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Home My WebLink AboutMiscellaneous - 60 LONG PASTURE ROAD 4/30/2018 (4) Location / � 10,0 '.. ore_ No. 7 Date NaRT� TOWN OF NORTH ANDOVER 3? O ,BOG � 9 ' Certificate of Occupancy $ O CHU <� Building/Frame Permit Fee $ �a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14346 ' Building Inspector TOWN OF NORTH ANDOVER , BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: T � � � 60 X SIGNATURE: J4 jz q�p—,t� Building Commissioner/lit9f5ector of Buildings Date SECTION 1-SITE INFORMATION I O 01.1Property Address: 1.2 Assessors Map and Parcel Number: 1— --k 106;"/j L/ CrAMap Number Parcel Number r 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 R "red Provided ReqWred Provided 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 0 Municipal ❑ On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT M 2.1 Owner of Record C t-0 u-) 1,UA (0-0 Ed Name(Print) Address for Service: Signatu a Telephone 2.2 Owner of Record: ✓1J�1 �--- O Name Pri Address for Service: Signature Tele hone SECTION 3;CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O / 1y� License Number Address 1J110 ��V la?h > Expiration Date Signature U Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name #171 J?/ M Registration Number r 'gess 0(jlll�) Expiration Date ^ Telephone Y 1 a 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 cher applicable New Construction Existing Building Jor Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to Dollar be xR ( � OI?Fl<CIAL USE ONLY Completed by permit applicant r 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of d �! 0 OR®a Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection �� 6 Total 1+2+3+4+ Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �5 ( �?-cl�( �e l` as Owner/Authorized Agent of subject property Hereby authorize MU�`� J to act on !��- i all m rs relative to work authorized by this building permit application. q Inco Ivo Signature of Owner 0 Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, _ns� as Owner/Authorized Agent of subject property T I 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> a100 0 0 1 � Si ature o Owner/A en Date NO. OF STORIES SIZE BASEMENT OR SLAB L,YI LQ.YIt SIZE OF FLOOR TEVMERS j a 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS J SIZE OF FOOTING X MATERIAL OF CHNUWY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ( Q r' r 32.r' AX ' 94.3' s LOT 4 72.5' •cS LOT 9 LOT 1 gp�Elrt N 0 OF 44 MICHAEL �J+ LONG PASTURE GE ROAD 191 234 I'J FOUNDA TION LCCA TION PLXN I CMFr rwr rw pMAur srwcrum smo*w coxmw m M M MI791 M MMOK J?E'WIIPE mn CW SMF LOCAL curn.• CROWLEY C®NSTUCT/CN Ma =MMMM�� >wr p � wir mak& SUM AS COULVAMMWj7LtMK&j AOVM, THIS ,CERTIIrICATION IS AMDE AND UNITED ORKM or SEM) TO THE ABOVE CUENZ: mus ONAWN@ SM"' MOr BE 113M 9r 731E CUW AV AW P/hYPMM 07mv ToAM 7MT 0Un MFJ? AMYE.B t&M MM jMr WMrMN PAWWSMN Or CU M477AMUN & SAM HN_ F1WP'791FiAl M 7M G r*w is 7w OAp!'MtAp m per LOCAWN: NORTH ANDOVER,MA. Is IMMW=vH $n4M rl a SM TAM NO for rGN TOM IA16fURiGli7M UM GF WX OM WM@ M ANr UVF1Qil-- ff4rXM MMraM M7PEGM SCAT.£: r"�eA'" T?AT�'; s/y/oo , CHRIS TIANSEN &SERGI ��ra 190 sUA(MM Sr. HAVEM8u mL aim TILL. 97's-.Y?J-wio 020M AW CMtXS'iMAWN r SMW tl� DWG.NO. 94080002 s FORM - U - LOT 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. APPLICANT CrOJ04 JJ PHONE 97 k 155'7035 ASSESSORS MAP NUMBERI LOTNUMBER SUBDIVISION Lona 6 �� S LOT NUMBER d STREET (00 6--2 hUxc STREET NUMBER (00 OFFICIAL USE ONLY j RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS ' C/'L M 44 DATE APPROVED TO DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HFALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE BUILDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number. Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: Location of Facility Si tore of Permit Applicant i Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r - The Commonwealth of Massachuse!ts Department of/ndustrial.9ccidents Gfrice of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Afflidavit dame ,n le W e—T . cd. Please Print Flame: Location T 11) c 1 c Cit/ Ar---1R-on(`Q M Fhcr,eR�0s�� 5 (— I am a hcmeawner performing all work myself. I am a sole proprietor and have no one working in any c-,pac ry ✓I l am an employer providing workers' compensation for my employees Working on this job. Comoanv name: r7)W1e L.Q)'lS► q i - Address CiN7 (�(,l}e�l l M 10 5O-R Fhcne T �- 6 7153__ /6-15 J Insurance Co. Ll `� t"�V� � Pclicv T U)C4 0C? Q I Comoanv name: Address Cib/7 Phone ` Insurance Co. Pclic✓ Failure to secure coverage as recuirac under Section 25A or MGL 152 can lead to the imposition a c:imiral penalties era rine up to S1.SCO.CO andlor one years'imprsenment as•,veil as c:vii penalties in the norm cf a STCP'NCRK ORCER and a fine cf(5100.00) a day against me. I understand that a copy cr t pis staement may ce fcrvarced to the Office or Invesrgaticns of:he GIA fcr coverage verification. I do hereby certify under the ains and penalties cf perjury that;he information provided accve is.