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HomeMy WebLinkAboutMiscellaneous - 56 MONTEIRO WAY 4/30/2018 56 MONTEIRO WAY _ S� 2101060.0-0146-0000.0 /I Cunningham Lindsey U.S.,Inc. AffA P.O.Box 703689 Cu inin ham Dallas,TX 75370-3689 Lindsey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM ***********************AUTO**3-DIGIT 018 814 T3 P1 95000059004 Building Commissioner or Inspector of Buildings 120 MAIN STREET { NORTH ANDOVER,MA 01845 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B I Calm Number: 2583815 07 Policy Number: 2583815 07 Company Name: MERRIMACK MUTUAL FIRE INS Cause of Loss: ICE DAM LO Date of Loss: 2/15/2015 0 Insured: CHRIS & KENNETH NASSIVERA Property Location: 56 MONTEIRO WAY f1• 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 36 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 313. 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 Z 2 ? 9931 Date.....✓.'.,.?.-..�.�.. NORT►, °f<"`°:•�"� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ACHUS� This certifies that ................ . ..................................................... has permission to perform .n.......StiC ...-5�'(-e7 wiring in the building of...... ... . .......................................... r at.... 6.....��..'".f...4nn�.�fes.. `...... . North Andover,Mass. • Fee... �'�,U,. Lic.No.4..:.y. CECrRICAL NSPECTO Check # 6 Cj c 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of-ongoing construction activity,and maybe.deemed.by.the.Inspector_of_Wires abandoned_and.invalid.if he—_. ._ 1 or she has determined that the authorized eesrk has trot commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,20 and extending-through August 15,2012. e 8—Permit/Date Closed: �� ***Note:Reapply for new permit ❑Permit Extension Act—Permit/Date Closed: C,or.;.;v.L✓aa�lh ot5{�cJsaclueaefla Official Use Only f / / c/ Permit No. 2.,aarhnenf ol5ire Sery:ce Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM( ELECTRICAL WORK All work td be performed in accordance with the Massachusetts Electrical Code(MEC).L_7 91NIR 1-. 0 (PLEASE PRINT IX INK OP. TYPE ALL I�VFOR 4TION) Date: oZ Y/// City or Town of: Oel-# 'eW>>vee- To the Inspector of Wires: By this application the undersigned gives.notice of his_or her intention to perform the electrical work described below. Location(Street R Number) Owner or Tenant . r w 1 v P Telephone No. 79 So Owner's Address Is this permit iii.conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service . Amps /. Volts Overhead ❑ Undgrd❑ No. of i1•Ieters New Service _ _ Amos / Volts Overhead❑ Undgrd-,❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe following table may be haired br the IrsDecror of IFires. No.of.Recessed'Lurninaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets' INo.of Hot Tubs Generators KVA �s No..of Luminaires `wimminn Pooi Above ❑ In- ❑ , o.o mergence to Q ttn I` 5 .arnd. grnd. �Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS \o.of Zones No..of Switches lNe:of Gas Burners No. of Detection and t Initiating Devices No.of Ra INo.of Air Cond. Tors' No.of Alerting Devices No. of Waste Disposers Heat Pump .Numher 'Tons_.... KW No.of elf- ontained i _ Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW L Municipal El Other Conn ion No.of Dryers Heating Appliances Kit ecurityvstem No.of ces.or Equivalent ,t No..of WaterKWNo.of No.of firing: Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: 41tach additional detail if desired,.or as required by the Inspector of 11'ires. Estimated Value of Electrical Work: U (When required by municipal policy.) Work to Start; Inspections to be requested in accordance with NEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work 'av issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECKONE: INSURANCE ® BOND ❑ 01TER ❑ (Specify:) Self Insured I cerdlp,under the pains and penalties of perjury,that the ' ormation on this application is true and complete. FIRM NAME: ADT. Security Services LIC. NO.: Licensee: Mark A. Brophy Signatu e LIC.NO.: C-45 (1f applicable, enter "exempt"in the licer-se number line.) 603-S94-5928 Address: 18 Clinton Drive Hollis NH Bus.Tel. No.:Alt.Tel. No.:_ *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. 