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HomeMy WebLinkAboutMiscellaneous - 614 FOREST STREET 4/30/2018 (2) 614 FOREST STREET 210/105.D-0127-0000.0 �I i NEW ENGLAND CLAIMS SERVICE, INC. Incorporated 1.985 Reply To 7M Reply To Mansfield, MA 02048 +%- rY 131 Dodge Street, Suite 6 P.O. Box 345 AHA1 i^tom Beverly, MA 01915 rtiW Y1 N(NNP. TEL. {508}337-8058 N: ,aN�` TEL. {978}927-3000 c ruA I FAX{508}339-5835 nr ' FAX{978}927-3002 wrandall@newenglandclaims.com Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec 3B To: Building Commissioner or Inspector of Buildings City Hall North Andover, MAO 1845 To: Board of Health or Board of Selectman City Hall North Andover,MA 01845 RE: Insured: Michele&Gregory Stein Property Address: 614 Forest Street,North Andover,MA 01845 Cause of Loss/Date: Water Damage/ 12/16/2013 File or Claim No: BOS 051911 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Section 3B. No insurer shall pay any claims (1) covering the loss, damage, or destruction to a building or other structure, amounting to one thousand dollars or more, or (2) covering any loss, damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code, to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven, the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Very Truly Yours, Robert L. Smith,Jr. Adjuster 71 0301 Datet 6................ NORTIy TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHUS This certifies that .....4//-1 41V ....................................... has permission to perform .... .... ... .......... ............................ .......... wiring in the building of...... atll� A A.Z.......... ............. .North Ando�!v,r,maso!g? Fee.... ........... Lic.No. � . .;;d . . v. .........,.. � AL INSPECTOR l� ELECTRIC Check # ow In olilllpa/�/l 0/�i4jjlacl.joffi J,.,, s"vicej BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .A!1 \\oik io kc"1121 1-orm'd .1-.,:, Dka-i"'.'! Date: Cih- or Town of: At, A-A Y 6 n-1 -s Af-- V> 7_0 the hiveclor of jf,ire�. the underql Lill ed Lri\eS of ilk or her imentior to perfolnil ill,, elec-1 icad \\,01k descilbed bdOv' Location (Street & NuIll ber) 6/ F-0 rF_Sr- ss r Owner or Tenant C— R Ec— 7—&*j Telephone No. OWliel"S .Address - No (Check AI)propriate Box) IS this permit ill Colli till Cti011 With R buildingperillit? es Ez� Purpose of Building ttilitN Authorization No. Existing Sen ice Amps I Volts Overhead t nd-I'd 'No. of Meters Ne\N Service Amps i Volts Overliend 7 Und(_7rd No. 00leters Number of Feeders and .Ampacity Location and Nature of Proposed Electrical \N ork: IVJ X�v_L, Completion oi*file/{,"lloll Ing tcrL ma; be it,m_,(i L1 lfj`__ J."'O. of Recessed Luminaires I ofCeiI.-SL1SI).(P2(Wle) Falls N° °f To ta ITransformers I",V A iNo. of Luminaire Outlets No. of I-lot Tubs Generators 11"VA No. of LuminairesAbove Ill- No. or Lmergenc\ Lightiil�z Swilliming Pool grad. BatterN Units No. of Receptacle Outlets No. of Oil Burners DIRE ALARMS iNo. of Zones No. of Switches No. of Gas Burners ji,No. of Detection and Total 1�._ Initiating Devices No. of Ran-es No. of Air Cond. �,N 0 Tolls of Alerting Deices No.of Waste Disposers iHeat Ptillip 1 Number Irons I\,NN, jNo. of Self-contained No. of DisliNNashers Totals: - Detection/Alertina Deices N I' E] MolliCilMl IC Heating 11"'W Local L Other Connection No. of Dryers (Heating Appliances Security SN-stellis: No. of Devices or EquiN nlent No. of Water N 0. o \o. of Heaters KW Signs BallastsDam \\Irina: No. of Devices or Equivalent !No. Hydromassage Bathtubs \o. of Motors Total HP _171000MMUlliCations\\firing: No.of'DeN ices or Equiv,-l`1eH1__- aL:e of Elect:Ical -'tach aJJ:.fiCmf1:dc""'li, ".0 W, (When ieclUffed b\ mluli ipai ;-,oh Woik to Start: 1 Is pec 0,Its Io IUL I e C�,11 L 5tCd, i.11 R CC 0!C".8 I I ce \k1:1l NIEC 'RAC 10. ar' ;mo INSURANCE C 0\ ER.AGE: Uniess, \N al\ed b% ti,e owne, the Pelfc:-Irance ofelca'c�! N\c:k 1�-,a\ :;ss ie +u;-Jest no or I I : C� P'I'C\,Ides m-ooi of Jjjbill:\ ir�:Jlai;ce illck!dim: a: :qu I a,,11:1 e uldollgned Ceiflfle5 I'Rt _Ll'-I, C el e !!1a:ld has exhibited piccffofsarle-,0 dic iw:-Illi; SSUHILI 01"�.Ce. CHECK GXE1.