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HomeMy WebLinkAboutMiscellaneous - 72 RUSSETT LANE 4/30/2018v Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. R. ......... ............................ has permission to perform4W/7774. /­`tp wiring in the building of ................ ............................................. -7 ;?- R U 7-2- Z -,V at............................................................................... .North Andover, Mass. Fee ..4 .................. Lic. Nod -s! .9 49 E ................... 6-zZ.1,&'c ... 2x?ze ELECTR CAL INSPECTOR Check. # V, Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code EC), 527 CMR 12.00 (PLEASE PRINT INEX OR TYPE ALL INFORMATION) Date: f$ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned�eP��tice of his or her intention to perform the electrical work described below. Location (Street & Numpq) I� J S S-rr ),k, r) Owner or Tenant �{ V Q_C)h <.N Owner's Address S� M Q, _. Telephone No. Is this permit in conjunctio with a building permit. Yes l C eck Appropriate Box) Purpose of Building W C I1 J- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of P osed Electrical Work: �/�,14 i t rimated Value o Electric Work: �/ Q 0 U "'"""` J uescrea, or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start 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 informati on this application is true and complete. FIRM N LIC. NO.: Licensee:IL L e Signature (If applicable,exempKnt)iq e nmb e.) LIC. NO.: Y (� Address: Cp Ort dlG� �I, l,l yh jy� _ �.G Bus. TeL No.: 3 *Per M.G.L c 147, s. 57-61 security work requires Department of -Public Safety "S" License: Alt TelLic. No,, G 5 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, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 0 k V, /V-09 fil-1�7 I I ti The Common wealth of Massachusetts ki ! Department of Industrial Accidents t. Office of Investigations 600 Washington Street ~ ! Boston, MA 02111 t ' www.murs gov/dia Workers' Compensation 1wiurance Affidavit: Builders/Contractors/Eleetricians/plambers nnlle2nt Tnfnre»afinw Name (Business/Organiza6on/Individuul); Address: City/State/Zip: Phone #: . Are you an employer? Check the appropriate box: 1-13 1 am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am: a.sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. _ ship and have no employees These sub -contractors have working for me .in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.) 3. ❑ 1 am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No•workers' comp. c..1.52, § 1(4), and we have no insurance required.) t employees. [No workers' COMP. insurance required..] +Any applicant that checks boO l must also fill out the section below showing their workers' Isom sat' Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other pen son Ful cy 1nrormanon. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that cheek this box mustatteched an additional sheet showing the name of the sub-connacto s and their workers' comp. policy information. t ant an employer that .is providbigworkers' compensation insurance for my. employees. Below is the poircy and job site information. Insurance Company Name: ' Policy # or Self --ins. Lie. #: Expiration Date: Sob Site Address: City/State/Zip: Attach a copy of the workers, comtpensation 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 a 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. 1 do hereby certify under the pains and penalties ojpedury .that the information provided above is true and correct. Si ature: Date: Phone #: Of j`tcial use only. Do not write in this area, to be completed by city or town officio[ City or Town: Permit/License # issuing Authority (circle one): L 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 apar-tments 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." MOL 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 certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to cant' 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 number listed below. Seim i£jsured companies should entertheir self-insurance- license number on the appropriateline. City or Town Officiais 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. Anew 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 Tbc Office of Investigations 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 Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or