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HomeMy WebLinkAboutMiscellaneous - 67 HICKORY HILL ROAD 4/30/2018 (2) / 67 HICKORY HILL ROAD 1/ 2101061.0-0085-0000.0 1� r I it i � I I i t i 9336 Date. . . . . . . . . . . . . NORTH 3?�.,� •�,;.��oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� l n This certifies that � �?�! has permission to perform . tpo!,q? . 4Kf plumbing in the buildings of/. . .P9.f�` ?z at . . . /?!if�,� '. . . .`� : . . . . . . . . ...... rth Andover, Mass. Fee o, 00. .Lic. No..3�S-3v . . .. . ....�jal?. 4i. . . . . . . J n PLUMBING INSPECTOR Check # / !3 r ' 00 MASSACHUSETTS UNIFORM APp1.tCATION FOR A PI`RMIT TO PERFORM PLUMBING 1NORK CITY A/C' `}-� 1� U VI M4 DATE I �_7 1'2 PERMIT It JOBSITEADDRESS 6? ty-r'Cibe-� OWNER'$NAMEJ J�,,,�5 ��.Jr�Z2 0 p OWNERA.DDRESS TEL '1&92 IFAXI TYPE-Ok OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIALM--' PRINT CLEARLY NEW; A RENtjuATIQN:I I REPLACEMENT f �_ PLANS SUBMITTED: YES f NOI 1 FIXTURES 7 FLOOR-' BS&l 1 2 3 4 5 B 7 a 9 . 40' 11 12 73 14 BATHTUB - .CROSS CONNECTION DEVICE ... _ .... DEDICATED SPECIALINASTE$Y$TEM DEDICATED GASIOIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAYWATER SYSTEM -j DEDICATED WATER RECYCLE SYSTEM DISHWASHER : . DRINKING FOUNTAIN 1 . . . ... . ... .. ".. FOOD DISPOSER FLOORIAREADRAIN I _. ... INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL 1 .. 1 ! f ..... SERVICE/MOP SINK TOILET URINAL - WASHING MACHINE CONNECTION -- WATER HEATER ALL TYPES, WATER PIPING ..OTHER J ,... ..... 1. INSURANCE COVERAGE: _ (have a ctirront liability iilsilral[ce holt y.qr its stllistantial iequivale"t vrhich meets the requirements of MGL Ch,942. YES J NO ( I IF YOU CHECKED YES,PLEASE INDICATETHH eEOFCOVERAGEBYCHECKINGTHE APPROPRIATEBOXBELOW LIABILITY INSURANCE POL(CYr I OTHER TYPE OF INDEMNITY I BOND�. OWNER'S INSURANCE WAIVER:I ant aware that the Ucensee.rloes not have iheinsurance coverage required by Cliapte042 of the Massachusetts General Laws,and that my si011ature on tiliS permit applicatioll WWves this requimtitelft. CHECK-ONEUNLY:. OWNER AGENT SIGNATURE OF OWNEk-OR AGENT I hereby certify that all of the details and infonnalion I Dave subnT1lled of•entered regarding jhis appiicaliorl ate true a d accurate to the best of my oerledye and that all plumbing work and installations performed under the permit issued for this application%All be in compull a srilh all ddinenl provi ' oftW � Massachusetts State Plumbing Cale afnd Chapter 142 of Hie General Latins. PLUMBER'S NAME Jos�Pn f 1 LICENSE fI 131530 SIGNATURE MP( I JP I< CORPORATION! .Ill; JPARTNERSHIPI' f) ,LLC D_G COMPANY NAME{J ro P vk.,%, r Y ADDRESS 2 �-�'4 r 1"11 �- CITY S °`t`� �STATE I IVO ZIP 1, 036 `t / TELT . q� �S 7 /;L5_S_ FAX CELL 9?6'X35�j AIL / I i _lR�I9l�I�k�PL-MMING l[11�TTSP7C'CTIGN'N.oTrlI5 MLAL tmspr,,cTtoN 1VoT5 Yet No THIS APPLICATION'-SERVt-S AS THr=PEREnT FEE::$ E�:nIIO�' i i r I I i t �� �'1ri��Atitfiior�tvefi(11rb,�IY1`ffs�(r�ft�ts�lls -� p��('rx`fuxeii�o�`rt(ctrrsrct�rl.•�t<ctr�irfs - � �4.b�Ytslifi�gfoiriSi�r��f 1Qsfotr;z&02ul i'1Pfp.Nrctsrvoi llfrt TSS,tail'cct�s��omYit;�isittinitT,ttt�ttirtttic��4f�id'�tp�f��iiifdors(�G`on€t�iti;�o�'s�l!;iet#i•ici�t�#s �t�tif el+ � �ytttI'iertjt€�tE`ot°t7ttiRitijf •: - .. � �� �` '�' .. .. :-�-`;• -.