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HomeMy WebLinkAboutMiscellaneous - 586 OSGOOD STREET 4/30/2018 586 OSGOOD STREET 210/101.0-0005-0000.0 III I i I I Date... ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 This certifies that F.;............. ............ .............................. has permission to perform-;7:�................../...................................... wiring in the building of .................................................................................. at ...... ......................... .North Andover,Mass. Fee .6.... ....... Lic. ............... . PLEPRIC;�4 Check # -- 78'1 2 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. ///� ' Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER 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& Number) t j 0 `j Cj � Owner or Tenant L,) 1?—,A , z Telephone No. Owner's Address 29�z c / Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building J Utility Authorization No. 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 Proposed Electrical Work: fi-/C -Z 526 1JA)D / D D L Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ n- ❑ o.o mergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No. o Detection and Initiating Devices a No.of Ranges No.of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Number ons KW No.o elf-Contained P Totals I Detection/Alerting Devices r No.of Dishwashers Space/Area Heating KW Local❑ Connectioln El No.of Dryers Heating Appliances KW Security Systems: Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters 'signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: OL) (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERA E: Unless waived by the owner,no permit for the performance of electrical work may 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. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) /certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: I r Z %l LIC. NO.: ,S 3 Licensee: , J-• (71& Signature LIC. NO.: /pl( (If applicable, enter -exempt"in the lice—nsl number line.) Bus.Tel. No.: g7 P16 S&2 r`Jo2 Address: Z Alt.Tel. No.: p *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S" License: Lic.No. _�1�� 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 Signature Telephone No. PERMIT FEE: $ i M cq tom. - ►�� O - Z Z -og O i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street : Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/Organization/Individual): F/ f1 Address: �� /'�) 57 City/State/Zip: 7 5,!� C)L97-K L97-KPhone #: 7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: J' 56 Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyde th ains d penalties of perjury that the information provided above is true and correct. Signature: k T Date: Phone#: 6 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Date. . MOFTh 0* so TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SACH S This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . . . . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee.? .611�1. . Lic. No... . . . . . . . . GAS INSPEC-eOR Check4 Aw 6462 MASSACHUSETTS UNIMRM APP11CATON FOR PERMIT T )DO GAS FITTING (Type or print) Date NORTH ANDOVER, /MASSACHUSETTS Building Locations c.�O tP ( I Cyl9 f111L� reC Permit# L v't'°/} _ ✓Y�/'r �`��? Owner's ner's Name Amount$ S New Renovation Replacement Plans Submitted Ed PJ 61 //&0114eo- CA CZ z W CA u w x y z4 0 H w x > d z e w d a H F o > w F u a w m z o z o x x o o > a a F o SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7 T H . F L O O R 8TH . FLOOR (Print or type) Pd ('S �T ���(' ( Che k Name _ one: C ificate Installing Company Address C Partner. f✓ Business Telephone AlAm f Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. Yes No� If you have checked Les,please indica a type coverage by checking the appropriate box. 13 Liability insurance policy Other type of indemnity D Bond 13 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. Check one: Signature of Owner or Owner's Agent Owner Agent 13 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 installationserformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S e G ode ter 142 of the General Laws. 2 I ill By: � Signature of Licensed Plumber Or Gas Fitter Title IIu er City/Town, Za-s-t fitter (cense NUMDer er _ APPROVED(OFFICE USE ONLY) © " eyman TRECOAMONwE4L,THOFMASS4CHUSL-M Office Use only DF.PARTMENTOFPUBIICSVEIY `/ I BOARD OFFIREPREVEMONRBGULWONS527 Permit No. It'EGUTAT70NS527C;�12. Occupancy&Fees Checked i APPLICATTONFOR-PERMIT TO PERFORMELE CAL WORK ' ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL C DE,527 CMR 12:00 C1ASE PRINT IN INK OR TYPE ALL INFORMATION) Date 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) Dwner or Tenant0 !