`rue and comp:. Signature l nate O�CO DU �._� Print name w Fhcne# Offic:al use only do not write in this area to t:e completed by csy crown cr:ciz( Cay or Tcvn P=rm1t1Ucansirc Building Dept ❑Check,f immediate response Is required ❑ L'censing Board Selectman's O lice Ccr,rac:person: Phcne T r`"'ealth Deparrmc-17t F-, Otiier i ---��zc 1�a�vsna7uur�Qcyl a � rtiwux<�rrd� € BOARD OF BUILDING REGULATIONS t i License:}CONSTRUCTION SUPERVISOR } Number: CS 058114 f i Birthdate: 02127/1961 hij Expires:02/27/2002 Tr.no: 16172 ' Restricted To: 00 i STEPHEN CROWLEX � 138 VIRGINIA AVE LOWELL, MA 01852 Administrator I 3 i i i 1108E INPROVENENT CONTRACTOR Registration= c 114187 i Expiration: 8111101 Type: 084 CRONIEY tO_NSINCIION I G.0 STEPHEN CROVLEY I 138 VIRGINIA AVE t+Dt�ISTRATOR i lOME1,l MA 0I852 I r V4 RTH s Town . of - 4 over 0 r _ No. y _ � zo 0-1�—?;4'--No dower, Mass. �o- ice-ad COCMICME WICK V ORATED P? ,�S S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � �► erl ..��.�.. ../Y........................I............................. .......... ......... ............. d oun anon has permission to erect....11! 10.., buildings on .. ... ............... ................ ...vN ..... ....� ough to be occupied as.... .....?A.... . . . so 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR ough ....... ..... ........ ....... .................................................. 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. NORTIy TONM ' of . �A o over, Mass., rs �v- AO a I� COCHICHEWICK V ORATED PPS\ 5 '9S H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........�r14�/ !.......14010.�i�.. ...y. ................:. *Foundation • has permission to erect....100V �...... buildings on,0W.. *.A0 'i P ...... oughA to be occupied as • • M�✓ Chimney ... ........ ..........�. AAWS0.................................................................... ....................................... 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 PER1V111 EXPMES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Service ...... Rough .WW . ...................... .... ....... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE smoke Det. A 77 V', MI. OP -5 ffltvv� K 4—-v, v :,e 77-7-M jv.- — — .1 A I VIk Y'a ri 10-0 it.- Mot 77-7 777,7777177y;�,- Y 05,W"- ,4j kM r z�-N w M T -AWS"'OFRIA 4, 'n*, I FAM -OQ--A; CDC C 'ITA OND --.,',T V 150 h Q,P S9 4 Ms m r2 .42 7 =xnC m A `RK.' 1 am—N6R YM;'�POOL, I zt k 41, 5.701-1 ? IN .A 1�Oil 4 414= N 40 VEN U: r OW S Ml :F-ND. GAR. A, Z7—, ;T777 007 A-11, -j r IS", vw 7, 47, FND oil Y7-- "FIVY F j % ykgm, T- Nor, % < ---------- Date. . ./U.. ��. ... . :l ,AOR TIy TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION y SA US This certifies that . . . . . . . . . . . . . . . . . � --. . . . . . . . k has permission for gas installation-.-JJ�. . . . . . iyj he buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ! '� . . . .(. .� �'-�-' ��?- ., North Andover, Mass. Fee Lic. NoL� e� . . . . �1,. . . ..�./J, 'GAS INSPECTO Check# t � n 3701 • -� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,MA Date9200/ Receipt# Perrttit# Building Location �� ,�-STyitce OwneesName i•Al �/�rT/0S .�- Map; Lot: Zone: Type of Ocatptanrys3` t�~ �'� New C2 Renovation C3 Replacement❑ PIaSubmitted: Yes C2 No ❑ Fee: y x uS Y NzWa2¢ ¢wJ— m¢ ¢ O O UO< = w > ¢ ¢ LLI O a O W LLI w O /w¢a ZZ > W W - rw_ LU � 0 ¢ LAI ~ W L7 f- 2 J F Z r W W O > LL z a w a ¢ r > w m z O z ¢ O m Q W > ¢ W O Z < ¢ < 6 O O W - O W 5 S O C7 2 LL 3 C t7 J U ¢ > SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR V T± Installing Company Name EASTERN PROPANE & OIL, INC . Checkone: Certificate Address 131 WATER ST DANVERS �,A 01923 Corporation Estimate Valueof Work: ❑ Partnership Business Telephone 800-322-6628 ❑ Firm/Co. Name of Licensed Plumber or GasFitter��Jo�l��%/t??�lD l9 INSURANCE COVERAGE: I have a current li ' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. A liability insurance policy Q- 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 best of my knowledge and that all plumbing work and installations performed underthe permitissued forthis application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By Type of License: Plumber Signature of Licensed Plumber or Gas Fitter Title Gasfitter Master License Number City/Town Journeyman. APPROVED (OFFICE USE ONLY) Rewwd 05117= BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES P110QRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME&TYPE OF BULIDING a' LOCATION OF BULIDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 20 GASINSPECTOR CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number �� S`f$ Date S->i-oo &-i_ -v t THIS CERTIFIES THAT THE BUILDING LOCATED ON )07 *Z 0 �vti PAS MAY BE OCCUPIED AS S 1 AMI U,-e 11tA-'f IN ACCORDANCE � b i WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. 10-Rv0 ft5 i y S-1z!