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Miscellaneous - 67 SURREY DRIVE 4/30/2018
I 67 SURREY DRIVE 210/074.0-0028-0000.0 fall, �I II Date.... ./........ NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING s i s ,SSACMUSE� Thiscertifies that ............................................e.. ....... ............;^ ............ has permission to perform ...:..;�:...:.. .... ....... J . ..... wiring in the building of at ..Z.. 17 u.��:�. L../. :........... ................... North Andover,Mass. , e Fee.......�....... Lic. ...................................................... ELECTRICAL INSPECTOR Check # 1 4 ; 40 TOWN OF NORTH ANDOVER r, BUILDING DEPARTMENT t 3y I _tPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR D MOLISH WONE OR TWO FA114ILY DWELLING 'I'gis for 9*id Use Oel BUILDING PERMIT NUMBER: ISSUED: M aJ,�bATE - a - X SIGNATURE: r Building Commissioner/In for of t5ullcpngs Date SECTION 1-SITE INFORMATION Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O c — .--- — Map Number --- Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: v Public ❑ Private 0 7.one Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT l Owner of Record rn -L— � Name(Print) Address for Service All A 676 tgnaTure Telephone 2.2 Owner of Record: Name Print Address for Service: O Z Signature Tele hone rn SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address g e Expiration Date Si nature Telphone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v mpany Name Registration Number Address r r Expiration Date Signature Telephone SECTION 4-WORKERS COMPENSATION(NLG.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 reit. Signed affidavit Attached Yes.......0 No.......5 l SECTION 5 Description of Proposed Work check all applicable) New Construction 0 E-casting Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: �TL(1) / �o 41 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 1V (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 e3 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT IA:Da;,d Sm u as Owner/Authorized Agent of subject property Hereby authorize to act on M} behalf.iu m s re tive to work authorized by this building pennit application. 5i nature of Amer Date SECTION 7b OWNER/AUT96RIZED AGENT DECLARATION 1, ;as Owner/Authorized Agent of subject properly 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 Signa.ture of Owmer/A ent Date NO. OF STORIES SIZE 13ASENIFNT OR SLAB SVE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS MAENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS l SIZE OF FOOTING X MATERIAL OF CII1 ANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE f Commonwealth of Massachusis Official Use Only Department of Fire Se /GLATIONS Permit No. T Occupancy and Fee Checked BOARD OF FIRE PREVENTION R [Rev. 11/99] leave blankAPPLICATION FOR PERMITRFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12-00 (PLEASE PRINT IN INK OR ZZPE ALL FO ATION) Date: City or Town of: To the Inspector-of Wires: By this application the undersigned gtves not e of his or her Xion to perform the electrical work described below. Location(Street&N ber) Owner or Tenant 9!— Telephone No� — Owner's Address Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts . Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above o.❑ In- o Emergency Lighting rnd. rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.o Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons 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 E uivalent No.of Water No.o No.o Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent a No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: �l Attach additional detail if desired,or as required by the Inspector of Wires. 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:) (Expiration Date) Estimated Value of E ectrical Work: _ (When required by municipal policy.) Work to Start: 9Rb-3 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the ains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: Security LIC.NO.: 1 5 q�jC Licensee: John S. Bassett SignatureA 43049 LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.