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HomeMy WebLinkAboutMiscellaneous - 56 GREAT POND ROAD 4/30/2018 (2) � � � ���--4 �0�� �� �'. E I I i I Alk Commerce InsurancesM The Commerce Insurance CcmpanysM Cac Citation Insurance Company sM Members of The Commerce Group,Inc.` CLAIMS DEPT. sM 11 Gore Road,Webster,Massachusetts 01570 (508)949-1500 www.Commercelnsurance.com September 26, 2012 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: PAIGE W COLEMAN/WILLIAM J COLEMAN JR Property Address: 56 GREAT POND RD Policy#: HL1781 Date of Loss: 09/16/2012 File#: CJNP58-XJHP54 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, 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 my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. GEORGE MILIOS Telephone: (508)949-1500 Ext: 15552 Claim Representative I,Property Toll Free: 1-800-221-1605,Ext:15552 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above,by first class mail. September 26, 2012 CcI11mCrc Ccmpanles ....COME GROW WITH us CIC 254 (Rev.4/95) MAE, M88 94u7 Date.... � f NOR7M'1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING US�`� This certifies that .........................................0 L ............................. has permission to perform /0 G! I,F 12,o l : _ Cfommonweall-///lay,iac1tt 4eLLs Official Use Only -1JeparinrenL-`,}ire Services Permit No._ �? ` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev, 11!99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORD{ All work to he performed in accordance with the Massachusetts Electrical Code(�A C),527 CMR 13.00 I (PLEASE PRJ1VT IN INK OR TYPE LL I'O 1L 1 T ION) Date: � / City or"Town of: To the Ins ecto� f Wires: By this application the undersigned gives notice of his or her intention to form the electrical,work described below. Location (Street & Number) Owner or Tenant Telephone No. Owner's Address 01 Is this permit in conjunction with a-: buildin; wrmit? Yes ❑ No Lsdo (Check Approyp/rite Box) 1'urposc of Building � Utility Authorization No. /C�f Existing Service Amps / 1'a Overhead ' ❑ Undgrd ❑ No.of tMeters New Service Amps ! Volts Overhead ❑ Undard ❑ b No. of Meters. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: L Cvmnletion vfthe folLnv(ne table ntav be n•aived by the Ins cctor of II'ires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)FansfOBattery Total ormers hV A No. of Lighting Outlets No. of Ilot Tubs ators KNIA ,No. of Lighting Fixtures ISwimtnina Poo] Above ❑ ln- Emergency tg mono eritd. �rndUnits b No.of Receptacle Outlets No.of Oil Burners FIRE ALMLI•IS No.of Zoites No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No. of Ranges INo. of Air Cond. 'Total Tons No•of Alerting Devices Flcat Puni \umber 1 No.of Waste Disposers ( p ........_._.__. Ions !KW No.of Self-Contained Totals: ! ._...............----- Detection/Alertino Devices , No. of Dishwashers ,Space/Area Heatin; Kati' Local ❑ Inunicipal Connection ❑ Other t No. of Dryers Heating Appliances ; Security Systems: Ido. of Water No.of Devices or E uivalent IINo. of No. of .,,- I•Ientet•s Ki"v Data ,.trina- Si�rrs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs iVo. of Motors Total IIP I'elecommunications NViring: No.of Devices or Equivalent OTHER: 41t,:cn additional detail if desired, or as required by the Inspector of Wires. INSUP--.NCE COV EIt-%GE: Unless waived by the owner, no cer mit for the performance of electrical work may issue unless the licensee provides proof of liability insurance includit: -con,'; Meted operation"coverage or its substantial equivalent. 1'he undersigned certifies that such coverage is fn force, and has e. hibited proof ofie t the ruff issuin,office. CHECK ONE: INSliR1NCE BOND ❑ 0.11JER ❑ (Snecify:) Estimated Value of E'.cctrical Work: (When required by municipal policy.) ( xOiration Date) Work to Start: Inspections to be requested in accordance u6th MEC Rule 10, and upon completion. I cet•tifj•, under the pa�i�' unit penalties of/ietjury,t/tat the infonttation nit this application is trite acrd coinI'e. LIC.NO.:/q Licensee: /'!