••�'7etis�'.['i•iitf:Z.e�iliiii I�tuti� i3c(lule.roiaaiit[�nt/%tificidualy: � V;,M� �. tidte;iirtitti�[r;��et?CltccirEhattliitioptFntebdx: i '��tribbf�trojcef�rt�,trl'eij; i.Q litnt `»olbJcrnttTt .. . .. t#.Et.[atllRgQiiClnlCaillrciato►Ali.{ i •ltoees(fd(nn(to rptitiinic):= ittieettirc<117lesnUcotitrnelors �' Kei4C�iistiiiction EJ Xttlttttsore-propeloororpagiw-K-- listetlotiiiien[(ttsltectslgtl.t `J� bnetuottetittg s1tiJ.�nntllt{n�cno cniltioyccs �:lats¢snb•i:oii4rne(dts liat'a �r .�I7etitolFlioit aotting.fotittctttnngCnpttcit}t tvofier�'cotnp:Easitrnttee, f]' liiittiingtitltliEion �I\a.teoikct,�colitp•.jnstn uce :[�1 e;Arencoittota;Tooand its: >lgitittT,j oftiCersLadgr�ercise<itT{cir I'0; 'IsJecirical.tzpnit -btnttdi[iotis 3.�I;itntrifionieotetiertioit iitl t o X ri tiiofceeau do ' • � �•' .�. +- `• � Y t rtt3'self[a`Ta•tti6riscr�'coat1?, '.C�,�ES2�..�sl..d),po.-6n��oehrMat"cCtLt�a •(t.2l.',,�E.•[n1Toi to mfUretup&a.tta t•ndtlilion� iristtrnttccregair'ecl�t ctil,��Tojeas.�QttorTeis`' cptttp,fnsurt�nccrznulretij 1 ,[ OtTter ��ns•i�;iltitc;,�tth�t<trtasGaxCt r;rtaletiort(or+i11,•ace(i<<zLelpusltoui:z�ttr;irUr�i;.ra toriz}�+�atiour�lig�tufait►z�tiat •' o Ci�az,auttc(s1t'it�lul,"illtdseftiithittudiclir li:cpttettain�nHtr�itardtiz;tttt&ednisUitfattir.�'l�ist;fslstT�.ti I ytnt.tte,.(tIx i1F;Widttgirt I If. 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PleaseAllou'.111-ii pt�:erg':calll}�:ils�tiou� fiii iitUoni Letott'Y5'eb7fe Vtt:'tloi,otes(llata I>� g btirsiiltofiptt�tit�,if .- alt ct s"s�r�;sap}i1�s sit b eontiacor{s)itatu( s),ttdcUesstes)'nlictpltottenwttttt(s}along�t-ith i[teir cect'iGEale(s)p£ in drettec=.Liu,ited ialiilit}°COtltpatlle5ijllliCtTl,lc�til�lt']?RltIlBfSltlps 341111 no}eill�Ioyegsofller'tliatielm lifen,hers of partners;aroilotreouiretTto eatiyF�4orkers'colpjensation insu�ariae.IfanLI;C or LLP do vs liavo ntploycess;tpolicyisrer�nired..B .�tdrisedthalfhis FfF(laeif>ita 6osiiUmittetitgtheDell, ttienEol Yndns[ri�i coidenfsforcottfo,ttafsQliofi�lstuaaco>;overage. i'i�sbbastwe.{eSig'landilntetllt itCfitl1l+If 'ghe[iFt((TattifS3lQt[1_ti lterefurnettfiothecityortown that tlteappligafionfor iheltetntitorlicenseisUeingregttesfcd,uoE fitelleparfntenfof ' Indtisirialfleciceii[s. Sllotflciyotlltttt ;a3tyfinestionsxsganiulgthefats orifybttare rcgm sdto:ob..[aitta1vorkcrs' t �uitipei►i,�ttionpolicy;pleaseca�l'tliEA..eiiafiinea ritt[ienutitbt:r�isfed beIotu.:��If-itisttts;<1,cotltllatfies�itoulclenfertitcir eIF??isuEatlee lice nsenumberOlU11etippropriatcline. Ctfv or ToTii1�ffiClaTS PletiseU �11I(it}i[t[tne i£iitat7itisGoli lef€attttliritltecfiiegibly: `tTitobepalftilentltasproYiae(ta.s}iticpntflt�GDliOlit o>`tlir, fticTat+it£oto+otlt6fillQtt�trtheevatfthe�Itic�t3finrestigatianslt�sfo'cotifac€ynur�ga�clutlbt applicant. Men se=tle surd to fill its tho pe-ntlifltice ustrrilnnUer VVI&]i dil l.ba.used-an:referencoaiiultTi et..In aiT(lition,an app)ieq,uf f7tafrnus€s1tT�titittttitltiplepsmlItIlicetisettppl[Cal iots tYany*gitiehyoa4lieed'allytsu)?niitoneP.fhdavitiudicalingcutranf ioTicy�lnfolntafion�ifneeesSdry)aft(T7Ltc�er"Toli