HomeMy WebLinkAboutMiscellaneous - 65 PRESCOTT STREET 4/30/2018 (2) 65 1 PRESCOTT STREET }
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CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 1q, Date 8-23-0 /
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS,-- d01'I IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO
ADDRESS / S4 /e A(i1(Jwe 0/,y/
{ Building Inspector
Al
•�ORT1y
Town of over
0
� L A A dover Mass.
-
COCHICHEWICK V Y
ADRATED P'P��-`�
S H �
BOARD OF HEALTH
Food/Kitchen
rERMIT T Septic System S '
BUILDING
....... IN�
S'
ECTOR
THIS CERTIFIES THAT..........DO-Trij.1043.......A-4-ortv ' " ' undation.: f�
Fo
has permission to erect ................. .,1f10... ...... *5Rough 1 J.....
to be occupied as ..® � ,�., .,.,, r W� /� Chine
p ..... 1........ ...... . a qp... .p.1.......,�...... ............................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 Inspecti n, Alteration and Construction of
Buildings in the Town of North Andover. M is d� P PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. ou
PERMIT EXPIRES IN 6 MONTHS Final
.UNLESS CONSTRUCTION ST S ELECTRICAL INSPECTOR
C c4 . -uglP". ,
r
Service
BUILDING INSPECTOR
Occupancy Permit Required to Occupy Building
g GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal
No Lathing or Dry Wall To Be Done
Until Inspected and Approved by the Building Inspector. Burner
D PAG ENS/
s A
Street No. 8�
� ((
SEE REVERSE SIDE Smoke Det.
Town of North Andover p10RTff q
O tt�eo ib 4
Building Department o
27 Charles Street o
North Andover, Massachusetts 01845
(978) 688-9545 Fax (978) 688-9542
w- LOL NILNL wKN
7 q°q^reo Pa`y(5
APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
ADDRESS
LOT NUMBESUBDIVISION
DATE.REQUEST FILED 1161131
DATE READY FOR INSPECTION '6'1140(
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN-OFFS 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 DATE /
PLANNING DATE
D.P.W. —WA k METE _ DATE
l
D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
TO THEPECTION REQUEST DATE.
GNATURE/ PW�AUT ATION
Location
No. Date
NORTH TOWN OF NORTH ANDOVER
P.41
9
Certificate of Occupancy $
tsulldinglFrame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ -
TOTAL $
Check #
1
f Building Inspector
t TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO COIF RUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
' as �
BUILDING PERMIT NUMBER: �` DATE ISSUED: �D /
`
SIGNATURE: C
Building Commissioner/In2eector of Buildings Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number ^
1.3. Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply M.G.L.C.40.§34),. 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private C 0 t Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M
2.1 Owner of Record
e
Name(Print) Address for Service
e.
�7J �
Signature Telephone
d
2.2 Owner of Record: \
Name Print Address for Service:
Signature Tele hone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor:
031 t3 V
License Number
Address
Expiration Date
Signature Telephone
ti
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Telephone
SECTION 4-WORKERS COMPENSATION(AG.L. C 152 § 25c(6) v
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. i
Signed affidavit Attached Yes.......0 No.......0
SECTION 5 Description of Proposed Work check au applicable)
New Copstruction_L Existing_Building ❑ Repair(s) ❑ Alterations(s),�_tP Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other-,- ❑ Specify
Brief Description of Proposed Work:
t
Y.
n
E SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to Dollar bei yps
( ONIs t ti x
Completed by permit applicant , �T
1. Building (a) Building Permit Fee
1 Sb 0 Multiplier
2 Electrical (b) Estimated Total Cost of
S-00 Construction
3 Plumbing 0 Building Permit fee(a)x(b)
4 Mechanical HVAC 700
5 Fire Protection 1(i
6 Total 1+2+3+4+5 O , Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
q.
as Owner/Authorized Agent of subject property
r:
Hereby authorize to act on
f My behalf,in all matters relative to work authorized by this building permit application.
f
F
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief
Print Name
Signature of Owner/A ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T MBERS 1 2ND
3
SPAN f
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CH VINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
NORTH
Town ® E D ,
Andover
No. 90 4
.�
�-oc.'LXb over, Mass.,
AERATED
S H E
BOARD OF HEALTH
Food/Kitchen
PERM I�T . T D Septic System
THIS CERTIFIES THAT....... `e IPN BUILDING INSPECTOR
.................................................. . . ..