I-8.77-MASSAFE Revised 5-26-05 Fax # 617-727-7744 www.mass.gov/dia FOUR SEASONS ASSOCIATES, INC. ENGINEERING * DESIGN * CONSULTINEi 58 KINGSTON STREET, N. ANDOVER, MA 01845 TEL 978-6887445 April 24, 2008 To: Building Inspector, Town of No. Andover 27 Charles Street, No. Andover, Ma. 01845 From: Eduard_Shenker—P-E. �- 72_Russett Lanet, No. -Andover, Ma Owner: Red Cohen Dear Building Inspector, April 22, 2008 1 performed inspection of structural integrity of the existing one story wood frame addition to the existing two story dwelling. At the time of my inspection the above -referenced structure was at the conclusion stage of ruff construction. During my inspection I observed support of the one side of the addition attached to the existing two story dwelling. The four Versa -Lam 14"x1 W beams create header to provide 16'-8" opening and the two rows of 2x4 studs are supporting both sides of the header. On one side of support all 2x4 studs, in the row of supporting one story building, penetrated with 1 %2" W. pipe. The other side Jack studs do not provide sufficient support for header. The rafters on the other side of one story addition are notched with violation of 780 CMR One and Two Family Dwelling Code 7th Edition - 5802.7.1 Notches at the ends of the member shall not exceed % the depth of the member. The remaining wood structures are in good condition. Recommendations: 1. The pipe shall be disconnected and installed inside of the cabinets on the other side of the wall. The drilled existing Jack studs shall be replaced with new 2X4 studs. 2. The new additional two 2x8 Jack studs shall be installed in the place where not sufficient support is provided. 3. The new U24 Standard Simpson Strong -Tie Hangars, or similar, shall be installed to support each rafter. E If you have any questions, please feel free to call me. . "OFMgss9 Sincerely yours 47 EDUARD L °y S z SHENKER �y �„PkaAl- 0 CIVIL NO. 30984 �o e uard Shenker P.E. 9O,�FSC,�STO- �ats� our Seasons Associates s�dNAL E� t� Date. . 3 . TOWN OF 116RTH ANDOVER PERMIT FOR PLUMBING 03 C, P, /� , C - I r This certifies that .... J� ..... ...... has permission to perform : ................ plumbing in the buildings of :' ......................... at .......... North 'Andover, Mass. Fee. Lic. No.. v< � . ....... PLUMBING INSPECTOR Check ;/?Ij (Is r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date �� ff Building Location Z PfZ' !r�'1LP Owners Name Q a P ay Permit #7G�I6. p� II Amount Type of Occupancy KN,S i 11AA New Renovation Replacement Plans Submitted Yes 0 No 0 FIXTURES (Print or type) Check one: Certificate Installing Company Name Guake, i J`^-bti,-, PU Zky— Corp. 2 72- 7 Address .C-) Z Partner. a blas L Business Telephone - Firm/Co. Name of Licensed Plumber: ♦ IAylnelS U R, Insurance Coverage: Indicate th type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond a Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: Slgna umr e�i7ennsea r um er Type of Plumbing License Title City/Town ricense Mum er Master. Journeyman [APPROVED (OFFICE USE ONLY 1 11 li it � ------------------------- or-, =1i. -----...--�--------------■ (Print or type) Check one: Certificate Installing Company Name Guake, i J`^-bti,-, PU Zky— Corp. 2 72- 7 Address .C-) Z Partner. a blas L Business Telephone - Firm/Co. Name of Licensed Plumber: ♦ IAylnelS U R, Insurance Coverage: Indicate th type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond a Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: Slgna umr e�i7ennsea r um er Type of Plumbing License Title City/Town ricense Mum er Master. Journeyman [APPROVED (OFFICE USE ONLY 1 11 Date .. D.� This certifies that ...A. " . . �—. (. .................. • • • • • has permission to perform .....13. F. P ...... • • .......... • • • • plumbing in the buildings of ...GQ. .................... at ....� .�... V. SK.-�./ti• • • • • • , Ncortth Andover, Mass. Fee.ca.�,�.Lic. No..��. .It ..� P` MBING INSPE TOR Check .7 7044 TOWN OF NORTH ANDOVER is �. �, ...... • °� PERMIT OR PLUMBING � qs7 .O•,n° •'•`fig .s- SSwrUuS This certifies that ...A. " . . �—. (. .................. • • • • • has permission to perform .....13. F. P ...... • • .......... • • • • plumbing in the buildings of ...GQ. .................... at ....� .�... V. SK.-�./ti• • • • • • , Ncortth Andover, Mass. Fee.ca.�,�.Lic. No..��. .It ..