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Miscellaneous - 66 WENTWORTH AVENUE 4/30/2018
Location (,Q-, No. '� Date 120 r Zog oR,M TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ '7 b'^•°''<� Building/Frame Permit Fee $ \SS.�....aE Foundation Permit Fee Other Permit Fee TOTAL !Check # O �� (� 14 r) r, r L L 5 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING yy JgY• .} S BUILDING PERMIT NUMBER: 4,�--� DATE ISSUED: D SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Prop/ert/y Address: lL zL2(1) 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide RecjWred Provided Re quired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHW/AUTHORIZED AGENT 2.1 Owner of Record / 1 Name (Print) Address for Service: / /C ature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: �r�4Z-eL/J�� Licensed Construction Supervisor: ' / I 5—//p? / f/� /p? 2� � %� % �/� %e�t t �� ` Address KK�J �gitature Telephone Not Applicable ❑ (0 5� License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date" Signature Telephone 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 ❑ 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 Completed by permit applicant {)FICIAL USE ONLY s 1. Building (a) Building Permit Fee Multiplier 2 Electrical (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 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 W� AW —0-7=3710MIR MIT NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR THVMERS iST2 No3RD 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 jo x�Z oep. 7� c /c Q- /Z - oo FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT ,!� �_ l�0 f� - PHONE ASSESSORS MAP NUMBER Le (a LOT NUMBER P SUBDIVISION LOT NUMBER STREETi,r/O /2�'� STREET NUMBER CO i ............... .......... OFFICIAL USE ONLY........................... RECOMMENDTIONS OF TOWN AGENTS ••••••••••••••••••••••••••••••••••• �.. ............................................................. ........ r DATE APPROVED / �' 06 C ' ERVATION ADMINISTRATOR f _ DATE REJECTED (A -Z -K -A C-4 TOWN PLANNER CONIIv1ENTS ' FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH COMMENT'S PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTNIENT COMMENTS RECEIVED BY BUILDING INSPECTOR DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED It P 0 0 A. E y .in N'139027'3 T W ac�•�nsr+�+�r� _r�«snem++.wm-n�zmssr-. - . .4 ... � . .r .90.0 r. O Z MA.P ASSLS r �a t m i. I"ifs 2 .j I F C)UNDA"1"[011 M-;- 22.4' .t ± ! l i I 1 t y •. d'� r !� ; j ^'�r f3' ✓1�/�"%} Ge� . f ,a t 13' `7 lf:.�.k^ k 1� �. _�L��u �Jk• kf ?: 1 cel V1, �;� " `{'F; �{�Sf: � S ;�rd�' r:C its#;ry V,1it, One LOmng bylaws' of } tn. V r ' } r r ', ix :.•'.� {�.•. r' 1 gi/'l k \ `1�.' � � F`' r] � �.: ! t L . f �' P� i J (31 �. � rJ il'• �l L�.% Z Ly '. x or 1aiG' of �1E� ltl :! �.. 1t � it 4'�:lis� i� '_' '!�# a:�C`i li��/ is c�� th dcJc q, nation of-o-,,ir ,, jlY or nai^ cCiilioi t rl,'y when c0nted.' .�I A 4l. '"�4 ,� t r P r of Ly '`r e tG� e l� i r._lr t R I,..I CORP �a,S 'rig P,crta ;::yll _21 JUNE 19 2000, rLi �.er,1 „_.. ....�.'..�.. _ �r� ;�i� :� PT; zt 1;I G, LA ND r�'N`GLAIND EN sD4EE;ING , 3 ) t. 'yC 11 3, INC Cj 'r'xsi•. .z t I'hAWN, uU 13ErC;%1.WOOD DRIVE #' 7 �+ CHECKED � � �,�___.w�r 1 r;(;;iZl'�? ANDOVER, It:A OI£34:} BY: '� I!. �� u E.:.� l X978) 686 1768 qNU ` 7 0 0 W cz ui om z z 0 U w N co .E O CI) C Q Q CO) O N C Q cc ,c cc d N r�l 0 CD 3 .o O Q Q d CL cmQ � c O O O z CD CO)CL C ui C) U) Lij w w Ir U) �4 O 4_ W � q c v q W a2 v) v z c G a v v U w a°' x r�° w 0z r : ao cn cn ui om z z 0 U w N co .E O CI) C Q Q CO) O N C Q cc ,c cc d N r�l 0 CD 3 .o O Q Q d CL cmQ � c O O O z CD CO)CL C ui C) U) Lij w w Ir U) CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number l k-1 Date ' 0 0 THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS S WV q `K 1h 111 7v e 11 A' 2 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAYAPPLY. fj Rco m -5, gt r/,Rt �-J1i 5/ a d. � 1 Vlud-e-e ,• "° "T ; �, CERTIFICATE ISSUED TO Je • / _. f 4f,2�/Q P' .. ADDRESS �I ,o/rn a oeW © �� x'34 $4us`� Building Inspector 0 O T.