• 603 594 9 $ Address: 11 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li , see 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. P, Owner/Agent Signature Telephone No. PERMIT FEE: $ Date..!. lJ� f �aORT1,, TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUS� This certifies that ......,-.^r' ¢ ` ...:r iL -t�....................... :.... � has permission to perform } wiring in the building of......_.k/ {,... a�.. ........................................... at.4. ...................., ..�.,.::�:- '...- P;North Andover,Mass. "Qe ]'ee...:.�.�. .. Lic.No. !/...1 ?-.`. .. ...!..�.. .................. ELECTRICAL I IsECTOR Check # 5 4 "1 4 TIM COM ION 'UTHOF'MASS46WSEM Office Use only DEPARTA1EVT0FPUB11CS4FMY permit No. / BOARD OFFMPREVFV170NREGULAHONS527CAR12.00 Occupancy&Fees Checked APPLICATTONFOR PERMIT TO PEI; ORMEUCTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MAS' CHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date I - O 9 -0 L( Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electricaAwrk d scribed below. Location(Street&Number) �.r. Owner or Tenant �r�� �pY�1� —( .,�-��, _ �� cZr 7 Owner's Address t✓0 `1 '�SUc-s-�✓ a-Is this permit in conjunction with a building permit: Yes_[ZkNo M (Check Appropriate Box) Purpose of Building P��CP,ne_e Utility Authorization No. Existing Service /b� Amps o10/ Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 77,77, 77 - C.c c- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets t No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local � Municipal � Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• r+ h U1MWCovaaW.RmarttDthemVMTaZafMwmduscZG=ialLaws IhaNeaamatLubkylnmz=Fbb yinchdTCompkle Opgabons Cc)wrageorils wbwatliblequivaiat YES NO IhavesubrrmodvaidpfoofofsametotheOfce YES ffyvuharedlededYES,p1e;whldicaietheMmofeomnWby INSURANCE box BOND MIER � (PleaseSpecify) EVirafimDak WorktoStatt ••�- �l-- EdVahreofFIWork$$ �0"�00 00 hq)ecfimD&Regtresmd Rot# Final sign�dunderTrpmakiesof FIRMNAME p`,u'Y* E l /-,' IicawNo. 0 -7 7Y� Lxmsx //romp,S tP.Cc. 1��1U5 Si j� Tel No. Add ? + f OG3LADOIO is, If'e- C�,r�G��a �l - . It- Alt Tel No. OWNER'SINSURANTCEWAIVER;IamawarethattheLio wdoesnothavetheinsordncecov$ageoritssubstantialegivalentasoltmedbyNbsmdngeusGernwLaws and du rrrysg-ahue on dus pmnit application waives this mgtmmifft (Please check one) Owner M Agent Telephone No. PERMIT FEE$ W w Signature ot Uwner or Agent Ul. l -lY-7 f 1''J Z)b rl'I t K :7uKVtY 'btibti tib4Yi� r. b� MORTGAGE PLOT PLAN EK SURVEY INC. MORTGAGOR jft&4& DEED REF. ��1�._ PG. 5, ADDRESS OF PRINCIPLE BUILDING PLAN REF. to? Vic! Ar. DAlt OF INSPECTION r , '77 ?.4 t� !�~9A V `moi 7fvysf fi `k'p 6oT �jq eta OTE: rhIm dly mert9aq• a+sp.cttw, s+oy pt�pa� �,t,�f� I' 1 FUIMER SATS THAT IN MY PRaq=ONAL 4 railed For gwt ►posbs dnd ti no! to o T �� OPINION the prtnclplt utr4atum/s and accessary ► rdlsd b yr. EK �lI1tVEY ��d�/� � rsspny (br tlWTtyyp RUDEL H wtthulh• yl Jtanca by anyone ether than tt, saki mortga w No. 38966 WO rrgti msnis of the locvl id tta ajstgrls h mectleh t.(t!t Its prep g a' inano+s. and that no enchroochments 'Ortgoge flnanoRtq to sold matgagor, �O fcJStE0.�6� of maJor. knProWmsnts wUw troy ocroaa MT)MATION M Mit UR phOp�y w" "t a: Womm. 112 c"fkullon is bpssd on !hs 1 5112 Pr*P�y t• hot In a Flood Hmmwq Area. f othW4, dnd dons not °melon of y mo�iWN ropes to a Flood H=ard Maa4 r�rssent a Prop.etV 04WA therafofy U�` iAfaMotlon Is MautRdset! .to Aa�twm1hs Flood Hvzard. Moots spawn art not to be }reed for the •+toblltrlu:-tsnt of Flood Hazard detelminsd *nm nm h�btst Redarvi Flood tipsrty Itnaa. Insurwee Rote Wap pam,l# Location Ngo. ie v Date r J J NORTPI TOWN OF NORTH ANDOVER Of "•D '•1�0 3? � • OL i + ; , Certificate of Occupancy $ CMUs CHU E<�' Building/Frame Permit Fee $ sA Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check ji`�� l r 3 , 9 / Building Inspec TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7 - BUILDING PERMIT NUMBER. DATE ISSUED: rn D� M SIGNATURE: JCA.A�� ic Building Commission for of Buildings Date Z SECTION i-SITE INFORMATION o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Q C/ Map Number Parcel Number ©l J 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided -Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Fly Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record CL Name(Print) Address for Service Signature Telephone Q 2.2 Owner of Record: O Name Print Address for Service: o Z rn i nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number mn Address Expiration Date ic Signature Telephone r M< 3:2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name Registration Number r Address r e z Expiration Date ^ Signature Telephone YI SECTION 4-WORKERS COMPENSATION(NLG.