/ v n:�/2 CERTIFICATE ISSUED TO ADDRESS s C(r� !I! Building Inspector I i Town of North AndoverFORTH O& tLeo � Building Department �? g°`., '16V6 o0 27 Charles Street o North Andover, Massachusetts 01845 _ (978) 688-9545 Fax (978) 688-9542ED CHUS APPLICATION FOR CERTIFICATE OF OCCUPANCY/ INSPECTION ADDRESS LOT NUMBER L�_ SUBDIVISION �' f S P�9ST�lZ G DATE REQUEST FILED DATE READY FOR INSPECTION 6/ /O/ FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE.($25.)DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVATION �~ r DATE � I PLANNING a A DATE I 0 D.P.W. —WATER ME R 6 �1�� DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. SIG ATURE/ P AUTHO ATION NORT;1y. Town. 0. 4 Andover0 M N o. v7/s/ o d®ver, Mass. '�� ' G COCMICKEWICK ' ' URATED � � IT T D BOARD OF MEA'.TH ELM Ek ., Food/Kitchen Septic System ./'�"/G!/� c� /�✓ a . � �s .............................................................. .r�`!e'v�r�i z� UI L DING INSPECTOR � .._ -� THIS CERTIFIES THATCrO.W.KeY......... .......... Foundation./ f in son.. . D . ..has permission to erect......... . ........................... buildON ............. ........ Rough, 44 ........ Chimney$0 be occupied as IO " W ��... ... .......... .I. .. ............................ provided that the person accepting this permit shall in everyrespect conform to thE,terms of the application on file in Final /406-e-- 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 MAo& Q 04aA x651,# VIOLATION of thti Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS TRIC INS ECTO UNLESS CONSTRUCTI ECTed .. ..................................................................................... ervic BUILDING INSPECTOR inal Occupancy Permit Required t® Occupy Fuildirlig GAS INSPECTOR Rough Display la in a Conspicuous Place on the, Premises — Do Not Remove P Y P is No Lathing or Dry Will To Be ®-one FIRE DEPARTMENT Until Inspected and Approved by the Building -inspector. Burner Street No. � 'Z e _ . SEE REVERSE SIDE smoke Det' • r NORTH ®Town - X over No. qq4 _ o'0 � C;�� dover, Mass., ORATED FPa\,`�5 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System � M BUILDING INSPECTOR THIS CERTIFIESTHAT...... ....... r . ..................... ..................................... Foundation✓�'1 has permission to arect...�o *Y&Y....... buildings on ...... .0... 1. I • Rough to be occupied as G a RA.614,�Q/QI,yC, 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. MA040" 044701 , PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. �� I Rough / Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS 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. .N SEE REVERSE SIDE smoke Det. NORTH Town , ofover.:: ,.... :«. L O w..4.. r .�i 0 'AVyo. OQA LA COCMICMEWIO dower, Mass., %- ice -ad ORATEO P'P�,C�� S H � BOARD OF HEALTH Food/KitchenPERMIT T D Septic System � � BUILDING INSPECTOR THIS CERTIFIES THAT........ 16........ ....... r..�i�......y. ...................................................... 11040 �N � Foundation AA�� has permission to erect.... .... ... buildings on P.,.,..,.. ough • ...................................... ........... . ..... to be occupied as A?A.... r� ^ . 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 &iteration and C nstruction of Buildings in the Town of North Andover. /30� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final A PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST 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 �A 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. N° 2735 Date..... .. .. .'7""""U r f NORTH 4 ° TOWN OF NORTH ANDOVER 3? 1, 0 p PERMIT FOR WIRING ,SSACMUS� This certifies that .....0....... ......'.. .!vt.`t.�/j.........�, .�.P.C........................ has permission to perform .......�v.F.!4..1.....,1 1..0 ��.E'............................. wiring in the building of....... ............................... at.... �.�...L.v� Jif Sf ./J r./).....................e-1,North Andover,Mass. Fee..... .. . ...... ...21.. ..... _,.. ..... Check # 7/ ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer THEC0MM0NWE<4LTH0FA' (MS`E77S Office Use only I DEPAR7 1EW0FPUBL1C&4FE7Y permit No. o?7. � BOARD OFFIREPREVE MONRE67ITA770NS5270KR12-00 Occupancy&Fees Checked M TI TOPERFORMELE�'TRICAL WORK APPLICA OlOjFDRP�1�Nll'T ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC,HUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE 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. AP PARCEL Location(Street&Number) Q d 'q c f — Owner or Tenant �'/ d�✓/c �'� y Owner's Address Is this permit in conjunction with a building permit: YesNoo r7 (Check Appropriate Box) Purpose of Building ;, /z ��..-y/ ,� �/ - Utility Authorization No.UO r— 1v� Existing Service Amps / Volts Overhead Underground No.of Meters New Service 7�G d Amps A-',:;lo a Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work ��/ t✓ ��%� ✓ �Ju�" `d— '1,No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA 1,No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground around rNo.