� owner's Address s this permit in conjunc,tt�It'Qith a building permit. Yes L: Nou !(Check Appropriate Box) 'urpose of Building L���� i Utility Authorization No. .. 3xw ingSe Service Amps Volts Overhead � Underground gT No.of Meters dew Service Overhead Amps= Volts Underground No.of Meters lumber of Feeders and Ampacity ocation and Nature of Proposed Electrical Work No.of Lighting Outlets No.,of Hot Tubs No.of Transformers Total Vo.of Lighting Fixtures Swimming Pool Above Below KVA -'VO Generators s KVA round round ' Vo.of Receptacle Outlets /��-� No.of Oil Burners No.of Emergency Lighting Battery Unit Qo.of Switch Outlets "� No.of Gas Burners Jo.of Ranges No.of Air Cond. Total FIRE ALARMS t Tons No.of Zones rc ^;bisposals No.of Heat Total Total p r � No.of Detection and Pumps Tons KW` Initiating Space Area Heating KW No.of Sounding Devices No.of Self Contained o.of Dryers Detection/Sounding Devices Heating Devices KW Local � MunicipalEDOthe-�� No.of No.of I �.of Water Heaters KW Connections Si s Bailasis >.Hydro Massage Tubs No.of Motors Total HP HER• anwCovaaga Rusmw Dthe mgzemffz ofmamdlEm Gataal Laws taatnatliabt7tlykmarreFblicyin kdWCompleeeOPwdtiOwCowrageoritsmbstpi W*ala* YES :parrer>i0edvalidptoofofsametoftOl�ie,YES ® NO Ingbox ffyouha�edrekadYES,Plea9ehk*theNXOfcovaageby RAMM BOND OTHER (»may) I �a rB#ik D Esfim&dtos4tt liupecyiortDateRegttesmd Val<teof>~7actticalWodc$ ' 3d O V iunder�ie ' of R0L1�' Final NAME C R Li=wNo. /]rl/G- sigrta>iue LimwNoS. dy/ rTelNo. 6O �) C3 Alt Tel No. �oS '".'NSURANCEWANFR;Iamawacethlhis egmenutesmthawftl o�mlworits ��as� by�C�Laws ��ne pemritapp�thislegtluartalt e check one) Owner Agent Telephone No. PERMIT FEE$ 19 signature o caner or gen 1 Location No. !, Date lJ� O 1 �OR,M TOWN OF NORTH ANDOVER 0 1 � A ` s Certificate of Occupancy $ s i Building/Frame Permit Fee $ AC NUS Foundation Permit Fee $ Other Permit Fee ' TOTAL Check # A/ `i 6354 Building Inspector ` TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING00 k BUILDING PERMIT NUMBER: / DATE ISSUED: ic SIGNATURE: Building Commissioner/I ctor of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0 sawed �f L Map Number Parcel Number V M a V$kS 1 (1.3 Zoning Information: 1.4 Property Dimensions: 11 Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red _+ Provided Required Provided a 0 3 c) 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record m Lr IAame(Print) Address for Service: \- Signatur�- �YA, Telephone Vol Cd 2.20 f Record: l Name Print Address for Service: O �z 1�1 Signature Tele hone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: O License Number wrl Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name m Registration Number Address r z Expiration Date �1 Signature Telephone G) 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.......0 No.......0 SECTION 5 Description of Proposed Work check all a h'cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL VSE ONLY Completed by permit applicant 1. Building /0? D �_ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee(a) X(b) 4 Mechanical HVAC Q �- 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS ( AG/ -ENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, C/ �/YA. r� x z as Owner/Authorized Agent of subject property y Hereby authorize to act on My bel in all matters la ive to work authorized by this building permit application. c1- - -tP-0a3 S igna6r6 of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si natlue of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIv1BERS iST2 ND3 RD SPAN DIlv1ENSIONS 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 Y-/Y 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*********************** APPLICANT APPLICANT_ & 66CL(A PHONE LOCATION: Assessor's Map Number_ PARCEL 00 03 SUBDIVISION -I LOT(S) STREET "J ST. NUMBER ************************************OFFICIAL USE ONLY****************** *************** RECO tWATIO OF TOWN AGENTS: cbN NATION DMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS (i���7� ��3 7 leg / TPon, R-0 ,a 0,-V d TOWN PLANNER DATE APPROVED r DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 4 PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 im �10RTi/ • c. OF tt LED 16 t '6 OL Town of North Andover y * Building Departments •- 27 Charles Street 4SSacHusE�Ic`� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. /\ DATE T N JOB LOCATION 0 l0 D Q4064 V� Number n yStreet Address Section of Town "HOMEOWNER �r� '�T�0 I g0 -06/ 4 Number A I ,(,� A A Home Phone d Work Phone PRESENT MAILING ADDRESS N�rt Ili XVNA er NI 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 req it ments.1A f 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. NORTH TED own oAndove r f 0 No.zo/(0 0 Z-: over, Mass., 0"?ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .... As) BUILDING INSPECTOR ............... . ................................................................................. Foundation ..... ...... has permission to erect..to....jel A............... buildings on ...*s...............................%S..4.0 10 b I; t (0 0 ....................................... Rough to be occupied as....5-�.!PA........I..Aj........ .........U tp�.Wax 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 the Inspection, Alteration and Construction of Buildings in the Town of North Andover. I C) , ' 3 30 MW PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR • 4r Rough 09 /1070 10 ....A..................................... 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. � ter �y .• F 7. � a? /34/ ,3./36tb 4•QC, 2o'ewwE SAv./rAeY o • /¢3:57 'Jd'u/Sh' �AJ�yJ7srvT .. . . GYiL'T'Y EAS�rI�u�.vr 'i. I • ,I I � • I I I OsGaaD ST�E��' s .v� eY �d r�fr x4a r1&'r�.v.�urn av P1, TNF dqN�!' 1' T.vE' 4m4�,lr loc'J�fYO'DN /N 1iyEceT�.4. .N�M7V.�/w0 TAT/ `OAt�r .fir I,rWAV. eTl Nc rs/ �stx ZOO'&MOits,. ' eT/✓ /�7.4 s 3 :T/'�!'7JHS3e� c�.c►ri. Y rws�r t.✓rs A$-ar".IA40 �►.t,vdt O.C.�/i✓il/ AMCLQGI7L�`O IWTA'd 'd'At.MSwG r+t~ A"zw w i�•!1[�: '.. • t2•s�a�8 G�,3 G 74, rt , • � .,. .'b,��at►�_ F �, r .111�!'�!�!/.ANGIi E".Iltre�.�� .!E�f'/Ce's' :SUFI r.r (se .7d er ..,_ - �4 � �koorE�;• s>.�+r.�crtvvse-rrs •oiei'o LocationJ �obOG� S'1, r No Date 1 4 w NORTH -_ TOWN OF NORTH ANDOVER 16. . ��, Certificate of Occupancy $ r Y Building/Frame Permit Fee $ a �'�b'"•�''t�' Foundation Permit Fee $ ACHUSE — s Other Permit Fee Sewer Connection Fee ' Axa Water Connection Fee $ TOTAL 51 0 .. � 9 Building Inspector Div,. Public Works", Tl— ,k,Ljjtocation t N0. j Date P: , ° „aRT►, ,' TOWN OF NORTH ANDOVER "107. Certificate of Occupancy $ Building/Frame Permit Fee $ g Foundation Permit fee $ .' �sAGMUSE " ra y. Other Permit Fee $ a lVa. f?3 Sewer Connection Fee $ ;40 77 Water Connection Fee $ x� 4 ,D ' TOTAL $ `k B ildi Ins . for Div. iL�lr Works 8395 _ Location ( S!�000 2T r� No. Date f NORTM -TOWN OF NORTH ANDOVER Certificate of Occupancy $ f # Building/Frame Permit Fee $ � Foundation Permit Fee $ s�cMuse Other Permit Fee $ ` Sewer Connection Fee $ Water Connection Fee $ i t TOTAL $ I Building Inspector _081c1/95`.14;19 1.570.00 PAID P�� 1:`• 602 DIV-Public Works +Location No. Date 3l NORT„ TOWN OF NORTH ANDOVER Certificate of Occupancy $ o ; : Building/Frame Permit Fee $ CL sAcNus`� Foundation Permit Fee $ Other Permit Fee A (Wj $. ` Sewer Connection Fee ' ' $ { Water Connection Fee $ TOTAL- > $ Building Inspector Q c R;- "D!#R.: .Div. Public Works PER311T NO. 3 01. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. AGE i MAP +40.1Z'� I LOT NO.DIV. 'Z 2� RECORD OF OWNERSHIP DA�TE�� BOOK PAGE ZOr�E SUB DIV. LOT NO. V `t V��C � LOCATION �- (( L� PURPOSE OF BUILDING A .}}-.� � I��j i���y� _ o ✓�� '� ta/�I.L�.I(_ J��v SF' ZGAQ �w1L DOWNER'S NAME NO. OF STORIES SIZE 21'4 0 71 0d X.3 0 ;- OWNER'S ADDRESS � BASEMENT OR SLAB ._(a•P,S_Rl e9ur ARCHITECT'S NAME ^ SIZE OF FLOOR TIMBERS IST 2.)C�C7 2ND 2x'Q 3RD BUILDER'S NAMEt�wa�.�..L- , n -' SPAN \ s a DISTANCE TO NEAREST BUILDING Ton/ DIMENSIONS OF SILLS ((x --- DISTANCE FROM STREET 300,E '• 31/2—" POSTS Lx(Ly .DISTANCE FROM LOT LINES—SIDES /,O REAR )Q® _ t/x(a" GIRDERS AREA OF LOT 3 it T FRONTAGE / HEIGHTOFFOUNDATION (�� THICKNESS IS BUILDING NEW /"(,,/e5 SIZE OF FOOTING 7� X Zo IS BUILDING ADDITION 7 Vic) MATERIAL OF CHIMNEY /i. IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND So WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ve S IS BUILDING CONNECTED TO TOWN WATER X� BOARD OF APPEALS ACTION. IF ANY 0 ``CC IS BUILDING CONNECTED TO TOWN SEWER, PS Y IS BUILDING CONNECTED TO NATURAL GAS LINE i.. " INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST It's r SEE BOTH SIDES PERMIT FOR FOUNDATION ONLY p EST. BLDG. COST Zc�Ctm PAGE 1 FILL OUT SECTIONS 1 - 3 REGULATED BY PARA. 114.0'. B.C. EST. BLDG. COST PER SQ. FT. \_1 . PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDGCOST PER ROOM Z FEE PAID oo.... SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDIIne�� ` 4 APPROVED BY S� ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR •DATE FILED `7T cz:- L• DING INSrECTOp Q � SIGNATURE OF ER OR AUTKORIZFD AGENT t FEE —' PERMIT FOR FRAME/BUILDING OWNER TEL.