00 9 53 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent F_ Signature Telephone No. ( PERMIT FEE. S �� _ CEPART:.ENT OF PUBLICSi;:ET•Y - STc`� CONTRACT.OR.: a + REGISTERED SY _ ' �r !.'/ Number. SS CO 031•53 — -" �ISSUESiHEA80VEUCcN5cT0: f _ Tr,no: ECURITY , SERVI.CES., :,INC .: .; ,.. PDT, S • a s-License: A0 SECURITY SER+!ICE - =..M1±.RiC-A .BROPHY•.SR - E� 4.1p"UNERSITY. 1vAVE j , P.I;RK?. BR'OPHYSR MGRS= ST / j - _ ._ MA'_ 0 2.0 9. r.. . t•+IA"4<0 Z WEST,W.GOD cum issioner i C 07/31/13 `'.`• :. —.— .. ' 111+ ..a..�rt•h�n•l;1••1 — r .'I FOW:T1an Oaacn AWn¢At PsecradcAl 4 1 G a . 1 N2 Date ......... At 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SACHUS This certifies that .........per, ...................... has permission to perform ...... ..... .........e.. wiring in the building of..Zt,% .............................................. ......�� ................ .North Andover,Mass. Fee. `....... Lic.No.�/. .. ..........472 ELECTRICAL INSPECTOR WHITE:App1icanP5/05/S@AWA?: Building MpPo PflfQNK:Treasurer m Office Use Only The Commonwealth of Massachusetts Permit No. I(ly 7 l� Occupancy&Fee Checked LN Department of Public Safety 3/90 (leave blank) JU BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 RULE 8 Effective 1/1/78 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code,527 CMR 1�2::00�p (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date `lla/�� City or Town of 1W 4 &11,t, To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street & Number) J(0 /y)OA� e 1yt/ `f R Owner or Tenant _ Owner's Address !�3 (g, L)Yl1'1%�c=� Is this permit in conjunction wt a bgilding permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building sal. Utility Authorization Na. Existing Service Amps / Volts Overhead ❑ Undgrd. ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd. ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of ProposedEle>cttrical Work 1`�5 ( (�✓i44'y /-.4 6 eJ'� 7 c�e-3. T No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Abnd. ❑ In- ❑ Generators KVA 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 No.of Disposals No.of Heat Pumps Total Total No.of Sounding Devices Tons KW No.of Dishwashers Space/Area Heating KW No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local ❑ Municipal ❑ Other Connection �. No.of Water Heaters KW No.of No.of Low Voltage f Signs Ballasts Wiring No. Hydro Massage Tubs No.of Motors Total HP a Other: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including CompletedO erations Coverage or its substantial equivalent. YES Ef 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 DI BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Wbrk$ /"506'Uy / Work to Start Lol! Inspection Date Requested: Rough Final Signed under the pena ti of perjury- FIRM erjury _ FIRM NAME �A � At 0, - � >� � J tce__3 LIC. NO. 3743a 5-- Licensee Licensee Signature LIC. NO. 3 2-13a�.— Address 3 .�e-.- at' Bus. Tel. No. �f ?� (®�' ??c� Alt. Tel. No. �f1� "?� -�a?� - 7 �• r, OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 requirement. Owner ❑ Agent ❑ (please check one) Telephone No. PERMIT FEE$�Y (Signature of Owner or Agent) FORM 18922(FPR11-RULE 8)A.M.SULKIN CO..BOSTON.MA S � Location " No. ! Date ' ,10RTN TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 41 a ; : Building/Frame Permit Fee $ Foundation Permit Fee $ JAG Mus! Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ f Building Inspector tS.CD P11D Div. Public Works Location No. Date MORT� TOWN OF NORTH ANDOVER off • - • ops Certificate of Occupancy $ 41 Iry ' Building/Frame Permit Fee $ Foundation Permit Fee $ SswCHU Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL T.TO � c�c�ej l 4gilding Inspector t z is�c cy 00 AP 45/04/98 16:07 • Div. Public Works r ' S PERMIT NO. APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, MA NIAP,NO. / `' rl LOT.NO. 416 .6 2. RECORD OF OWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. f_ab-Q7 Na4-£csex $oak /07 LOCATION �! ��'f'e nO PURPOSE OF BUILDING n (�CerfL h�/�, Skil��o dIdA. Fad yb OWNER'S NAME �c+ V ,r h Ked' NO.OF STORIES fin` SIZE ?j� F� OWNER'S ADDRESS 56 µon¢gird W a u md�bl�� C lGo-Hny V1 ND N ARCIIFFECF'SNAMEme- SIZE OFFLOORTIMBERS 7 X 2 3 D BUILDERS NAME h ry'46141C+►' h u, 'r SPAN t 6 , + 4, DISTANCE TONEARESTBUILDING 4d4atAcd deck, DIMENSIONS OP SILLS AIA DISTANCE FROM STREET 4pjVv0 . 6SF'• DIMENSIONS OF POSTS '"b DISTANCE FROM LOT LINES-SIDESg EAR Affr * j90 f4. DIMENSIONS OF GIRDERS 3 Y Z X S AREA OF LOT 3�7�" tri. FRONTAGE r¢ I IEIGI IT OF FOUNDATION 'THICKNESS /0 IS BUILDING NEW A GW � Its T SIZE OF FOOTING )0 It I t X IS BUILDING ADDITION H of MATERIAL OF CHIMNEY IN/4 IS BUILDING ALTERATION 0 N IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE e5 IS BUILDING CONNECTED TOTOWNWATER Dh'1G �S CONheL fD hWn AJa BOARD OF APPEALS ACTION, IF ANYNIA IS BUILDINGCONNEC-FED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL.GAS LINE dUII'IG r55 (q . INSTUC'1'IONS 3. PROPERTY INFORMATION LAND COST EST.BLDG.COST Gl S PAGE I FILL OUT SECTIONS 1-3 EST.BLDG.COST PER SQ. F . EST.BLDG.COST PER ROOM ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. /V IA A'I-FACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUI1. NG 1'ECT0I1 DATE FILED OWNERSTEL# �R?g) 99q-ow la CON-FR.]El_# CONTR.LI C# SI ATURE OI'OWNER OR AUTF-10RIZED AGENT FEE $ PpR2g , PERMIT GRANTED 19 Y I MORTGAGE INSPECTION PLAN Note: AAs plan was prepared for mortgage inspection PurPoses only. ft does not represent o property line sunray nor was it prepared in accordance with If.e procedure! and technical standards of Z50 CMR. Section 6.04. Any dimensionol offsets are approximate and are not based upon on actual boundary survey. This plan cannot be used to esloblfsh fence. bu4ding, or other improvements. The property depicted is based on information furnished by the client and may be subject to other takings, easements, out—setas or rights—of—.ay. No flobAity is proffered to the land owner or occupant of the Premises. 205.00' r 0 g ,r LOT I26A DRIVEWAY EASEMENT o, 2 STORY H !!! \ WOOD FRAME OKLUNC \ v o No. 8y97 �s y� DRIVEWAY 4 BASBAIENT b MORTGAGE INSPECTION Of PROPERTY In North Andover, Essex County. Massachusetts Prepared for. Professional Advantage Financial Group, Inc. Owned by: Themoe L & Helen N. Arena Scale: l' . 40' Oate: 08-27-97 book No. 1697 Page No. 46 Land Court Cert. No. (Not Applicable) In myprofessional opinion thebulwted shown on this pian is (are) approximately o on the ground as shown hereon and to the best of my knowledge and ballet conformed to the dimenslonallorth-And ratZont timLawe of the Town of North-Andover at the thea of construction or may be exempt from violation enforcement under Mass. C.L. Chap. 40A, Sec. 7, unless shown otherwise. G R E �Y On this date Aug. 21, 1997. 1 hereby declare SURVEYING that to he best of my knowledge and belief the tparcel as shown Is located In Zone X (areas outslds 24 Raymond Ploc4 617-721-1944 w 500 yr. flood plain) as depicted on the FCMA/FIA Winchester. MA 01890 Fax 617-721-4780 National Flood insurance Mop No. 250098 0006 C doted June 2. 1993. 