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) 0 Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: L f1-( (� 0 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be °OFFICIAL USE ONLY Com leted b permit applicant 1. Building (a) Building Permit Fee 0. O-0 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 1, 7)Q v� � o l_r�Qr-- as Owner/Authorized Agent of subject property Hereby autho to act on t, behalf,i alllm erg relati e to work authorized by this building permit application. C� b Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION a 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/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2 3RD SPAN DM ENSIONS OF SILLS DIMENSIONS OF POSTS DINIENSIONS 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 4 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 Q �! j � I' tr— PHONE 9 7C("6 e.7'd,26 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET S-U (I `" d r 4TREET NUMBER `C .......................... OFFICIAL USE ONLY ......Ld RECOMMENDATIONS OF TOWN AGENTS L �L R r m •,,��urs .y. ......... .... .......................................j.. .... /.1�....... DATE APPROVED l� w CO SERVATION XbMR4ffTRATOR DATE REJECTED COMMENTS /VV wl�� W T/� G DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE OCT-14-97 04 :56 PM E K SURVEY 5086880485 P. 02 MORTGAGE PLOT PLAN EK SURVEY INC. MORTGAGOR OM 01-4& DEED REF. 2777 p0, 57 ADDRESS OF PRINCIPLE 13UIL.DING PLAN REF. 6swc ' I DAlt OF INSPEC'11ONAt r zie•77 ' ?0 47M P 47M b N � ��71oVsf S LoT A:4 40. ° 9 OTE, ThIs m °y Inspection ray prIspar� �,�,1��N ' �' .` I FURTHER SATE THAT IN My PKOMMMONAL I roiled-_u_pw as 9w� C �UKM not to o T• a� OPINION the principle rin+otur•% and occ•>tiory a �PW4Z1RY for tlylTlayyp a � AVDEL N butbuAding:, Bianca by anyone ether thOn the void mortya w No.36MI) ro�Sn�s setback reQufrerrtents of the loco! lort� : fh ewmecub" Mth Ito propos f •'' g andinaross, and that no Onohroochmw* 94 Anonoltg to sold mortgagor. `� �R ASTER of major ImProWmsnts ehhw ,roy oarays ERTIFICATION M °��I l�Nob PrOPerty Rhes "t as *,Wm. tbart]Aeoljon is based on the 1ocCd}on of ProPsetY tv not Ii o Flood Nazmd Arses !s►sey star sxs 02- Prop" la In a Fl000l Ncaard Arsa. F others, and docs not ropr•swlt a Pr'oP�y purvey, thwfoh D1 lnformatlon 1% 'Mauff el A{ .to A&t nths Flood Hazard. kaet3 shown are not to be peed for the establIthment of Flood Hazard detelmtned *om Hm jtft*t Federal good voorty (thea. insurance Rate Map Pard f i y Town of North Andover o� Na RTH Building Department o 27 Charles Street * _ North Andover, Massachusetts 01845 + ?, `' (978) 688-9545 Fax(978) 688-9542 .�,.'. .9 1TED I•P �'� SSACHUS� 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 Signature of Applicant 61doU Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. TAORTF1 Town o 4Andover 0 VIA No. 0 = L-A E dower, Mass.,- Ij *7 COC HICHEWICK RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........7)A S ............................................................./.. .'..Y... ........................................................................... Foundation has permission to erect... ........................... buildings on ..... .............................................. ................................. Rough to be occupied as..40 .............................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Finai this office, and to the provisions of the Codes and By-Laws relating to the Inspection Aft ti J Construction of IV p erag and Buildings in the Town of North Andover. 0" 1' 12 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STAB 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 X, 5� r r y f/ir No. �U Date 1 r �RTM TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ 41 • i Building/Frame Permit Fee $ • 0 ... ,•• t�' Foundation Permit Fee $ ,Ss4CMUS t Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 'A ss 11-tl k,# Building Inspector I J O 56704/99 11:37 25.00 pAlp Div. Public Works 1'I?RMIT NO. c 6 APPLICATION ICOR PERMIT TO BUILT)**"""NORT11 ANDOVI?R, MA iAT%VNO. - 1.0I.N0. 