# '-2Q(/,3-57/ /,3S7/ .PERMIT GRANTED S-b ^ G`d CONTR.TEL.# 7 ~35-7 ( 44�FEE PAID! o 2 19 DATE: CONTR.LIC.# H.I.C.# l � $3q a `�C�l K*- 3 484 gwe L o �' is too am fm Km ►s BUILDING RECORD 1 OCCUPANCY 12 _ - SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM w. w MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I I S. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE +7 B 1 2 13 CONCRETE BUK. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT' AREA FULL FIN. 8 M AREA _ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDY✓'D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME {j 'ti '•n i ".�I r T; _AT - •`BRICK ON MASONRY. ATTIC STRS. & FLOOR r� {{�� �^' }' BRICK ON FRAME I .al.Ci 3' .y�' ! ,l'9.41 2 C#J3 rljl!jb .q CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR IPOOR NONE . x�E..••e-11.l3(;Yf "".-w"'"Ii3,TY` 5 OOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBRELMANSARD TOILET RM. )2 FIX.) 1 FLAT rl SHED WATER CLOSET ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK'S SLATE NO PLUMBING '+ _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ - TILE FLOOR t TILE DADO 6 FRAMING 11 HEATING e WOOD JOIST PIPELESS FURNACE �- i FORCED HOT AIR FURN. _ TIMBER BMS. &COLS. STEAM p.:( �ly4 4 ,•.} • Tv - _ .. STEEL BMS.'& COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING e RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS ✓ OIL B'M'T 2nd. . ELTRIC EC1, •��{ 1st S 13rd I NO HEATING OWN overo o �� No , 361 W4 11"0i dover, Mass., 0 �( oLAKE T 'r e � COCKICHEWICK , ED '9 BOARD OF HEALTH Food/Kitchen PERMIT Septic System 4 ',r,f � �. BUILDING INSPECTOR rr t THIS CERTIFIES THAT .��►�...... u. s ................................. Foundation as permission to ere �.a01�...4?.r............... (JZ Rough erect... .... r0�1i�„buildings on ...taCo... 4 ,` /� p i �. . W.A.W.M7.....��t�-�Z...CAe...IOSJOA6E. Chimne e occupied as �S .-..... .. ............ y rovided that the ertsbn accepting thiss rmit shall In every respnform to the terms of the application on file In Final r , this-office;land,to theprovisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR j }s REGULATED BY PARA. 114.8-S. B.C. E . VIOLATION of the Zoning or Building Regulations Voids this Permit. Roush Final � . FEE PAID r � ; PERMIT EXP M� - ELECTRICAL INSPECTOR UNLESS CONS U T S Rough ' 6 .. .. Service BUILDING INS TOR x� Final �r � W } Occupancy Permit Required to Occupy Building �,� GAS uvsP c ` rt Display in a Conspicuous Place on the Premises — Do Not Remove 4 . OWI" I ' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT ' '.;Until Inspected and Approved by the Building Inspector. : y Burner. , % ` ":;PLANNING FINAL CONSERVATION FINAL street No r °* Smoke Det.:,• ` E `;•-'SEWER MATER FINAL DRIVEWAY ENTRY PERMIT Of r I o7- */`3 603 / 3.1360,4C, _73.8 r ��,� 20/cv�oE SA,v/�geY • \ 2 Sews,- 55456 £u! /43•S7 a W/OE S Aet/ / A I , '. s�wE/�' Erv.f Ejyltr•,vT . GTiL/TY EASr'm�.vT I I Os�ao� STYE - �» T.vi-d►.�.vl�s�rf4T ram�w'r-u.�e�s �cics+�r�ro oa, �N ryE ceras.rwww.�.vo y.wr/roars �z'ciA�i�dt.►/ �.eri� � »�rr�v rvE'�N GVH,�,�:�ANoo�E,e tLW/Nd .l1!dHCAI.�I�.f•• � N.oU//E'R ��i4 s„S .ArsNAVIAV AerWemr .tri s,�tdr��w�t�:�+ -O.�•IIM✓�I/ fO.P , s�/ir�.r ctrrrirY rw,.r r,✓rs urarcci.+� rr,ver . cnu�r-o i,✓ fvd �''e'Arr.�G �aielo sr�t•�,e4D iett:�: � . JryMw/v ON fPiN.f C4AAAo'9,I N/s"Y P.IA0w A 00 n /'7rv4.E�Gc/ /�/gv,PICE,�U/G�6,eS • f '2so498 �3 C s orov OF (� G4 /''*Ce .J7A •f•VOOYE�, .N•I.f"C,P"J rT.f viBiO , FORM U - IAT 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 local or state law, regulations or requirements. ****************Applicant fills out this section*******'*!********* APPLICANT: ALLOKQ11 fYAWK-C BL/k6%< Z'�� Phone 7-IV-357/ LOCATION: Assessor' s Map Number Parcel Subdivision �fi /'Ef�iJ� C/eOSS/�ej Lot(s) Street 5!?ab( . St. Number ************************Official Use Only************************ RECOMME DATIO OF TO AGENTS: 9 Date Approved G Conservation Administrator Date Rejected Comments - L't m woir - i0o bu Ak-f qs SkovJ " „ Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected "di /�� � Date Approved /v�0 r2S Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections 7- 1?-4 - driveway permit i��( 7-i9-� Fireepartment 4124A76- �ceived by Buil ing Ins ector Date 12 KAREN H.P. SEI O Mala Stse�:.OI8�5 D"`ffOT :� f; - NORTH As�1DOVER t os esz-r, BUILDING .H PHEAL L\.NNt\(i PLANNG &- COl�L1�IL-N,-= DEVELOP-N NT L\\� n APPLICATION AND PER-MIT DATE _j 3 PERMIT - .S6f C LCCaT=vN J`"'S� O.SG�Q S�-' S NAME - IV-ASCII ' s NA14Z / At/,e�CG� C=f*rCvsLADDRESS :3 61 gkne- -- s,ge S . Aef c s:: A9 a *'µ471 ..nen C.as and reau! �' O i� .C.C C OM V T R. Ll v. V 6 "J/Y Sl(-,:z i-.