\SUPAXCE U\D ❑ C HER , I (S,)eCiF\:) � B I certify, under the pains and penalties o/ 11ttli,the illformalioll on this application is true and complete. FIRM NAME: LIC. N SAA 6 A Q 0 AE-:77-j- 4_4e7-1Q1 4__ U Licensee: C . t if IT L I C. 0.: Cr'L 131 Ful. No.2)b_A.SY"/_ kdd;_ess: Ali.Tel. No,: 'Pci M.G.L c. i- ieqpuiios Depa:,,mCiil ofilublic S­ L'�C i LJC. \C%. 0\\N E US, I N S I, R A N CE I LR: I a i i) vI a,c [i"Zil :cquffeCl b\ i'm. P", mler,s Own e r/A aen I�ignaI" C ture Telephone \o. PEff R.IfFEE: S i ;ti` AC40R O CERTIFICATE OF LIABILITY INSURANCE0711DATE(MMIDDIYYYY) 011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Elaine C.Dozois.AAI Fred C.Church.Inc. NAME: t Wellman Sires! PHONE 478 3227243 FAX (978)454-1865 Lowell.MA0185 i _ E-MAIL -------L--)---------- (800)225_ ADDRESS: edpzois )fredcchurch.com --------------- --------- INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Travelers ---------------- ------ -----..-------- ----------------- INSURED Charter Oak Fire Ins.Co. —- — Richard W Gaudette INSURER B: INSURER C: Phoenix Insurance Company. 8 Kiberd Drive N Chelmsford.MA 01863 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 17699 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDNYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000.000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PRE300.000 --- - MISES Ea oc_urrence� S -__- CLAIMS-MADE X OCCUR MED EXP(Any one person) S 5.000 C -- --- _ 680359K4390 i/i4l2011 1/1412012 PERSONAL&ADV INJURY S 1.000.000 -- ---- -- GENERAL AGGREGATE S 2000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPiOP AGG 5 2.000.000 POLICY PRO- — ----- ------ E T LOC 5 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT sEa accidents 5 _ — ANY AUTO BODILY INJURY(Per person) $ 50.000 B ALL OWNED X SCHEDULED BA4322A99.A };}2011 }11!2012 __ AUTOS __ AUTOS BODILY INJURY(Per aaidentj 5 100.000- X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE -- ---- _—AUTOS lPer accidenj 5 50.000 --- - c UMBRELLA LIAB _ _OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE --- -- ------"------ --- --------- ------- __A_G_G_RE_G_ATE $ DED RETENTION$ $ --- WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N -_ TORY LIMITS_-_f_R_,_ A ANY PROPRIETOR�PARTNEPJEXECUTIVE 100.000 OFFICER/MEMBER EXCLUDED? NIA UB783BX770 411/2011 -E.L.EACH ACCIDENT $ 4!}!2012 (Mandatory in under E.L.DISEASE-EA EMPLOYEE S 100.000 If yes.describe aunder __. __. _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) fax?978-446-7103 CERTIFICATE HOLDER CANCELLATION ,- Attn: Wiring Inspector SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cbent-: z hast; 17899 Cert Holder# 5323 ©1988-2010 ACORD CORPORATION. All rights reserved ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD t CQMMONWEALTti Ur MA*OAvnvac, ,a AS A REG JOURNEYMAN ELECT ICtA . :; ISSUES THE ABOVE'tICENSE TO: RICH'AR.D W GAUDETTE -8 KIBE.RD DRIVE RO CHE;LM.SFORD MA 01863=1622 15330E 07/31/13 831834"y C6MtA0NWEALTH dE MASSACHUSET M IREGISTERED MASTER ELECTRICIAN 1 ISSUES THE ABOVE LICENSE TO: � m GAUDETTE ELECTRIC .RICRA.RD W GAUDETTE 8 K.IBERD DR {� CHELMSFORD MA 01863-1622 5868 A 07/31/13 83183 ' wol QRVVER'S = - - r t_ICENSE ` +Ea RS '4aEi95 4d NktiiS&R '" 4 -201 Nam 5 - ° 'svgs TaEs7� TT RDICHARVI� a 8 KIBERD DR N CHELMSFORD,NA 01863.1622 k4,�"^'d'^'"�"5 DD 0&27.1010 Rev OT^152 9 . — T VN Id wa'W p wo o� 4d 97/T A Opo o' �w I 1 Date.4-2-c:PF.