�. —;: .•�4' i%' Signature � �Ll LIC.`i0.• (If app((cav(e, enter "e.rcnrnt"in t1;e(iceirse r:tinted'line.) Address D Bus.Tel.No OWNER'S INSURANCE 1:':1Alt.Tel.No.: I�LR: I am aware iliac the Licensee does not have the liability insurance coverage normally required by law. Fav anv signature below, I hereby wa;vc this requircmcrxt. I am the(check 011c) owner ❑ owner's a_ent. Owner/Agent Signature 1'elephor,e No. Ej--R-111T 1--E-E- S (,� w I � f� ,� V� C No 2 i C O Date... .. ...�`. ..� . t p� Np oTM 1+ pp` TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SgACHUSE� This certifies that ........ / has permission to perform ......� r �............................................... rf p )-(, 0S wiring in the building of............ . ................................................................... at.......J.....�....(.�-.y. '7�� ..fir..:....................... .No hAndQver� ass. Lic.No./— ,>��.... ...... ..... .... "'� �. c�c� ELECTRICAL INSPECTOR Check It 7// WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (/1/< TMC10AW0NWF.4LTH0FMAS&4C,HU.S'ET1S office Use only /) DEPARTMENTOFPUBLICSAFM Pemvt No. V BOARDOFMEPREI/EM70NREGMTI0NS527CMR12 1 ' Occupancy&Fees Checked APPLICATION FOR PERW TO PERFORM ELECITIICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELE MCAL CODE,527 CMR I2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DatL. 2-_L1'a Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) J� 6 r'Go-7-Aa rr t1—A,q, Owner or Tenant Owner's Address 4 e41- 190/'7 Is this permit in conjunction with a building permit: Yes©"No (Check Appropriate Box) S Purpose of Building Utility Authorization o.f�77 Existing Services Amps -//�?aVolts Overhead 'Underground No.of Meters t New Service 20 o Amps /!D/2 laVolts Overhead Underground M No.of Meters �t �Number ofFeeders and Ampacity Location and Nature of Proposed Electrical Work �T Pvp-iw 6 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipala Other Connections No.of Water Heaters KW No.of No.of _t igns, Bailasis NoAiydro Massage Tubs No.of Motors Total HP OTHER It>Sq"=Cove Ptas►>atttbthetagtetartt r Gt alLaws ^� Iha%eaomatLmbibtyhurd=PcbcyerhdingCarpl* Comag crilsskstFtialeWhdait YES NO Ihares muttadvabdpodbfsatn 1o&Offm YES r7rNO Ify uhawdtadWYES,plt=mdc*thgpecfwmaWbydudangthe box, i WSURANCE BOND OTHER R ftmSpecdy) Expiraart D* Est mNedvahrecfl kchd Wdk$ WaktoStxt hVediwD*RoWesrod Rao Final FIRMNAME I== 62/ r -t 17o!^/,// Sigtrahue -- `�� �.� Ltoa�eNo 6472-141 _BtsQtessTeLNa 7 r�� -� 2 Z 1y.� Arlrircc o x e��a b' d/ ' y Ak TeL Na yze'yy QdPeL OWNER'SINSURANCEWAIV ;lamawatethattheLioarsed=ud Lam andthatmysigtffitseatlhis pamitapptimtiatwai�thisre�alt (Please check one) Owner Agent X -In Telephone No. PERMIT FEEt S- d Date. . . . . . . . . . . .! N2 �'� 777 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACNUSEt t This certifies that . . . . . . . . . . . . r. . . . . . . . . *. .11 hasipermission to perform . . .'. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . plumbing in the buildings of : . .! . ... ... . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . ., North Andover, Mass. Lic. No..F;7 . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBiNNSPECTOR Check # —J WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) /'YlJ1CT/� AY&b)Le,MA Datq_-�*-2qQ) Receipt# Permit# Building Location666rto-+ Pond (Z44_ Owner's Name 1 jr Cob.,A 11) �76� Map: Lot: Zone: Type of Occupancy YP P Y New ❑ Renovation U-- Replacement❑ Plans Submitted: Yes❑ No ❑ FIXTURES Fee: Z N 2 N 13, F- N N N O Z >W Y -� } W WJ N V Q N = O ¢N - H W y M N Z - 4}¢ N N 2 ¢ V W N X ¢ a LL'.�Qa -a "S� x rlo Cr W O a y ¢ Q W ? t7 a 0 Z ¢.