970835 �� ID �1 C FORM U - LOT RELEASE FORM s INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and^Apartments having jurisdiction have been obtained. This does not relieve ' l the applicant and/or landowner from compliance with any applicable or requirements. I ANf�4�MA�M1A�fff�trrrstnrnt* .> APPLICANT FILLS OUT THIS SECTION " "— T [ t`�t ICeh l�Vq(GL5 f� 1 -� k PHONE 7q�"' -K18 t LOCATION: Assessors Map Number PARCEL N LOT(S) VREET M oh�c.i ra (nla�� d-ST. NUMBER, : --- OFFICIAL USE ONLY ;. RECOMME AT N F N AGENTS: • -Rz �w CONSERVATI N ADAWISTkATOR DATE APPROVED . DATE REJECTED I COMMENTS � iV C (,l a f 1�I(� �dvl- vt� -Ov ,�,✓ '. #: ! TOWN PLANNER TE APPROVED JU. j D TE REJECTED } 1 COMMENTS i FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS ti • r: yi 2 Y PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT _ FIRE DEPARTMENT j RECEIVED BY BUILDING INSPECTOR DATE ! 'MORTGAGE INSpECTION ''LAN Note.* thh plan was pryrod for mrfyops►»ry flo"P+P"a an►V rt does net represeet o t>rprfy ewe —y nar wee it preOred rerdaeu w+tn the proeedwaf and technical standards tuR. Seothsi #.p#. Any dauenaiond etfeef$ r# p r enn! be used to md are not based upon an ectad boundary a�svex ep conn! the property eatobNt$h fenCR bw#'Olny. or eih- knprove deplCted is based an im1brnobon fiurnrshed by the diem and mdy bs VA)"t to other taflinga, eosemsu tss Cwt—ads$ ar righla—of—ee}e dvo Nobaly i$9roamd to the tend sen-Of e-V—t of the Orom'"S' 203.00 i th LOT 26A N i 1� DRIYYI►AY �+ IIASIXENT o, 2 STORY WOW ntAME \ Q t"t:.W He dy9? ]P DRIVEWAY J Q SASSM07 tz 1dORTGAGE INSPECTION OF PROPERTY b North Audovw.Eaess County' H02sattw7stte Prepded for pfthfeseiohal Atmoto9e Ff WWM drop- i.c. Owned by. 4w4wes i k 14@1411 M. Arena Dole:05-27 91 �e iNo. 46 Book No. 1697 po9e Land Court Crt. No. (Nei Applicable) in eny pretesetood wntnift' the iwalog(s) shown an tAb PWM is(ere)epprONknotely boated on the ground oe�a belief can and to „io boot of any tyro.Mdge E the dlmon~dl Ienfng lows of the Toen of NwsrtA.An4o'n►of the fine of cohslrhlatton er may be eronwt fro^ viotelton cntoreerneet under Mpss G.L. L G IR Chap. 40A. Seg. 7- whteti show" eth-w tm SURVEYING 0. thb date Aug- 21 12'),el hereby dsalere %hot to the beat of my and bells( the prod os shown Is 1ewled In zone X (roes outside 24 Rorachd 1`Iot4 617-721-1944 _�� .. d�lctod on the fEMA/FlA tv—k..tr- N•011190 Fos 617-721-4760 • OR Town o over No. 0 n 4COCHLAXE ICICK over, Mass., 19 P-cs HEW ICK BOARD OF HEALTH Food/Kitchen PER ...M IT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......................................re......................... .................................................... Foundation has permission to erect....4-101�71.4.00..... buildings on_.JS..4*........A.. I R'.6...........W.4 Rough ............ to be occupied as...... 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS j 1,*T r ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONS Rough ......................... ............... Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. • Location Jr- �Y1 h t o WAY w No. Date q c) 0-3 �aRTM TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ Building/Frame Permit Fee $ MU 3 ,) Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 30 Check # 606 b '� 6 5 6 J Building Inspector t f� TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a' ", S +CtW`for,Off R ..: BUILDING PERMIT NUMBER. / DATE ISSUED. 0 2 (O ic SIGNATURE: Building Commissioner/12Epectdir of Buildings Date Z SECTION 1-SITE INFORMATION I o1.1 Property Address: 1.2 Assessors Map and Parcel Number: 6-6 MOYVLOW 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 Required Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.