. .. ......... .... ..
............................. Foundation
...
has permission to erect....^' 5................. buildings on ...lcs... .... �S C o'7y` s'�
Rough
to be occupied as........., dse/h• �!` kec �mm M /^J �%0�,�� �c �� Chimney
provided that the person accepting this permit shall in eve res J
...........................
P P P � 9 P � every pect�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 CONSTRUC'T'ION STARTS ELECTRICAL INSPECTOR
r s Rough
......... ......................................................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required t0 Occupy Building ing 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.
CCC QC\/EZ00c: Olnc: Smoke Det.
PREIA.RF.D BY
PAGE---[---
DATE NO_
x'
FROJE(JACTION NOMS PRO)ECr PUNNING NOTES
1
L
3
a �i�Fw
11 4%.
r —
' ll
13
14
l5
16 _
I � /
.I_7
1
d
r �M1 19
to A
21
It
I
OF
L�
�S
r
to
29
4a
31
32
GOLD FIBRE® 31
....... ...
PREPARED BY
PAGE '
))Ally
PROJECP AMON NOTES PROJECP PLANNING NOTES
35
35
36
37
38
35
40
41
4"2
43
44
45
46
47
0)
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
6S
66
Location ,/,
No. Date 6 fb-0
NORTh TOWN OF NORTH ANDOVER
f 9
' Certificate of Occupancy $
Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # ( �
2 �6"
Building Inspector
i
SUMMIT I
P&",5 C04 +
STREET
CQ
PRESCOTT STREET
106.80' N87°4654"E
. I I
'r
u/
0 3
0
Z 17.7' N
EXISTING N
FOUNDATION
66' 16.2'
O
O N
ao
C6
O rn
LOT 2
159850 S.F.
! 46.33' -
S87'46'54"W i
i
."'O/
O oh
50.00'
S8901 0'49"W
I HEREBY CERTIFY THAT THE LOCATION OF THE STRUCTURE SHOWN ON THIS PLAN WAS DETERMINED
BY A FIELD SURVEY AND CONFORMS TO THE SETBACK EQUIREME T OF E NORTH ANDOVER ZONING BY—LAW.
REG. PROF. ,LAND SURVEYOR
FCERTIFICATION PLAN
, PRESCOTT STREET OF
NORTH ANDOVE R, MASS. /1\(aindove
Prepared for consultants cL D
,6 i.
George Hughes & Douglas Ahern inc, ` ESS1 '
\01-04\CERT2.dwg I SCALE: 1oe 20' DATE: 5-10-01
1 East River Place, Methuen, Mass. ��J� SUM�yo
Location 6 � 7"'—s Cy-#
No. :�?cc,(n Date
NORTN TOWN OF NORTH ANDOVER
0 s
+ Certificate of Occupancy $
Caus _ Building/Frame Permit Fee $
Foundation Permit Fee $
o Other Permit Fee $ _
TOTAL $ 5
Check # as r
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
a,,:c•
BUILDING PERMIT NUMBER: / / DATE ISSUED:
SIGNATURE.-
Building Commissioner/Inspector of Buildin2 Date
SECTION 1-SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
�l
C / Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
'aVa e iC,�'v I o 0
Ila— Proposed Use Lot Arg&(sf) Fronta e ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide Required Provided Required Provided
1.7 Water Supply M.G.L.C.40 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑
SECTION 2-PROPERTY OWNERSHIP/AUTH0.
ED AGENT
2.1 Owner of Record
anG tL
Name nt) Address for Service: �f
1
Signature Telephone
I .
2.2 Owner of Record: .
Name Print Address for Service:
M
Si nature
Telephone
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
`emu �j
Licensed C stntction Supervisor: e)31 C:?> O
License Number
Address
Expiration Date
Signature Telephone
�!A" <
3.2 Registered Ho,m pro rent Contractor Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Tele hone
SECTION 4-WORKERS COMPENSATION(1VLG.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 ail applicable)
New Construction ❑ Existing Building ❑ 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 be s I� OFI� # 4IISEON :Y *g�
Completed b � {
1. Building (a) Building Permit Fee
Multiplier
2 Electrical (b) Estimated Total Cost of (Z"
Construction T
3 Plumbing Building Permit fee(a) X tbI Q�
4 Mechanical HVAC 5-
5
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 Ovmer/Authorized Agent of subject property
Hereby authorize to act on
My behalf,in all matters relative to work authorized by this building permit application.
