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HomeMy WebLinkAboutMiscellaneous - 67 PRESCOTT STREET 4/30/2018 �r PRESCOTT STREET 210/082.0-0007-0000.0 Date.. � �� r. ............... . 40RTH •` °� TOWN OF NORTH ANDOVER o � PERMIT FOR GAS INSTALLATION CHU�t�g This certifies that .........ref..e...F..Q1........... ...........:..................... has permission for ga 'nstallation . !�-� e►�-- Pae ' inthe buildin of......... .. E'.'..................................................................................... at...... .............. : ..................... ......................I ,, North Andover, Mass. Fee,}R�.`...... Lic. No. . �o 'j.. ....fl. ...................................................... GASINSPECTOR Check# r� 09877 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK U'T' CITYo RT N a/a waDc� _._, MA DATE _ yT 1 s PERMIT el JOBSITE ADDRESS b7 - rr. o"w ST OWNER'S NAME as o OWNER ADDRESS TEL�� FAX TYPE OR PRINT OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: E1 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES _..I NO APPLIANCES 7 FLOORS–► BSM 1 2 _3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE j FRYOLATOR FURNACE _ GENERATOR INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN P05L HEATER I ROOM/SPACE HEATER RODF TOP UNIT TEST _ UNIT HEATER UNVENTED ROOM HEATER I WATER HEATER OTHER hieref, "e INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES OfO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND F 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® AGENT ❑I SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true a d urate to es my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn ' th all Pe ent ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JLICENSE# i S6 y 70NATURE MP E3,MGF❑ JP ® JGF❑ LPGI® CORPORATION[ .3(.,( PARTNERSHIP❑# LLC®F� COMPANY NAME: ee_ 8ro �g,S Sei v t eS _ ADDRESS — CITY t�3a�-� ( STATE'�ZIP - TEL FAX CELL �°��a6-IRQ4 EMAIL i .�: k�. / ��/�' �S/ a � � i i i COMMQN,WEq�TH • • • • OF MA,98A HUS • . , x P L°UMB E I�S�� r SFITTE ¢. ISSUES THE JFO'L ' * 15: ,I#CEA}SEO. L;'OWIEAIG; LI�E►�"SE AS A MASTER p p +w L UM`B AVIGp,.W GAR.F xl .v0. 2..1 6dhGI.PW��tT �B72.0'RKi'p,� 4 s. 1'S6 JAtA 0�3oI 4 �x 05/o I/16 f.. ,226442. < n. COMMONW' I �HQP, MASS1kGHl?SETTS° , BOAR©jQFL PLUMBERSstiWGASF ITrTJ:RS`; ' t 'I SSUE_S TIE F0ULOW I NU' STARED AS A P.LI#MBYI'' CICO' P ptAVt SIJ GARF"I ELD ' KEENE`! BRQTIERS� SERVIroCE, ell Z,r I3RQE1(T N sMA 02301 36,1 0122x43 ,.; FEENBRO.41 SMORAN OF LIABILITY INSURANCE DATE(MldlDDIYYYY)F -- ---..... ... 1130/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE F^X 877 816-2156 434 11t,134 A1C No Ext i AIC No: ) South Dennis,MA 02660 ADDRESS: INSURERS AFFORDING COVERAGE MAIC 9 INSURER A:Old Republic General Insurance Corp, 24139 INSURED ENSURER B Feeney Brothers Services LLC INSURERC: 103 Clayton St PO Box 220801 INSURER D: Dorchester,MA 02122 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IS SBR POLICY NUMBER lAhVPOLDDYNYYY MMIDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 CLAIMS-MADE a OCCUR A2CGO7501601 0210112015 0210112016 UAP'LAGE TO RENTED PREMISES Ea occurrence S 300,00 MED EXP(Any one person) S 90,00 PERSONAL BADVINJURY $ 1,000,00 GEN'LAGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ 2,000,00 JECTPRO- .LOC PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY PRO- -„ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLO"NFD SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) S $ UMBRELLA UAB H=UR EACH OCCURRENCE $ EXCESS LIAB CLAMIS-MADE AGGREGATE $ DEO RETENTION$ $ WORKERS COMPENSATION X PER 0TH- ANDEMPLOYERS'LIABILITY YIN STATUTE ER A ANY PROPRIETORMARTNERIEXECUTNE A2CW07501601 02/0112015 02/0112016 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMSEREXCLUDED? FRI NIA (MandatoryinNH) E.L.DISEASE-EA EMPLOYE' S 1,000,00 If ns,describe under DESCRIPTIONOFOPERATIONSbekrN E.L.DISEASEPOLICYLIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If mora space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ,Y ,F, ©4988.2014 ACORD CORPORATION. All rights reserved. r ACORD 26;(2014101) The ACORD name and logo are registered(narks of ACORD t. Date...'..... 14ORTof TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......CZ.:....... ..... ..................................... ... .has permission to perform .... ..... .............................................. wiring in the building of.....C..... at.A,.... . ... ......... ........ . ....... North Andover,,,-Mass. Fee�6 ....... Lic.NoZ� xl/... .... ....... ELECTRICAL�INSPECT Check # 4115 8029 Official Use Only ' Commonwealth of Massachusetts a y 1? NEWEW , Department of Fire Services Permit No. MWOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank f APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3– /p —6? 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 below. Location(Street&Number) G 7 �������-� 1 r Owner or Tenant d� �e ,ki 7- Telephone No.97 P .7-9 OZ, Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No E� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service,D a Amps 49 /,ZZo Volts Overhead Und rd L g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above E] In- ❑ N—o-of Emergency Lighting nd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners L No.of Detection and Initiatina Devices No.of Ranges Total g No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers .Heat Pump Number..,Tgns KW....... No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Dvices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 190 (When required by municipal policy.) Work to Start: .j-/d 0, ' . Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability 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. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: I.eoll 1-4 A v,' f Signature,,-,r LIC.NO.:,124�ya 7 (If applicable, enter"ex�m.ppt"in the license nyrqber line.) Bus.Tel.No.•9 7� -Jam. Address: iCd AAs,;, !i A.4 u-ey � • Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,secul4ty work requires Department of Public Safety"S"License.: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ , � ��'. / � �, ��� 3_.��� � g e� -�J � . � � .: �, r f The Commonwealth of Massachusetts k� ! Department of Industrial Accidents .. • Office of Investigations 600 Washington Street Boston, MA 02111 i www.»wssgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lembly Name(Business/Organization/Individual): ze o N ZeA 1/tl f�f Address: City/State/Zip: /u, l �a.,,�✓ Phone#: . 71--J�/o Are you an employer?Check the appropriate box: Type of project(required): L❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. []New construction moloyees(full and/or part-time).* have hired the sub-contractors 2.E2i am a sole proprietor or partner- listed on the attached sheet._ 7• ❑ Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for mein any capacity, workers' comp. insurance. 9. Q Building addition (No workers'comp. insurance 5. ❑ We are a corporation and its l0.❑Electrical required.] officers have exercised their repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11..7 Plumbing repairs or additions myself.[No-workers'comp. c. 1.52, §1(4),and we have no 121-1 Roof repairs insurance required.]t employees. [No workers' comp, insurance required.] 13.Q.Other *Any applicant that checks bozr}t I must also fill out the section below showing their workers'compensation policy information. ?Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infom�ation. r I am an employer that.is providing workers'compensation insurance for my employees: Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. C I do hereby certify der the pal a penalties of perjury that the information provided above is true and correct Si afore: Date: Phone#: OJ,Twial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 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 or 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,§25C(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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)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. Be advised that this affidavit.may be 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 city or town that the application for the permit or license is being requested,not`the Department 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 numberlisted 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 home owner 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 Investipations would like to thank you in advance for 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 4ffiee of Investigations 600 Washington Street Boston, MA 012111 Tel.# 617-7274900 ext 406 or 1-11.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia Town of North Andover & tAORTH O A.tLHD 16'9e� Building Department 27 Charles Street o 4 North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 T.o° CO<NICHI K cH 1' s S A°q�reo .a u APPLICATION FOR CERTIFICATE OF OCCUPANCY/ INSPECTION ` Y P.S CO 1+ ADDRESS � r1 LOT NUMBER SUBDIVISION DATE REQUEST FILED DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REOUIRED 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 CONSERVATION DATE PLANNING / DATE I cI 0 D.P.W. —WATER METER DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO UE INSPECTION REQUEST DATE. SIGNATMEADPW AUTHORIZATION i Location �✓ �r Z-S o ! ' S No. l Date i NOR, TOWN OF NORTH ANDOVER 3? OL Certificate of Occupancy $ ��ss+C14 Building/Frame Permit Fee $ S o Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Checkj�2c�� 14678 Building Inspector a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r eg.;, r"A..