iteAcTcTress"tlleapplicalit'shotildwrite"otlIoc;tiions #61111}"A cgpk o€ttle ath'davi€tliaCvas6een offcit ilyr.famped of nlarkect by tlie.cit}f o:t0wil nia3 be-pro>;idcd to ilia ` aliplican€asPro afthaFatralitlnft`tclai+itisbtiLila,for£ilture.pernii'sorlicenses.;l rienrxifEiciavitrt,us fie;filled outetich f vefr.Wierap Ito tlteon9terarcitizertisoGfaiiiut�.rilicensa i 1 F o I EtuutnotrelafetTfoan)Itttsitle�sorcoliiniercialt'alttilko 0-e a flog Iiecusi.ae ernukto burn leat'es ete)saiil person is NO rz(}uira(l to colliltIeteftiis affici;urt, - . itcr,se cTo.noi Itesitale tagi4a,is fi calf_ 3 '�l�c}�<<�ia�t,iellf'sactcts�ss.falep7tonenttttfalltiniTier .. . '—' f - Dqai-iluent Of116§1etiil�aczdeltts r �t'�ce o�Ziz�+�sii a X011'• • 600�ZVasllitigtoi>.Sfi�e�t TA.Ar Gl7?27-4PQU e406-oI � ~7tA��AE � t *9Vt617-�72 �7�9 f � � , Date..` . .. . ..... .I ,�ORTp o� TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION r SSACMUSE .0 r 13 This certifies that � .p4 . . � �. " has permission for gas pinstallation . . . . . . . . . . . . . . .�. f in the //buildingss of . .AIq Z ZU ' at . . l�.7. . ./. !.'� �P;' .C�. . . . . , North�A dover, Mass. ? Fee—�,:pv . Lic. No.. . . 3U GAS INSPECTOR Check# l 8087 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:NL4'-41 1440�'w , MA. Date:�� 7 ' I z Permit# Building Location: to 7 J L�v Loot- Owners Name: 17r -►vlty4- iq Z Z CP Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential[ New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES - - - - - - - - - le W Z Q C0 W C) = m = F W w tq 1-- O = W W U' _J O Z Z O W HW W O E" FesI-- w W to m0 O> Lua >C W tU Z 0 W to O W Z LL Z W } z to J H P O z ...I 0 u_ H = W H W Lu U O 0 I=i (7 (9 Z Z m > O Z O cn f" z Z F' O a H > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 6 FLOOR 6 FLOOR ' 7 FLOOR 8 FLOOR Installing Company Name: Check One Only Certificate# 1lY1C� � ,n,�� `��..��,� LN �q El Corporation + Address:2 (-R,cLao' 4, L N CitIv- y/Town: State: ,N Business Tel:17/b 7'b 3� 17!!;S Fax: ❑Partnership r--� ❑Firm/Company Name of Licensed Plumber/Gas Fitter: Jos t( Lit •DOA Fliability COVERAGE: t liability insurance policy or its substantial equivalentwhich meets the requirements of MGL.Ch.142 Yes�o❑ ecked Yes,please indicate the type of coverage by checking the appropriate box below. urance policy Other type of indemnity ❑ Bond ❑URANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that m signature on this Y 9 permit application P waives this requirement. Check One Only Signature of Owner or OwnerOwner 1:1 Agent's A ent g ❑ By checking this box❑;I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. B pe f License: By lumber Title El Gas Fitter EJ Master Sig a re of licensed Plumber/Gas Fitter Cityrrownouneyman License Number: 3%�30 -I APPROVED OFFICE USE ONLY El LP Installer - 4 The Commonwealth of Massachusetts Department of Industrial,(ccidents Office of. nvestigations 600 Washington Street Boston, Meq 02111 ovldia Workers' Compensation Insurance Affidavit: $udders/Contracfors/Elecf ' ' A.�.