__a O Q LL W O J N ¢ M J - a ¢ LL rLL X > F O N N y 3 Z O O N ? W ~ O U 2 - a Q x - - a a 0 a J J a ¢ ¢ ¢ Q O Q F 3 x J m N c c J 3 x r y LL o Q 3 ¢ m o SUB-BSMT. BASEMENT I ` 1ST FLOOR 2ND FLOOR 7 i. 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Et+,+ J a Installing Company Name Checkone: Certificate 00 Address 70 &ysrdr 2w1 aFje.S ,4 / � ❑ Corporation Estimate Value of Work: — ❑ Partnership Business Telephone 9;0 %A—VFW/ D �❑ Firm/Co. Name of Licensed Plumber or Gas Fitter &091 " 9Pr5l INSURANCE COVERAGE: I have a current ' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Signature of Owner or Owner's Agent Owner❑ Agent❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State PlumbingCode and Cha ter 142 the Gene r Laws. Byl Rature of Vics d Plum er Title City/Town Type of License: Master Journeyman C3�A�l APPROVED OFFICE USE ONLY License Number Revised 05/17/00 F 's BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE 1 NO. I APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BULIDING LOCATION OF BULIDING PLUMBER I PERMIT GRANTED DATE 20 PLUMBING INSPECTOR Date. . . . . . . . . . . . . . .. ... . . f NORTH 1 41 or '` TOWN OF NORTH ANDOVER F A . o PERMIT FOR GAS INSTALLATION . 9 SACHUSES4 This certifies that . . . . . ... . . . .. . .. . . . . . ..... . .. .. . . . . . . . .. has permission for gas installation . .:. ' . . .`4. ..`. . . . . . . . . . . in the buildings of . . at . . . . . � . . . . .. .. . . . . .!'. .. . : . .`.: . . , North Andover, Mass. Fee.-i . . Lic. No..'?�. . . . //:'e��� { GAS INSP CTOR Check 36 9 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 20L Receipt# PPe�rmit# Building Location .56 Grp P � IC.G Owner's Name l Pr A✓ Map: Lot: Zone: Type of Occupancy T7,44, New ❑ Renovation a_ Replacement❑ Plans Submitted: Yes❑ No ❑ Fee: (n CO G �?^ L M 1V7 Y W x of , N N N U 2 H CC + W S N M O ¢ N x H ,(� O w ¢ O V in I 0 Z J_ y W ~ y m Z 0 �j /� J Q iu O W Q ¢ O O W �. 'r^{ m y F W W O _ d ¢ Q 1 O {� y O W W f!1 Z Q CC O C > W 1 V W W M N Z Q x 0: W ¢ W F W F- x F Z J F Z F W W O O > U. F LU J ~ w y, 1 Z Q W _ Q p� � > N ap Z O Z M O y x Q W > Q W O Z Q CC Q Q O O W — O W Cr X 0 O x LL 3 c t7 v ¢ > O a H o SU BSMT. BASEMENT I IST FLOOR r 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR f 8TH FLOOR Installing Company Name zD OD dvwo Checkone: Certificate Address UCS ❑ Corporation EstimateValueofWork: ❑ Partnership D Business Telephone 7 29 Z'14 —yY�Iz) > / _❑ Firm/Co. Nameof Licensed Plumber or Gas Fitter /y�'��/TT ��I;Uax INSURANCE COVERAGE: I have a current li Ity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ygs, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner❑ Agent❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the bestof my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G neral Laws. By Type of 'cense: umber Aignature/boAsedl mbar r Ga Fitter Title sfitter Master License Number City/Town Journeyman APPROVED (OFFICE USE ONLY) Revised 05117/00 BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME 3 TYPE OF BULIDING LOCATION OF BULIDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GASINSPECTOR kANCOCK Environmental Consultants #8726 ❑235 Newbury Street Route 1 North Danvers,MA 01923 (508)777-3050 December 8, 2000 (508)352-7590 (508)283-2200 North Andover Conservation Commission FAX(508)(617)662-9659 2-96596 27 Charles Street 13 12 Farnsworth Street North Andover, MA 01845 Boston,MA 02210 (617)350-7906 Att: Brian LaGrasse Dear Mr. LaGrasse: This letter is in regard to the delineation conducted by Hancock Environmental Consultants (IEC)on the property located at 56 Great Pond Road. The property owner, William Coleman, is proposing to construct an addition to his house. The addition will be constructed along the westerly side of the house and will measure 28 by 42 feet. The addition will be constructed on grade within the existing driveway. The addition will be utilized for family room space. Wetland resource