee $
31 r t�yr
Other Permit Fee
\1fiewer Connection Fee $
�pVdl Connection Fee $
��®�z� TOTAL $
Building Inspector 'I
Div. Public Works
�gwrfl� � � O I;!Ilr�l;llll,`�Illy"I
'3:`;,�,.�- hlU1�"�'�1 �1.Nt)U`'1' 1i► r.�.1II1.�I�,i,�, �,,
I )IVV;11 IN 111; If i1 1 � - 1 itT T�
1'LikNNING & (;OA1I11L!N1'YY !)I;VI:LO1'1111:N'1'
,TE.
CATION
NER' S NAME:
I�. HF1\1 1 I.I'. NI: I.ti( )N. 1 )Iltla: I OIt
CHIMNLY APPLICA1I014 ANO I'LKA11I'
ILDER'S NAME:
SON'S NAME:
SON'S ADDRESS: 0.3
SON'S TELEPHONE: c/,/7-
TERIAL OF CHIANEY:
FERIOR CHIMNEY: _ W ER1OR CHIMNLY:
EWER AND SIZE OF _FLUES:17 / _ _ —
ICKNESS OF HEARTH:
tt chbiney oA. OiAepeace con(anm to Ae. lie .gmiv(enlell.ls u() .the curie and have "min (II0
gue.ati.om been iceee.i.ve(i: �j .y%�, —------------- ---
TE:
NATURE OF MASON:
:Z.11+T GRANTED:
BEI,T NICETTA
ILDING INSPECTOR
)PEC1 EU:
`'{ARKS:
SOLID FLOCK REQU 1 RZE)
1-111S PERMIT MUST GE UISPLAALO 014 ME IWWISPS SLS.
North Andover Building Inspector
North Andover Town Hall
Main Street
North Andover, MA. 01845
Building Inspector,
I, Paul Healey, owner of # 55 Wintergreen Dr., North Andover,
accept full responsibility for the construction of a deck on
the rear of said dwelling. I have constructed safety barriers
until such time that the deck is complete.
Sincerely,
Paul F. Haley
**. To
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1-0K
CHRISTIANSEN & SERGI, INC.
PROFESSIONAL ENGINEERS AND LAND SURVEYORS
160 SUMMER STREET HAVERHILL, MASSACHUSETTS 01830
November 30, 1992
Ms. Sandy Starr
North Andover Board of Health
120 Main Street
North Andover, MA 01845
RE: Lot 10
Wintergreen Estates
Dear Ms. Starr:
(508) 373-0310 FAX: (508) 372-3960
I inspected the soil used to build the sep�ic sysLera on
the above lot and found it acceptable. I ran a percolation
test in the soil and found it to be less than 2 minutes/inch.
fuer, ly you s,
Ph' p G. Christiansen
PGC; lc
(/50) X /50 - _ .......................... .
,OE5/6N EL E/4T/ON 47 .........(Fop OF 570NE) _
EX/5TIM ELEI/.WZON 4T......... zEQ&,eE0 FILL = ........
FZEy..4Tlow,5
DES/�/V 40 BU/LT
INV. P/PE OL/T OF._,/OUSE
/N!! P/PE INTO T4 N1,
INV. PIPE OUT OF THINK�
z � , q Z
► z'I q 5
INV PIPE INTO D. BOX
► z� ,� 0
12q , l
//VV P/PE OUT OF D. BOX
/NV END OF PIPE
I Z9.
N,4TE2 EL 6-V,4 T/ON
,4 VE ?,466c STONE
Dcc_1oT/1 ,47 10,eOBE
e.
FIJ
SUB-SU.2F.4CEA-31 0 qL
IN
SYSTEM
�!o, by t>E Ma
� voe
P
scare: _ 40 1 Dare: S
NOTE. T1,11s PLAN is Nor ,4 w,4,e1e,4NTY C1I1?I5TIQNSEN SER GI, INC.
