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Home My WebLink AboutMiscellaneous - 66 COVENTRY LANE 4/30/2018 66 COVENTRY LANE f 210/104.1�6'0000.0 r � i Datel.�....... v gORTq TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SACHUS 7" This certifies that ...............................................c.-....................................... has permission to perform ........ ................../..............��-(. ................... wiring in the building of.... Ov r ............ ............. .......... at Z,�.e....... ....... ................. ZNorth Andave Mas9I Fee...i .. ...... Lic.No.............. ......... .... . ........... LUEMMUCAL R Check # 10559 C 111wwnrunahli.a/MaddaciaudaEE3 Official Use Only tt��rr�� c� PermitNa._ 1��9 oUoparEnwre�a��ira.�aruieai 7r' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.]/07] (leave blank-) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC),5-77 CMR 12.00 (PLE,4SEPR1NT NB fi ORT]TPEAIN ORA! T1011� Date: iZ Z j/ _ City or Town of: �> To the Xnspec or of Tflires; „ N By this application the undersigned gives nottc of his or he intention to perform th electrical work described below. Location(Street&Number) Owner or Tenant M, L C0Ci Telephone No. Owner's Address Is this permit in conjunction with a building per it? Yes ❑ No (Check Appro nate Box/� Purpose of Building /eyY1�1 Utility Authorization No. ! 9 Existing Service Amps / V Overhead❑ Undgrdjo No.of Meters New Service Amps / Volts Overhead❑ UndgrdX No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Worla S T 2-00 06 se4tui Ce d Com ledon oftlre follaivin sable may be ivoived hp Ilia bis ecror of 1117res. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers INA No.of Luminaire Outlets No.of Hat Tubs Generators ICVA No.of Luminaires Swimming Pool AboveElIn- Ela.a °mergency Lighting nd. d. Bette Units No.of Recept,•rcle Outlets No.of oil Burners ° ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initinting Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers HentPump Number Tons 1Co.of el[ antained Totals: Defection/Alertin Devices No.of Dishwashers Space/Area Heating 1(W Local❑ Municipal [I Other Connection No.of Dryers Heating Appliances KW Security Systems: ti No.of Devices or E uivnlent No.of Water lav No.of No.at Data Wiring: Heaters Signs Ballasts No.of Devices or E uivnlent No.Hydromassage Bathtubs No.of Motors Total HP Telecommnnientions Wiring: No.of Devices or lj uivnlent OTHER: f d trach additional detail if desired,or as required b3,the Inspector ofA Tres. Estimated Value of E ectric I Worlu (When required by municipal policy.) Work to Start: ll Inspections to be requested in accordance with MEC Rule 10,and upon completion- (3E,,-Unless-waived-by-tbe-owner.-.- ompletion_1r:-Unless-waived-by=the=owner; ofelectricnl-work=rosy= All 0 M r _ 2012 Massachusetts EIectrical Code Amendments 527 CMR 12.00§Rule 8: In accordanee with thepzovisions of M.G.L,x.143,§,3L,the permit application form to provide notice of installation of wiring shall b e uniform throughout the Commonwealth,and applications shall be bled' on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M G.L o.166,§32,an electrical permit shall be issued to the person,fur or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shalLbe limited as to the time of ongoing constrctionactivity,and maybe deemed_by_thelnsp.ector_of_Wires abaudoned_and.invalid ifhe—. or she has determined that the authorized world has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the,permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Se4ons.