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 Detectiort✓Sounding Devices No.tpf Dryers Heating Devices KW Local � Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.k-lydro Massage Tubs No.of Motors Total HP OTHER' ... hisL==Cot=aF-Plantm�totheiegimarla�o#2v1a�d GalaalL3ws (�/ Iha�eatz>Qa�i�abtbtyh neF�Cy>rl�r�IgCon>plr Caaageorrtsst alagnvalag YES ! NO IhawsthrAodvalidgoofofsatnetotheOfoa YES C-� a Yyouhmdmd®BYES pkmri:ic&tteMmofw)=Wbydukmgthe box NSLRANU p�BJgD � � � ) y - o�, FstnaledValueofflo&al Wolk$ Wollctoshatt `�- 2 >< DWeRe4,2s1ed Ra# Final Sigwdunir %n iescfpajtux FIRMNANIE r� s"� E, 11:r/ I�oaseNa /T � Li UBW1, 1 ✓� , Sigllahae �� ` Lioar�eNo , ' _S �� Al Tel Na OWNER'S INSURANCEWANIIZ;Iamawmedig theLiar-Bedoes nut fmwdemrmwataag itsstibs&talegtuNehgastec}medlyIV Laws andthatrrrysigzl�.aernthisparrl¢applicariaiwaiu�thistec�.marla� � (Please check one) Owner Agent Telephone No. rERMI T FEE$ Signature of Owner or Agent 1 9 �Lvp I i 1(0 `✓�"K �� r>>, o. �. -Tx12 5 91<1:117 G;ERALO architects Pngtneers p: 2 �cft - 111S.`v Tp rJ M A, 0 2.4'42-1 .. �.. .i .'r M:A'.•. s.iM-+L� k. 'v.Fv.4. ...t61Gii.n... _...-v.a,+ ........e.v+.f- <. ... .. ,.c�... w.. .+ • .. .. .. . u. -, n.. t. f j C1dl Y i Location No. I ¢-- Date x NORTH TOWN OF NORTH ANDOVER i O:t . o :�,h•G MO 9 Certificate of Occupancy $ sAC11USEt� Building/Frame Permit Fee $ Foundation Permit Fee $ / � e-2 Other Permit Fee $ TOTAL $ E Check # / ICI 3 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 'S g`iT�3sa3/ �� APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. / DATE ISSUED:so, C 60�-SIGNATURE: A4 IN Building Commissioner/Insl5ector of Buildings Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 2 lac . Zoning District Proposed U Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft . Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water S M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: —/ a Public (>LPrivate ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System d' J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Serv' e MA -7ry t Signature Telephone O 2.2 Owner of Record: I Name Print Address for Service: O 1 z . M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed onstruction Supervisor: nn 5 (15 2 11 L4 O 3 8 � '�� CZ. ✓1(;L� - we.I,' 'v l�-1 License Numberwn Ad e Z 2�- 1 c� Expiration D to giZn'at4e Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Inc- Company Name � Registration Number 131 1Cq I n I d � - LUi�c�e. M A g Addr s -7b L� 3 -70 f 5Expiration Date ^Z Si nature --Telephone P1 1 SEC')"ION 4-WORKERS COMPENSATION(KG.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.......0 SECTION 5 Description of Proposed Work check all a Ucable New Construction Existing Building ❑ Repairltera7itions) ❑ Ations(s) ❑ ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ":' ..,OFFICIAL USE;ONLY Completed by permit applicant 1. Building ,�} (a) Building Permit Fee t o Multi Tier �a7 2 Electrical (b) Estimated Total Cost of 0 Construction J v 3 Plumbing Buildin Permit fee(a)x (b) eZ � 1 4 Mechanical(HVAC) a 'a 5 Fire Protection. ft 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 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 4 I, as Owner/Authorized Ag J Agent of subject t property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief u,) e CJ S ` (_,_en e C0. o I y L rnt 2-1 L a�atur f Owner A ent Date NO. OF STORIES SIZE X G BASEMENT OR SLAB SIZE OF FLOOR TIMBERS '7 1 2 3 SPAN DIMENSIONS OF SILLS 2 (p DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS ? - HEIGHT OF FOUNDATION THICKNESS �1CC SIZE OF FOOTING 7 X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE U Fn "7voo'12I 21 A int ,zAlof 1 t UQ ,de IL 0 14 it AUG-02-00 08 :40 AM FITZGERALD 617 964 9539 P. 01 R".,q,�f •,! I r M' t Vs Orb iFw i mAsm Intl AN a.,y5 r i I i ' � p .1. l,e1�p , TL- too. N P9.2 -Z Location; No. JU Date NORTH TOWN OR NORTH ANDOVER Certificate of Occupancy $ E�� Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee $ " � TOTAL s Check # �3 a -1 i 0 4 � Building Inspectof TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TOt CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a m BUILDING PERMIT NUMBER. I I DATE ISSUED: SIGNATURE: Building Commissio er/I for of Buildings Date Z SECTION 1-SITE INFORMATIO i • ^" 1.1 Property Address: 1.2 rAssessors Map and Parcel Number: O 6 / 10,19� r ®� t2 0 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Recitlired Provided R -red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5- Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT 2.1 Owner of Record si-m C-P u—, PAW� Nam Print) s Address for Service. Z Signa6 xL. Telephone 2.2 Owner of Rec C W el) lieCG.U/j 13 f- Nan e P nt dress for Service m Si ature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ `S� / ' G41/jeCi`k,t/ 0 Licenssinstruction Supervisor: �ly 40:5,// License umber Mn AdNkg&" � �� G Expiration Date Signa a ,�7�-Ieplione �. 