- . . . . . . . . . . . ,AORTII TOWN OF NORTH ANDOVER 0 I- A PERMIT FOR PLUMBING 41 3.,4cwus This certifies that has permission to perform . . . . ... . . . . .. . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at. 4 .///. . . . T. .6'"' '. . . . . . . . . . . . . .. North Andover, Mass. . . . . . . . OO 7 . . .Lic. No..—. . . . . . . . . . . . . . . . . . . . . . . . Fee PLUMBING INSPECTOR Check # 5082 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) - 11�1 �A Z9��Mass. Date �.•� / Permit # Building Location E)f):R ct owner's NName fl jj- ntV nre�r� Type�o"f Occupancy Residential New iJ Renovation ❑ Replaceme t�` Plans Submitted: Yes❑ No ❑ F , ORES Z N = r x r O C7 f a `L3 .n N n O Z S til r11 W Y J UI a U h Z G Z N O. •tom i- 1,4n Z o a — x o — W h W 1- U¢ z a — n w0. - 3 Rt b rd S f V Z Cr m R N N tt ¢ W N Q J Z p a W H r w ao 3 H ¢ � w w u �1 ft 1r •YFi F U a z 3 = a z PN k Z a C 0 z w F' C t) 4 F a a z N ¢ ¢ o 3 Y J 0 N O O J � � !- N U. � � O a 3 tt M SUB-BSMT. BASEMENT IST FLoon 2ND FLoon 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR l 8TH FLOOn ` Installing Company Name Heritage Htg. &P1g. CO- Inc. Check one: Certificate AddressI1 Corporation 714_ 35 Pleasant Street p Stoneham, Ma 02180 [] Partnership Business Telephone_. 781 —4 3 8-77.76— F1 Firm/Co. _ Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy IN 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: Owner El Agent❑ Signature of Owner or Owner's Agent 1 hereby certify that all of the details and informaiion i have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By4�'�'L� — ignalure of Cicensed Plumber Or- Title ----- Type of License: Master[X Journeyman❑ City/Town 8 3 2 2 APPROVE F0FFICE UUSE ONLY) License Number______ BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME do TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR Location l /y zn No. <; ' Date NaRT� TOWN OF NORTH ANDOVER 16. A Certificate of Occupancy $ * Building/Frame Permit Fee $ GMUSt Foundation Permit Fe $ sA Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector L X34: 55 Div. Public Works l'rRMTT O. �j� APPLICATION FOR PERMIT TO Y3UILD********N 'RTH ANDOVER, MA M1.11'NO. / LOT NO. 2. RECORD OFON'NERSIiIll DATE BOOK P SCG ZONE- STIR DIV. LOTNO. I.00:1'IION E6,9 r., PURPOSE OFIIII11.DING "7 / �-�1 OW-NLR'SNAM E MA= &LDEXS OA/) NO.OF STORIES RSILK, ON'NI. 's-'k"ESS �J+l7 M F— BAS EAI ENT 0R SI 11 i A I t CI I HTC'1'S N A N IE - ( %� c A- SI'LE OF Fl.n(,)R'fINI ItEits J' I 2Nn 3RD RIIILnR L 'SNANIE DAV //! C 0"]; L I - SPAN f... . _.- �a IL %• i _ DISTANCE IO NEAREST BUILDING DINIENSIONSOFSII_l.S/ DIS FANCE FROM STREET. DIMENSIONS OF POSTS DISTANCE FROM LOTLINES-SIDES REAR DIMENSIONS nFGill DERS - AREA OP i.0"1" FRONTAGE IIEIGIITOF FOUNDATION THICKNESS IS IIt11LDING NEW SIZE OF FOOTING IS BUILDING ADDITION MATERIALOFC111NINEY IS UIIILI)ING ALTERATION IS BIIR.DING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE - � IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, 1F ANY IS BUILDING CONNECTED TO I.OWN SE%vER IS BUILDING CONNECTED TO NATURAL GAS LINE — - LNSLUCIA�NS 3. PROPERTY INFORMA'T'ION -- - - _ -- LAND COS"[' EST. BI.DG.COST i'.1CF 1 FILL OUTSECFIONS 1-3 EST.111.00.COSTPER SO. FT. EST. III.1)G. COST PER ROOM l'.I.F.C'1'IlIC NIL"FURS MUST BE ON 011'fSIDE OF BUILDING EST. PERNIFF NO. VI-1'ACIII�l)CARACFS MUSTCONFORNI TO STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST Il F.FILED AND APPROVED nV IIIJILDING INSPECTOR IT1111.111NC INSPECTOR DATE FII-Fn 0WNEnS TEL// ' CONTR.TELN 7 Co 2S SICNA"fIIRt: OFO\1'NER OR Al11110R1"LED AGENT �}.