-rURS i C� :. -.1 IR CCS.,'C - PRICE •-T GR _:.S RE`'L�=cRS THIS P��.`SI T :SL:=_ ..= DISPLAY-':) O:i T'ri PRE:IIS S ORT ® of over &V ... No. 361 r �.. .. yy rt , dover, Mass., 19 IrS T O LAK ('_OCriICntEwICH 1 TED P' "\� � TH 1 � �,,,� By-O��ARD OF HL2�:�--�-�, q o'�cicf7 ,cher n PERMIT T Septic Sy!t BUILDING INSPECTOR 1 THIS CERTIFIES THAT AM. Mw ""' Foundation has permission to erect..�JIOW....RME-bwidings on ....taBG...��11>...S�T.................. td��/9�Z-4 Cw $y ^ k 6 tD1 to be occupied asT'.�.�. .MA!.. �1��.1�.�.f.lad....W�...Z...�i4.Q,...(a4Q�lroSlE,..,........................... 4 provided that the2persi n accepting this rmit shall In every respect onform to the terms of the application on file In Fina 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR REGULATED BY PARA. .114.8-S. B.C. owe /��- VIOLATION of the Zoning or Building Regulations Voids this Permit. �� ,@� f FEE PAID �a� PERMIT EXP MPJ �ti• O ELERIQAL INSPE UNLESS CONS U T S Rough PERMIT FOR FRMMUBUILDING ............. ....... ... .. ..... .. ervice s BUILDING INS TOma DATE: �FEUAID' GAS INSPECT ccupancy ermit Required to Occupy Building ` 2� Display in a Conspicuous Place on the Premises - Do Not Remove & No Lathing or Dry Wall To Be Done FIR DEPARTMEpTT t Until Inspected and Approved by the Building Inctor. � Burner ,�•q • a5 ��� Street No. I ei�� PLANNING tl� FINAL CONSERVATION.�I FINAL t Smoke Det. 'SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT {r q CERTIFICATE OF USE & OCCUPANCY- Town CCUPANCY Town of North Andover : a f }1 ° } y�j r:. w rfi F y } 1. ^ �` t f 4 y �'� f,- •,) { }fes ., Permit Number g'�- 3(0� Date �ltrtlrlQt Buil Ing 0xz �.wa'rr agi9 t-t•.: "��,kfWll} a g`>x34ia '¢.:fi.M'V K`.1,,•� .�j•?f« X43 .;}C�,..jE{ } n %ayV ' f" i 1 . : , Y r 14.',� c n s•� �,tt:7,f" 'Rs.�y:.a¢I�r?k�# -.: � r.,, k �¢ .'�_ ��; .. t'r r°� '.y:,.. 1¢ ¢vf . ' ,r i, p', } #p lit..° r x F,4; rc""aa 4;•',Std i {.� s yry.'., I�' :R; .. .�sty5 1 t t.: }r : .,; 'c .: y .,..t .. .:_' � ,,...• pq¢�`d�i.° �t�l' r.':r� a n tn"' ,} b!'e�` � i�.,c.'4 fia f ' 't -"s ..{ :,'.,r -..,�}�•,;t.�.o�S� { '"•;i ri f ..{, :- a ix.%Y¢':°�' n .. . Jar 6 i �� f'...� a Sd. rt, t s_: , THIS CERTIFIES THAT ^� 4 i a i r� gg � ..�, '� SIM. n��l.�t�»irl ��r,.(i°•',,�'.rt- •ai�i;' r{f,�T'1l,s wt -���.f - °.'H' �' , t•° a �i 5 r ,fav ,,,,## Y kr•;`.w € � ,�� E ,�r+� �'� .yi ft ;i'��v� n! a�^;' r✓'..�. -.{s iv.' � "�.}','t7 '�,i `=f �{ i.�"ls �,�; + i - }, .$. �• :i �h°J.:':s r"i, } is x-I 1PTHEBUILDING'LOCATED ON cs{x,K':-3 1f, a r-.i. it}} ,,ap�} s ..�.t� r.sr M>=L., rt «;.� rf bar +y�y ++t ' '• .,'.. N ACCORDANCE MAY BE OCCUPIED AS � , m # IWITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND # I` }`. SUCH OTHER REGULATIONS AS MAY APPLY. `' 3, t r AQ.t:CII� Ail j CERTIFICATE ISSUED TO �6NAVCC�Q� ¢ �4 r i. + °•r °.° p a,� r ea�i ;sit r r1 RS 'a«k�i,-t r � ADDRESS " �1 k} b • ? f ! . 5 r « 0,j i 4+ f{y (,.�A¢ 7,�� S� f �; H y � , i ur d g Inspector r 3 , ,� i x t wGNU , f ¢t b � �-;� � i � a.' N9�•¢�� �'�"�� kyr �� Y� � � l � t � .�' �-��� x rt `i}L5 a a,l �tt: iy }ryl7 i a �. :a•'�.dia,j4�a el Az sc�} �FayV .,q:�}}., pr G6� a is 5 .,1 + ¢° f $ 5 r s { , T'r- _5 : . $t kw ,spf ° b t 5 f �f r j{a 1`64 _d't" ';y.. SRS' _ •• • • — —... • ui1 !1WV ( ( P�1 Ak44I r%4" f GiI&VIAs Iv aiv ............. .v !Print or --Typal t./ NORTH ANDOVER, Mase. Date V13 _10 Building .� Permit #-Z A 70 / Location J & 0 s'�-0 d a Owner's Name1ti1i1,� New p---- Renovation ❑ Replacement ❑ Plans Submitted: Yes p No ❑ FIXTURES ..__..... 44 K w�sH! t,�e 1 F<n- �zJowMwo t•0 30sup<yosa� >wrsssf <wo a 31U rs x IL < r rr Ors a aMJ< �.a3saa.rc O = O n wrt 1 w o06 rla.r<sa �awHu Is IL y r»ML�7azCe . - -.. _ O < s -- aua—vaMT. BAaaMaHT ISTFLOOR 1H0 FLOORI I— $110 FLOOR. ITHFLOOR aTH FLOOR aTH FLOOR. - 7TH FLOOR aTH IFLOOR - Check one: Cartylcate Installing Company Name 42 L-T, �d��G Al Q Corr- Address-,� orp.Address_J-�) t) Y- PfdPt� Ste`^ ❑Partnership i //f��- ��.