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job;growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits-and licenses concerning the use or development of real property.With limited exceptions,the Act automatically dxtends,for four years beyond its otherwise applicable expiration date,any permit or approval fhdt was "in effect or existence'during the qualifying period beginning on August 15,2008.and extending through August 15,2012. O(Rmle 8—Permit/Date Closed: —�Z--— '�**Note:Reapply fornew rmi �i�._� ❑Permit Extension Act—Permit/Date Closed; '� Date....7.1 .7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING A u This certifies tha-it........ ...... ................. ........ .�z 1. has permission to perform .. ........ . . . .... ....... .. . P. ...... wiring in the buildin of.., 77;-7,�:, 9 ........ ....................................................... at.. ....................................... North An over Mass. Fee ............. Lic.No.I'P.L2 4P — Check # 88 %12 ` lr0/lWnO►tll/aaGth o�/I/a�aaCizr�ded Official Use Only Permit No. �Ueparlttaent o�..tir¢ �eruece6 Occupancy and Fee Checke BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with.the Massachusetts Electrical CodaC),527 CMR I2.00 (PLEASE PRINT•IN INK OR TYPE ALL INFORMATION) Date: 7/1 %9 City or Town of: North Andover To the Inspector of Wires. By this application the.undersigned gives notice of his or her intention to perform the electrical work described beim,, Location(Street&Number) 66 Coventry Ln Owner or Tenant Michael Hitchcoc Telephone No. Owner's Address 66 Coventry Ln,North Andover, MA 01845-2127 B this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of BuDdeae Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W1 it C Completion of the followirt table may be waived by the Inspector of Wires. r No.of Recessed Luminaires No.of Cefl wSusp.(Paddle)Fans ,e' Ro,ofTotal Transformers KVA No.of Luminaire Outlets No.dfHot Tubs Generators KVA No.ofLuminaires Swimming Pool Above ❑ - ❑ o. of-Emergency amine grind. aMd. Battery Un No.afReceptacle OutletsNo.4o€Oil Burners FH' ALAICMS Na. of Zones No.of Switches No.ofGas Burners o. o Detection and Initiating Devices No.of Ranges No.of Air Cond. TotaTo +J No.of-Alerting Devices p No.of Waste Disposers ft eat amp 'umber lions lKW No.of 96-17-C—ontained Totals: I ' Detection/Alerting Devices No.-of Dishwashers Space/Area Heating KW Lott❑ Municipal Connection D Other No. of Dryers Heating Appliances , Security Svstems:1 No.of Devices or Eaaivalent No. o WaterNn,of Heaters KW n g s Ballasts Data Wiring: No.of Devices or Eouivalent No.Flydromsssage Bathtubs No.of Motors Total HP eiecommunicafiona irisgg: No.of Devices or Eouivalent OTHER: �\� Attach additional detail if desired, or as required ov the Inspector of Wires. W Estimated Value of Electrical Work: ✓W' 00 (When required by.municipal policy.) Work'to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1NSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof ofliability.insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit-issuing office. CI IECK ONE: INSURANCE ❑ 3DND ❑ OTHER ❑ (Specify:) Liberty Mutual I certify, under the pains and penalties of petjury,that the information on this application is true and cotttPlete. FI IZA.1 NAME: KeySpan Home Eneru Services N.E. LL LIC.NO.: 10128A Liccnscc: Richard F.Cayer Signature 69kLIC.N0. (A f applicable,enter "exempt"in the license number line.) Bus.Tel Nn. •t,z 1_�s4_96nn Address: G79000nd Alronue. Burlinaton lMA nl Qn� A7�T 1 ll Q" *Per M.G.L. c. 147,s.57-61,security work rely quiz Department of Public Safety"S"License: 111 LiGc.N,o. O',AIN ER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. O w n e r/Agent Sien:u.ure Telephone No. PERMIT FEE: ,55 00 ,I Ir Date.. . .r�. ..G:°%..... .. ,ORTH ,tip or TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SSACHUSE This certifies that ... . . . . . . . . . .has permission for gas installation . . . . . . . . . [ !' in the buildings of . . . C' . . . . . . . . . . . . . . . . at .