�licanf Information ricians/Plumbers �-� Please Print Le ibl Name(Business/organizafion/Individual): J INI 6 i - -- - - - -• Address: City/State/Zip; (��pp3� Phon FAr _ n employer?Check the appropriate boa:mployer wjI ¢, Type of project(required):'loye's(fulland/or part-time) ❑ haeme eaeral contractor and I the sub-contractors6 ❑New construction asole proprietor or partner_ Listed on the attached sheet t 1• ❑Remodelingsp and have no employees These sub-contractors have working for me in any capacity. workers' comp.insurance. 8' ❑Demolition [No workers'comp,insurance 5. ElWe are a corporation and its 9' El Building addition required.] officers have ex 10. 3, exercised their ❑Electrical repairs❑•I am a homeowner doing all work right of exemption per MGL 11.❑plumbing repairs or additions Myself. [No workers'comp. C. 152 14 j insurance required.]t employees.g )'and we have no 12-El Roof repairs [No workers 3 comp.insurance required.] 13•❑Other T H appL;cani that ch_ks boxEl must also fill out the section blow EhMing their T Homeowners who submit this affidavit indicating they are doing all work and hen irework=s,i eJ swan poky {arm4 Oa ,contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,poIic informafio then hire outside contractors must submit a new affidavit indicating such. ��Aram an employer that is providing workers'compensation insurancefor my employees Below ' y nnformation, is the policy and job site Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: — Attach a copy City/State/Zip: of the workers'compensation policy declaration page(showing the policy number and expiration da Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties date). fine up to$1,500a d and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER andof a Of up to$250.00 a day against the violator. Be advised that a co a fine Investigations of the DIA.for insurance coverage verification. Py of this statement may be forwarded to the Office of Ido hereby certify u er the pains and penaltie perjury that the information ro vide �� provided above is true and correct Sisnature: � Date; Phone#: 7 �^ / S Official use only. Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# Z.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Piumbjna 6.Other c Inspector I Contact Person: Phone#: i i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express 6r implied,oral or written." An employer is defined as"'an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer.,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling-house-of another-who-employs persons to-do-maintenance,-construction or-repair work-on-such dwelling-house-. -.- - — or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,,625C(6)also states that"every state or local licensing•agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub'-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Br-advised that this affidavit maybe submitted.to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date*the affidavit. The affidavit should be returned to the c:s or tovm th^t the app l.ication for the pe�I,mtor 1 cy�se 1E be:n^rprJ'e t.