� -e 2 `fir-r �/ ! l r4'yj 0j m/Co.. Business Telephone 7-1' L/) .Name of Licensed Plumber_ ('�d b INSURANCE COVERAGE: Check one 1 have a current liability Insurance policy or Its substantlat equivalent Yes G ' No ❑ It you have checked y", please Indicate the type covers e b checking the g Y appropriate box. A liability insurance policy �� Other type of indemnity Bond O , OWNER'S INSURANCE WAIVER: I am aware that the Ilcensee does not have the Insurance coverage required by Chapter 112 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: - .._ ' -, . . sign a(ure o of or Owners Owner ❑ent Agent ❑ . I hereby cwtly that aq of the delaNs and kntwmation I have sutxr Med for entered)I#AbOV* tion we bus and a ata to the best of my knewtedge and that ail plumbing wak and installatlons p*dormed uhdx the antia comp partlnen provisions of the Massachusetts State Phanbing Code and Chapter 142 of tea Sana with all e3y -Signa urs TRIO / liens•f kxnber b� City/Town ' Master AF'f'riQW13(OFFICE USE ONLYi Typo of Plumbing tJcansa. Jowne �I yman ❑ 4.. j' i Date. 1 b N, 2870 NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNUS� - � / f This certifies that . . . . ! : . . . . . . .. .. has permission to performs plumbing in the b}�ildings ofj . . . . . . . . . . at. . • • C: . . . . . , North Andover; Mass. Fee. . 7. Lic. No.. �� . . . . . . ... . PLUMBING INSPECTOR tom` 04/444 11.43 i�, PRID _ J WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File --N M SETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING , (Print or Type) NORTH ANDOVER, , Maas. Date BundIng A 22 Location- �f Permit # f�Ca� Owner's �� Name New ❑ Renovation ❑ Replacement Plans Submitted: Yes 0 No [Q a - a s K J h K N at aC h OC O 1C *4 x aC 14 19 0 a s ~ d a S = x O1L 1V�1p Jx 00 WA ' 'Z O d x 1�1. 5 $, A J V 0R Y O A O Suq-88MT. • DABEMEHT tiT FLOOR 211D.FLOOR I !RD FLOOR 4TH FLOOR $THFLOOR 0TH FLOOR { ` 7THFLOOR ATH FLOOR /� Check one: Certificate Installing Company Nam r� 0''� f�7 Corp. Address ,30 n� [i partnership pFirm/Co. Business Telephone / Name of Licensed Plumber or Das Fltte�� 6 4 4; INSURANCE COVERAGE: : Check ne I have a current liability Insurance policy or its substantial equivalent. ' Yesv No O it 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. Check one: nature of Owner or Owner's Vgent Owner ❑ Agent 11 I= hereby certify that an or the details and Information I have submitted (or enter bove application are true and a to to the best of my knowledge and that allplumbing work and Installations performed under the rmit is ued for this application II n pliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 the al Law BY Type of License: tAllumber Mgnature of se eim or Gas Filter Title Gasfitter Master Ike Cftnse Num r /G3G yRo LD Joumeyman AP1110NED(OFFICE USE ONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO, APPLICATION FOR PERMIT TO DO GASFITTING NAME do TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFtTTER LIC NO. PERMIT GRANTED DATE��19 1 GAS INSPECTOR • Date. A?` ,Pfs . . . . { NpRTH TOWN OF NORTH A6OVER pEs,,,Eo ,691,0 � A ' PERMIT FOR.GAS j STALL` *JJ0N 41 .�,q m • '`�'1 1992 9SSACHUSEt9 This certifies that . . . f . . . . }} . . . has permission for gas installation/. t �Iwz-.&1,4t4t ee.�e!: in the buildings off . .4 _ r'?... at . .Y..Z..? . . `.. fl��' . . . . ., North Andover, Mass Fee °'. ". Lic. No,/a3,9 . . . . . . . . . . . :. . . . {/J *.�-7' GAS INSPECTOR WHITE:Applicant LAN•ARl'? Building Dept. PINK:Treasurer GOLD:File Office Use Only 6 L� _ 014E (fummilumatti of fflusar4adw Permit No. 5 i9e}artist tt of Vubltt 2mfetq Occupancy& Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 1 0 _ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /d y T& or Town of NORTH ANDOVER To the Inspector of Wires: j` The udersigned applies for a permit to erform the electrical ork described below. Location (Street & Number) �J Owner or Tenant Owner's Address Is this permit in conjunctiio�oiiwith a b it ing permit: Yes No ❑ (Check Appropriate Box) Puroose of Building /� �, �x` �P Utility Authorization No. - Existing Service Amps _J Volts Overhead L! Undgrnd ❑ No. of Meters New Service Amps /at/�`�olts Overhead ❑ Undgrnd UL riNo. of Meters �— Number of Feeders and Ampacity c Location and Nature of Proposed Electrical Work No. of Transformers Total No. of Lighting Outlets � No. of Hot Tubs I KVA Above.— In- of Lighting Fixtures I Swimming Pool grno. grnd. r_ I Generators KVA No. of Emergency Lighting No. of Recectacie Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Totai No. of Detection and No. of Air Condi No. of Ranges I tons Initiating Devices No. of Disposals I No of Heat Total Total ?umos Tons KW No. of Sounding Devices No. of Self Contained I No. of Dishwashers I SoaceiArea Heating KW Detection/Sounding Devices Municipal i l(Other No. of Dryers I Hestina Devices KW Local i ii Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Winng No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the recwrements of Massachusetts general Laws _ I have a current Liability Insurance Polio inducing Com^-etec Operations Coverage or its substantial equivalent. YES NO _ I have sucmitted valid proof of same to the Office. YES NO - f you have checked YES. please i ate the type of coverage by checking the I opriate box. INSURANCSONO C OTHER (Please Scec,ty) (Expiration Datel Estimated Vaf E!ectrical Work S 0 Work to Start Insoecuon Date Recu'eested: Rough F nal Signed unser e e Ities of P14"<-L,ry: / ) LIC. NO�J al FIRM NAME Licensee Signature LIC. NO. Bus. Tel. No. Address Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does no a the insurance coverage or its substantial equivalent as re- quvea by Massachusetts General Laws. ana that my signature on ihi rmit aoptication waives this requirement. Owner /Agent (P!ease check one) '3s.S .v d Teleohone No. PERMIT FEES U (Signature of Owner or Agentl c 6505 Cly 3 ��5--- • Date..:/. fi 0....r,.. 