��.�. .v ^�-x �!I /North Andover, Mass. ell Fee . . . . . . Lic. No. G. / ``._ . .,� . . . . . . . . . . . GAS IN <<OR Check# V�� d- 6850 | ! 6,p MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING 7/14/09 City/Town:! North Andover 'i Date: Permitki Building LocaticL�� Owners Named Michael Hitchcock _21 Industrial! lnstitutional � Residential, i Alteration: Renovation Replacement: FIXTURES Ui ix Cnowwwo WU) O = E: SUB BSMT. BASEMENT '1 ' FLOOR u FL OR 3"FL OOR 4'm FLOOR 5'� FLOOR FLOOR 8'm FLOOR JAstalling Company Name:1, Keyspan Home Effergy-S rVT'cr3_ Check One Only Certilijite 1 Corporation Address:i 62 Second Avenue Baditigton Partnership 1 Business Tel: 781-359-2690 Fax: F_____78t-_359_2741 An taw W. FlIV11111ir �!Firm'/Companyf INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Ye If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy X .7-7 1:21 Other type of indemnity L r OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement Check One Only Owner i It _j Ager Signature of Owner or Owner's Agent By � � | checking this box__. I hereby certify that all-~the details and.information.have submitted(or entered)regarding mmappncau � true accurate u,the best ofmyKnowlethat all plumbing ---� *ufo,misapvUcatiunvvmuuin compliance witU � with all provisionthe Massachusetts State Plumbing Code and Chapter 14opfthe General Laws. lb' �7�C � _� a /tit�/� N�'�� ,,� � • � � i � w,' .�P� �p �.of •an1 W� , . ax ?o aftnor ; et► ' fcP7tS, S' u'b H+�q ^ + i CdLT.'I lb- , S , '.� _a Sn ✓ 9*1.15/X: Jac 00 hors; kvA TRY WC, - + i Vp j 9se)o "-Ow �- s f"a 1 -'I.7ID SIJ r�s 7N-11 I rlX 1 �XIC .�f 9 no " No. /��-- (✓ Date { , NaRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ JACHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # /11) T `� ` ' v 2 Building Inspe6t f est.-ru w r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI R,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s• ,tea E BUILDING PERMIT NUMBER: V3 e. DATE ISSUED. SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ,,/ �� Map Number Parcel Number 4V Mq f7%� `�S 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronta 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 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Ln 2.1 Owner of Record Name(Print) Address for Service Signature Telep ne 2.2 Owner of Record: Name Print Address for Service: z Ci nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 1 , 4,tjW1C' b ceryl 6!t1Z k--q3 F"'A� Sri Cx-It?tp(�A . Licensed Construction Supervisor: License Number Address Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number M Address r Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(XG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit'will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes.......❑ No.......❑ ' SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. GY Demolition ❑ Other ❑ Specify Brief Description Iof Proposed Work: 32MtAr / RCA- L6 slrf C�C�srJVL !�ccr� ld�I,lti G �D,..�(s ��, �?��.�c_ .m:LI Sz,�✓rc�c C� ZX-3Y, 4 F-vai �Ji 47-- ? r? 711AI _oy c,!i� %, H x J5J ng_ �srz!fL� �`7 ��1G /� S��C/0 � Sr�-� of l�un'- � �� yD � lcl�ff� lv��-�.;r�✓� - 3�H�.,N=� 'J'-h�`. - �: G�u,.�o,�j L-"+� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE<ONLY' Completed by permit applicant 1. Building / (a) Building Permit Fee Sf OV-10 Multiplier 2 Electrical coo (b) Estimated Total Cost of Construction 3 Plumbing -- Building Permit fee(a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner/Authorized Agent of subject property Hereby authorize 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 J/c nC k_ 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 f Si attire of Own /A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 ND 3 RD 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 NORTH Town ® l� over No. T� ~ __ -_ o� dover, Mass., dtri�� , A � t ORATED PPP � '9S H BOARD OF HEALTH Food/Kitchen PERMIT T D . Septic System BUILDING INSPECTOR THIS CERTIFIES THAT hid .q"�. .....