\, v co O � U AG W , OZW G � � Qa o UZD ® p4Cf) Ca r. O a \ J "••' p Q w z o p Q LE co p O C u2 c� U w p C C p 046 r� cn cn co O v Y a) L A o � Z A:'m C A � c s i CO CM N A— y v Ca . •nom 00 W ev 0 U) �r 3 VJ ro Cc .8 > to: EQ 0 A A' cc A M:o,a O �• fAA m .o ZCO CIO Cuc 2 r0+ d J : 2 N Be C O Ha CD o" LS i E L O O d 0 1m 3 z N y+ `i► 'O m b cu V z C c N ca O w 0. Q cncn last LAJ cu—AA 1� C o • acz m o� m cu. O ®� C CL C CD C •C Zm m ~ m=w C2 y.m 0l"' N m LU _•+ •N O C � dt •N .m` Z O V V m cm H CL CDO CL CIO �10 co O a) L A o � Z C0 CL A � y A i CO CM A A— y A �A �f 00 W CD 0 U) �r 3 VJ A > 0 A A' cc A M:o,a O �• W w ZCO CIO Cuc 1..) •C J O CD u y tt cc b cu CL ® w 0. Q cncn last LAJ cu—AA No 2515 Date ...<J.....0.. �..... .. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that?�'....................................... .... has permission to perfo m—...�..�.o................................................... /A wiring in the building of.f.........................,............................................... at'`� 44--' or Andover, Mass. ....................................................�..................... ... 0Lic. b. ` ` _ $ .. ..... NCS.' ..�' ...... ,........... NSP -E -TIO ................. `'ELECTRICAL INSPECTOR Check #-171ov WHITE: Applicant CANARY: Building Dept. PINK: Treasurer IL= f 1U1y1MUldWr_4LM UP MA,?o,"CIF GINE113' utnce use only DEPARTAf EW0FPUBL1CS4FETF Permit No. (J� BOARD OFFIREPREVEN'TIONRWUL4TION.S5270V 12.00 Occupancy &Fees Checked U', d APPUCATION FOR PERMU TO PERFORM ELE=CAL WOW ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -9/e/06 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) (0L W C &2 T 1 tJ -FH,--.. to 1) P 'N —ANQbQ(? Q� Owner or Tenant Q L_.f co 2 A. Owner's Address Is this permit in conjunction with a building permit: Yes M No ®/ (Check Appropriate Box) Purpose of Building Awe (. j K p S u3 eu T t O L ijaote Utility Authorization No. Existing Service Amps`/ Volts Overhead 1-1 Underground New Service C Amps � Volts Overhead ��Jnderground Number of Feeders and Ampacity .-) Location and Nature of Proposed Electrical Work 0 4C No. of Meters No. of Meters No. of Lighting Out]ets No. of Hot Tubs No. ofTransforrners Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW ® Connections ® No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER s WaktDsirt Sigrid taxlW,& FIRMNAME O F&Tw>ed Val ofl3ectrral Wc& $ htspccticnDateRegtte;tdd Rattgl, /Qyyi .Lo Final Loatsee ( A k L� � C H e1,=L� �1% �%�1�St�• Li�eNo —� ��O J� t� pp BusirmTdN V 3 -?.57 j 7� tis L A A C Q r O� AiTeIN�8 OWMM'SPgSURANMWAIVMlamawaettxttheL domrd theinsta ne orilss aie gasre#rdb 7 Cbi2dLaws am>hazmysi�ewithspt�t�.app�onwai�esdnstac�rtaa>t. . (Please check one) OwnerED Agent 00 Telephone No. PERMIT FEE t GCi Date ............. n f' N2 : 5 .- ".� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNUSi / This certifies that ...� .� . �....,!//?�� :......... . has permission to perform .... ............ plumbing in the buildings of ......................... at .. �. .. �, .?.�. . �.�t. f.4........ , North Andover, Mass. Fee. Lic. No.. .. ....... l.....: - ...... PLUMBING INSPECT6R' Check # Z WHITE: Applicant CANARY: Building Dept. PINK: Treasurer A MASSACHUSETTS UNIFORM APPLICATION FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Owners Name TO DO PLUMBING Date 8''3-00 Permit # Amount .O _ Type of Occupancy New I!f Renovation Replacement [:] Plans Submitted Yes ❑ No (Print or type) Installing Company Name A4 Business Check one: El Corp. 11 Partner. Lj Firm/Co. Name of Licensed Plumber: Z - Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policyEI Other type of indemnity ❑ Bond Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner [—] Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in la ions performed under Perm' ssued for this application will be in compliance with all pertinent provisions of the Massa use Stat I 'ng Ater 142 of the General Laws. By: SignaRre or Licenseau er Type of Plumbing License Title d City/Town cense TNum5er Master oumeyman APPROVED (OFFICE USE ONLY 111JJJ • (Print or type) Installing Company Name A4 Business Check one: El Corp. 11 Partner. Lj Firm/Co. Name of Licensed Plumber: Z - Insurance Coverage: Indicate the a of insurance coverage by checking the appropriate box: Liability insurance policyEI Other type of indemnity ❑ Bond Certificate Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner [—] Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in la ions performed under Perm' ssued for this application will be in compliance with all pertinent provisions of the Massa use Stat I 'ng Ater 142 of the General Laws. By: SignaRre or Licenseau er Type of Plumbing License Title d City/Town cense TNum5er Master oumeyman APPROVED (OFFICE USE ONLY 111JJJ �, J 5 J Date ... .... :...... .� ..... TOWN OF NORTH ANDOVER -'� -- IA PERMIT FOR GAS INSTALLATION 'a This certifies that .../../.. `..... .............. has permission for gas installation .. : ':. t .... ! ` ................ in the buildings of ....... L.. ............................. . at ... ....: ..�..........::.:.. (...... , North Andover, Mass. Fee. J. Lic. No../ ... ...... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer lj�MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT O DO GAS FITTIN or print) Date —ORTH ANDOVER, MASSACHUSETTS Building Locations (O/ �1ti�.e�l./�� Permit # ,3j Amount S X --r/ Owner's Name R ` New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or Name_ Name of Licensed Plumber or Gas Fitter J f Check one: Certificate Installing Company ❑ Corp. ❑ Partner. -. - ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance icy or it's substantial equivalpnt. Yes ❑ No❑ Ifyou have checked ves, please i icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I I best of my knowledge and that all plumbing work and i compliance with all pertinent provisions of the ;ldassa� By: Tide City/Town APPRO`+ED wFPICt: USE ONLY) (or entered) in above application are true and accurate to the formed under Permit Issue or this application will be in d'Code!!tnd Chaoaer 142 e General Laws. Si re of Licensed Plumber Or Gas Fitter lumber / go ® G fitter icense i umoer iVlaster ❑ Joumeyman r (Print or Name_ Name of Licensed Plumber or Gas Fitter J f Check one: Certificate Installing Company ❑ Corp. ❑ Partner. -. - ❑ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance icy or it's substantial equivalpnt. Yes ❑ No❑ Ifyou have checked ves, please i icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I I best of my knowledge and that all plumbing work and i compliance with all pertinent provisions of the ;ldassa� By: Tide City/Town APPRO`+ED wFPICt: USE ONLY) (or entered) in above application are true and accurate to the formed under Permit Issue or this application will be in d'Code!!tnd Chaoaer 142 e General Laws. Si re of Licensed Plumber Or Gas Fitter lumber / go ® G fitter icense i umoer iVlaster ❑ Joumeyman Location A 6 �/©!2 f / No. f Date TOWN OF NORTH ANDOVER 9 ' Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ sic"USE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / NO 13 4 Building Inspector 4 .TUN 2_ '00 11:_2 P.01 � r ASSESSORS MAP ; #66, PARCEL #4 9.138 SQ. FT. 46 � CD r�jz,-ag 29.2' 24.8' 2.9.6' MUSTING 24' g 36' FOUNDATION 90.06' s35035'30"E f��N�TitN � Ri�f�i � Vim r 22.4' 24.4' 7-vlie- 01PAMM WWW certify thot the offsets ShOWM comply with the Zoning bylaws of the Town of North Andover, MA when built. Offsets shown are for use of the building inspector only and such use is for the determination of zoning conformity or non conformity when cons rutted. FOUNDA'T'ION CERTIFICATION NA E DAT LOT 4 WENTWORTH AVE NORTH ANDOVER, MA 01846 NOTE: PREPARED FOR: Property lines taken from x.LI CORP ` existing plans of record. SCALE: I" = 20' JUNE 19. 2000 This property is located in NEW ENGLAAID ETtGLANIs ENGIN-EERJNG the R-4 zoning district. SERVICES, INC 60 BrECHWOOD DBXV'E NORTH AXMVER, MA 01$45 B_C.0 J.F.F (876) 886-1748 Q Q [Owl 3 F° z a O O um a z Q Ner� L CL 's N N e a d cc tm v O Cf _e 'c 0 N as r 0 g 0 I E, O 3 c c m rn 3 o m 4- u W, ` a u Q' O c 2 O a a E e o a O E U_ a CL a �4- a a ai :2u c .c �� O 0 a C CL 3 U m Po to is �s V: %ii;z; O 7• U U W: G s o. c C •r _o 0��3. .: � I: o a��co ,o -p .o c O a a� � N � o V � U 0) d ��n. = c G O 0 u. y O c0 t Ix O r c W U ay d co L ,0 o L CL 's N N e a d cc tm v O Cf _e 'c 0 N as r 0 g 0 I E, O 3 c c m rn 3 o m 4- u W, ` a u Q' O c 2 O a a E e o a O E U_ a CL a �4- a a ai :2u c .c �� A Location "No. / X Dated MORTol TOWN OF NORTH ANDOVER • . • OL A Certificate of Occupancy $ -2 CHUst Building/Frame Permit Fee $ ��- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14-11) 13764 ��/' Building Insp�or TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: �y s V SIGNATURE: Building Commissioner/12EQ2Etor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property� /Address:: _ j, /% / � / 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zonis District Proposed Use 1.4 Property Dimensions: 137 Lot Mea s 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. 54) 1.5. Flood Zane Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System; Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 wner of Record r L T- Colea Kd Name (Print) Address for Service I `Signature /1 Telephone / �� / '�f v e / ( 6,V 0 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 LicensedConstruction Supervisor: ('R ., Licensed Construction Supervisor: `-� Address /� 1 �< tgnature Telephone Not Applicable ❑ bS 7� License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name""" Registration Number f APR ji Address Expiration Date € /-rJ1 iVG Signature Telephone �T SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) 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) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: v0. CU St AJ CJQ n7,'l l �—, , ►r, 1 `) a p x SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL'USE;UNLY #; ks 1. Building (a) Building Permit Fee Multiplier V 2 Electrical (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 / heck Number SECTION 7a OWNER 01RIZATION T101RECOMPLETEDWFIEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner /Agent Date Mom NO. OF STORIES SIZE BASEMENT OR SLAB] SIZE OF FLOOR TINMERS 1 /0 2 / © 3PDx / o SPAN I DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIN ENSIONS OF GIRDERS 2 HEIGHT OF FOUNDATION THICKNESS @ " SIZE OF FOOTING p " X ' MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND so P o IS BUILDING CONNECTED TO NATURAL GAS LINE e.S° DOFS ,Uv 7`_. FORM U - LOT RELEASE FORM r r INSTRUCTIONS: This form is used to verify that all nec-essary 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. *�""*KK****'*****rt K*�'KAF1✓L1CA.NT FILLS OUT THIS SBC i lC�N APPLICANT�n��, PHONE LOCATION: Assessors Map Num.ber PARCE? SUBDIVISION LOT (S) STREET L�(��n� �-t�o �2 , 4yp— . ST. NUMEER� *** K*'` � K.