Si-nature of Or-
and
Date
NER/AUTHORIZED AGENT DECLARATION
as Owner/Authorized Agent of subject
the statements and information on the foregoing application are true and accurate,to the best of my knowledge
Si iature of Owner/A ent Date t
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1 2 3 KV
SPAN
DWIENSIONS OF SILLS
DIIVHEIGHT
1NSIONS OF POSTS
NSIONS OF GII DERS
OF FOUNDATION THICKNESS
OF FOOTING X
RLAL OF CHIMNEYDING ON SOLID OR FILLED LAND
LDING CONNECTED TO NATURAL GAS LINE
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.
........................................//.....■.m......a......m..wo..om..a...
APPLICANT /=,[(� tr ' G l�ttl PHONE ` 7 J I �- E;
1 (1��a ��
ASSESSORS MAP NUMBER LOT NUMBER
SUBDIVISION LOT NUMBER
STREET STREET NUMBER (05 — 64,7
1116111111111111011
OFFICIAL USE ONLY
RE C ATIONS OF TOWN AGENTS
as M. MM.Emmmmmmm, �� 070 a
DATE APPROVED W M)
CON VATION ADMINISTRATOR
DATE JECTED
COMMEN-is /Up
DATE APPROVED
TOWN R
DATE REJECTED
DATE APPROVED
FOO INS C R-HEALTH` DATE REJECTED
DATE APPROVED
SEP S CTOR-HEALTH
DATE REJECTED
COMMENT
PUBLIC WORDS-SEWER/WATER C9 NECTIONS ( 1
DRIVEWAY PERMIT G(� 5-260
e%�• 'd� '��/��1 'r DATE APPROVED
FIRE MPAR14tZ1,1T
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE
® ECE0WE
MAR 2 9 2001
BUILDING DEPT.
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Please Print
li
Name:
Location: & Pr
Phone 10
am a homeowner performing all work myself.
(� am a sole proprietor and have no one working in any capacity
i
j 1 am an employer providing workers' compensation for my employees working on this job.
Com an name.--
Address
ame.Address
Ci Phone#
Insurance Co. POII .#
Comppny name:
Address
city. Phone*.-
Insurance Co. Policv#
Failure to secure coverage as required under Section 25N or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00
and/or one years'imprisbnment'as well as civil penalties in the form of a STOP WORK ORDER and a fine of($1 oo.00)a day against me= I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herby certify under the pains and p Wallies ofperjury that the information provided above.is true and correct
Signature Date 3, Cl
Print name Phone
Official use only do not write in this area to be completed by city or town official-
0 Building Dept
DCheck if immediate response is required Building Dept 0 Licensing Board
0 Selectman's Office
Contact person:_ Phone#. I] Health Department
Other
RM WORKMAN'S COMPENSATION
1
Town of North Andover tAOR ,
Building Department 0 w
27 Charles Street
North Andover, Massachusetts 01845 , ®yy
(978) 688-9545 Fax (978) 688-9542 �s R;r¢a IV"I.
�AC U��
DEBRIS DISPOSAL FORM
I `
In accordance with the provisions of MGL c 40 s 54, and a condition of
Building permit # the debris resultingfrom the e work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in/at:
Facility location
Signator of 1plicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
� i
� ' ✓!ie �ioritmea`.xu�eiz!-ll a�' •��i:iaculeiea/,�
+ SOARQ OF SUiLIG REGUtAI IONS
Wc#. CONSTRUCtiON SUt?EFtVtS<)R
Nun�tiet- GS 031830'
``� S,irtt►date 0�2�1/1953
fi
Expo 09l2 6/ 001 T�.no: 5457
` �BS�lIct6d'' 1: 00 +!