�'�`... ..........................�.: •4.,,.R,.... .................. ................................................................. Foundation c � � � 1 �t has permission to erect.::.......'...:....?.�.................. buildings on ................... Rough .............................................. -t to be occupied as �Zt E- �' s��v W l� � i �`+�� e� � y ........................ . ...........Q► .................... .. .'*. .............................................. �......�...... 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 ........................................................��-........... ................ .... Service .. ........ BUILDING INSPECTOR Final Occupancy Permit Required t0 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. FORM U LOT RELEASE S FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT q,Tc ff -1PHONE 97 - (, { LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) 3 STREETLST. NUMBER (off *****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm town of lNorth Andover ¢ woWrh Building Department ° - � 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 1e Coe _K. ".4 �AgTEO /`Payi5 SSAC�IUs�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and.a condition of Building permit"# / 'A7, the debris resulting front the work shall.be disposed of in a properly licensed solid waste disposal facility as defined by MGL C 1, sI50a: The debris will be disposed of in/at: Facility location Signature of Applicant tt� Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Building Department 27 Charles Street Ys � North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978).688-9545 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE ��t,�y r; 2q 7,m I JOB LOCATION C? Co vE;1/1-4v Number Street Address M P/lot "HOMEOWNER A)A-vm � ��, < <--m9"71 - 4,+1 7 / - �j.. � Name Horne Phone Worte Phone PRESENT MAILING ADDRES4--, sv f/ City Town State Zip Code The current exemption for"homeowners"was extended to includeowner-Occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory.to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be'considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, byNaws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL - - I'. ::SSEY.`NORTH REGISTRY OF DEEDS COPY: ATTEST: ? ' REGISTER OF DEED N U0 �'aw / HEREBY CERT/FY THAT THE PROPER7Y L/NES SHOIyN ON THIS PLAN ARE THE LINES OF EX/ST/NC NSF1,77-00--- ON'NERSH/P, AND THE L/NES OF THE STREETS ANO ✓OHN L. & ,2 THAT NO MW L/NES FOR. EX/ST/NC OWNERSH/P OR THAT MRA S/TIONS N7�•59�� 0� / FOR.NEl4' WAYS ARE SHOWN ANO THAT TH/S PLAN CONFORMS TO THE RULES ANO RECULAT/ONS OF THE REC/STERS OF OEEOS OF WASSACHUSETjS N F ,1l4FT% SAy"OLA/( _ ----- _ �o) � /lEL EN P S.1lOLA/f, REG. RROF LANIJ SURIlfYOR /h` '�� `� '� ^ AAV `^ (�Q 'y foe,C'HACZ S.tIOLA/( SUSAN L. BRUCE �ry _ AND / 10NAIWAN S. 7. L O/ Iv ORA/NACE y- t�CHA/N UArrENCE NXF A MEO A & L/NO Y 1 ER/' ,� AA P A NFTER t, OGRE N #33604 , 8 P L=5�,2• 00 - U o -7 C? o 71�4 � N -Y J 5 Date..... 401tTh "'t '. TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING 4L This certifies that ............................................... has permission to perform ...... ......1.,td......................................... wiring in the building of...... /C ........... ......................................... W............. -1�w at..........................1�.............. ................................ ,North Andover, s Fee.7 ..-.().