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name frn Registration Number r Expirati Date ^) Si nature Tele hone Y/ n 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 a Hcable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Pro sed Work: rr N-1tco.r' ® r 1 b lca� a APW-V- 40 e fcm�t F SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � � OFFICIAL,USE ONLY y ` Completed by permit applicant 1. Building / (a) Building Permit Fee Multi Tier v'! 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC C/1 r� 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 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 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 Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3RD 71 . SPAN DIMENSIONS 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 *0 Ale—Lu ho w►v- t O&Pt- C06t _00 1 'i 4 i FORM — U — LOT RELEASE FORM a i 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 j applicant and or landowner from compliance with any applicable requirements. Ilj APPLICANT hO tt�• PHONE l—U ASSESSORS G MAP NUMBER LOT NUMBER ICA'CN9 PAS'�Pe 5JA S. LOT NUMBER STREET �d�%f/ ' STREET NUMBER O OFFICIAL USE ONLY RE ONIl�IENDATIONS OF TOWN AGENTS r- DATE APPROVED O V CONISERVATION ADMINISTRATOR �. < DATE REJECTED COMMENTS Nop ��Jf lS��(•�� r) I i DATE APPROVED TOWN PLANNER {'{ DATE REJECTED 11 1 COMMENTS 1 i j i s DATE APPROVED FOOD INSPE970R- AATH DATE REJECTED DATE APPROVED d J� SEP71N IN CTOR-HEALTH DATE REJECTED COMMENTS ✓ - /CAo °^ ✓c��„�S { 1 PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE �4g S w T.O.F. L,a158.2 94.3' LOT 4 72.5. J t LOT LOT 5 F.ASE)JEN� L��H OF lygS�� . t MICHAEL Gu- LONG PASTURE c1, GI ROAD 191 g 23. F®LINDA TION LOCA TION PLXN I CEJMFY 7HAr THE PRIMARY STRUCTURE SHOWN CONFORMS TQ THE HORIZONTAL SETBACK REQUIREMENTS aF THE LOCAL CLIENT: CROWLE'Y CONSTUCTION AoHs cmBwnc�rwmv `mar �� R Amy oTlwER RESTRICTIONS SUCH AS COVENANT *TnAM= ASEUEN THIS CERTIFICATION IS MADE AND LIMITED OMM OF caNW EMJ TQ THE ABOVE CLIENT: Tars DR wm SHAFT Har 9E USED 8r THE cuENT FCR ANP PURPOSE OTHER THAN THAT DUTUNED A8OVE,EXCEPT WN THE WRfrm PERMISMaN OF CHR1SMNS£N t SERM INC. FURTHERMORE THIS DRAWW IS THE COPYRIGHTED PROP&M OF CHR/PUMN & SIM INQ AND ANY UNAUTHOVPrZED USE 40CATIDN: NORTH ANDOVER,MA. a PRDNIeW&CHMMMSEH t SERGI WES NO RE3PIaMXLlTY FOR THE UNAUINOR/ZED USE aF THIS DRAWING OR ANY INFOR- MAWN CONTAINED HEREON. SCALE. f"=s0 DATE. 6/7/00 CHRISTIANSEN &SERGI PROLE L L"osuSNEERS 1190 sUMMER ST HAVE"U.MA. alesa TEL 197e-37'S-a3fO 02000 Br CHRrsTrAHSEN SEM INC. DWG.NO. 94080002 ....fes— ...—;r.-`-•w+r��R- »,...,.. n„ ....s ,.. r. rte$ a-x"--,tR'y�'.'- 'a"� '".=�' �'F .�'• ..a f��.� y,r••�•--.��t+ ] e 4` 11777 71, 500 X9.12• SEPTI:: TANK , T L:EACH,TRENCH I�.w_'ere.,d�... ��..�re. i�; ..r.. �ex_.. � :»,'.k �• c .f: - a .� '.may a•: > f. p* a F<YS D. BOX: R.Tk q RE..a .. c�..SERVE �r.�!�. -. .,�y .:� �•c<�}�.k✓'.',:..c,'' -.1 �� ... ^'4 not"Y'��2;4' ,s° :. a-}r _ c• ,C.;� .t. � MS'S �t.--ert?r� -''�`a4r Wv.:�Y., F•� � !r .{ za ir�{,•�� ...",..... rt .:r S.•.. .n•t,•r \ '; --'-s :3rf4 ifiis o-R<; ;�•1. '�Y 9' ;b.h.:? �-•�•`a.+`C^'4ik.vt� a, 4•. � n,0 X, .. :xaiC'': �s .'i.•^.....-=k3a r^�, ia t,�'.g� '..�, �'a_'r.'�#I,..,�''y,.3� .fg•.�Y+.`ri• - _ �,• W"' a ,y :. ..::.�"r,a,ay.Yss,a.,•...x.•.h�... ,..�.. �. <.-,•.r ��:. .. ,w^i�r'w�[r�w.r ',}x T�", '^4 ,6 _ s� �a "'a�`J+,.wr,:,'j. p A _..;s..t ,.,, u.. RE A •. .��' ... .. 'Ft.'.� .; •4-as< ,'ry°jt a:'< ,.em�.`r: .s1.r;. Via" :5,». 4 x .�Y+ t.1�?'; }�R�'SERVE.rt _ ..�._r.._ --_.. � „�� 'rn�.r• .k:'_ � y .«f;�.. .-S +r"...i7 e, a�'.y x r". t „Rss9r9 -5:: 4 ',r � a.._ a; k i'` "tl�. r,�r•. �! ._. .. ,-.- ..� a'- ,.;.. �d .�� f '.r rC..6,-,t "');r, an+ � v.4 r.. .. "•tS, k' -..:;r,, 40.507 X .......... .r.nL.r. ...V.. ..... ...-.. .:...::<_•:•.. :r: r a. a" Pdi ' f t� y tl .. .F@�y'• TJi";. iwiimw x+'F"..1 __ 'wr.. ""`Y .1'sk .N': H i.,M p 1. F .;.. eF`•, .a I• �. „ ;r-�. k fir. �' r+ } ;r. t '±1° ik1.;.; 'Fi#:•,:4•, z .�,�r -t.�-'`r,4�'�,p`$ �,. ,r• � t4teL�,fJ� +�'i-`�• ,x, • !Y -..lr�•arC't"l. it�l` . •Jt l i •Y_ 4.�r.^ "�F. e •,} :4' ••t x.;g' '-:t' � ;�-¢ - r �4�i;VJ .a r ,� ,r �?a. r "•j":s. .i, .'rS- :i; J SRR,,'. 'y^S - �a°`, t :•A''"•'. �{;�� w _ �}' ;'� -ya,« - Y .,�] �5 YY 4:i •d .+1 r'rt 5'� M "a u., t �'�.5,S i Y - eMa �,`".. 'T .F.h �. �EA�H =TR,ENC , £,:r F• _.�; � k T`O F �_;� �; � _ . � • . . � rt• e `.y z s. .b r� d 1 ° .y.• ty,��. ,`,nth - `� ... -, r e 2 { shy a f 1.• � 4 '® ! ,\� � C! _ r .fq; , 9 ;r r AREA = O� ,� A CRSS a r ASSESSORS REFERENCE F AoRT"' To"', Of 4Andover No. q44 o� coC�c, dover, Mass., ADRATED S H BOARD OF HEALTH . Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT...... ~. ......... ...N ./ .�...................................... Foundation I has permission to erect...��....�C?..V....... buildings on.......�.0...�oti. A."��...� Rough Chimney to be occupied as G a �14 G 1 , ,w!V y ................................................... .. ...... .. ................................................................................ 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. pv'"44 A" / PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. / Rough 4$ PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS 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. 