areas exist across Great Pond Road. The wetland across the street is delineated at the toe of slope associated with the road shoulder. The resource area is dominated with red maple (Acer rubrum),northern arrowwood(Viburnum dentatum) and dogwood(Cornus spp.). The area is currently ponded and beaver activity is present, as observed by recent tree cuttings. Small pieces of unnumbered blue flagging were hung in the field along the edge of the bordering vegetated wetland resource area. The property is not owned by Mr. Coleman, therefore flagging was only placed to properly measure the 100 foot buffer zone. The intermittent stream associated with the bordering vegetated wetland flows northerly under Great Pond Road along Mr. Colemans easterly property boundary. The stream has an average width of approximately three feet, with a bank depth of six to eight inches. Observed flow depth was approximately three to five inches. The stream is not identified on the USGS quadrangle map, therefore it is assumed to be intermittent. Wetland flagging series Al-A2, B1-B7 and C1-C3 identify the bordering vegetated wetland associated with the intermittent stream. The resource area within.the B series is dominated with an overstory of mature white pine (Pinus strobus) and an understory herbaceous cover of sensitive fern (Onoclea sensibilis), purple loosestrife (Lythrum salicaria), skunk cabbage (Symplocarpus foetidus) and a variety of goldenrod species (Solidago spp.). No developed shrub layer exists within the B series delineation. The C series delineation is vegetated with willow (Salix spp.) and a developed shrub layer consisting of dogwoods (Cornus spp.). Soils were investigated during the delineation. The B series delineation exists along the limits of lawn and wetland vegetation. The area has been historically altered by the installation of a sewer line that runs parallel and directly adjacent to the wetland delineation line. Division of Hancock Survey Associates,Inc. i i Stakes have been set identifying the limits of buffer zone associated with the wetland resource areas. Measurements were conducted by pulling tape in the field. The stake located within the field, behind the house, identifies the 100 foot setback from the limits of proposed activities. According to the measurement, no work will occur within the buffer zone to the resource area located within the mowed field. According to the delineation presented in the field, and the measurements conducted on site with a tape, proposed construction of the addition will not be located within the buffer zone of bordering vegetated wetland. The proposed addition will be within several feet, in some locations, of the 100 foot buffer zone limits. Mr. Coleman is willing to install erosion controls during construction, in order to prevent any potential erosion into the buffer zone. The area is relatively flat and erosion from the project construction is anticipated to be minimal. HEC is of the opinion that proposed activities will not require a filing with the North Andover Conservation Commission. Attached is a sketch of the proposed activities, wetland resource area locations and buffer zone limits. I would be more than happy to meet you on site to confirm locations of the wetland resource delineations and buffer zone limits. Please contact me if you have any questions. Thank you for your time and consideration. Sincerely, Hancock Environmental Consultants �2 J�'A' I Ju 'e Parrino Wetland Scientist I Attachments cc: Bill Coleman i i 4 p� b wI N'•�� A 4 I t S h RN S r j 1 { jJryl � :V f - . t ti �•t c'' t$' ;.l �. �� rte• • , �� 1 ., ILt it 490° lei:1 Or IN 77 ip IL rt ,t F., • M • + r 1 3-D TopoQuads Copyright 0 1999 DeLorme Yarmouth, ME 04096 Source Data: USGS t—�500 ft Scale: 1 : 12,800 Detail: 14-0 Datum: MS84 VI/ � 3 � Pf VNf vl- - - - - - y .SCv G'C �f- /v 4i CERTIFICATE OF USE &OCCUPANCY Town of North Andover Building Permit Number 6/2— 7l Date THIS CERTIFIEpS, THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS- IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ADDRESS �— - tNu3 ,i., Building Inspector VAO R T fy Town of � 4 R - Andover No. b'71 h 0 o � � dower, Mass., �y Coci"ICHEwtCK ` y .B �pRA TE D A`?