(). Lic.No.t .....?,'.. Z V- �i7l ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer \ TBE MWOIVWLE+' UHU A14J►1AGH(1MI UtticeUseonly DEPARTMFM'OFPUXJCSAFM Permit No. / BOARD 0FMEPREVEW0NRE9JTAT10AN5r(W 12-(x0 � Occupancy&Fees Checked APPUCATTONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR,TYPE ALL INFORMATION) Dat C� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant ;c / J ; G r, Owner's Address V rwe- Is this permit in conjunction with a building pe it: Yes M No LJ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ..ems Amps / Volts OverheadUnderground Q No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs N fTransformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA _ and and No.<<Teceptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas.Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat, Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER - -- -- b X, htstmxeca mgm Laws Ihmea=atLabkhtstttattce CaYVkMOP=b=CmcrBWcrgsWJstftdqimlat YES NO Iha%eaibmkedva1idptod0c 1DftOffi=YES F1 NO U IfjcuhatedtedredYESpimeedia#ethetypeofWVWd ebydakmgt6e box 24SLRANICE 'BOND OIII-)FR � (PleaseSpaafy) Die BWvWdVahrdUecftxalWak$ WaktDSW h tacbrnD*ReWc*d Roth Ebel FIRMNAME U°. �% C, Lioa�ee / G ��.C /�c,.�iLoi�Tty� ' ' LiartseNo Business Tel.Na 7 �� AItTdN;a OWNER'S ItS[1RANCEWANE2;Iamawat dAthelio=domnot Canal Lam and�atmysi�tsernittsp�app5c�onwai�fl�stac�ttat. /, (Please check one) Owner a Agent a f Telephone No. PERMIT FEE Location No. +,-vim " �I L Date NORTN TOWN OF NORTH ANDOVER �? • • O9 • Certificate of Occupancy $ y�s''•t°'E<� Building/Frame Permit Fee $ sACMus Foundation Permit Fee $ f r Other Permit Fee $ TOTAL $ r 1 I r Check # �'�`�� L, G 5 6 11�, Building InspVtor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT !9PPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING g. i": BUILDING PERMIT NUMBER: DATEISSUED. _^� Q®� SIGNATURE: a® Building Commissioner/Ir ofRqildings Date SECTION 1-SITE INFORMATION , , ! f 1.1 Property Address: 1.2 Assessors Map and Parcel Number: L D Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Pr osed Use Lot Area Frontage it 1.6 BUILDING SETBACKS ft - Front Yard Side Yard Rear Yard Required Provide Rapired Provided R red Provided 1.5. Flood Zone Information: 1.8 Sew e 1 S 1.7 Water Supply ht.G.L.C.40. 54) �8 �� ys�: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT 2.1 Owner of Record CA Name(Print) �j Address for Service Signature Telephone Q 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES RO 3.1�Licensed Construction Supervisorr`:�) ` Not Applicable ❑ Licensed C&;;tru6Aon.Supervisor: -l� License Number dress Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 1 ,� Registration Number M Address Expiration Date Si nature Tele hone SECTION 4-WORKERS COMPENSATION(MG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ' 4 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be 4FFlECIAL VSE ONLY Completed by permit applicant 1. Building l,. (a) Building Permit Fee V Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC a 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTO/RAPPLIES FOR BUILDING PERMIT I, `L �.V 1 V�� as Owner/Authorized Agent of subject property Hereby authorize CO to act on M behalf;mall matters relative t work authorized by building permit application. Si ature of er Date SECTION 7b OWNER/AUTHORIZED AGENT D TION 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 Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T vIBERS 1 2ND 3 RD 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 FORM - U - LOT RELEASE FORM . " INS TRUCTIONS' 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. Ia09a0a005aaaaXAra m■r...\..■r■rr..rrr■■rr■rr■....r...r.r.....r.r..rr......r.■G APPLICANTL. �1L PHONEf ASSESSORS MAP NUMBER _l LOT NUMBER X o (fes SUBDIVISION LOT NUMBER rr STREET CbV�� L`A�� STREET NUMBER b� �.