%Ownerof Record I Lam - � h 1-0 6U�� . t Name(Print) U Address for Service: Signatu Telephone r1 C to tLtj 2.2 Owner of Re IJV Name Pnnt Address for Service: I 4 PAN M Signature Telephone M SECTIO 3-CONSTRUCTI N SERVICES 7� 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: o License Number on Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v pany Name 1357735 Q Z �v `l ��1 CU t Lh. ( vQf A4, /} 'I I j It,/ Registration Number r ASzkb%--�JL i �l'10(f �{ (J 1J�`J' r. T�'- Ml ' Expiration Date ^� Si ature Telephone G) r= T� 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) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other l Specify ynAIGA'�D�N/� H+%rq Brief Description of Proposed Work: j , QrN CQ C-, JgVeL X Li 54' U& To 1-34- -SECTION s4- `lixl Y Pv�li�t� r. '�O�Cc�Xf-}►�n�—e SiSL- 1'Zr X l�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL„USE ONLY Completed by permit applicant 1. Building I+w� (a) Building Permit Fee Multiplier 2 Electrical 62 (b) Estimated Total Cost of Construction 3 Plumbing 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> as Owner/Authorized Agent of subject property Hereby authorize __PU✓ to act on My behalf,in all matters relative to work authorized by this building permit application. - 1�P -Signature of Owner Date r SECCTIION 7b OWNER/AwU6THORIZED AGENT DECLARATION I, /Ox1 �¢G 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 ` D) ougl Pr a Signature of weer/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1 ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS f' 11EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X { MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ,� FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *APPLICANT FILLS OUT THIS SECTION LACAZIfjbj q 5 � V'� / '�L� ��`� PHONE_ N: Assessor's Map Number &D PARCEL_[' 1p ON LOT(S) �o �/t/�(��-ro �� UJ ft XST.NUMBER OFFICIAL USE ONL **** ** RECO E A ON TOWN AGENTS: CO EFS TION AD INISTRATOR DATE APPROVED d DATE REJECTED _ COMMENTS 1�2 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS 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 INSPECTOR DATE Revised 9197 jm t&ORTI{ 3? 4�.+ Xie OOL F 7�0 Town of North Andover * c e Building Department 27 Charles Street �Ssac►+us��� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE (4I(916 JOB LOCATION 5 ZO filyeol-e/,4,6 GJY Number Street Address �.Section of Town "HOMEOWNER 50 im,&LVJA�� f ecru KAq L4,G� Number 9Home Phone Work Phone PRESENT MAILING ADDRESS rya6nteAGJ'_�j �j 1)r I 0MAAM.-r- ev%,q City Town State 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 HOMEWOWNER: 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 dwelling,attached or detached structures ac- cessory to such use and 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, a form acceptable to the Building 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 No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and require ents. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet,or larger,will be required to comply with State Building Code Section 127.0 Construction Control. RT' Town of Andover . ............... No. C' *LA dover, Mass., Ifo �-O�:Hic WIC ORATED C5 BOARD OF HEALTH Food/Kitchen PERMI.T T D Septic System 00 . o BUILDING INSPECTOR THISCERTIFIES THAT......... .. ...................Y............ ................................................................................I..................... Foundation 10 0��•....has permission to erect * I N................I............ buildings on ...... AU ov 4%* veo 1AAA r ...... Rough tobe occupied as..........iv..N........ ......... .................................................................... 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>t(f the Inspection, 0 t e Aperation and Construction of Buildings in the Town of North Andover. (0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR S 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.