DOUGLAS J AH8!tN
i
SPiLEM ST
ANDOV'E0, MA 01810 AdmiMsVator
i'
LW
F) RESC,OTT
— — EXIST. 8" SEWER--,,,,, SMH C"TREET
—yv— — —W — —W — — W
EXIST. 8" WATER-
- - - --� •�- - -- - -�-- --- -- -- - -�: — ._ - -�-_ -- - - - - -- - - -- -- .- - __ _
� — — 106.80' N87°4654"E HYD.
I.PIPE(fnd.) I LP
I
LIJ ` a cV a 3I W
> ro � ] I
a a
o
C) Q I a 0 a 3;
Of C`J
c) sJ
17' 'n 17' u�
-i
1:3' 13' -
Py PROPOSED
N/F �,.,� DUPLEX
►�
Kenneth
J. Tokarz �. DWELLING
a n cl
Karen Bailey (D 17 I 66'
C) 00
C)
i� Marion G. Rollins
"r) LOT 2 and
Clifford Lund Rollins
15,850 S.F.
i. •,. 46.33' —. i
'• • `�
I.PIPE(set) S87°46'54"W "—I.PIN(set)
I,PIPE(fnd.)
S.B./D.H.----
moo, C-)
�C)
O h
I.PIPE(set)—
50.00'
S89°10'_49"W —
I.PIPE I.F'IN(set)
(fn(J.)
N/F
Meadow View Condominium
PLOT PLAN
LOT 2, PRE SCOTT STREET of �.�s
�� WILLIAM S.
NORTH ANDOVER, MASS. �anoo er, fir.
. � Macl_EOD
Prepared for consultants 4 " QVIL
• :\o
George Hughes & Douglas Ahern No. 147
mc,
\01-64,\PLOT2.dwg SCALE: 1 ==20 DATE: 3-14-01 1 East River Place, Methuen. Mncc
NORTH
Tomm E Of ' over
0
C., -S-p7 0d�/
� o �oc�,���� dover, Mass.,
5 Rq r E D PP 5
H BOARD OF HEALTH
Food/Kitchen
PERMIT T Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT...............TA(0.1,ho... .... ........Ahorov.... ........................... Foundation
has permission to erect.......�fa�� .�... buildings on ....6............... .1'S O................5............... Rough
to be occupied as......Alugh.0081 ...51!��..�/e......,S.fo .... �� 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 Insp tion, Alteration and Construction of
Buildings in the Town of North Andover. p/, �8� �— PLUMBING INSPECTOR
VIOLATION of the Zoningor Building Regulations Voids this Permit. Rough
9 9
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION ST TS 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.
Location 6 5- C,04 Ste.
No. / `l Date
NORTH TOWN OF NORTH ANDOVER
Of ` e , ,h•0
3? ' OL
Certificate of Occupancy $
�s'i •"' tt�' Building/Frame Permit Fee $
AMUS
Foundation Permit Fee $ / 001 —
Other
dD1Other Permit Fee $ _
TOTAL $
i
Check #
t
,j 4 I .,
/ Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO VONSTRIICT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: / DATE ISSUED:
�0
SIGNATURE:,
Building Commissionevl for of Buildings Date
SECTION 1-SITE INFORMATION
1.1 P op ess: }- 1.2 Assessors Map and Parcel Number:
_ Map Number Parcel Number
o YUP
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning Drstrrd Proposed Use Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide R red Provided R red Provided
1.7 Water Supply M.G.L.C.40.1§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
fouLAS e Ec'
Name ri Address for Service:
Signature Telephone
2.2 Owner o ecord:
Name Print Address for Service:
M
Signature Telephone RO
SECTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
U,1 , ghee
Licensed Co tniction Supervisor:
License Number
Address
Expiration Date
Signa a Telephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name M
Registration Number
Address
Expiration Date
Signature Telephone
cp
SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) t
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building rmit.