2. ItECOR8OFOIYNERSIIIP DATE BOOK PAGE ZONE SIIB MV. I.OT NO. L(1f:.111ON1'llltl'OS1:(k=BUIIUIN(i OWNER'S NAAIE NO.Of:SroltIES 1• c t Cl SIZE. I L' OWNER'S ADDRESS BASEMENT OR SLAB ST FID RD ARUI III ECI'S NAME SIZE OF FLOOR 1 IMBERS I 2 3 BI 111 DER'S NAME SPAN DISIANCETONEARESTBUILDING DIMENSIONS OF SILLS DIS I'ANCE PROM S TRF:ET DIMENSIONS(N'POS IS DISTANCE FROM LOr LINES-SIDES D REAR / 1^4 DIMENSIONS OF GIRDERS AItEA OF LOr FR(NJIAGE IIEIGIIT lN=FOUNDATI(NJ THICKNESS IS BUILDING NEW SIZE OF 1 O(JI ING - X IS BUILDING ADDI II(NJ MATERIAL.OF Cl IIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID(Yall LED LAND WILL BUILDING CONFORM TO RF.CK IIREMENI'S OF CODE �S IS BUILDING CONNECT ED-10 TOWN WATER y - BOARD OF APPEALS AC1ION, IF ANY IS BUILDING CONNECT ED TO TOWN SEWER � IS BUILDING CONNECT ED TO NAI URAL GAS LINE INS11-11CT1ONs 3. PROPERTY INFOIINIA'HON LAND COST 1.31L5-3 EST. BLrxi.Cosr . G. o d PAGE I FII.I.OIrFSECr1(Ns 1-3 EST..BLDG. CO-3rVLRS(i. T. ESI. B1.1 Xi.COS I PER HO(N.1 EI EC-rklC MEI ERS MAST BE ON OU rSIDE OF BUILDING SEPI1C PERMIT NO. AI-I ACI IED GARAGES MUST CONFORM"ToSTATEFIRE REtiULAIIONS a. APPROVED 131'A r PLANS MUST BE FILED AND APPROVED 13Y BI111.DING INSPECTOR BIIII.DING INSPECTOR 1 DA 11:1:111:1) OWNERS I EI.II. CON IR.IEI.H C01,41 I I.I.10 SIGNAI HII:OF OWNlat OR Alrll It RIZI'.D AGI N`I' ^ ` I L L C.11 1 III: V;) 1 ' I'FRMITt GRAN 11:1) 19 9 -- � 1 NORTH T �F® O Own L over O w 0 No. _C0C dover, Mass.,_Ip/I �t ADRA TE D PlP' 1 S cG 74 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT..... ..........(�. ........a Foundation has permission to erect..... .. ...................... buildings on....6.... ....... V n 1^.L�..�jl. ................ Rough i t0 be occupied as......RV N. ....... ......Pe0 f I N M to a l! .....t g...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. pNAjN'rilN lot St*64gk jw" wo., PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. k01- I{.1 #A S • Rough 1Z 014 u PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUC N T S / Rough .... ............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. OCT-14-97 04 :56 PM E K SURVEY 5086880485 P. 02 M RTOAG E PLOD' PLAN EK SURVEY INC. MORTGAGOR DEED REF. - z717 PG. �^ ADDRESS OF PRINCIPLE BUILDING PLAN REF. 47 Ay�m y—'ar, DATt OF INSPEC71ON �1.,I�1G4 ,r►L 1L zie•77 472;4 Poo A aq A L i P°Q14 "pad N �wund doM p pli so 'A�pzoh Pflo� �u►u °�PL4nnq to24l} pooh ) }w 4�Jlq°1►� •4} 'N PWY a �3+0da •a+lr P`—" Poon o W 3 U 01 �d4JdJ -Z0 �f1otU �j d p ��cadoigQ�o Q U'Mo4r C=ory +1 �.doud •1■ �iWaot •t}� uo P644 P P�4 'tuay}n _ 9 M" '4 Wd�c• bwao ��q�pvt tYNp� Puo -"Ouc �ti31S1� NOUvo tcoqlio � a •.roan6 leu �o�t�aaQ � �'x6u 41 r oases oN M 0Qb }pW'P�J 4c 4ut;o y x -j •603}mi PUO a/+►rrM 1PCnq��V W iaanH '�3 �tqo •c�gRt�,OFAM 'W pt �'"1O t+d .t►v �J�"'E'd 'to P�U1NIdo ,'1 gPou+pp ,W (1i11� ,u�a }i1 sirs c uar� i o u X3 K(IKJM o ;o 40d dsw o od•ae cwt ato { FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT L, �, �, Soaa LL( — PHONE ;2-0 7 4 LOCATION: Assessors Map Number 7 PARCEL SUBDIVISION LOT (S) STREET h <;c._0_ �- (� ' � ST. NUMBER OFFICIAL USE ONLY"' RECOMMENDATIONS OF TOWN AGENTS: _ CONSERVATION ADMINISTRATOR DATE APPROVED Z Gl DATE.REJECTED COMMENTS TOWN PLANNER DATE APPROVED rJl DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRJVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Date. . . t lk f NORTH 1 3rp`„co ,n. hOL TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION 9 •1 5 SACHUSESS x&7 This certifies that . . . . . . . . . . . . . . . has permission for gas installation � . . . . . . . . . . . . . . in the buildings ofIndover, at ? !� l!1 . . . . . . . . . ., North Mass. Fee-?� . . . Lic. No./: :Y . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# 0711 4 29 COMPLETE ALL INFORMATION MASSACHUSETTS UNIFORM APPLICATION FOR PE IT TO DO GASFITTING (Print or Type) W � n �,,,,�� �( �I I Check# TOWN OF / VG'�(� Jj�/L(�CQ Date 200 64 Permit C Building Location 4-7 Su'l'y-9 V ^' O ner's Name svvwt ell Nearest Cross or Intersecting Street /'Type of Occupancy Aj)A'.1 New Renovation ❑ Repla,e ment ❑ Plans Submitted: Yes❑ NoV APPLI NCES Y Cr Q rn Q Lu W w O c) m t= _ rn r Z Z cr z 0 cc CC¢ m W w w W O U) a � w Q dJ cn � cn C7 U W = � z ¢ cc O > w Lu 0 U) LIJ Z J Z Z = W W 0 LLJ > LL W U J U) Q Z ¢ W J Q Q N F- >- W m Z o Z w o H 2 ¢ W > CC W D Z ¢ � ¢ O o w E o W Cr o 0 _ LL D 3 0 o g U > o a o SUB-BSMT. BASEMENT 1 ST FLOOR 1 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing CompaW Name4\4,\�--ua{ l Ch ne: Ce7rt'ficate Address '�, Corporation J kO� 0 ❑ Partnership Business Telephone-Area Code > US-,'J(3 d ❑ Firm/Co. Home Telephone-Area code( ) Name of Licensed Gasfitter INSURANCE VERAGE: I have a curr t liability insuran/polior its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked YES, pl athe type coverage by checking the appropriate box. A 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: Owner 1:1 Agent 11Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the besf Tyk wledgeandthat all gas work and installations performed under Permit issued for this application will be in compliance with all pertinent provisions of chusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. SI/GINATURE OF UC�E1{USSED FITTER DESIGNATION AND UCENSEqMBER OF FITTER CURRENTS NUMBER 1 � 6b EXPIRATION DATE V R Locationr-e- Nd. _2 Date "ORT 1y TOWN OF NORTH ANDOVER O?O•tt`aO /•,MOA �—` Certificate of Occupancy $ s=� Building/Frame Permit Fee $ '— �'+b''n°''��� Foundation Permit.Fee $ `— SSA�MUSE Other Permit Fe $ 1 d c_) Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector ' - 7 3 c � 09:46 15.CEJ RAID • - Div. Public Works PEWilT tib. C2 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK iPAGE ZONE SUB DIV. LOT NO. 1' OC,ATION PURPOSE OF BUILDING j j�Y S(afk rel G�f (-,O NER'S NAME �l�trC_�j ,Z.,WlrL7- NO. OF STORIES SIZE NER'S ADDRESSSUn LI�y r1�w� N� .,1� A` ��� BASEMENT OR SLAB ARCHITECT'S NAME C1� 'l L( SIZE OF FLOOR TIMBERS 1ST 2ND 3RD UILDER'S NAME ZI IeZN 3�,2✓ef SPAN -- DISTANCE TO NEAREST BUILDING �� /6 DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING % 19 BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST s SEE BOTH SIDES EST. BLDG. COST _ /6)C) Co PAGE t FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. �PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY xATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROCV,�ED BY BUILDING INSPECTOR DAT�.F1L �P / BOARD OF HEALTH SIGNATURE F OWtJ - AUTHORIZED AGENT F E E �l//JAI• / PERMIT GRANTED OWNER TEL.# &6 3-4,Vd 7 PLANNING BOARD o?"? 19 l CONTR.TEL.# CONTR.LIC.# BOARD OF SELECTMEN BUILDING INSPECTOR 44 -2-2,2Ll � BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES __ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d I 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/. 1/1 '/. FIN. ATTIC AREA _ N_O'B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD"J D _ ASBESTOS SIDING COMfdCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE ADEQUATE NONE 5 ROOF 10 PLUMBING f GABLE I HIP BATH (3 FIX.( GAMBREL MANSARD TOILET RM. (2 FIX.( _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ 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 I NO HEATING 4 f own of f, of over fir, x` lr F,w1- f Cr No. 255 Tort( '" dover, Mass., ne" 19 910- /-O�lil(IiF-WI(k A0/�ATED P"OL �5 S A BOARD OF HEALTH s PERMIT T D Food/Kitchen . l Septic System BUILDING INSPECTOR i THIS CERTIFIES THAT.... ; ...... ..4W ............... ..... """"""" Foundation has permission to erect.~04�s..... buildings on .&.2 9404.E Affl .��.... Rough g to be occupied as... 0 /40.p4me... .1 � Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. g PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 'aFinal PERMIT E,-',(I'IRES IN 6 MONTHS -, UNLESS ��(JNSTI) -.TION STARTS ELECTRICAL INSPECTOR Rough ` aw.................. A .. .............. .. Service B DING INSPECTOR 1 Final occTtpal :: Pel-1111t 1?eql f17-Cd lo oc l(l)� 13[tildilig GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT i Burner PLANNING FINAL CONSERVATION FINAL Street No. 7 Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT l , i I PO E30X 55098 Boston,MA 02205-5098 617-951-0600 YAW- Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To- Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: LISA SMOLAG and DAVID SMOLAG Property Address: 67 SURREY DR,NORTH ANDOVER, MA Policy Number: HMA 0351168 Claim Number: BOS00054058 Date of Loss: 3/6/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Philip Cormier Claim Examiner 3/9/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3459 Fax: Email: PhilipCormier@SafetyInsurance.com • Location r No. C-R . Date MORTM TOWN OF NORTH ANDOVER O��`•1D :•,ti0 f � 9 Certificate of Occupancy $ NUS Building/Frame Permit Fee $ AC Foundation Permit Fee $ Other Permit Fee $ TOTAL $ y0� r Check # c?C;kl?z) 17433 _,1llAALC� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: - _ 67,3 SIGNATURE: A4 f-C—Q--,— Buildin Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: _G Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ��� (v Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Regifired Provided v 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 OWNERSHM/AUTIIORIZED AGENT M 2.1 Owner of Record Name(Print) Address for Service: XJ CA I ltg�n. , Telephone 2.2 Owner of Record: A O Name Print Address for Service: z 1 M Si nature Telephone M SECTION 3-CONSTRUCTION SERVICES 70 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v s Company Name m t Registration Number r Address r Z Expiration Date n Signature Telephone Q i i SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) F 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 0 Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: f a x `/ �CIO) SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee i.as -ar Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(8)X (b) 4 Mechanical(HVAC) C{® 5 Fire Protection 6 Total 1+2+3+4+5 Check Number e3 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT T��U (A as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in m s re five to work authorized by this building permit application. i nature of O er Date SECTION 7b OWNER/AUTIMRIZED AGENT DECLARATION ; 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 SPAN DMIENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS DIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEV NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE s • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 1' 18 UilC011 4 rn BUILDING PERMIT NUMBER. DATE ISSUED: ic SIGNATURE: •-4 Building Comnfissioner/I22eeaor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ti 7 5�•1, �� G nom. � �� �8 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zane Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHIP/AUTAORIZED AGENT histmic Dlstrs No rn 2.1 Owner of Record Name(Prin r Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable, ❑ Licensed Construction Supervisor: O License Number aan Address Expiration Date z Signature Telephone r 3;Registered Home Improvement Contractor Not Applicable ❑ v Company Name rn Registration Number r Address r Z Expiration Date G) Signature Telephone V, e 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 it. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description o-,f,Proposed Work: I n � 4YQ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building { (a) Building Permit Fee 4 Multiplier 2 Electrical ; (b) Estimated Total Cost of aQ Construction V V 3 Plumbing Building Permit fee(a)X (b) ��� 4 Mechanical HVAC I--- 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 Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �O ,) e? ,4 C�. ,as Owner/Authorized Agent of subject . property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS iST2ND 3RD 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 zy e__> � FORM U - LOT RELEASE FORM ' Z, 37o INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *******************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT',k)Ck-0 Z�. SM a LA G- PHONE 9 7 5 G 9�7-0 '7 G LOCATION: Assessor's Map Number PARCEL_ SUBDIVISION LOT (S) STREET , b c (L (L? ST. NUMBER 6/7 **********OFFICIAL USE REC9,WENDATIONS OFT N AGENTS: CONSERVATION ADMINISTRAWk DATE APPROVED 9 F I yZa^�� - o� DATE REJECTED COMMENTS_ `t'&-<,,Te_A �i a.