■r.rrrrrrrr■rrr■rr■rr■rrrrrrrrrrrrrrr■rrrrr■rrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ OFFICIAL USE ONLY IrrrrrrrWORD mom rrrown r■rrrrrr■'rrr.rHangman rr.........................snow... . RECOMMENDATIONS OF TOWN AGENTS ..!IrrrrOman rrrrrrowns rrrrrrrrrrrrrmemo wages■..a......r....... ............. DATE APPROVED l CO SERVATIONADMIMSTRATOR DATE REJECTED r DATE APPROVED b TOWN P R DATE REJECTED COMMENDS DATE APPROVED FOOD INSPECTOR-'HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT _ DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENDS RECEIVED BY BUILDING INSPECTOR DATE ` NSURANCPID MF- 03/20/0L ONLY AND CONFERS NO RIGKM UPON TKE CERTIqCATE- Kittredge- Znsuzanoo AgXy Inc 276 W-Main St-, P-0- (1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW ow t* C Inc INSURER V. VALIM FOROB INS. CO.- at n6lviewlhos r8:alM) d&' muleA 0. 1.0 COVERAGES the PouaeS OF INSURANCE LMW 5121-OW HAVE SUN L"SLIED To THE jkSURW MMED ASM FOR THE POLICY PM=INDICATM NOTINIMSTANDING ANY pMURpQW.TM OR CONDITION OF ANY a)NTRACT OR OTHER D=MENT WITH RIMPMT TO WHIC14 TAS CERTMATE MAY BE ISSUGO OR NKY PSMAIN,TM INSURANCE AFFOROM BY TMF POWIE3 DEWAISM HI:Rft IS SUBjECI To A"THE TgMS,EXCLUSIONS AND CONDITIONS 01'SUCH POLICIES.AGGREGATE UMITS SHOWN mAy HAVE SEEN RM)U=BY PAID'101011. - t - 'NSRI TYPE OP INSURANCE POLICY HUM fl GENERAL UAMUTY' PUMNAL&ADV INJURY j$1000000 132000000 im MY Comm SriGLE LIMIT 03/01/02 (EA smdwo S1000000 c 3.08192996% 03/01/01 ALL OWNED AUTOS 11 SWCULM AUTOS (per I HIRWAUTOB BODILY INJURY MON.OWN&D AUTOS PROVEM DAMAGE E.LIAMLrFf AUTO ONLY-EA ACOWCT EAACC NY 07 A AUTO MUCTRA 17. RlylvioN s:1.0000 I EMPLOYMWLIAMUTY 2048661276 03/01/01 1 03101/02 E.L.EACH ACCIDENT 1$3.000000 ri 0IMA"—M-lCYLMff IS 3,000000 OTMM mortbborc XL 01632- INSURERS AFFORDINO'COVERAOr' --'--_- SHOULD ANY OF 7M AMM DMAMM POLICIES CANCELLED BEFORE THE EMRAMONACORD 25-3(74n -(§ACORD � *� TOTAL PAGE.01 m* M� Board of Building ulatons lm 1301 One Ashburton Place, Vim-{ Boston, Ma 02108-161 S License: CONSTRUCTION SUPE-USOR UCENSc Birthdate: 0311411934 Number CS 027999 Expires:014002 Restricted Ta 00 RODNEY P ANDREWS 164.7 LOWE`.L RD CONCORD, MA 01742 Tr.no: '792B Keep top for receipt and c tge of address notification. HOME IMPROVEMENT CONTRACTORS REGISTRATION • Board of Building Regulations and Standards One Ashburton Place - Room 1301 = - Boston, Massachusetts 02108 ' HOME IMPROVEMENT CONTRACTOR -i -- -- " `"`'"�•' _ Registration 113772 Expiration 0715/01 ype - PRIVATE CORPORATION HONE IBPROVE34ENT CONTRACT' Registration 11377Z ANDREWS GUNITE CO . , :NC . Type PRIVATE CORPORATI: RODNEY P . ANDREWS Expiration 07/15101 6 REPUBLIC RD N BILLERICA MA 01862 AHDREIIS 6UNITE CO.,..IH_C_ NEY P':ANORGS 6 REPUBLIC RD N anjBiCA MA 0186Z • H NORTH E Town of dover 0 No. o� 't- dover, Mass., 6 � a '%A-r E D .9S H BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....P.)1.444.41........./i ....... lr.. .. ... . . ............................................ Foundation 46 has permission to erect.. .........a y........ buildings on ...................... Li.1/...... Rough to be occupied as......1../V. i�►.�^ .v.N. ......... .v�N� 'e.......Po 0/...!. .....Vii,�.... .A It of 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, Alteratio and Construction of Buildings in the Town of North Andover. ,O y C �G I� �� i PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough fn A i N T a #N 10 ,f PERMIT EXPIRES IN 6 MONTHS Final 01ro m UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 1..1 N g c94d 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 a Street No. Smoke Det. SEE REVERSE SIDE Location Fi� 3 1 No. Date i j0RT" TOWN OF NORTH ANDOVER ,�1ti00 r ca 1 j&L0 Certificate of Occupancy • - Building/Frame Permit Fee $ Foundation Permit Fee $ ----- Other