4of- f�� C. N Location '� S No. i f Date MORT� TOWN OF NORTH ANDOVER 3? � •SOL 4 - 4L s $ + ; . Certificate of Occupancy • air cNus C Ett' Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ abS� Check # 130 14 r (1 3 9Building Inspector IE 'i (a•��_�gyp?-��l'�C� X95,6 r � ( �2W 32.1' w QTR � o?-/ �i T.O.FCrL . L,=158.2 Oct 01. '7—rANs�KIe o 94.3' .. 4 72.5' LOT LOT f LOT EAS£M£ L-�, MICHAEL yGs LONG PASTURE J ROAD 23.I' i FOUNDATION LOCA TION PLXN I cERTTFr THAT nir PRIMARY STRUCTURE SHOW CDNFORats T!7 PC HDR/ZDNTAL SET34ACK REOU0*WEAfM OF THE LOCAL APPt1CA"ZONrNC 81=LAWS Ix EiFECT EN colvsT�ttcrEo. CLIENT.- CROWLEY C®NSTUCTION rs CE7PTTfTCATION DOES NOT caN51DER ANYwHo7HER RES7RIC7DDN3 SUCH AS CpVpWiAITS WE7LANDS,EASEAIEAIT35, THIS CERTIFICATION IS MADE AND LIMITED ORAM OF eaNDlrxA%r c.} . THIs DRAwm SHALL NOT BE umv BY 7HE ctiENr Fom ANY TO THE ABOVE CLIENT- PURPOSE O7NER THAN TMT OUMNED ABOV[,EXCEM WIN INE B981M PERNISSON air CHRIS77ANSEN & SEM rnM . FURFUERNORE 00 DRAWM 6 ME COPYRIGHTED PROPAR" OF CHRZYMNSEN 4 SETtGf Or— AND ANY UNAUVONIZ£D USE LOCATION. NORTH ANDOVERRMA. IS PRONIB WACHRISMNSEN 4 SERM TAKES NO RESMNSIBIUTY FOR THE UNAUTHORIZED USE aF THM DRAWING OR ANY INFOR- eMATTDN CONTAINED HEREON. SCALE: DA TE: 6/7/oo CHRIS TIANSEN &SERGI U", NEERS too SUMMER Sr. HAVERHIL4MA. W&W TEL e7e-373-03t o ®aOOD BY CHRrSTIAxSEN 4 SEM INC pH/G.ND. 940 0002 i! r ;� I TOWN OF NORTH ANDOVER BUILDING DEPARTMENT . APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �q ' i r BUILDING PERMIT NUMBER. � , DATE ISSUED:AA C s 6/ SIGNATURE: N/if 6^.0. .Building Commissioner/InActor of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: (00 D a n A �� A A /� Map Number Parcel Number 1.3 Zoning Information: \f'� 1.4 Property Dimensions: 2- Zoning District Pr osed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Repired Provided ReqWred Provided 1.7 Water S° M.GLC.40. 54) 1.5. Flood Zone Infomration: 1.8 Sewerage Disposal System: —/ Public C1/ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System R J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record �ccn Tisk s a s+tk rc Name(Print) Address for Se V� h r A C9 \ kAA � - X5-1- `� r 1� 1 Signature Telephone 2.2 Owner of Record: Name Print/ Address for Service: O M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ hm -71 Licensed Construction Supervisor: tt n n C5 ()!5 I O 8 Vi(e ►-ka menu - L,cicl), hiLicense Number m A7b@%11JU //�� zI7i� 10Z, / b l 5 3 UJ Expiration D to Signa a Telephone �.. 3.2 Regi-stttered Home Improvement Contractor/ I'n Not Applicable 11 r 1 Company N� I ' — MA- Registration Number Addr s 7k - Lf53- �U 35 ° Z Expirationlate /1 Si nature lephone ll) SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) 4" 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 ❑ Specify Brief Description of Proposed Work: S u �-�3 g lu SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be i" `XX}I+ CIAL USE(}NLY ` Completed b permit applicant 4 � �, 1. Building ,}f (a) Building Permit Fee / Q Multiplier 0 2 Electrical (b) Estimated Total Cost oft ) � Construction O �j 3 Plumbing Buildin Permit fee(a)X tbl 4 Mechanical HVAC 5 Fire Protection V 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 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 I, —T? cwc {' as Owner/Authorized Agent of subject properly Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief I t J e onS ` (5-co-e-ca l C 111 C_ r nt � I Si a ui-56r6wner Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 sr Zxl 7 2ND 3 SPAN DIMENSIONS OF SILLS 2 X �p DIMENSIONS OF POSTS '/ \)e T�c1 DIMENSIONS OF GIRDERS _ HEIGHT OF FOUNDATION THICKNESS f1C SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i FORM U - LOT RELEASE FORM IySTUCTIONS: 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.requiraments. APPLICANT FILLS OUT THIS —SECT1CN*'"'** *"*�*'"�' �~ APPLICANT W\\Z-j CbM `; 6-C 0 C n • 1�C-` PHONE q63_ ID� LOCATION: Assessors Man Number I ' PARCEL SUBDIVISION �� r � LOT (S) STREET K0 k x a ST. NUMEER(0 OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: _ O CONSERVATION ADMINISTRATOR DATE APPROVED OQ '' II DATE REJECTE ND COMMENTS �>s�.�✓1��2.1'�e�.�� Are 6,A b r-r e . i\ 001 -4i^ TOW NER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SE. S ECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUELIC WORKS -SEvVEFJWATER CONNECTIONS bf DRIVEWAY PERMIT / ? FIRE DEPAATh1E7`IT fi=r— RECEiVED EY EUILDING ii ISPECTOR DATE Revised 919;im //z, Xao? ,c�L /s�� 5f- / /X y 9' foyrr-/TAti, R1 7S1 0 /sr /a x z�,P,�3 ic, / 4L d 33 b C a X C3 81 (a G vl 3 0 of D o 6 Y 3 a 57),;t e s 3 3 a 9 o O 0 s xa8 z B A-*bs 3� a Q► g o 2x11 ti a2 �3 Cj2 r Z -e p� �O 3 J OZ pJ' � 0 o Lo D a► S i m P S Dui, /34 RpV A7 N `7 ARR-11-00 TUE 12.06 PM FRANCIS PROVENCHER INS FAX, 19764649343 PAGE 1 AGOR1,�� MOM; ... ,�i � ;.:�:, . 