� #� .�;.:: '�sx`'sr ✓'v' :a�`� s. ..r'`.,,.:.����� $�„c�Y, ,,,�l�l' d�lA��� ,7�z,�.i 'F,,�';�3�"��, �� ,,zi,...r�i��a e�,�#.:;, "°s�„-�.' �i� '. BUILDING PERMIT NUMBER: 0 DATE ISSUED: © / c SIGNATURE: Building Commissioner ctor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: Q %A. 1.2 Assessors Map and Parcel Number: Map Number Parcel Number .3 Zoning Information: 1.4 Property Dimensions: V L GanaG c� ��0 / 0 Zonin 'strict Proposed Use J Frontage ft 11.6 BUILDING SETBACKS R Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 71�0j$lr�c 1 Name(P 'nt Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-COI\ TRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ oy- VCM Licensed Const rction Supervisor: 0`t 0 1 I"� 8� �,V 1 License Number Address t6Gy �Gd Expiration Date a� Signature Telephone 3.2 Registered ' me lt&rovement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone P 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 0 Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAIL USEONI. ' r Completed b rmit a hcant � � � s g ...a . ., 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction c�C 3 Plumbin Building Permit fee(a)X(t,) 4 Mechanical HVAC `J (J 5 Fire Protection b Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L 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 Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 4 r. Print Name Si tature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS ISr 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINRVEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT El--t C► / ,' `G PHONE ASSESSORS MAP NUMBER LOT NUMBER 1 SUBDIVISION j� LOT NUMBER STREET f R S Cy STREET NUMBER C'� 677 OFFICIAL USE ONLY R �.MVIENDATIONS OF TOWN AGENTS Wi ... ......... S< DATE APPROVED 07 G CON ,VATION ADMINISTRATOR T-- DATEYEJECTED COMMIE-IM �U t, ` DATE APPROVED TO R DATE REJECTED JJJ CONRV1ENTS -hlm-/'I (i Sz =,e-d DATE APPROVED FOO INS C. R-HEALTH (� DATE REJECTED DATE APPROVED SEP S CTOR-HEALTH DATE REJECTED COMMENT PUBLIC WORKS-SEWER/WATER CO CTIONS ( 3-mac DRIVEWAYPERMIT 5-26o-d L DATE APPROVED `� L FIRE PAR1q&NT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE ® ECE0VE MAR 2 9 2001 BUILDING DEPT. Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: "Pr 7"'S C Phone am a homeowner performing all work myself. �t a a sole proprietor and have no one working in any capacity I I am an employer providing workers' compensation for my employees working on this job- CompanV name: Address City: Phone# Insurance Co. Poli .# Company name. Address Cit Phone,*. Insurance Co. . Poli.cv# Failure to secure coverage as required under Section 25A or MGL 152 can feed to the imposition of criminal penalties of a fine up to$17500,00 and/or one years'imprisonment'as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.1]0)a day against me_ understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and p nalties ofperjury that the information provided above.is true and correct Signature Date U �. Print name Phone# Official use only do not write in this area to be completed by city or town official' El Building Dept OCheck if immediate response is required Building Dept L%censing Board Q Selectman's Office Contact person.' Phone#- Health Department El Other RM WORKMAN'S COMPENSATION Town of North Andover Q� �RTH , R4L�0 'fE 4O. Building Department - 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 -S CHUS���� I DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location Bi Signator, of plicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. • ti 1 I {fl! ✓fte �+Jo�n�nta�tu�ca��i o�� l�.aysacliitdel�6 ' BOARC'1 OF BUILDING Fi�GULA'TIUN5 ` We 6fis�: Cl3 ISTRUQ,,f N SUPERVISOR „ Numtieh CS, 031636 Blt M41W xOW1/1953 { EX}slf �09/2M1/ 00"I U rte: 5457 of Restr 4c 4tnx 00 •1 i DOUGLAS J Mit }31 SALEM ST ANPOVEk MA 01810 Administrator k-: LW 1 ) I \ E CS C O I 1 EXIST. 8" SEWER-, SMH c)TR . E E T _ _ - _ — EXIST. 