` ' D e t f ' r' a. �.t S P4, 4! �ncP leprrrc of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill in the permit/license number which will be-used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would'Iike to thank you in advance f6r your cooperation and should you have any questions, please do not-hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington,Street Boston,MA 0.2111 Tel. #617-727-4900 e.xt 406 or 1-8.77 MAS.SAFE Revised 5-26-05 Fax#6.17-727-77449 YTTfTITrr+r..n.. ._..._.IS_- .d F Date. . . . N° 4473 Jr o' "aRTM TOWN OF NORTH ANDOVER ,,..o ,•�tio p PERMIT FOR PLUMBING ;,SSACMUS� This certifies that . . . . :. . . . . . . . .f has permission to perform . . !7-. .. . . . . . . . . . . . ell plumbing in the buildings of r + at . . k- �. !. . . North Andover, Mass. Feeti . . . . . .Lic. No..!. k!!r. . . :,��JJ.. . . . . . . . PLUMBING.INSPECTOR Check # l� WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 's MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Owners Location Permit# � Z Amount Type of OccupancyfO'A I I New Renovation Replacement Plans Submitted Yes n d i� FIXTURES U r H w a zD H= Ham 4M FLOOR s�rFLo�att 7ffl moat stxi�>1�oat (Print or type) Check one: Certificate Installing Company Name (/ k-li! G orp: 21:—> Ad I / r FlPartner. �Y Business Teleph a —`=6 i 446 7— 7 El Firm/Co. s Name of.Licensed Plumber. Awwe vo jo Insurance Covemee: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond u 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 Q I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass etts S in C ter 142 e General Laws, ?Z By: Eigna�MoMae—nsedrjum er Type of Plumbing License Title City/Town LiceQse Numoer Master IK� Journeyman APPROVED(OFFICE USE ONLY I ' Location b7 .4, G�»<<. L�l f ✓. No. `��� r Date s . ,.ORTH TOWN OF NORTH ANDOVER A Certificate of Occupancy $ t `f +o Building/Frame Permit Fee $ 4 7v Ac ,,�,� Foundation Permit Fee $ '• 7-% 5� O, r { it Fee $ `- A;UG Sewer Ektion Fee $ 1 MO vmwj onnection Fee $ b@P tcya L $ Building Inspector Div. Public Works Location 'r�a�� lr.r No. ^ '58/ Date rt NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ 41 Building/Frame Permit Fee $ s',.,°''•t� Foundation Permit Fee $ is Foundation Other Permit Fee $ Q Sewer Connection Fee $ -� teeepjeMion Fee $ TOTAL JUL 91991 I Building Inspector eoi� ��( j� Div. Public Works PEA\t;i►►Np.ys_ d I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE i "F' LOT NO. 2 RECORD OF OWNERSHIP IDATE /// j BOOK PAGE ZONE .1P_� SUB DIV. LOT NO. A„� p��A��r �� LOCATION ;� Gs PURPOSE OF BUILDING ' A fit,171l l� flPrT' ;t _ RCS ID&*LTi o/l,f f lJI.0 OWNER'S NAME �Q�, � �- NO. OF STORIES SIZE _ x. OWNER'S ADDRESS 19 G71(o s ; C BASEMENT OR SLAB ASr �N•�, ARCHITECT'S NAME 4 / , '�a SIZE OF FLOOR TIMBERS IST{;a)C 10 2ND �XI'� 3RD BUILDER'S NAME ma s. �i1 7 SPAN (� {J T DISTANCE TO NEAREST BUILDING �•1/�� {f DIMENSIONS OF SILLS DISTANCE FROM STREET 40t (ao 10 Llv�L POSTS 1/ 5-to /Cox^peer, �A,i p/ac DISTANCE FROM LOT LINES-SIDES nm- REAR t 130 "� GIRDERS �LJ) �Yl (0 RQ/ +'�C O AREA OF LOT P- O j' I SyC?� FRONTAGE / iL ' HEIGHT OF FOUNDATION �+/ O {' THICKNESS I^N' IS BUILDING NEW YC S 1 {d SIZE OF FOOTING "-K O /' X Cd IS BUILDING ADDITION MATERIAL OF CHIMNEY BR%r- IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Soi. D WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yle s IS BUILDING CONNECTED TO TOWN WATER YD'S BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE gs INSTRUCTIONS 3 PROPERTY INFORMATION PERMIT FOR FOUNDATION ONLY LAND COST (0.5” 01 SEE BOTH SIDES EST. BLDG. COST -it 3 , DAO REGULATED BY PARA: 114. 