Signed affidavit Attached Yes.......❑ No.......❑
SECTION 5 Description of Proposed Work Lcheck all a Ucable
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
AM, -
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be f �(3I+F'IC USEONLY � <
Completed b permit a licant .,
1. Building �VV (a) Building Permit Feet'
V Multiplier
2 Electrical U L//1 (b) Estimated Total Cost of 9
�O
l Construction
3 Plumbing (1v Building Permit fee(a)x (b) `
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Ci U, ,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 Nam
kA—Y\ A 4 L AA—
Signature of r A ent Date
NO. OF ST... S SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1 ST 2ND d 3
SPAN a
DIMENSIONS OF SILLS
DIlvIENSIONS OF POSTS 77
DH\,1ENSIONS OF GIRDERS L g V d
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHDANEY eWipC
IS BUILDING ON SOLID OR FILLED LAND c�
IS BUILDING CONNECTED TO NATURAL GAS LINE
x
Building Value Calculation - for Property at..... LOT#
Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost
Kitchen 28 18 504.00 65 $ 32,760.00
Brkfstnook - 65 $ -
Dining Room - 65 $ -
Family Room - 65 $ -
Study - 65 $ -
Living room - 65 $ -
Garage - 35 $ -
Entry - 65 $ -
Mudroom - 65 $ -
Sunroom - 65 $ -
Sittingroom 28 18 504.00 65 $ 32,760.00
Walkin closet - 65 $ -
Basement Finished - 65 $ -
Deck - 10 $ -
Screened Porch - 35 $ -
laundry - 65 $ -
Bedroom 1 23 18 414.00 65 $ 26,910.00
Bedroom 2 - 65 $ -
Bedroom 3 - 65 $ -
Bedroom 4 - 65 $ -
Bedroom 5 - 65 $ -
Bathroom 1 - 65 $ -
Bathroom 2 - 65 $ -
Bathroom 3 - 65 $ -
Bathroom 4 - 65 $ -
Bathroom 5 - 65 $ -
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FORM - U - LOT RELEASE FORM
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
applicant and or landowner from compliance with any applicable requirements.
APPLICANT � ff r C U l 6 j)UU.S a h.e 0AJ PHONE �� 7 S` We
ASSESSORS MAP NUMBER d LOT NUMBER /
SUBDIVISION f� LOT NUMBER
STREET f R S Cy S STREET NUMBER 65 - 67
OFFICIAL USE ONLY
REC ATIONS OF TOWN AGENTS
DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE JECTED
COIvi1vlENTs !v�l � � � � C�
DATE APPROVED 666
TO �
DATE REJECTED
DATE APPROVED
FOO INS' C R-HEALTH DATE REJECTED
DATE APPROVED
SEP S 9tCTOR-HEALTH
DATE REJECTED
CO
PUBLIC WORKS-SEWER/WATER C�CTIONS -0/
DRIVEWAY PERMTr G(� 5-2(n
DATE APPROVED
FIRE DEPARIWIENT v
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR DATE
pECE0ME
MAR 2 9 2001
BUILDING DEPT.
r
74 }, y
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a ;�•r'�'
RVA i!f
DPW 328
Date....
i � �r►ORt�y,�0
TOWN OF NORTH ANDOVER
* a
* i
RECEIPT
J.WILLIAM;
DIS Telephone(978) 685-095G
o
Fax(978)688-9573
This certifies that.....:......
IN
haspaid.. .....�................ ... D(,.�..��.........
for.... 2(.t,Yet" e1?If/. ... .�...l�S-��...�.�.��`?G��.c�� &f e
c
Received by................. ....we�
.............................
Department..................... .I1 LAC...... �.✓�+���........................
WHITE: Applicant CANARY:Department PINK:Treasurer
DRIVEWAY PERMIT
DATE 2j- Z C� - c) I
LOCATION 5 -G �cSco '� I e l -a
BUILDER phone
OWNER --�Ghone 4-75- l 9&1?
S
THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS
MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM
STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE
FINISH GRADING AND SURFACING FOR APPROVAL OF
SUCH"ENTRY.
FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT.
I
1651
APPLICATION FOR SEWER SERVICE CONNECTION
North Andover, Mass. 4?X7 19�
Application by the undersigned is hereby made to connect with the town sewer main in F/1e�C.Ai Street,
subject to the rules and regulations of the Division of Publics Works. y�
The premises are known as No. �/ — (o 7 / ���� GP) �� Street
or subdivision lot no. i7' - fj
art- tic, &erll
Owner Address
Contractor kddress
//Lxlv�
Applicant's Signature
J07
PERMIT TO CONNECT WITH SEWER MA N
The Division of Public Works hereby grants permission to
to make a connection with the sewer main at �'� Street
subject to the rules and regulations of the Division of Public Works..