�K:K O F F I C IA L USE RECOMMENDATIONS OF TOWN AGENTS: 1\� 'e -\N �4n � F - CO SERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TO PLANNER DATE APPROVED DATE REJECTED COMMENTS a FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUELIC WORKS - SEWERATER CONNECTIONS -� tel/ �l 3 ��-� MI DR1VE'NAY PERMIT FIFE DEPARTMENT ' \ �'�U " ( � `w• FECEiVED EY EUILDiNG iNSPECTC R OAT= Revised 5�9' im it Looney & Grossman LLP Attorneys at Law Maria Galvagna Mesinger Voicemail: Ext 520 Email: mmesinger@lgllp.com November 12, 1999. Mr. D. Robert Nicetta Building Commissioner Town of North Andover 27 Charles Street North Andover, Massachusetts 01845 Re: Putnam Road (Deed/Legal 04751 0292) Wentworth Avenue (Deed/Legal 04751 0292) Dear Mr. Nicetta: 101 Arch Street Boston, Massachusetts 02110-1112 Telephone (61.7) 951-2800 Telecopier (617) 951-2819 www.lgllp.com This letter confirms the conversation that you had with my mother, Carmelina F. Galvagna, that the above captioned property is "grandfathered", and will not require variances in order to obtain building permits. We greatly appreciate the time and effort that you took in investigating this matter. cc: Carmelina F. Galvagna L: \mgm\I tr\fredri ckson. doc Very truly yours, Maria Galvagn esinger J -496 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. Application Application by the undersigned is hereby made to connect with the town sewer main in w�'�l/ u��`'� /+ �e Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. �eG�G�'�ti Street or subdivision lot no. 12L E f Owner Contractor z7s z PJ, 641 /fir Address ©lam Z 1 Address Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN ,, The Division of Public Works hereby grants permission to Jam– 2-27 Co/'//J- to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date Street —� ivi�sionhof Public Works By See back for rules and regulations NO 963 �'!vAPPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. l 19 --- Application by the undersigned is hereby made to connect with the town water main inStreet— subject to the rules and regulations of the Division of Public Works. The premises are known as No. lit/PjUL��i_ ° "�� Street or subdivision lot no. l�L7— NA Owner Address bj g Z1 Contractor Address &Applicant's Signature -� p ,oD PERMIT TO CONNECT_ WITH WATER MAIN The Board of Public Works hereby grants permission to to make a connection with the water main at "V ellb ZVDr subject to the rules and regulations of the Division of Public Works. Inspected by Date Street _ Board of Public Works By See back for rules and regulations TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 Telephone (508) 685-0950 Fax (508) 688-9573 DRIVEWAY PERMIT Date: LOCATION: BUILDER: phone: OWNER: ie L �- (���. phone: q76" The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: w. TOWN OF NORTH ANDOVER DIVISION OF PUBLIC WORKS z" 384 O,^SGOOD STREET � �KLii1J51 NORTH ANDOVER.. MASSACHUSETTS 01845 6, 5-0950 KOx (9 - June 1, 1999 FORM U & DRIVEWAY APPLICATIONS PROPOSED DRIVEWAY PLAN - a plan which is required to show the dimensions of the lot, the location of the proposed driveway and the building(s) it services, the type of street pavement, type of existing sidewalk, type of curbing, location of any permanent structures within ten (10) feet of the driveway such as utility poles, hydrants, catch basins, stone bounds, etc. The plan shall be submitted to the Engineering Department for review. If the plan is approved then a driveway permit can be issued.