�,� �3 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR �� .lt a�I v INA N Foundation has permission to erect.. '. b ildings onSA �............ Rough / to be occupied as..... ... ..... �r"'r F */�IN / M Chimney e ��_ _ � pI/ a✓.. ........................ ..o............, ....... k `......... 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 Inspectio Alterat' and Construction of Awca - Buildings in the Town of North Andover. M � � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ou _� I �. ELECT��Y/ PEC /'(I►*J&....................... d BUILDING INSPECTOR Occupancy .Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove No Lathingor D Wall To Be Done K Until Inspected and roved b the Building Inspector. FIRE PARTMENT P PP Y 9 P Burner Street No. SEE REVERSE SIDE '� Smoke Det. XAORT1y own of 4 over No. p -= A o dover, Mass., COCHICHEWICK H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......W.1..11.1.4.............. ........ Foundation has permission to erect.Q.6� build' gs on ... ,b �� .... Rough,414f 66— 6--"— �.. .................................................... .................... to be occupied as..OVA 94.11AAAA X00 u r a %lorw • I Out .. ..................................... 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. 3m v � PLUMBING INSPECTOR� 9► � Py8 � l/ o� VIOLATION of the Zoning or Building Regulations Voids this Permit. 7 �``( P 3 T EXPIRES 6 MONTHSS _V UNI-ESS CONSTRUCTION START ELECTRIC INSPE ............................................. ........ �u BUILDING INSPECTOR _` 00, i q 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) lee—, REVERSE SIDE Smoke Det. ition Sim 6t / �o�'c rc� Date /� J NORTh TOWN OF NORTH ANDOVER Of „ac ,a,yC f 9 Certificate of Occupancy $ NusEj� Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # X56 0 Building Inspector TON" OF bo cii(TIl ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,,RENOVATE, OR DEMOLISH ALONE OR TWO FAMILY DWELLING 7.7 �:... P 1 1'.p j_. P'��" ?i"^`'4� ka. ai':1Vf��'i x xc 7» "a is ' •F BUILDING PERMIT NUMBER: / DATE ISSUED: / /3 D� ic SIGNATURE: C BuildingCommissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 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 Re red Provided 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Information: 1.8 Sew a Disposal System: Public 1K Private 0 Zone Outside Flood Zone K Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record U/Iw�lAly GOLL M41U ro 2d Name(Print) Address for Service: \ Signature Telephone I 2.2 Owner of Record: Name Print Address for Service: z �f ZP-_G d- _ 57C -P 2 M Signature Tele on SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ T Licensed.Construction Supervisor: C S p 23 License Number 2�df S n� i3 o X Fan 0 l�li+ 'In� 2 . Address 'Zd &f 7-SGBS— It 12,Expiration atey O C, / 'Siggnattiie` Telephone �. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name I Q _ Registration Number Cf. 1-f-4110r�' �1lI �jUk'1-0�2�y �f�Sr � Address `2 d0 2 z g 2J' J4'7— 5-0 Z S' Expirati 'Date' Si ature Telephone SECTION 4-VV dRS 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 rmit. Si ned affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check aII applicabte New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 19, Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: , Q-/;P1 r i oA) 1-o L- r 0 X 1 fru it n wt--t,L i A/ 14 x Z 2 57z)i2 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be s OFFICIAL USE C3IVI ' Completed by permit applicant 1. Building (a)F Building Permit Fee / 6-0.; ac�' �� Multiplier 2 Electrical '7 Gd 47, a r a.4LLaw (b) Estimated Total Cost of Construction 3 Plumbing o 0o, 6, •-hj&o w Building Permit fee(a) X (b) 4 Mechanical(HVAC) �(� 5 Fire Protection / 6 Total 1+2+3+4+5 1Z o o o, o Q Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT QR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner/Authorized Agent of subject property Hereby authorize M./!i a i G 1-1-A 7J` to act on My, ,in all n er rel tiv� /�to work authorized by this building penuit application. Si-nature JL.INUd.