Division of Public Works
By
Inspected by
Date
See back for rules and regulations
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APPLICATION FOR ATER 'SERVICE CONNECTIONtco`
A !r $ > 1
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r r '.
tv .k, IVorth`Andover,,Mass�z_
.
u
Y Applicatior:by the'_undersigned is'hereby made to,connect with tfie town uwater man in Street;:
subject to the rules-and regulations of the'Division of:Pu' lic Works
F 1 he premi6esare known as No. e`� Street`r
Or SUbdIV151 IOt no.
x �a;
Owner d f t 4 Address A4.
3 ,
Contractor Address,
y -
, a,r., Applicant's:Signatur
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_
PERMIT=TO CONNECT WITHWATER MAIN. '
The Board of fsublic Works hereby grants permission to �
a.
A
t0 make a COnneCtlQn Wlth`:the water maln'atA
Street )
a s
sub'ect to:the rt�les�and;re ulabons of the.Division>of°Bublic W rk�
• }� +. ° r
a r r - r s i Boa d Q7,P bll or .
}r fhi b 1 -FA+ aS/ � X X Y fit,
Inspected.:by , ��, ,h -> I rr e-. ¢ .*may a •a
- yJi
Date ry
.' (
a
'..See back for rules and re u1'ations r +
M
to
,o
,: . ermt
Town of North Andover & thORTH
o
'_2m
4t �it 6
Building Department 0
27 Charles Street _
North Andover, Massachusetts 01845 4 ,
(978)688-9545 Fax(978) 688-9542 ° AT
�
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s 54, and a condition of.
Building permit# the debris resulting from the work shall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a.
The debris will be disposed of in/at:
�"F A
Facility location IL
Signatur of Akplicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
project through the Office of the Building Inspector.
i
GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT
TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
This form shall be used to assist the Building Department in their determination of exemption under section
8.7.6 of the Town of North Andover Growth Management Bylaw.The applicant shall provide all of the
necessary information as requested below.
Permit Ap licant Property address Map/Parcel
Applicant's Phone Number Single Family Two Family
I the undersigned applicant for the above property attest that the attached building permit for which this form is completed
does comply with the EXEMPTION section 8.7.6 ofthe Growth Management Bylaw.I also understand providing this form does not
absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building
permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only
officially accepted when the building permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building
permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark.
This is an application for building permit for the enlargement,restoration or reconstruction of a dwelling in
existence as of the effective date of this bylaw,provided that no additional residential unit is created.
The lot(s)was/were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the
Zoning Bylaw.
This application is for dwelling units for low and or moderate income families or individuals,where all of
the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is
restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For
purposes of this section"senior"shall mean persons over the age of 55.
This application is part of a development project which voluntarily agreed to a minimum 40%permanent
reduction in density(buildable lots)below'the density permitted under zoning and feasible given the environmental
conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open
space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation
Restriction,Conservation Restriction,dedication to the Town,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 Developer in common ownership with
an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned
Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit
on the parcel.
This application represents a lot which is ready for a building permit(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 accommodate issuing a building permit in that year.One building permit will be issued per year per
Development until such time as the development schedule accommodates issuing building permits.Applicant must
submit an approved FORM U with this EXEMPTION.
PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A
DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS.
BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED
BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE.
FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE
CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR
NOT S ROUND FO FUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING_PERMIT.
APPLIC 'TS SIGNATURE DATE �—
THIS F(VA BE ATTACHED TO THE BUILDING PERMIT APPLICATION
1
I I
MAScheck COMPLIANCE REPORT I i
Massachusetts Energy Code I Pe rmi #
MAScheck Software Version 2.01 Release 2 I iij I
I
i Che ced by/Date-'l
CITY. �►^,/L'� , N�UCF, I I
STATE: Massachusetts
HDD: 6413
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING S STEM TYPE: Other (Non-Electric Resistance)
DATE: 0 J
DATE OF' aENYS.