8" WATER-7- --W--- 106.80' N87°4654"E. '(VI YD. I.P I ID E inn d. --' � �UiLdI V) N r� A j Oo I O Q a o o T- 6. o- cJ 17' in io 1 7' u� �r � ' - PROPOSED o " IN/F ,s"'V DUPLEX , t Kenneth J. Tokarz ;�y��� DWELLING & �. a n cl Karen Bailey cJ - 17�_._ 66' R117y N O °Q O N/F V) Marion G. Rollin: LOT 2 and 15t850 S.F. Clifford Lund Rollins �• -� 46.33' -. i S87°46'54"W '' I.PIPE(set)-Z � �""�I.F'IN(set) I.PIPE(fnd.) S.B./D.H. o (,C) 0) C-) Ov �C) ..° 50.00' S89°10'_49"W — 71 (.PIPE I.PIN(set) (fnd.) N/F Meadow View . Condominium ['LOT P LAN 'A -- LOT Z PRE=SCOTT STREET ��� of �' ��' �� WILLIAM S. NORTH ANDOVER, MASS. CIS ove ' �-'= e., o Mad-EOD Prepared for consultants "; " QVIL o No. 147 George Hughes & Douglas Ahern inn, \0f-C)4\PLOT:?.dwg SCALE: 1 '==20" DATE: 3-14-01 1 East River Place, Methuen. Mncc .row �� _ NORTH �E TO" . of - Andover No. 2.-Ce 0c0c„, dover, Mass., ADRATE D PPS\ �C`-1 BOARD OF HEALTH Food/Kitchen PERMIT T D . Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........4!p .... P..... D..Vl �� ��� Foundation .. �! lP I!rSto 7�....s� has permission to erect.... . ......... ......... buildings on ...... ....... ......... ........................ ...................!............... Rough to be occupied as... .. I .C r.. ........ ..S �//..... ................................. Chimney c provided that the person accepting this permit shall in very 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, A eration and Construction of Buildings in the Town of North Andover. M 8a )0 1) s"& 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 to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location /,, ! r�-S c o-4 S — No. /T Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ E<�' Building/Frame Permit Fee $ swcNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 14 00 2 3 `Building Inspector /1 SUMMIT S TREET Pr'P;"s C-04 's* PRESCOTT STREET 106.80' N87'4654"E — 1 L i U/ NO o f. V o M�� Z 17.7' N V) 714 EXISTING FOUNDATION 66' 16.2' o 0 0 o 0 I � LOT 2 15,850 S.F. ! 46.33' i S87'46'54"W s� / (b CMN ^�A) 50.00' S89°10'49"W I HEREBY CERTIFY THAT THE LOCA11ON OF THE STRUCTURE SHOWN ON THIS PLAN WAS DETERMINED BY A FIELD SURVEY AND CONFORMS TO THE SETBACK EQUIREME T OF E NORTH ANDOVER ZONING BY-LAW. REG. PROF. LAND SURVEYOR FCERTIFICATION PLAN SIN of/yam , PRESCOTT STREET a NORTH ANDOVER, MASS. \andoverC cL D Prepared for 0 , 16 4 George Hughes & Douglas Ahern ES " i 1 East River Place, Methuen, Mass. ������ \01-04\CERT2.dwg SCALE: 1 =20 DATE: 5-10-01 VY` 4 ' CERTIFICATE OF USE & OCCUPANCY Town of NorthAndover Building Permit Number '� Date THIS CERTIFIES THAT THE BUILDING LOCATED ON aS Cts MAY BE OCCUPIED ASIN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. ,�a�o.*�hS f �� 'g,4S1 Sf, if CERTIFICATE ISSUED TO ADDRESS �/ . CM°S� 71A Building Inspector I i FORTH Town of over 0 0 No. o ==== A o dower, Mass., COCHICHEWICK � ADRATED Pp�t��J W G`0 i BOARD OF HEALTH Food/Kitchen ' PERM - IT T D Septic System BUILDING INSPEC'T'OR THIS CERTIFIES THAT . � V '/4 � rN Foundation has permission to erect .................f................. buildings onvb •.. '�so .•S� Rough to be occupied as..... .................m,.............. ..SL4�..+�. �!I!�...�u+�t. l Ao chimney provided that the person accepting this permit shall in every respect co form to the terms of the applicati n on file in Final . this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction ofy � Buildings in the Town of North Andover. "I is 61 P17 $ qV1160 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. J u tr,2� PERMIT EXPIRES I1 6 MONTHS UNLESS CONSTRUCTION STAR ELECTRICAL IN E �� ............ ... e ... . .. .. .. ........ ..... ......... BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough , LU� No Lathing or Dry !Nall To Be Done FIRE DEPARTMENT Until Inspected and Approved by.the Building Inspector. Burner ?,( SME Smoke Street No. SEE REVERSE SMESmoke Det. wr FORM - U LOT RELEASE FORM �V STRUCTIONS: This form is used to verify that allnecessary 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 J e F r C U f (l U4" ,a La I f r'f ate PHONE :5 " 1 t� ASSESSORS MAP NUMBER r1 LOT NUMBER / SUBDIVISION LOT NUMBER STREET P R 1= S C J STREET NUMBER 67 OFFICIAL USE ONLY NDATIONS OF TOWN AGENTS..................... ..TOM . .... ��M<M DATE APPROVED CONSPRVA11ON ADMINISTRATOR DATE CTED CONRVtENTS C DATE APPROVED TO DATE REJECTED i < CONRVIEN S DATE APPROVED FOO INSC. R-HEALTH DATE REJECTED DATE APPROVED SEP S ACTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CC NECTIONS DRIVEWAY PERMIT 3^2(o DATE APPROVED FIRE MPAR144ENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE flDIECE0W MAR 2 9 2001 BUILDING DEV f Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: ' Location: �S C G S Ci e,U�C,'V/ Phone 10i ,arm a homeowner performing all work myself. Q1'am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job- company ob.Com an name. Address City- one# Insurance Co. Policy.