-Conte frw cT ., TOWN PLANNER DATE APPROVED. DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm �3C1EtYk Town of North Andover Building Department k :" • 27 Charles Street North Andover, MA. 01845 sactatss� D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542.Fax HOMEOWNER LICENSE EXEMPTION Please print. / DATE � � Q� JOB LOCATION f7 R D Number Q 1 Street Address Map/lot "HOMEOWNER7" Name v Home Phone Work Phone PRESENT MAILING ADDRESS C City ToOm State Zip Code The current exemption for"homedwners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL • FORM U — LOT RELEASE FORM t1 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT C� i tl �s � t� G— PHONE 9 79 4�r 7 7 6 LOCATION: Assessor's Map Number / PARCEL SUBDIVISION LOT(S) STREET S 2 -` ( --(STV�, ST. NUMBER_�� ************************************OFFICIAL USE ONLY*************** ***** * ***** * * REC2PMEENDATIO S O OWN AGENTS: CONSERVATION ADMINIST TOR DATE APPROVED DATE REJECTED_y//6 0 COMMENTS MuS�' Ft�[. ISO L ��an.�c j✓lrn /OC -f nrGt�r o TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm BO1TM BC CALC®2002 DESIGN REPORT- US Thursday,April 03,2W3 22:11 le Single 5 1/4" x 11 7/8" VERSA-LAM®3080 DF Name - BEAMS:GIRDER Job Name - Description - Address - Specter - City,State,Zip - Designer - Donna Kerr Customer - Company - DL Kerr Code reports - ICBO 5663,NER 442 Misc - Standard Load-40 PSF 11, PSF Tribute 12-00-00 06-00-00 18-00-00 BO B1 B2 -2430 lbs LL 9120 lbs LL 3510 lbs LL 306 lbs DL 2584 lbs DL 986 lbs DL Total Horizontal Length-24-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Live Dead Trib. Dur. S Standard Unf.Area Load Left 00-00-00 24-00-00 40 PSF 10 PSF 12-00-00 100 Member Type:_ - Floor Beam Number of Spgt s.. 2N Controls Summary Left Carrtilev '` t F No Control Type Value %Allowable Duration Loadcase Span Location Right Cantilever "'No' Moment 19405 ft4bs 61.2% @ 100% 2 1 -Right End Shear 3887 lbs 32.8% @ 100% 5 2-Right Slope 0/12 Cont.Shear 6013 lbs 50.8% @ 100% 2 2-Left Tributary 12-00-00 Uplift -2736 lbs 5 1 -Left Repetitive n/a Total Deflection L1392(0.59) 61.1% 5 2 Construction Type n/a Live Deflection Lr"(0.431") 95.8% 5 2 Total Neg.Defl. -0.049" 9.8% 5 1 Live Load 40 PSF Max.Defl. 0.55"(Limit:1") 55.0% 5 2 Dead Load 10 PSF Span/Depth 18.2 2 PartLoad 0 PSF Duration 100 CAUTIONS: Uplift of-2736 lbs found at span 1 -Left. Disclosure The completeness and accuracy of the input must be verged by anyone NOTES: who would rely on the output as Design meets Code minimum(L240)Total load deflection criteria. evidence of suitability for a particular Design meets User specified(U480)Live load deflection criteria. application. The output above is Design meets arbitrary(1')Maximum load deflection criteria. based upon building code-accepted design properties and analysis Minimum bearing length for BO is 1-12". methods. Installation of BOISE Minimum bearing length for 61 is 3". engineered wood products must be in Minimum bearing length for B2 is 1-12". accordance with the current Entered/Displayed Horizontal Span Length(s)=Clear Span+12 min.end bearing+12 intermediate bearing Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions,please call(800)232-0788 before beginning product installation. BC CALC®,BC FRAMER®, BCI®, BC RIM BOARD'"',BC OSB RIM BOARD-,BOISE GLULAM-, VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, VERSA-STRAND-, VERSA-STUD®,ALLJOISTO and AJSTm are registered trademarks of Boise Cascade Corporation. Page 1-of 1 BOISE" BC CALC®2002 DESIGN REPORT- US Thursday,April 03,2003 22:14 File Triple.13/4" x 18" VERSA-LAM(g)2800 DF Name - BEAMS:RIDGE Job Name - Description - Address - Specifar - City,State,Zip - Designer - Donna Kerr Customer - Company - DL Kerr Code reports - ICBO 5663,NER 442 Misc - 1__10 12 Standard Load-30 PSF 115 PSF Tributa 12-0400 AL Akx BO B1 4320 lbs LL 4320 lbs LL 2451 lbs DL 2451 lbs DL Total Horizontal Length-24-00-00 General Data Load Summary Version: US Imperial ID Description Load Type Ref. Start End Live Dead Trib. Dur. S Standard Unf.Area Load Left 00-00-00 2440-00 30 PSF 15 PSF 12-00-00 115 Member Type: - Roof Beam Number of Spans - 1 Controls Summary Left Cantilever - No Control Type Value %Allowable Duration Loadcase Span Location Right Cantilever - No Moment 40628 ft-lbs 55.9% @ 115% 2 1 -Internal End Shear 5925 lbs 28.7% @ 115% 2 1 -Left Slope 0112 Total Deflection U348(0.825") 51.6% 2 1 Tributary 12-00-00 Live Deflection L/546(0.527") 43.9% 2 1 Repetitive n/a Max.Defl. 0.825'(Limit:1") 82.5% 2 1 Construction Type n/a Span/Depth 16.0 1 Live Load 30 PSF Dead Load 15 PSF NOTES: Part Load 0 PSF Design meets Code minimum(U180)Total