2634 i y. NORTq 3? 6"°°� TOWN OF NORTH ANDOVER } PERMIT FOR WIRING SSACMUS� - This certifies that C. q./ ........ ��t����d........................... has permission to perform ..... !2 c�, ........ ( c .............. wiring in the building of.... G at....:,a�f ...... ....sT ,North Andover,Mass. q Fee..3kr�JO Lic.No.j6F: .'�W........................................................... r - ELECTRICAL INSPECTOR 10/24/95 12:53 385.00 PAID. . WHITE:Applicant CANARY:.Building Dept. PINK:Treasurer GOLD:File Location No. Date NORTIy TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ Building/Frame Permit Fee $ 00 sAcNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 " 17830 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATIay TO CONSTRUCT RF8 RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BLMDING PERMIT NUMBERDATE ISSUED: m 113 � o SIGNATURE: Building Colnmissiow dBuildin Date zSECTION 1-SITE INFORMATION O 1.1 Property Address 1.2 Ammors Map and-Parod Number O'scoorlG Map Number Pared N C9.1 .1.3 Zoninghlfomletim: 14 PropedyDmensions. C \ Zonm Didrid Proposed Use Cat Arcr F 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Rcqtiired Provide Required Provided RegWred Provided 1.7%ur SapplyXGaLCRO. S9) 13. Flooazaaotofmmuoa: f.8' Sewe�oDisposelSysteax Pobho 17 Prwo 11 Z— 0wM de FWod Zona 11 mm ic4w U On Sim Dapow&YOM Q SECTION 2-PROPERTY OWNER5HIPIAUTHOR=AGENT m 2KOwncrof Record N {Print) Address for Service: -7 &-b U- J is /L (+�Telephone 2.2 Owner of Record: -S TZ Si Tet M SECTION 3-CONSTRUCTION SERVICES ire 3.1 Licensad Construction Supervisor. Not Applicable Licensed Construction Supervisor. O License Number Address a Date Signature Telephone_ r t 3.2 Registered Home Improvement Cwh1clor Not Applicable 0 CompanyNeme M Registration Number r Address r z Expiration bale G) Si ature Te I i SECTION 4-WORKERS COMPENSATION(M.G.L C 152'§ 6) Workers Compemetion Insurance affidavit must be completed and submitted weh this application:Failure to provide this affidavit will result in the denial of the isstmm of the building permit SignW affidavit Attached Yes.......4 No......D SECTION'S Descri on of . "-. ed Work ehe& New Construction'0 Existing Building 0 Repair(s) 0 Alterations(s) 0 75dition "0. Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief}Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS . Item Estimated Cost(Dollar)to be Y O05E, Com leted by permit applicant 1. Building Q (a) Building Permit Fee M»1' lier 2 Electrical (b) Estimated Total Cost of ConsWction 3 Plumbing. Building Permit fee(.)=.(e) 4 Mechanical AC 5 Fire Protection - 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPI)ETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Herebyau onze to act on ' My if all matters lativ to rork authorized by this building permit application Sig,Mp'of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION b as Owe/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 5i tare of Otvnerl ent Date 140.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Isi2ND 3 SPAN DIlvIENSIONS OF•SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH NMEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS.LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover , I b Building Department � • ;, `;; ' 27 Charles StreetN� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print.,( ) DATE 116 u ;?'g JOB LOCATION 6o Number J Street Address [ Section of Town "HOMEOWNER �1 -7 (p — 96 ,T/ "1 6 o Number Home Phone W A Phone PRESENT MAILING ADDRESS COLO- 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 requireme ts. r. 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. WORTH T T oVM of Andover No. 0 LA dover, Mass..,- //-0702 -0�0!?Y COC HICHEWICK A TED TED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT.. 1* P it OU BUILDING INSPECTOR *Cj�ij oft4 jAj .................................................................................... Foundation has permission- to wM..............I................. buildwins on...."A........0.460 Rough to be occupied as... 40 0%* "..1.................'