8-S. B.C. EST. BLDG. COST PER SQ. FT. � PAGE 1 FILL OUT SECTIONS 1 - 3 • 91 FEE PAID. .� EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 DATE: ;(/ /o SEPTIC PERMIT NO. p1 Jwe1� ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SEPTIC APPROVED BY X11 l ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDI INSPECTOR DATE FILED f • BOARD OF HEALTH SIGNATURE OF OWNR AUTHORIZED AGENT OWNER TEL.# 6 F E E __ ✓�7b CONTR.TEL# CONTR.LIC.# PLANNING BOARD PERMIT GRANTED 19 PERMIT FOR FRAMUBUILDING SM MWBOARD OF SELECTMEN IT FEE LESS FDA FEF--A--..L0° DATE: FEE PAID (60fFRAME URAME PERMIT$ 170 • °�-° --�_���� BUILDtNO INs' � BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY PC iORIES THIS O MULTI. FAMILY SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM OFFICES LOT LlNES�,AND EXACT DIMENSIONS �OF BUILDINGS. WITH PORCHES. GA- APARTMENTS 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 D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT 11 AREAlFULL 5 - 114C FIN. B M'TAREA _ 'I 'A °/, FIN. ATTIC AREA _ NO B M'Tv FIRE PLACES L HEAD A ROOM MODERN KITCHEN 4 4 WALLS 11 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE X �_ Wf�G�9SHINGLES EARTH AS?HALT SIDING HARDW D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE STLjC'.O ON MASONRY STUCCO ON FRAME 11 Ix BRICK ON MASONRY ATTIC STRS. 8 FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR _ ADEQUATE ( NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) OIL GAMBREL MANSARD TOILET RM. (2 FIX.( FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK L SLATE NO PLUMBING _ TAR & GRAVEL I STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. STEAM STEELB#A&.-*COL5 HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC 1st 13rd 11 NO HEATING w . 9 Town of - 6 ®ver VIM DRVEWAY ENTRY PERMIT A E_ IC er, Mass., u t 1 97 l SS BOARD OF HEALTH PE11MI LD THIS CERTIFIES THAT................... &*e •.......... has permission to erect 4��!P.0 buildingson ....A?e R o u BUILDING INSPECTOR .... ..... buildin son ...... y to be occupied as # . ...��f Chimney Final provided that the person accepting this permit sha I in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY •REGULATED BY PARA: 114. 8 S. B.C. Final � VIOLATION of the Zoning or Building Regulations Voids this Permit. ' FEE PAID:'-6 PERMIT EXPIRES IN 6 MON �' � ELECTRICAL INSPECTOR Rough UNLESS CONSTRU ST TS Service FERMIT FOR FRAME/BUILDING Final .A ....... ..... ... . ...... .......... .... DATE: AILY-4 FEE PAID: va BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathingto Be Done Until Ins ected and Approved b STREET NO.P PP Y Smoke Det. Building Inspector Lo -t- 2 .c2 ,o�► �. ENVIRONEERSN IGKoRY r1�1 1.R ;Q-N.Awao��ri. �p•. ALFRED A. SHAB00,:P.E. � P.O. Box 516,160 Pleasant Street, North Andover, MA 01845 • (508)683-3893 �RC9p0S ED %S) T E EVM LO'PM FNT H IC Ko'RY J I L-L, ROA.I> _ .. .. - - - - - - - - - - - -- - - - - J®t �,TQa-ry " H .0 o- i..1 1 t,.. t .. lTKIV TEA. DAD 1 ! ,Y _ S 3ct-Od5'- I I F- },` O a s— � f".