1 .c �teo� . Doalz looI PRODUCER THIS CERTIFICATE 16 ISSUED AS A MATTER OF INFORMATION x Francis 8roveneher Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 330 Rogers Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Dowell NA 01852 I - COMPANIES AFFORDING COVERAGE Godfroy Insurance Agency f COMPANY Pnw.No,•,.�,478-d59-8681 F*(Ne. 978-454-9343 A Maryland Casualty Company INSURED COMPANY ' 8 Legion Insurance Crawley Construction General COMPANY Contracting Inc. C 138 Vi inia Ave. COMPANY -- --..__.._._.. -....._........................... yy��t Lowell HA 01952 D �1�•rQl��s: k; r ` :i i S I t r } 7 .. .: ..., THIS 118 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE TO THE INSURED NAMED ABOVE F OR THE pOL1CY pERlbb INDICATED,NOTWITHSTANDINQ ANY REGIUIREMHNT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EKPIRAT*N LY DATE(Rdwo m DATE(MMIODYY) LIMBS GENGRALLIABILITY GENERAL AGGREGATE 1110001 A 7L COMMERCIAL GENERAL LIABILITY 9CF33190507 01/29/00 01/29/01 PRCDUCTS-COMPIOPAGG S600000 ~ CLAIMS MADE OCCUR PERSONAL&ADV INJURY $ 300000 OWNER'S 6 CONTRACTOR'SPROT EACH OCCURRENCE s300000 FRE DAMAGE(Amy ohs fife) $ 50000 -A IMED EXP{Ary ons person) $ 10000 AU70MCRILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT t i ALL OWNF;Q AUTOS BODILY INJURY SCHEDULED AUTOS (Per pin) 5 ... HIREO AUTOS BODILY INJURY --T NON-OWNED AUTOS (Pet acoidenU --........... PROPERTYDAMAGE $ GARAGE LIABIL(TY I AUTO ONLY-EA ACCIDENT $ ANY AUTO i CTHER THAN AUTO ONLY: , EACH ACCIDENT S AWREOATE S EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM 5 _.._.......:...,'_............. _.... _ $ WORKERS COMPENSATION AND X W 8T 0 EMPLOYERS'LIABILITY ELEACHACCIDENT $100000 B THE PROPRIETOR/ g INCL, WCS-0023520 01/15/00 01/15/01 EL DISEASE-POLICY LIMIT $ 5500000 PARTNF.R&lEiCEOUTIYE _ OFFICERG ARE: FKOL EL DISlASE.EA EMPLOYEE $],00000 OTHER DE50R1"ON OF oFWRAnoNwLcCA71oNwvEHICLr;ai$%CIAL ITEMS Carpentry Residential 3 stories or less OERM�p NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOnOCTO TMC CERTIFICATE HOLDER NAMED TO THE LEFT, VAX53 North035Andbvar DOPAIWAEvcMAIL SUCH NOTICE a4ALLIMP_OSENo001JOATI- ALIABILIYY FAX 453-7035 27 Charles Street OF ANY KIND UPON THHCOM 8 ENT'S OR A91PRESENTATIVF& N. Andover MR 01845 A HORIZEDREPRESENTAT,t MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE : Other (Non-Electric Resistance) DATE: 3-2-2000 DATE OF PLANS : 3-2-00 TITLE: New Home PROJECT INFORMATION: Lott'' Long Pasture IV. 00/'0.'15 )PASTU%G RdJ COMPANY INFORMATION: Crowley Construction 138 Virginia Ave. Lowell, MA 01852 COMPLIANCE: PASSES Required UA = 949 Your Home = 700 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1840 30 . 0 0 .0 65 WALLS: Wood Frame, 16" O.C. 3924 19 . 0 2 .0 222 GLAZING: Windows or Doors 695 0 .350 243 DOORS 80 0 . 350 28 FLOORS : Over Unconditioned Space 2998 19 . 0 142 HVAC EFFICIENCY: Furnace, 94 . 0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST , Massachusetts Energy Code MAScheck Software Version 2 . 0 Kew Home DATE: 3-2-2000 Bldg. Dept . Use CEILINGS : [ ] 1 . R-30 Comments/Location WALLS : [ ] 1 . Wood Frame, 16" O.C. , R-19 + R-2 Comments/Location WINDOWS AND GLASS DOORS : [ ] 1 . U-value: 0 .35 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? ( ] Yes ( ] No Comments/Location DOORS : [ ] 1 . U-value: 0 .35 Comments/Location FLOORS : [ ] 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Furnace, 94 . 0 AFUE or higher Make and Model Number THERMOSTATS : [ ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ l Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: e [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . e DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or g / cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS : ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ---NOTES TO FIELD (Building Department Use Only) ------------------------- -------------- 40-' 967 APPLICATION FOR 'WATER SERVICE CONNECTION North Andover Mass. -A, i C 1'9-- — A lication b the undersigned is hereby made to connect with the town water main in /`� �y�– PP Y g Y Street,subject to the rules and regulations of the Division of Public Works. 7 ✓ The premises are known as No. r e- Stce,�- or subdivision lot no. 70 Owner Address Contractor Add s Applican Signature Il PERMIT TO CONNECT WITH WATER MAIN �D The Board of Public Works hereby grants permission to to make a connection with the water main at Street subject to the rules and regulations of the Division of Public Works. rd of Publio Works By Inspected by Date See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS t DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone(508)685-0950 Fax(508)688-9573 r10RTM ?Oeit�eo 691.0 3 L I # _ * r �SSACHUSEt DRIVEWAY PERMIT Date: LOCATION: 4 BUILDER: phone: OWNER: /C �� P�� Phone: �35 The North Andover Superintendent of Highway Utilities&Operations MUST be notified of the g .__.. __.. .__. - -- - ---- -_._ ..... -way maintained by th ng for approval 01 I`T° . 110 4 Date ..4.—.O.'00. fJ of NOR7ly THIS PERMIT. F� ` 9 TOWN OF NORTH ANDOVER R * V. RECEIPT gCHUS • ,'ll / This certifies that ...... !.