# Company name: Address City- Phone.* Insurance Co. __ __ ___ POli.cy# 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($100.00)a day against me_ I understand that a copy of this statement may be forwarded to-the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains andp naRies ofperjury that the information provided above is true and correct Signature Date (J� Print name Lq V' �` Phone Official use only do not write in this area to be completed by city or town official- El Building Dept []Check if immediate response is required Building Dept [] LicensingBoard ED Selectman's Office Contact person._ Phone#. [] Health Department Other El )RM WORKMAN'S COMPENSATION 7Ia �r Town of North Andover �� t%ORTil �gtktr p�� �O Building Department ® c µ 27 Charles Street North Andover,Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 OtArE C2 AcHus DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: Facility location i Signatur, of plicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I i i ✓fre �ia�rr tc�xu�a ✓ # BOARD OF BUILREGULATIt7NS``p, L-IdbhsM CONSTRUCTION SUPERVISOR ! x$ N imbhot Cs 031830' J �{. Birt#tdate u 09/21/1953 Expt1 .'09/211 001 Tr:no: 5457 `,RestrlcteiJ'To: 00 r DOUGLAS J AF thN ! 13i SALEM ST !«•�' f i rANDOVER, MA 01810 Administtatar �I Building Value Calculation - for Pro a at..... LOT# ®R 11M Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen 28 18 504.00 65 $ 32,760.00 Brkfstnook - 65 $ - Dining Room - 65 $ - Family Room - 65 $ - Study - 65 $ - Living room - 65 $ - Garage - 35 $ - Entry - 65 $ - Mudroom - 65 $ - Sunroom - 65 $ - Sittingroom 28 18 504.00 65 $ 32,760.00 Walkin closet 65 $ - Basement Finished - 65 $ - Deck - 10 $ - Screened Porch - 35 $ - laundry - 65 $ - Bedroom 1 23 18 414.00 65 $ 26,910.00 Bedroom 2 - 65 $ - Bedroom 3 - 65 $ - Bedroom 4 - 65 $ - Bedroom 5 - 65 $ - Bathroom 1 - 65 $ _ Bathroom 2 - 65 $ - Bathroom 3 - 65 $ - Bathroom 4 - 65 $ - Bathroom 5 - 65 $ - MOM � �ksr astb %a Location No. V(� Date cIL10-0 t0RTPq TOWN OF NORTH ANDOVER 3? • OL F 9 L CJ . �,� • . Certificate of Occupancy $ -' _ SACI1USEt• Building/Frame Permit Fee $ O s Foundation Permit Fee $ b Other Permit Fee $ 1i TOTAL $ /5 f CIA I / Check # �( � 1 14753 j % Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING w. rn BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE:, Building Comniission/er/IEEeEtor of Buildings Date z SECTION 1-SITE INFORMATION 1.1 P dd elIss: 1.2 Assessors Map and Parcel Number: D Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: h\ T2 (-S -� 1y (4i � Zon'mg District Proposed Use Lot Areas Frontage R 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R rjd Provided R red Provided d-- 1 u O a 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record ` Namen, t Address for Service J Signature Telephone 2.2 Owner o ecord: Name Print Address for Service: Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Lic,e?ed Co traction Supervisor: 0 ,D License Number 1271 U i9 o C6,�- c��e Address Expiration Date Signatj e Telephone l 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name / Registration Number 1090 Address o� Expiration Date Signature Telephone SECTI(3N 4-WORKERS COMPENSATIQlJ(hLQ I;,0.152 § .25c(6),,:, Workers Compensation btsurance affidavit trust be I 1complet6d!"Jsubinitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildingit. Signed affidavit Attached Yes SECTION 5 Description o!Proposed Work check all a" licable New Construction ❑ Existing Building..Q '..'Repair(s) 0 Alterations(s) 0 Addttron i, .0 , Accessory Bldg. 0 Demolition 0 1"Othei 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost(Dollar)to Completed by permit applicant ONE 1. Building n/� r ' v (a) Building Permit Fee 0 -060("0p/ � Multiplier 2 Electrical / ) (b) Estimated Total Cost of (�O 0 Construction 3 Plumbin Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number. SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owzier 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 Namtn 1,4 -)A-AA— )A—AA—Signature of r A ent Date NO. OF STORES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1 2ND I 3 SPAN a DIMENSIONS OF SILLS DIMENSIONS OF POSTS ' DIMENSIONS OF GIRDERS 1- &AI V HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 2NL, C LewA,_C IS BUILDING ON SOLID OR FILLED LAND v IS BUILDING CONNECTED TO NATURAL GAS LINE I MAScheck COMPLIANCE REPORT Massachusetts Energy Code I Permi # MAScheck Software Version 2.01 Release 2 i Che ed b I y/Dat e I CITY: /vo, STATE: Massachusetts HDD: 6413 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING S STEM��/ TYPE: Other (Non-Electric Resistance) DATE: 7��a�IQl DATE ONS: TITLE: `TWO end unit3 DUP&I7 ) PRbJECT INFORMATION: Aes-oxy -C-1- 0 wAv ho en e COMPANY INFORMATION: \ e Tco PA8oue v AiA, C)I8/0 NOTES: Unit is 20x28 COMPLIANCE: PASSES Required UA = 280 Your Home = 272 Area or Cavity Cont. Glazing/Door ---------------Perimeter R-Value R-Value U-Value UA ---------------------------------- CEILINGS 400 30.0 0. 