*.*........10# 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 rel ing to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 07 PLUMBING INSPECTOR 14) 1 r VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCT1 � 4TARjTS ELECTRICAL INSPECTOR I 'W'& Rough A ...... ...0.....#"or....... .... . ............................ Service ;XLDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer. Street No. SEE REVERSE SIDE Smoke Det. tkd k __— _.._. --- — t A k a--i y 17 qp 1-4 NO V Vp tt 7 , t i 1 F I 1 iI ' "—. e...,; /! + .. a ,.�I;�1,:11 �. :i ::: �m••vo-w ,:.",' ,rl �.y!—�-. r fjf�;j,) ytt-. _ v : i 69 I j f -:a U.r a-H j I � mi (94 r t , x,u 44 X/\. �� r lM0 f Y IS Eke-, '1 .,s L� I 7Vf�,"131.Yi�- m lfi r : M; -. *•_ � per st�9. ..,-- 'kyfp 1•ry1 - M1 Date... ...... NORTH TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING S CHU This certifies that ............................................... ................................ A has permission to perform .......................................... wir!5FF4 building of...... .................................. ...........................North Andover,Mass. Fee.9 ............... Lic No.. ....7... ELECTRICALINSPECTOR Check # 5489 TUE COMMONWEUTHOFARSSACHUSETIS Office Use�only DEPARTA1EW0FPUBIICSA= Permit No. BOAROOFFIREPREVEMONREGUT4T70NS527CMRI2. _ cry Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PERFORMELECAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL C DE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover g4 To the Inspector of Wires: The undersigned applies for a permit to perform the electrical workdescribed below. Location(Street&Number) <- Q d � p AUL- Owner or Tenant ,/E� Owner's Address -r Is this permit in conjuifctiQith a building permit: Yes® No (Check Appropriate Box) -a ���G � Utility Authorization No.Purpose of Building -Ci(J6QJ✓�6{�� Existing Service Amps Volts Overhead O Underground No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting OutletsNo,of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round Rround No.of Receptacle Outlets -,X5— 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 1 No.of Dryers Heating Devices KW Local Municipal Other M Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• lrmimnceCoverage.Rus =tDdrmgtmanaltsdWbmdmscmGmralIaws ave&ibmiWdv-Adpwofofsarnelodr,Offlm veaa>IIartLiabl7ityltiauanoePblicyinchldmgComple�OpaationsCovaageoritssubalegtuvalaixYES NO YES ® ( ffyouhavuchededYES,pkw--indicaledletypeofeovaageby gdr Vpn2j&box LTJ �t4SURANCEEj BOND OTT R E:] (PrMspecfy) FkpiraaonDate /o? ®ev Estimaledvalueof iecticalWolk$ Wolktostalt IrVectionDaeRequ Rough Final signeduncierTiie of6xwL ` C RRMNANIE 7 Lkff eNo.• _ liar>9eNo I1�se>��E�/y16/�I ���G� Siglahue _ Tel.No. Alt Td No. _C��� OWNER'SINSURANCEWAIVII2 Iamavmedrittul-xnwdoesnothavethe' covaageoritsabstanfialequivalaaaslecumedbyMasmd ug2a.sGenffW aws and thatmysignal neon thisperrutapplicMonwaivesthisIegtucernent (Please check one) Owner r7 Agent Telephone No. PERMIT FEE$_ 96 Signature ot Uwner or Agent Date z AORTN 3r��.� •°„•_��oo` TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s � � +• SA US This certifies that .�3�s. . .l'i��i? ! l.�. . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . P(nh. q~""f °. plumbing in the buildings of . . . ..�e^ ' ”. . . . . . . . . . . . . . . . . . . . at. .S.t .G. Q.S . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee.". . Lic. NoP). . . . . . . . . . . .. . . . . . . PLUMBING ICTOR Check # ;,yl 6250 f, A. MASSACHUSETTS UNIFORM APLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS J / Date Building Location G elf Owne Nam/ Y4 31 r(I tl, Permit# 6 Amount Type of Occ c New Renovafbn Replacement Plans Submitted Yes n No FIXTURES a d o a $G • O r7 O 1ww� � a A s s18B%K BkgRvm >STRD t ti 3MHDM i� 4IH ROCK ,'"IlI HIM six IL" 7MHfM 8M ItOCR (Print or type) /c Check one: Certificate Installing Company Name V ® Corp. Address ® Partner. Business Telephone ® Firm/Co. Name of Licensed Plumber: Q Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy {ate Other type of indemnity a Bond a Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature 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 i tions perfo ed er Permit Issued for this application will be in compliance with all pertinent provisions of the Massa use S to PI and Chapt`e 142 of the General Laws. By rim Type of PI bing License Title ity/Town icense um er Master Journeyman a APPROVED(OFFICE USE ONLY �. '�'i` `` - 'e1. � 9 t � c �� ,. � � � , .