Permit Fee $ F Sewer Connection Fee $ EjUN, �r1l Water ConnectionFeer $ � S` ' tTAL 12 • $ j ak��,�y Building Inspector f TO 601 Div.Public Works 3 Location 1 No. Date NORTIy TOWN OF NORTH ANDOVER I 3? ` 040 - c p Certificate of Occupancy $ + \Building/Frame Permit Fee $ • �'s""" E -5oundation Permit Fee $ j s�caus t Other Permit Fee $ gewer Connection Fee $ i '. o Vater Connection Fee $ TOTAL $ Building Inspector Div. Public Works S PER3.fiT NO. 4/Z� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40. I LOT NO. 12 RECORD OF OWNERSHIP JDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. I LOCATION /�9 /� �ju PURPOSE OF BUILDING �,v�S� �dfr^jg �yc�/y+IreK S� Ca✓ OWNER'S NAME NO. OF STORIES SIZE&p �/�✓/d r'1 N� G•GC vesrtiL _ F .Gc �i►n.�[� OWNER'S ADDRESS ` �Ov�_.L. L��` BASEMENT OR SLAB se-_ ) •S-C;•R• ARCHITECT'S NAME /`/� �f?7 SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME J. SPAN - DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS - DISTANCE FROM LOT LINES -SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATER:AL OF CHIMNEY IS BUILDING ALTERATION Q�71rQ1/1aF.7rA? IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE yep INSTRUCTIONS 3 4PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST ov O PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FIL BOARD OF HEALTH SIGNATURE O OWNER OR AUtHORIZED AGENT FEE o5G sa OWNER TEL.# (a8t-S6Vo PLANNING BOARD PERMIT GRANTED CONTR. TEL.lem G l0 19 g3 CO N TR.LIC.#--04?a 6 vrovw.Oi BOARD OF tELECTMEN Cb A(f�` 'E /o 3133 j. AA. M• CO/U s- r u of i o+ % (-7 M/f AS, 4 b racl< Rel. ,�y.�, BUILDING INSPECTOR Sob -fo67 -A7yo —' t.171— BUILDING RECORD 1 OCCUPANCY 12 INGLE .FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICE LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARiMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. ' CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDw 0 — — PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ FIN. ATTIC AREA N _ _O B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDNWD ASBESTOS SIDING COMMCN 10, _ VERT. SIDING ASPH. TILE VV _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORPOOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ i—LATI SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 3 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G _ UNIT HEATERS 7 NO. OF ROOMS ' GOAD BstA T 3rd 1-11 NOOCHEATING ORT To.NNm of over 0, 70 No. 2 2 3a t dover, Mass., TUDC /Ap 19 TS ep cocwc _1C 4F AO''A T E D P"' �C '9S H BOARD OF HEALTH ' � a Food/Kitchen PERMIT T Septic System • BUILDING INSPECTOR �� THIS CERTIFIES THAboqoloft. .............................................. Foundation Roe ...41,1dings on ..... Rough has permission to �e!ll.......... ..i ��.�.■..�...�. . ........ ........ .. .. . .......•to be occupied as...........0.�....1. ... f I... ...... he.................................. Chimn y eprovided that the person accepting this permit in every respect co rm to the to application on file in Final this office, and to the provisions of the Codes and By-Laws relating to t e 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 Fina' UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough • Service .................. . . .. .......... . ........ . BUILDING SPECTOR 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. CMAMD /kA/ATI=R FINAI DRIVEWAY ENTRY PERMIT gfyryt'A`�y t t 3z .+ na� wruf s•; / ''a'r��wkyfyt t\. '•..'•T'4'Yx• ){ ,�-� '' y ..a *y .s F :� .� 4.��,� s�A�. i. �Pj i- �. :&� t f 1 � �^ ',f;sw� �,�-i t n a,� ! Y�?{ '{i�k�ti�Bi2�x �a�^"eri'F� ""� ��f�^• ', •�'C '{". t vi Yl" I. P" a.'x i ;r. 3•x t ��yK'd{r �fi� H' t� r 't.t� ,,._....... � 1 ,. ,�., :�,+t '°� 3� ti « -' t• ..` �'� y�<4 s,� � �.i. t, *i. 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