OF T�1E SYSTEM BUT Q !/E�2/F/C,4r/ON 1600 SUMMER STREET �- RAVER�I/LL , MASS.
OFTN�//OT1E EX/STING
STeUCTU2ES.
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION
ASSESSORS MAP 47n.4aVX
SUBDIVISION LOT(S) ;20o2 Lo 1-
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
STREET
APPLICANT U, EA = PHONE 373
DATE OF APPLICATION is Ai A
TOWN USE BELOW THIS LINE
PLANNING BOARD
TOWN PLANNER
CONSERVATION COMMISSION
CONSERVATION ADMIN.
BOARD OF HEAL
HEALT
L 1[11-Lr"I
4 6C72'0�
DEPARTMENT -OF PUBLIC WORKS -
DRIVEWAY PERMITelvl'-f
SEWER/WATER CONNECTIONS bu
FIRE DEPT.
DA'L'E APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DA'T'E REJECTED
39 � ia600__D 4.
RECEIVED BY BUILDING INSPECTION
DATE
rr,cCli1�/ /
/ Z1JC1I!/
This form shall be signed by the agents of the Planning and Health Boards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
y
t NORTH
o �
f A
sS�CHuse
Applicant
NAME
Site Location
Town of North Andover, Massachusetts Form No. 3
BOARD OF HEALTH
�-� 19
DISPOSAL WORKS CONSTRUCTION PERMIT
0
ILL
Permission is hereby granted to Construct Kor Repair ( ) an Individual Soil Absorption
Sewage Disposal System as shown on the Design Approval S.S. No.
Fee bb
,
CHAIRMAN, BOARD OAL
D.W.C. No.
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Town of North Andover, Massachusetts Form No. s
�1ORTH BOARD OF HEALTH
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Permission is herebyranted to Construct p ( ) p
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Sewage Disposal System as shown on the Design Approval S.S. No. E
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C IRMAN, BOARD OF HEALTH
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Cunningham Lindsey U.S., Inc. eZA
P.O. Box 703689 CUrinin am
Dallas, TX 75370-3689 L�
Telephone (888) 738-8714 Facsimile (214) 488-6766 1
CLCAT@CL-NA.COM
Form of Notice of Casualty Loss to Building
Under MASS. GEN. LAWS Ch. 139, Sec 3B
Building Commissioner
1600 Osgood Street
Building 20, Suite 2035
North Andover,MA 01845
Claim Number:
1542188
Policy Number:
1542188 23
Company Name:
BAY STATE INSURANCE COMPANY
Date of Loss:
02/15/2015
Insured:
PAUL & CHERYL HEALEY
Property Location:
55 WINTERGREEN DR, N ANDOVER, MA 01845
Claim has been made involving loss, damage, or destruction of the above captioned property,
which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6,
to be applicable.
If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please
direct it to the attention of the writer. Kindly include a reference to the captioned insured,
location, date of loss and claim number.
Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destructions to a
building or other structure, amounting to the one thousand dollars or more, or (2) covering any
loss, damage or destruction of any amount, which causes the condition of a building or other
structure to render section six of chapter one hundred and forty-three applicable, without
having at least ten days previously given written notice to the building commissioner or
inspector of buildings appointed pursuant to the state building code, to the fire department or
arson squad of the city or town and to the board of health or board of selectmen of the city or
town in which the same is located. If at any time prior to the payment the said city or town
notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a
lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or
section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment
shall not be made while the said proceedings are pending; provided, however, that said
proceedings are initiated within thirty days of receipt of such notification.
Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and
forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven,
shall extend to and may be enforced by the city or town against any casualty insurance policy or
policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect
the lien were initiated.
No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other
interested party for amounts disbursed to a city or town under the provisions of this section, or
for amounts not disbursed to a city or town under the provisions of this section.
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.
Cunningham Lindsey
Catastrophe Department
cicat@cl-na.com
800-867-3885