0 14 WALLS: Wood Frame, 16" O.C. 1844 11.0 0. 0 164 GLAZING: Windows or Doors ►r 136 0.390 53 DOORS 30 0.270 8 DOORS 19 0. 350 7 FLOORS: Over Unconditioned Space 560 19. 0 0. 0 26 -------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed .to meet the requirements of,,the Massachusetts Energy Code. , ,The heating load'for this building, and the cooling load if appropriate, has been determined usingthe e applicable Standard Design Conditions found � in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4. 4 . L DPW 328 t Date .... ®� o °m TOWN OF NORTH ANDOVER JJ RECEIPT J.W I LLIAM SSgCHUS�t DII Telephone(978)685-0950 Fax(978)688-9573 This certifies that.......... has paid.. ........ ...14 .....Y.�(�.�..�� .................................... for ....62e-we.t".�GJf?'?�1. ... .�...��........�7...�. Received b e Department............. c 1:�...... �: ........................ WHITE: Applicant CANARY:Department PINK:Treasurer DRIVEWAY PERMIT DATE C5 �P I LOCATION 5 —G (`cSco r 1� - z BUILDER phone . OWNER phone 75- 19&,8 1 THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF I SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. i I I i I f 1 APPLICATION FOR SEWER SERVICE CONNECTION l North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. (7 Street or subdivision lot no. 7 _ Aborjl Owner Address Contractor ddress i Applicant's Signature �/ I PERMIT TO CONNECT WITH SEWER MA/N The Division of Public Works hereby grants permission to to make a connection with the sewer main at � ? > Street subject to the rules and regulations of the Division of Public Works.. Division of Public Works By-7:Z 6 A,4-/,7 4 Inspected by Date See back for rules and regulations , .. . I"#4,:I I; AP 'UCATION FO�t` ATER SERVICE CONNECTION 3 11 P F J ,. - 3 _ iil- North --over, Mass: / e' F Application ey the Undersigned is hereby rnatle to connect with thli e town water mam in ky` ��.;P, r Street subtest 1.to the rules ah1.d regulations of the Diviswn of Public Works 4 { # d -Y I '�7..EI a� ,, ° � &e 17 f r,� .3,'x f}'r- `+" J- ,, .... -` �:- ,' r , ;u a-}a 'c '�a x s "G's x t Ga The premises are known a5 No (�S /"2'`� y,, 1. % Street Ian ,, x j.• } £ e #rc.t} °t ,I- bi»E ? R a,--..a r., .,Y4+ L 3P »$ I as+ '4#, vt r »;�$L;, c br SUIZd�visi' blot not °� f <<t �Y.3 tw,:e� r 2 2' w E s"' 4 r ,. d A I R �}yr F ', x u t �. z a a ..T •r 4 q r -� .j. .�e 0,`t ", r �' x C � y 'C r i �} 3 r, .f T r t ,s ,,r n':.} d �� t' a } -,i %i N ° r r s..€� t�� + Y j b ? 7 ti d`` hr 4az va i 3 - a { t� _q �" k T k }7`3 a r / I)a� ' �/y (ter &?yd{ �/+f�Si e(k� y �.� 1. 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I I . . I u 1. r 11 I . I . . . � � � : I I. . r I . � I _ . . . . . I i GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. lqi� c)�/ _7 Permit Ap licant Property address Map/Parcel r Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this foam does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further 1 understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the budding permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application fora building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland The land to be.preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the planning board that will ensure its protection This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT S ROUND FO REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLIC TS,�SIGNATURE DATE Q THIS FO �p BE ATTACHED TO TIE BUILDING PERMIT APPLICATION i I Boston, Mass. 02111 Workers'Compensation Insurance Affidavit - Please Print Name: Location: City lAU i / �"'��'U � Phone am a homeowner performing all work myself. i �eam a sole proprietor and have no one working in any capacity r providing workers compensation form employees an em toe .P yworking on this job- Ad I am P Y P 9g Q Company name dress Phone# Insurance Co Policy.