�; W 1"t O • i; w ►�, c °�\�'y�• __`` �� 21p^, X72 X t. I ' !e!o ACC E3S • � -r-r•-=— X142 C�T4lO �L %t M egg �� /f�a^O•h ' `� ,� '' `''-15(0 • 0 Si (Q 162 • o P`�Qf �gsS4 11445 r 1'44 9 a.. �G1�1 f j FORPf U TOWN OF NORTH ANDOVER LOT RELEASE FOR14 t. SUBDIVISION I���,Ixp ill Es Wes i' ASSESSORS MAP 4 r. SUBDIVISION LOT(S) ©� PERMANENT ADDRESS ASS NED BY D.P.W. �. STREET APPLICANT mSD- 7aL2' tAJ x�o PHONE '�,�—� 6-7 i DATE OF APPLICATION —7111ql TOWN USE BELOW TH1S LINE PLANNIN BOARD �. OnrE APPROVED77- 1 TOWN LANNER DATE REJECTED CONSERVATION C0MMISSI N DATE APPROVED 7 4/ CONS ERVATIO ADMIN. DA'Z'E RI;JECTEll BOARD OF HEALTH DATE APPROVED 7 EA NI AR DATE REJECTED DEPARTMENT OF PUBLIC WORKS _ 7� q DRIVEWAY PERMIT D SEWER/WATER CONNECTIONS FIRE DEPT. \Y'fi ���}Cc L�`� �t.� ` r--, RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of: any building; permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. a . -ENVIRONEERS HICKORY �lLl. \CAO-N.gKDaV�R.MA• ' ALFRED A. SHA900"P.E. P.O. Box 516,160 Pleasant Street, North Andover, MA 01845 • (508)683-3893 H..1�'T3'TIVz IF-D FoUWDArioN ` 1 L-,AN .... . .:" HIC KORY {l.l.. OMD _.._. w SCALE i o�Y - ae N . HICKowe ' H �. (PMtVATf..) R0Ab �� g 5 3,�t-OE'S'-IInE- -. �oo•oa� 5� tp a Lor 3: 734,' 20. —� Accass /EGRc ss -Exts-r—�m !� F_I.IaA-._ y 1 I^S� GAEL M w4 T f g T ��-- 1112, ID ~•23'8. . 2 O .L -CET T►FY Tl4T TH M - ► - OFF5CT5 Si,1Ow w .40 m r-f CA's O�FsaT's S�,ww Air.__ Folk Tim use C-F S SPEcTOR ON>^.Y. 6� `` 3 � .LIETERM�NIN6 �4.NING. i. N ., o_ � 99 + ��'qtr. • �isc, 1 E TIFI ATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 301 Date NOVEMBER 19, 1991 THIS CERTIFIES THAT THE BUILDING LOCATED ON LOT 2, HICKORY HILL ROAD (#67) MAYBE OCCUPIED AS SINGLE FAMILY DWELLING W/GARAGE UNDEIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. NORTH O tt 5. X6'91.0 OL CERTIFICATE ISSUED TO Thomas D. Zahoruiko *�D ADDRESS 24 Woodland Park Drive 9q 14 A Al A3E) , ' �•9 DAT[D'PP (G1� SSACHUSES -_ aiuddinp Inspector SEWE /VVATE ` 1i� FINAL PLANNING I. Fire ne y V 9. 3• FINAL F 6 O OW11 Of K L ndover NO 301 w nit C E IC►► er, Klass., 19TI Aff ImBOARD OF HEALTH THIS CERTIFIES THAT............................... ......~ .�.......�. 20R has permission to erect ®....0 ..... buildin on ..... ..... Ro a to be occupied as .6 ...r .. .. ... .�. Ctii .. n provided that the person accepting this permit sha 1 in every respect conform to the terms of the application on file in MING 1f/s TOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Ro d /v/i�.l_ Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY (/ REGULATED BY PARA: 114. 8-S. B.C� VIOLATION of the Zoning or Building Regulations Voids this Permit. ' FEE PAID:�� �� PERMIT EXPIRES IN 6 MON ' ' ELECTRICALI SP_ECTOR UNLESS CONSTRU ST GS Sef9c PERMIT FOR FRAME/BUILDING Final 00 DATE: IT- ��� PAID. 470 ..••,•. •••. ... •••.. ,• BUILDING INSPECTOR ..., IFEE PAID jr GAS INSPECTOR Occupancy Permit Required to Occupy Building �sj A i Rough / 1 n tlh�( Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burney No Lathingto Be Done Until Ins ected and Approved b STREET Det P PP Y Spoke Det. Building Inspector v 0 t'-� %-� /e'er. 1�s