load deflection criteria. Duration 115 Design meets Code minimum(L240)Live load deflection criteria. Design meets arbitrary(1")Ma)dmum load deflection criteria. Disclosure Minimum bearing length for BO is 1-10. The completeness and accuracy of Minimum bearing length for B1 is 1-12. the input must be verified by anyone Entered/Displayed Horizontal Span Length(s)=Clear Span+12 min.end bearing+12 intermediate bearing who would rely on the output as Member Slope=0,consider drainage. evidence of suitability for a particular application. The output above is based upon building code-accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with the current Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions,please call(800)232-0788 before beginning product installation. BC CALC®,BC FRAMER®, BCI®, BC RIM BOARD-,BC OSB RIM BOARD-,BOISE GLULAM-, VERSA-LAM®,VERSA-RIM®, VERSA-RIM PLUS®, VERSA-STRAND-, VERSA-STUD®,ALLJOISTO and AJSTm are registered trademarks of Boise Cascade Corporation. Page 1 of 1 Q �tORTh q O ,StlD '!Y�O • �2 yr'•f' '.a OL 0 p Town of North Andover Building Department ,q • 27 Charles Street �SSACRUS Et� North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. 2 DATE JOB LOCATION L' Number greet Address Section of Town "HOMEOWNER c� Ste!" Number Home Pholle Work Phone PRESENT MAILING ADDRESS 9).. 4--vL do City Tow6 State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official, a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned"homeowner"certifies that he/she understands the Town of No. Andover Building Department minimum inspection procecluancLrequireme is and that he/she will comply with said procedures ,,requirements. HOMEOWNER'S SIGNATUREQ _Z �0 <�_� APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A.. The debris will be disposed of in: �DO'� (Location of Facility) Signature of Pe pplicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector M RTGAG E ' PL O- T PLAN EK SURVEY INC. MORTGAGOR *K&46, DEED REF. Pc. 5, ADDRESS OF PRINCIPLE t3UILDING PLAN r,L Alt OF INSP>= TION v �ie•77 ' y nr ApVsf LoT �q d _ J►eefticdJ far fi e +1specton was prepared a�'�P` '' ; ( FUMER SATE THAT IN MY PRaFE=oNAL r reliedlyup" as$ 9490 Purpose: and is not to oOPINION the principle ttPLIG CS/8 and occoa a sutwey4 EX �gtVLY oacrpt>. T.' � butbuAd[n `� r'aP. ny fbP tlgfipyyq RUDEL Nth 9+4 I Its by anyone et�fer thOn the said martgo w Na 38889 h�mon Id ht ossi + h requfrernant>r of the local �� S� °esthectieh ldtll Its propos c �. and that no enahroochmv* 9a9+ linanoLtla o Z mortgpyor r QISK of major. knprovwt�entw eVW May across ERVICATiON M �1 hN�b pray nhte a'xcept a•11. siwwn. ah fle based on the 1 CSZ P+'aP�Y ti riot h a Flood Hazard Arae. acett m of w fry mo ers raperty is in a Flood Hazard Ar+w fNsets athero. and docs not >~be pie►t a property sG vhy.•then f*4 U"Ood Hamid deieimtned *nm "m h ts! ederml Flood ,opar shown dm not to be },sed for the astvbtlshrnent pf Insur'anoe Rate Map ponul f 'oD.rty Itnas. i r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of FacHity) Signature of Permit 4plicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector r_.. ..........._...•._...... tj .................. C, 0 0 r".41 io Fl J r .... ............... ntain6r size W",kly ,p hamy, i *ft-kllp Ch Meh(my thLor. • ............... • 21) fiD f arknowlOdge that when paying by credit card 6 aulhor4*Ailanfic,Waete SysterrIS North to charge my credit marc fnf,,wny average and rentaV ............. � NpRT1y Town 0 t over 0 . No. - �]`( CN` _ L1 1 dower, Mass. 7 •&3 r 09F T O COC MICC HE WICK V of'?ATE PF. �5 BOARD OF HEALTH PERMIT T DFood/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT..... ............... ..!0.044.... ............................................................... ""' Foundation has permission to erect.).Y..J"O.y........ buildings on ..... .... V.N.N r.. .V Rough to be occupied as 101 &*r4A Il ov 00�.Pot1P ! 0 V Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- ws relating to the Wection, Alteration and Construction of Buildings in the Town of North Andover. 7 4114 A? V066mo• PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ART 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 Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT • Street No. SEE REVERSE SIDE Smoke Det.