[/L� Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION V 1, ,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 nattue of ON'vner/A ent Date NO. OF STORIES SIZE 2 S- BASEMENT OR SLAB C,nV- 100 e L SIZE OF FLOOR TEVIBERS 1 2 ND 3 SPAN 17 DBAENSIONS OF SILLS 'L- _246 Pr DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 6 X k HEIGHT OF FOUNDATION CjT' o;/C- C-oe JHICKNESS to SIZE OF FOOTING X MATERIAL OF CH VINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE A/Q < ; 1 �t A \ ® p CON AmErs PHYLLIS 57-iFVENS .92. to to 0, r � \ - O \ ArzEA = z5 ®sO 1 � CO 175:0 STEVENS yf1�4 d. r'y PLAN 0 rJ ANDOVER . MASS, i ®'� •tai. ,J;i_' ya µ'�a: FORM - U - T RELEASE FORM , INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. (v,� APPLICANT_ WILL 1, � C GGC kr,� PHONE �Zs-'-C %, e2- ASSESSORS 2ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET 6 r Ao`u,6 n°Q L2 STREET NUMBERI Mason news an sommoommommomm as SOON so a a am mammon mansom son mammas sun 0 an mass so Noma! OFFICIAL USE ONLY RECOWOENDATIONS OF TOWN AGENTS ... .■f......r■.■ ....................................................... . V"' DATE APPROVED t Z t q o CO ERVATION ADMINISTRATOR DATE REJECTED I- 00 C N0AENTS �� II DATE APPROVED TOWN PLANNER DATE REJECTED CON04ENTS DATE APPROVED FOOD SPECT -HEAD V DATE REJECTED DATEAP SEPTIC INSPECTOR-HEALTH DATE REJECTE CONIIv1ENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONBAENTS RECEIVED BY BUILDING INSPECTOR DATE C 0 c eA) F NORTH 01" 0fAndover 0 T YO LA E o dower, Mass. , zd_ COCKICKEW1 K V • �i9 ORATED P ,�5 S BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System � /�t a� G.. �� NBUILDING INSPECTOR THISCERTIFIES THAT....... .................... ................................. .......... .......... Foundation has permission to erect...��..�0g..... b ;Ildin Is on .... h N� Rough ............................. ................... ............... g to be occupied as.. IMA+ rt... /4iM/`Mrd�i ...► �......................... Chimney ................................................. . . .. . . . . .. . . . 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 InspectloEL Alterat' and Construction of Buildings in the Town of North Andover. M #? e. qPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR C Rough ............................ Service -:BLTII,DING 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Location 56 c�4 /G UL.� No. 613 Date NORTH TOWN OF NORTH ANDOVER 3� • • OG h ; 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s+�cwust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 O S— Check # Building Inspector i t . TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: X SIGNATURE: Building Commissioner/I for of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 44K Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: W Zoning DiAric­t Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record VV 111, l y h1 G c L M 6 N S 6 !i1 i��.l" P0 r✓ y �t'o U Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ x nA vvt )C W-A7I Licensed Construction Supervisor: ® l Itf/� )�L y �s i��/� j'�JX FO�Zy -N,4 11 License Number Address lit u�wc.0 / 4 -RS 7- SD 2 rr EY4 /24- o O T& K xpiratio Date � Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 12A v n/c � tth r 7- Company Company Name 2o ,7 1 1 7 Registration Number rn M Address Z G0' Z 6 P �7 � Z " S6 2 Expiratto Date ^ St nature Telephone Y 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.......