* Company name: Address Ci Phone,*. insurance Co Policy# Failure to secure coverage as required under Section 25A-or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($1 oo.00)a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and p Wallies of perjury that the information prrndded above is true and correct Signature \N�- Date i Print name b�v S Phone Official use only do not write in this area to be completed by city or town official- Ej Building Dept []Check if immediate response is required Building Dept p Licensing Board . Q Selectman's Office Contact person._ Phone#: 0 Health Department Other i:)RH WORKYAN'S COMPENSATION i O.RTH � Town o �►� �? _'0 ,1. 6 Andover 0 i � No. CAKE O1 ndover, Mass., '���"0100 / CO C HIC HE WICK ADRATED 1`? ,�5 7SSACHUSE IT FOR EXCAVATION AND FOUNDATION THISCERTIFIES THAT . ©.� ..�A s....... ..................................................... .......... has permission to excavate and our found tion at T a �x 4� ..... .... ......... ....... forthe purpose of....H........�.... .......................0 ....'......................................x.................... The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. PJ7 da"Wo VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS Thp holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. ....... . .. ... z� .0 BUILDING INSPECTOR NORTH Town . of . 4Andover 0 .1. ." -4W. 0 .. ......No. - zyA o dover, Mass. COCMICMEWICK � SO PRA TED P"e C �`S BOARD OF HEALTH Food/Kitchen . ..PER , v , 1T T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... ...... .... . .rN........................ Foundation has permission to erect . buildings................ ................... buildm s on )jO'�J.........�.�............ .. ...........�.......... Rough to be occupied as.....q 0010m, ! �t /4 r ,� ' �W�►I/I!�/ ........ ...... Chimney . .................... ..... . ........................... ... . ..... ....... .......................... ... .. . provided that the person accepting this permit shall in every respect co form to the terms of the applicatih on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 1M Buildings in the Town of North Andover. a a n C/ q S� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STAJELECTRICAL INSPECTOR ............. ............................... ough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT . Until Inspected and Approved by the Building Inspector. Burner street No. SEE REVERSE SIDE Smoke Det. -� EXIST. 8" SEWERS `'MH " c)TR E E T F' R E `�C.C) T I v. — W— J� —\A, _W• _ W — ' EXIST. 8" WATER _ 10 .8 6 0' N 87°4654"E H YD. D ��� I �I.PIN set I.PII E(1nd.) I W � I ( ) Icr V) V) I W Ia > > a 3 a CV a 3 I W c 5= I - I c> Q� 0o � 3r o G n a I o s' z 17' 17' iso 13' 13' PROPOSED oy''rV N i- DUPLEX I ° �� / �?,.\ DWELLING Kenneth J. Tokarz �fw and , A Karen Bailey 0 17'' 17--- N o Co o vi o N /F Marion G. Rollins LOT 2 and Clifford Lund Rollins 15,850 S.F. ,_ 46.33' S87°4fi 54"W ' i i�I.PIN(set) I.PIPE(set) , I.PIPE(fnd.) ham' i S.B./D.H. 40 p� O /A( I.PIPE(set) 50.00' �S89°10'_49"W — I.PIIDE I.PIN(set) (fnd.) N/F Meadow View Condominium PLOT PLAN �jH of LOT 2, PRESCOTT STREET alldov►�rWILLIAM S. NORTH ANDOVER, MASS. k., o tia�e1-EOD QVIL Prepared for ccin u l tall is `�U Nc). 147 George Hughes & Douglas Ahern inc. \01—C)4\PLOT2.dwg SCALE: 1 '==20" DATE: 3-14-01 1 E=ast River Place, Methuen, Mass. f i OI a0 1 - r- _— _— L ZL r d j i I i 12 14 V1 12 110 ---- -.. .---- 77 7-:-- - U-0 LIJ 5 Li LJ --- ------ --------- ---- -i L------------- - _ - _ LEFT SIGH E1_.�/ATICJ�-� 216HT �� ��?,TION _711 Ir— =Au� ®R - EDI= a I cfi�•LG �/ro^ r.o" io ti. ud: rk f fi , i 1 i Y i —. A � � S I ! � ! I RAJ 1p, i ie ° 1 221WI: r Zij i t ot, _ I J 1 i 1 ? !Ot r i I i I i 1 _..V3-7'1121:4'y ! o I _ va LIN FOLS Up - L- c _I .uo - < < �t iI o _ �r'- �; � ••�I� '" _��.r�-fes___ .t I I ' I I - 13 I 4$:p "7:0 IFIGWE1._ oil:.x�, I NG, lP45*vM Mme. G�OWH P-r: mp4A4o A*. 16,1951 I : - w Lopr-------- S — w►a- Rai��) — mw Lt -j z - I v -� — - -- --- -a4-o° _.- ----- ----- — 1 I — — i I ' f I � I a 1 i -- i wPLac FOR --'---- ° � nIGL-!EL �UILf��s11�c, ----- + 1 I I ICe"O G, MLiL �,PrPOPIQL�7i; .1olv'r � WrIGRM'�t T��U� WHOM ioK+P.R9 t-t7 4rr c�CALL a4 ( 0 � v CP I i 1 � I i i ' 1 - I I i t t . I �._.� v _ o a� i I ♦Nm��w- rM. aPAW4 er 46e owl- `� - `, �d c Yn�D G•X1 ET' - -%tet RY'.�a < j _-- �-- -2x8 R/'FTE'RS ICs QG, V2' GTr Ca �..R V.T '5x1'1%;LAHINATeO 6«r1 Ila -rl�T.-- ,// R•19 till � I -2-2x4�P P�•TL .. 'SIC.0.C. I O _ f I , 2x4 ivrIAO¢ 2x4-,Mc*�K,'9.G. '-Y<T•Aa.K:ro4v,-: 8a1 PUTe c>l 1 ,c4 IVP FtA?r ! -irr�ulaT� 5!Gir1� i L ,---2X4 gor FwI-- --2-tido Or- -d7F.JEhI � go i III ; I I -D �� f5'1 CWT-:5L- N 1L IkZ. 4;� AOovtTzj Mrs• cvlo Date....t1- 1k1 ..... 