(See Sketch Plan Attached) CREATION OF A CURB CUT - If there is existing curbing where the new driveway is to be located, then it must be removed to create the proper ramp from the gutter. The new'driveway shall not protrude' into the gutter. Im any instance the new curb cut shall not allow surface water to enter the property. (See Sketch B) EXISTING SIDEWALK SURFACES - If there is an existing curbing and / or sidewalk the new driveway shall match the existing material and shall be a minimum of 4 " thick. The contractor shall provide a detail showing the thickness of material, number of layers, reinforcement and sub -base. DIG SAFE NUMBER - The applicant shall and have a valid Dig Safe number CONTRACTOR - The Contractor doing the work shall have all insurance's required and be in good standing with the Town. DRIVEWAY PERMIT - The permit shall be good for thirty (30) days and may not be transferred without prior written approval by the Town of North Andover. IINSPECTIONS - The Contractor MUST notify the Town 24 hours prior to commencing construction. The completed work must be inspected and signed off by the Town, within 48 hours of completion. C:-WORD\DRIVEWAYSIFORM U & DRIVEWAY APPLICATIONS Town of Nord Andover Division of Public Works 384 Osgood Stmt North Andover, MA 01 845 z JDB opo Ski SHEET NO./�2.. OF CALCULATED BY L- y /"� /�f� I(/ DATE �� + J' • CHECKED BY DATE JC 7- 1< ✓ �r �� J* TYPICAL DFWAY DETAL. N.T.S. PREFILE NOTE: 1.) ALL DRIVEWAY APRONS TO BE PAVED WITH Y •BITUMINOUS CONCRETE. 2.) DRIVEWAYS SMALL NOT BE INSTALLED IN LOCATIONS WHERE STONE BOUNDS ARE PROPOSED. Growth Management Bylaw Exemption Statement Town of North Andover Euilding Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of,Ncrth Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (Eelow) Ma and Parcel :a' Map 3�Purpase of Application (check below) Phone Number of Applicant: • _ZSingle 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 E <EMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or ary party to this permit from the requirements of obtaining other permits required prior to the issuance of the wilding Permit. Further I understand that my interpretation of the E<E:MPTION status is subject to review by the Building Department and is only officially, accepted when the Building Permit ig 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 a building permit for the enlargement, restoration, or reconstruction of a dwelling in existents as of the effective date of this by-law, provided that no additional residential unit is created. _ZThe lot(s) werelwas created prior to May 6, 1956 are exempt from the provisions of 'his 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 conaitions of 8.7.6.care met and/or represents Owelling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior' shall mean persons over the age of 55. I This application is a part of a development project which voluntarily agreed to a minimum 4011. permanent reducdon in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/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 aclacent parcel an the effective date of this Section 8.7 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 an the parcel. This application represents a lot which is ready far building permits,(l.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Oevelopment 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 supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination" that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an -above item which does not comply, whether done to my knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit. Signature or Owner or AuthorizedAgent wno signed the Attached Budding Permit Cate This form must be attached to the Building Permit upon application for such permit. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: — Location: �. City fm _ Phone aam a hoeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity 0 1 am an employer providing workers' compensation for my employees working on this job. r`k ng— mm�nnv nnmp• L J , C-,,, o Address Te 4 City &�) � P y i 4 )"� 0 � Y,:� / Phone #: % �� G cv 3� (o ©O Insurance Co. l7 �R/v.c' S-I� -fie S. & -pnc)l POlicv # (A) C'_ /.2 5-- D 1/ —,/-- Company name: Address City Phone #: Insurance Co. Policv # 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. 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 penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' ❑ Building Dept E] Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone #. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION r BMLDING DEPAR TV=2 DEBRIS DISPOSAL FORK! In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: l.oeUc�•vd e4,z,14 Locati n of Facility Signature of Permit Applicant 3%3doe ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector BMLDING DEPAR TV=2 DEBRIS DISPOSAL FORK! In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: l.oeUc�•vd e4,z,14 Locati n of Facility Signature of Permit Applicant 3%3doe ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector U Q O Z � z y Z z O _w o s� um �O o U') Q ° ..: O L_w3 1 °-'0 <u WQ� ai �r .. w r Q °u a f ° o ca L O N c rn Q_w!7 c �- rD 0 Z 0 N y o O.L _ * -p �� `— w =c Ir6 ° _ p c '3 0ai O moi; y o c ° n u c ami in c E a, rn u Q m LL- m ° 1 w+ N tm a R �- x ~ ° O Q 0- 00 j m C aj C O ` O ` W p t/> V O O O � � •y O co � Of r*-D �•- a— ~ H 3 O •_ ++ E H e O E s-• r� r a, V O 0 0 NU- O w as Ul m uj m ca o� aj m s -C o p a in z > ti m 0 O rA cz " a O u u O w° Cl cn O Q - Or 7 w2 C C2 U i� C w a o U W C a°' is C w a 0 W W C C2 (X ro w F ¢ to 7 n ii W Q r.r w� 6 O V) O o cn Rk 0 s 6 P4 4-1 CO O co O O C.3 Z O CL O H � C I v Y O — CO) O c m m y C O CL O O ~ �.+ U) R m w = O O 0 C Lli > y c) i B c O I: Lmo cr CL :_• f: o 2: o o. � 7 O 2 •C �oL CD z �.S A v C 0 mc E m 0 1m 3 z y... 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C s o c.3 G) Z a d C Oy � m m c CD cm �o O E Q co Limo .9 m CO s s LLJ _ o c Cn 2 = = 'o=c W Ir 10 JCD c fI^^:mc E 17: v1 m R W �C O' O a I N CM< w w c cqoC •C C :44 A C Z t O m .Q0 ` cm m N m � cc y C Cf O C CO mor C3 C3 m >Z o oo c a m N m c C = F- m o� 3 � N m o ►- N m W G �rL...�LMD L � ... c •- aC/) 2 N G.Z C = `r m •N E Q -0 u Z O W C1 m "m o g ti n o� W a 2 = *- CL � a �' 2 G� 0 CD O s Z a Oy � C CD cm O CA co .9 m CO LLJ O CL O O ~ _-+ Cn = = W Ir 10 o c j O L W �C O' O a I CL CM< w w cqoC •C Z t O CL V y O C d i tJ ; A. aC/) L.A.J Town of North Andover t&ORTH Building Department 27 Charles Street o North Andover, Massachusetts 01845 * ,� (978) 688-9545 Fax (978) 688-9542 COC MIi M. wKM �4 Q�AgTEO PPa`�(5 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS 6 6 W,eK.'1 wm.;`t"\ 978) 6,�3 -6006 LOT NUMBER SUBDIVISION DATE REQUEST FILED �2 - ® 0 DATE READY FOR INSPECTION V - :2 8 - Oa FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING CONSERVA' PLANNING D.P.W. — WATER METER DATE Lo--7-Loo DATE Z'I 0_* DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR INSPECTION REQUEST DATE. c SIGNATURE / DPW AUTHORIZATION Location (019 JA44�,✓OrA ka— No. Date ;L TOWN OF NORTH ANDOVER Certificate of Occupancy $ ��s'•^ E�� Building/Frame Permit Fee $ SACHUS Foundation Permit Fee $ Other Permit Fee TOTAL Check # 15773 $ 1,9PI z) $ 3 01 aD Building Inspector 09 M Z O O z M 90 O D ic r M r r Z a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: A IN G z DATE ISSUED: SIGNATURE: �� C-� Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number / Uk _ wo 1�� 4v� . 