❑ No.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 5d Addition ❑ j Accessory Bldg. ❑ Demolition ❑ Other ❑. Specify Brief Description of Proposed Work: AYJ l0 2 NU/ ALOyo? Tc� �Xi S7"GIRf62 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be " -OF#tCIAL USE'QNL Completed by permit applicant 1. Building (a) Building Permit Fee 7 00 v, p Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection l 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1> as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date. SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, 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 r Print Name Nature of Owner/A ent Date r NO. OF STORIES SIZE tq a BASEMENT OR SLAB SIZE OF FLOOR TINMERS I ST2 2 3 Z IV SPAN /4 �F� 12� DIWNSIONS OF SILLS -- DIMENSIONS OF POSTS 6 v i`r U 6 DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING — X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND 5 IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations t Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: f�1,Ay f2/ (. L 140 r� A, h k s i n v c,7 ro>✓ Address 11 JLa i21?�� !2 h City i±,0K r-0 Ay / Phone# yS-r kS-17 - �-o 2 Insurance Co. LL A t2 r f--0;21) 6W,� C-'lo Policy# D� SSS A P Company name: 0d IN S&ieAV L tC itioa !�G Address City Phone# Insurance Co. Ar Zt:714 c->45 0 L i t P POlicy# W c V 2 yo b 3 9-1 Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature_ ter er4.riAe4 2&i/- Date O&T 3olohy Print name )11hy 12 ►c IiIJ7 7 Phone# q-1k S-P -r623- Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person:_ Phone#: ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSAT10N Town of North Andovero� NORTH Building Department o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 Ac, gcHus�� i 'i DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: I r � GFA/ 19A 1LU 1,y4 ✓ Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. ✓fig �nrrxrna�tufe�ldi n�; •��cr.�:urc�rrfe�s BOARD OF BUILDING REGULATIONS ` - License: CONSTRUCTION SUPERVISOR �v Number: CS 023993 Birthdate: 11/2811929 Expires: 11/28/2001 Tr.no:,10505 Restricted To: 00 MAURICE G HATT 7 HARRIS RD BOXFORD, MA 01921 Administrator t t �e �a>nr�rru�r(Cf-O t��,utr�trrtrfts NOME IMPROVEMENT CONTRACTOR Registration: 1b7I1] Expiration: 07/19IZOb1 Type: Individual MAURICE G. MATT Maurice Hatt Farris Road ADMINISTRATOR t Bozlord MA 01921 �CQ 00� CQ r � FORM - U LOT RELEASE FORM � v INSTRUCTIONS: This form is used to verify that allnecessary approval/permits from Boards and Departments having jurisdiction have been obtained.This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT N1,4 PHONE T 7,C-, 2 6" ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET G P-I e"A-7- po Ajtro.� a STREET NUMBER 5- I........................................................................... OFFICIAL USE ONLY ..............................,RE .............................................. COMMENDATIONS OF TOWN AGENTS DATE APPROVED j OC CO SERVATTON ADMINLSTRATOR DATE REJECTED a n T(, 10,)� GV OPV �� �t��f-�� DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE AmErs JPHYL.Lis 57-EVEN5 �! \ 4 o e 0 \ A REA = 25,080 /75'0 moi►•:.. IP. i STEVENS H o s O-A I PLAN OF LAN 0 - --NORTm AND NORTH own . of . 4 . tit over NO. * _ - ver, Mass. o COC MICMO O ORATED APa� 5 `S H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......4r!�..I..Ilial. ............ a. N..A. ....... ..................... Foundation has permission to erect. . .... build' gs on ...4?... ...:w" .... .... ........... Rough to be occupied as... A . '�f.... ►�!. .. 0r r AN Chimney 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. M 9P & *0 sow PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START ELECTRICAL INSPECTOR Rough 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'