6 NORTH.. "O TOWN OF NORTH ANDOVER OG o PERMIT FOR WIRING ,SSACHUS� This certifies that ........T. ..... ..................... has permission to perform ... 'c.c.,:....... 4,.1r. ....... wiring in the building of..........�: .......� ..:......................... 7.....&" Y' r17� ,North Andover.`,Ms k_-Fee—l-J 0X01) Lic.No.�l�.,.�76.....J�...!/................. ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer T1&CO3W0NWE4LTH0FM SS4GHU.SE77N Office Use only DEPARTAfENTOFPUBLICSAFM Permit No. <:�;)� BOARD 0FFIRBPREVEN170NR09JL4TI0I KS S27CMR 12:00 Occupancy&Fees Checked PAPPUCATTON FOR PE[ZAW TO PERFORM ELECTRICAL WORIK 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 Town of North Andover To the nsp or of Wires: The undersigned applies for a permit to perform the electrical work described be Location(Street&Number) 2LO -- Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes[71-go- M (Check Appropriate Box) Purpose of Building p2.46AU 6/ Utility Authorization No. Existing Service Amps Volts Overhead a Underground a No.of Meters New Service T Amps1 !O Volts OverheadUnderground No.of Meters Number of Feeders and Ampacity J• ion and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total _ KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges `SNo.of Air Cond. Total FAZE 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 /I�, Heating Devices KW Local Municipal a Other F1' Connections No. 6 not Water Heaters C KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 0 OTHER hrstrdroeC Rasuat>rtolhelegtnatla��GataalLaws Iha%eaa>amtLiabiityhmrmxPb ymd d'agCa Co+aageorilssth ttrdec�uval�t YES NO Iha%esl rm vMptocfofsmnetotheOlfw-YES [71-90- Ifj uha%edudWYES,pkmeed c*thetypeofam'dWbyd�gthe INSURANu Q�B�a `011m � Sp ') /( � FAVn&d ValwdEkdncal Wait$ Waklosw h 0dMD*Re*xsW Rao Final j S�Iadulxi�TieP�Ialtie; ... ,�I FMM NAME 7` LjoaiseNa � �7�� Lioatsae Sigt>ctlue LioalseNo Bts¢lesTeLNa -597,P" AkTd?Nh OWNER'SMJRANCEWAIV ;Iamaw=dattbeLjomsedoe etheil>suauaammgecrih msbnfidl ascBcltmedbyMm&u=CaxralLaws andtitatmyaernfluspa�app6r�iatwai�dtis tac�msrec>< (Please check one) Owner Agent Q __J/ ) Telephone No. PERMIT FEE$ b l r (/C,i � 4 O .:ate Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: ✓ PROJECT: I ATE: UNIT NO.: FLOOR: WING: BUILDING NO.: �m f oZ 6J�I REMARKS: Excavation-depth and soil onditions Framing- Other: Date: 'moi`,/fib Date: 7 � v Date: Inspector A(W`1� Inspector — Inspector Footings and foundations and drains- Insulation- Other: Date: /Y Date: `a ,v Date: InspectorInspector ' Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: (--a a —'be' Date: — Lo-- 07 S C9 Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: %` / 1 _ Date: A Of Q 0 — o Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: '� I ` Date: ��) `f/� Date: —Cof 0# Inspector M Iw�lf Inspector // 1�� `ts�"'J Inspector Form#995 Action Press,685-7000 1 1 8 SACHU`+ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 337 Date ` —c5^ o o 3 TMSHICERTIFIES THA THE BUILDING LOCATED ON h/ t,40 e MAY BE OCCUPIED AS :/w e-/A /U / T / /?&, /g m 5 , o? '/.7, S IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO C g V e /7�/ Ph �SCv s7L , Building Inspector Tkr)wn., of3r - a y r I�'®r�' dower, Mass., `� �L. BOARD OF HEALTH 1111-0 IE Food/Kitchen R IT T BUILD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .;. �.� . ... . .... ... �. ........ ..,_ ..: .... '.. .. :1....................... .f.................. Foundation undation has permission to erect..... lt..:... ... buildin IF son .:� .�. .. ..1� . � .. .. ..............`�.. �................... Rough.�f�.lG ��—7_ c�—l33 to be occupied as...... � a i ' 10 0 � c ih mney ... ..f... ..... ..... :....... ......... .. .. ':. ..... ......... provided that the person- c®pting this permit shat! I a" N respect conform to-the terms of the application on file in Final �� this office, and to tho.provisions of the Cods' and Sty=Lavas=relating to the Inspection, Alteration and Construction of Buildings in,j a Town of North Andover.. ` / PLUMBING INSPECT,�R VIOLATION of the Zoning or Building RegAtions Voids this Permit. r /fd u O PEI i JT71�;` ELE ICAL SPEC�C(SSR +, qy YR 3 T� i, �' f (! / F L�OUC, '".., '".. 6......... ........................................................................................ Ser vice BUILDING INSPECTOR 1 -• Final 0 iC'Cll 11 U. ''` ' Ref';,tr J:cu�7\ 'UI�C` GAS INSPECTOR Display in Conspicuous Place on the Premises — Do Not Remove Rough - ''�� P Y a u P� FA1 No U-tithing or Dry. Mall To Be Done Until Inspect d�- d Approved by the Building Inspector. FIRE DEP TM NT Burner Street No. i Smoke Det.REVERSE SIDE H