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R red Provided 1.7 Water Supply M.G.L.cm. 54) Public ❑ Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 420wner of Record Name (Print) 6K /^ 1f /J411LJ) /per../�� Address for Service : 1 Signature Telephone 2.2 Owner of Record: Name Print s Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 09 M Z O O z M 90 O D ic r M r r Z a SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 aU 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 Completed by permit applicant OFIFTCIAL';USE OISILY s 1. Building POO9-V (a) Building Permit Fee Multiplier 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 APPLJES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property (ereby authorize to act on My behalf, in all matters relative o work authorized by this building permit application. 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 Si ature of Owner/Agent Date e ME NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS 1 INIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE o , FORM U - LOT RELEASE FORM `�' iv v 1 r e sti�� .� v� y�= C) INSTRUCTIONS: This form is used to verify that all necessary approvals/p re m� f 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 U ,4 a PHONE < %�r 91 / LOCATION: Assessor's Map NumberZ--1-24 PARCEL SUBDIVISION LOT (S) STREET W r-),)4 y w 0 ro A ST. NUMBER ************************************OFFICIAL USE ONLY*********************************** REC MMENDATIONS OF TOWN AGENTS: CONSERVATION ADMIN TOWN PLANNER COMM FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECT DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm R , - 09/28/2000 N::':[ 7814498475 kEEUHAMSURVEYASSOC PAGE 111/01 _ �QPno�•. LOT 103 TO CHADWICK ST. WENTWORTH AVENUE SCALE: I" = 20` MORTGAGE LOAN INSPECTION PROPERTY ADDRESS: 66 WENTWORTH AVENUE, NORTH ANDOVER, MA L'EEC REFERENCES: 5731/321 OATS 200p/OB/,7 Needham Sursoy Assnclotes REFERENCES: 230 800 REGISTRY OF DEEDS: ESS ER NORTH 281 pLAN---NCES: DATED; i906 MARCH_ By! Chestnut Street R. W. StAMANS C,i Needham, ihls Plot, is NOT A BOUNDARY SURVEY and was not rncds from an I Certif Instrument survey, Tho ' �_ 149` 24U wtruclures o■ shown ars opprowimais only Y ihvf 1111s locus does nvi Ito An insrrument aurvey is nscrsaary for o preeise deterrninatlon y lrl TRe flood hazvrd zone the building r' 1 1. S�; .j of 69 8hDWn locetion(s) and encroachments ecroes pro etty (Imes, On map 0003C, dated 1993/06/02 slthsr way, if an ewint. This plan pp r p mutt no! be used } "'• d •% ' fa lo0ofs comtnunM number 25pQgg, praperiy lines. eut(dlny l000tisns, property Ilse dlm■ntiions, font• IatlJtiORer or lol centiqurOtion oat, only be v+rl!Isd by o proclas • Permar,ont s radar--, o,s approve;— Ina:rumsnt aurvey, which may rety upon and rr.oy re Iwai different n'ataly iocofeo on the ground of shown, n;ormet.on Phar, whet is shown ar referenced hereon. This ane they either conformed plan to the horl— s oropsrve for bank, uee only, FOR MoRTCACE PVRPOSES ONLY, sonfal dirnenotonai setroek roquirv.nsnle Ind its Yes for any other fr / purpose, such as, but hot Ihnited to, of the iocal zoning ordinonaes in elfeat speeldl permit, or bu?idlnr� time o+ con:fruchon, r c':'.'" at}onangt'vortancs, plans or f,pppp_ at lh* or they are pnoaratlen of decd dnacrlp$ons Is strictly prohlbiled. p from entorcemenf action un4er '10; �y :ERi1FIED N.C.L. 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