�'�.. ......`��..�'moi?........................... haspaid.................t.......�.. ..�..J.�..�.d�......................................... / L � LpT for ...�..i .... ....... I ..��?... ... . .. `? Ur�. " Received by...........................�.Ii. ....1 l`%.f.! . ........................ Department ........................Fu401.).C. .....!✓Y.....4 ......... WHITE: Applicant CANARY:Department PINK:Treasurer Growth Management Bylaw Exemption Statement Town or North Andaver Euiiding Oepartment This form shall be used to assist the Suildinc Department in their determination of exemptions under section 3.7.6 of the Town of.North Andover Grcwth Management Bylaw. Tlie building appli=nt shat)provide all of tt e necessary infcrrnaticn as requested 'below. Name of Applicant on Euilding Permit (be!cw) Address of Frccer-,/ fcr Permit(be!ow) S U (n Map and' arca! ; Purpose of App!' -tics (check below) F�tcneNumber 3 Applicant Ingle Family _Two Family I the undersigned applicant fcr the above property attest that the attached building per it `cr which this form is =mpleted does comply with the EXEMPTION section 8.7.6 of the Nonh Andcver Growth Management Bylaw. I also understand providing this farm does not absolve me cr any part/ to this permit from the requirements of obtaining other permits required prier to the issuarca cf the Euiiding Permit. Further I understand that my interpretation of the E(EMPTION status is subject to review by the Building Department and is only ofF.Gally accented when the Building Permit ig issued. Eased an section 8.7.6 of the North Andover Growth Bylaw the above lot and the wcrY as applied fcr on the above let, in the building permit application and associated attachments, ccrof with one or more f she following sections as indicated by'a c'ieck mark. This is an application for a building permit for the enlargement. restoration,or reccnstruc ice of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The Ict(s)were/was created prior tc May 6, 1996 are exempt(rem the provisions of;his Sec.cn 3.7 of the Zoning Bylaw. This apclic,tion is for dwelling units far low and/or moderate income families or individuals•where all of the conditions of S.7.6.care met amd/or represents Owelling units for senior residents,where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section'senior'shall mean persons over the age of 55. This applicaticn is a part of a development project which voluntarily agreed to a minimum 4(3%permanent reducicn in density, (buildable lots),below the density, (buildable lots),permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable aces and permanently designated as open space and/or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restncon,Conservation Restriction,dedication to the Tcwn,or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Ceveloper in common ownership with an aclacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Panned Growth Rate and.Oevelopment scheduling provisions far the purpose of construGing one single family dwelling unit an the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not ac.rmmcdate issuing a building permit in that Year,one building permit will be issued per Year per Cevelepment until such time as the Oeveleoment Schedule accammadates issuing building permits. Applicant must supply approved form U with this E(EMP70N. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attac'-ed building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. ignatur at wner or Authonzed Agent wne sign Attached Budding Permit Oate This forth must be attached to the Building Peftpllt upon application far such perch �I NORTH F Town of Andover No. a?/ vow LA E o dover, Mass., & COCHICHEWICK AERATED oP�` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............CrOWK..... ........Co.a ....................................................... ............. ... Foundation !� VrY has permission to erect........./............................ buildin s on .110 D...�o!!� g � ... . r...../.►.. ..... Rou h 0) 40 1110 4 t to be occupied as.. ................... .� 40 Y.A4011-21 . .............................................. y 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 n0 & Q A A a 1 $ do 0 /0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI ELECTRICAL INSPECTOR �RT Rough ............. ..................................................................................... Service '00000BUILDING 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 I FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. r pRTly Town o 0 > > Andover 0 No. a 10, ndover, Mass.,0 LAKE C OCH CNE WICK �� A0RATEQ v`?,?-\" Cl SSACHUSE I T FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ......� has permission to excavate and pour foundation at r for the purpose of.. .. ...P0M1. 4l.!.... The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLDG. PERMIT FEE a O LESS FDA FEE I AC DUEFRAME PERMIT � .. .... ... .. ... . ....... ................................... BUILDING INSPECTOR