TITLE: `Two end units
PRbJECT INFORMATION:
Presi,,_Aoi s"1' --tvww horn e,
n/d, Apc cvey /iD'
COMPANY INFORMATION:
14A'�ove v Am, GI810
NOTES:
Unit is 20x28
COMPLIANCE: PASSES
Required UA = 280
Your Home = 272
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
CEILINGS 400 30.0 0.0 14
WALLS: Wood Frame, 16" O.C. 1844 11.0 0.0 164
GLAZING: Windows or Doors VTV 136 0. 390 53
DOORS 30 0.270 8
DOORS 19 0.350 7
FLOORS: Over Unconditioned Space 560 19.0 0. 0 26
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design described here 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*kor this building, and the cooling load if appropriate,
has been determined usingthe
applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 1255 of the design load as specified in
Sections 780CMR 1310 and J4 . 4 .
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C ✓�"C+7a�nynonu�eal/�i a�✓G�tr [id
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 031830
Birthdate 09/21/1953
O Expires:
09l2112001 Tr.no: 5457
Restricted To: 00
DOUGLAS J AHERN' r
ANDOVER, MA 01810 Administrator
I
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
n
Please Print
Name: N
Location- En C
City UV[� ! M'��U�✓ Phone t�� �t��' 8
am a homeowner performing all work myself.
�d'am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensatiort for my employees working on this job-
cam any
ob_Company name.
Address
City' Phone#
Insurance Co Policy.#
Company name: - _-
Address
Phone#:
Insurance Co Policy#
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00
and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. 1
understand that a copy of this statement may be forwarded to the Office of Investigations of the D[Afor coverage ver cation.
Ido herby certify under the pains andp nakies of perjury that the information providedaboveis true and correct
Signature Date
Print name S RAI Phone# —
Official use only do not write in this area to be completed by city or town official- Building Dept
❑Check if immediate response is required Building Dept p Licensing Board
Q Selectman's Ofce
Contact person:_ Phone#. Health Department
Other
FORM WORKMAN'S COMPENSATION
NORTH
® Andover
Town ;
O4
No. /d(d
A o dover, Mass., `
COCHICKEWICK
ORATED
'9S H BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT..........a.
.v.. ..� .......A-3-orev........................................................ ............ Foundation
f�
f b s �rst
has permission to erect....... .......�.................. b ildin s on. ..I...... ............................. ................. . .................. Rough
too �/� i/�/� Chimney
�'!!+......�..�. �+I. .... .,7. ... .. .... �y........
to be occupied as.....!y....................... 2... ........
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 Inspecti n, Alteration and Construction of
Buildings in the Town of North Andover. M SO) P q Al foe PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERMIT EXPIRES IN 6 MONTHS Final
ELECTRICAL INSPECTOR
.10
UNLESS CONSTRUCTION ST S �
.......... . ............A ............................................................................ ough If cu4mon 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.
ORT#i
Town o . Andover
_-
y ti _ o dover, Mass., —// m0700
T Q - LAKE
COC MIC ME WCK
ADRATED P?a\ �C5
�SSAC HUS��
FOR
EXCAVATION AND FOUNDATION
THISCERTIFIES THAT ....... .V.. ..�� .........Aokeri6o.............................................................................................
has permission to excavate and pour foundation
........ ..........
for the purpose of....:.AT...r90.!9 ...,A..8i4 > /'e o Dim to � ..................
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. �Sa
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.
J ........ .. .0...44
..................................................
BUILDING INSPECTOR
LA
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PRESCOTJS TR E E T
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EXIST. 8" WATER—
106.80' N87°46 54"E HYD.
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P . PROPOSED �oy�7
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Kenneth J. Tokarz
and ss'
Karen Bailey cD 17'--
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Marion G. Rollins
LOT 2 and
Clifford Lund Rollins
15,850 S.F.
LPIPE(set)_// 46.33' �
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Meadow View Condominium
WNW
PLOT PLAN of
LOT 2, PRESCOTT STREET �G`' WILLIAM S. T:
NORTH ANDOVER, MASS. andov►er `= f'
o MacLEOD _a i
cc►n su I tants `` ` �,v�L N'
_. Prepared for � � No. 147
George Hughes & Douglas Ahern inc.
\o1'()4\PLOT2.dwg SCALE: 1 '==20" DATE: 3-14-01 1 East River Place, Methuen, Mass. Y=