�{ eCON1R.l.ICH /y FEE (o • II.I.C./I U 7 �� 7 ill-AIM IT 19 0. V;I NORTH Tow, i ® - L over T _ T 0�A CO HI E dover, Mass., x.19 ORATED P' -`C S SE BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........................................... ..................................... ........................................................................... • Foundation has permission to erect .............. ..... ........... buildings on -40-A/....... ... 't'`� ...- �sr..................... Rough to be occupied as........!'T-it. Chimney provided that the person accepting this permit sha 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 T ELECTRICAL INSPECTOR Rough v ..................... Service BUILDING 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. Burner Street No. SEE REVERSE SIDE Smoke Det. Location- No. ocation No. �� Date ,.ORTIy TOWN OF NORTH ANDOVER ?,• • os 9 ` " Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�cHust 9 Foundation Permit Fee $ Other Permit Fee $ . TOTAL $ a-J Check # 16677 Building Inspector G' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 0 , M BUILDING PERMIT NUMBER. , DATE ISSUED: 3c - a '3 X SIGNATURE: (L Building Commissioner/I for of-Buildin Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: i�M—D l / 1e �do��,C 0/6' t ( ` Iviap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (n Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required +— Provided Required +— Provided 1.7 Water Supply M.GL.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 M 2.1 Owner of Record / \ lJ - �J Na6e rint) Address for Service Signature Tel hone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number on Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name m Registration Number r Address r Z Expiration Date ^ Signature Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction [I Existing Building ❑ Repair(s) ❑ [Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 42 X d SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OI*'I!ICTAL USE:(NL Completed by pen-nit applicant 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbinE Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on f n n Hers r e to work authorized by this building pernut application. i a re Ow er Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Herebv 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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1ST2ND 3 SPAN DIN ENSIONS OF SILLS DM ENSIONS 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 . FORM U - LOT RELEASE FORM 3 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 an a pplica ble or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT Q �9 �..�/i'� �LHON 7(T LOCATION: Assessor's Map Number__/_! _4D PARCEL / SUBDIVISION LOT(S) STREET_ Po r �ST. NUMBER_J_�a L� ************************************OFFICIAL USE ONLY****************** ********* *** �RE MMENDATIONS . TOWN AGENTS: CONSERVATION ADMINI RATOR DATE APPROVED DATE REJECTED COMMENTS �ti oxe,Q., C eVk IQ_- TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR—HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED /O DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm NORTH ,` To­ wn of over � �. 0 10 No. 0 7z;_; 0 0 dower, Mas 0 L A S*f COCHIC IC ORATED H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR o THIS CERTIFIES THAT... ......... .....r............................................................................... Foundation has permission to erect...... .......... buildings an ....... ...... ..S........j .................... Rough ... ............... .... to be occupied as..... .......3 A.,&d I"V Re Q P, %4 e /-D 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 STARTS ELECTRICAL INSPECTOR Rough . ........W "",W ......................... ........ ...... 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.