� P` MBING INSPE TOR Check .7 7044 X MASSACHUSETTS UNIFORM APpUCATION FOR PER �o Pel MIT TO DO PLUMBING Mass. Date i' 1p� �//j� 20 Building Location P it # ner's Namo Now O Type of Occupancy Ren t Insta111n I I� g Company Name Address b COMPANY INC, 18 COVE AVENUE Check one; Certfllcale BEVERLY, mA 01915 ® Carloratlon 1990C Business Telephone .571-4900 ❑ Partnership Name of Ucensed Plumber AL BELL ❑ Flrm/Co, INgANCE COVERAGE: Have a Current Ilabp Yes ® tty No Once policy or hs substantial oqulvalent which meets the requirements It you have checked, hecked yam Of MGL Cn, I,2 A Ilab[i ty Insurance palsy, Please Indicate the typo coyerago by checking tho•approprtato'bOX Other typo of Indemnity C] OWNER'S INSURANCE WAIVER: I am aware d gond Chaplet 142 of the Mass, General Laws, and that that the licensee signature m g S- nt Kaye the Insurance coverage requires On thls permit application watyes this req v!remeni T'' '''I of Owner or Check one; Her s ent Owner ❑ Agent i Hereby certify that all of the details and Info g ❑ knowledge and that all plumbin rmaUon I have submitted (or red pertinent provisions of the M 9 work and tate lu Qn4 performed un Ye Q( n ue true and accurate to the Desi c! T. assachusells State Plumbing Code �e issued for By apt 4 o the Oe UQ true a In compliance Wun a: W roue gna we o ce um arY/Town Type of Ucensa; Master ]Journe SPP I ynw Ucense Number 9033 ,ova On O Replacement OPlans S ubmftted; Yes ' O FIXTURES No O ", o z7�/T z V V O ° .d Z N N W J < N N ¢ W •� x = C7 > ¢ N Q V= W ac m v► W x < cc W w < vJcc O < V < < 3 x 1 W !- x V Y .< x x = q X W St J p Cz 0: G y y J X _ z Q 4 W Q W u, X J m N O O J 3 x < J J < a < W y. O V z SUB-83MT. V < 3¢ m O 8A39MENT IST FLOOR 2HD FLOOR �ROFLOOR 4TH FLOOR STH FLOOR 0TH FLOOR 7TH FLOOR 8TH Fi00R Insta111n I I� g Company Name Address b COMPANY INC, 18 COVE AVENUE Check one; Certfllcale BEVERLY, mA 01915 ® Carloratlon 1990C Business Telephone .571-4900 ❑ Partnership Name of Ucensed Plumber AL BELL ❑ Flrm/Co, INgANCE COVERAGE: Have a Current Ilabp Yes ® tty No Once policy or hs substantial oqulvalent which meets the requirements It you have checked, hecked yam Of MGL Cn, I,2 A Ilab[i ty Insurance palsy, Please Indicate the typo coyerago by checking tho•approprtato'bOX Other typo of Indemnity C] OWNER'S INSURANCE WAIVER: I am aware d gond Chaplet 142 of the Mass, General Laws, and that that the licensee signature m g S- nt Kaye the Insurance coverage requires On thls permit application watyes this req v!remeni T'' '''I of Owner or Check one; Her s ent Owner ❑ Agent i Hereby certify that all of the details and Info g ❑ knowledge and that all plumbin rmaUon I have submitted (or red pertinent provisions of the M 9 work and tate lu Qn4 performed un Ye Q( n ue true and accurate to the Desi c! T. assachusells State Plumbing Code �e issued for By apt 4 o the Oe UQ true a In compliance Wun a: W roue gna we o ce um arY/Town Type of Ucensa; Master ]Journe SPP I ynw Ucense Number 9033 z 05 m n 0 r O ra -C o > > _ -4 m z ,°� c 'Ot1 O v c z = m C � 9 Q ; Z O v O IV r c ao z Q i c 3 0 Date .....J..` ./ //��.. N , .... .......... 0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING r d e f+( L� (,c +a t t -- This certifies that U. �` .............................................................. ............................. has permission to perform �- k..) .... ........:...... (PUf� wiring in the building of .......... c...1(..�:...................................... at ........ 4......... .``.55..0..0.....i'"�%................... North Andover;W s. Af Fee.... Lic. No... LEc r'Ric;11INSPECTOR 10/15/99 13:46 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer e �ommonLvec�il�t v� ,-lua,�c�,ru��L� r.ra;r �� r _ F l� N REGULAMONS S27 CMA 1Z-03 3/90 APPLICP.I ION FOR* PERMITTO O PERFORM ELEC71-RICAL WORK /.11 .writ to be p`isrmcd In icc=rdsncc tic H`Ac_iuscns ��cc:icsl C,04c. 527 C.t{n 12-00 =70 Date /�— City 0= To Of A%+ /�/V ��(%OL'�� io the ?-_-vett:.-. a -- he : e elect='_�iyl��o;k dcsc=ib-_d ✓lc�+.' Location (St=CtC b ?n:=b'er) riss �T_ / 7` �PARCEL Ld O%.nerrs Add=css S�7LiL Is Cris per=, eon;u:.et:o : :grease c= 4;v Se =^ cr— / Yts �'%o ❑ (Check koo=cor=::_ ax) Qfer`_tad ❑ Und..=d C! lic. C_ 4�b== c_ =et• e=-5 and 1_�aei=� Locatic : and o: ?=opcscd----t---''- S or�C i.�%/ %� �' j4)6- Cllyij,� ��Z i :�o.�a_ L:ghc_-3 Ctclets No . a! Lighc_-:g No.ro_ Rectotaclt Ct:tlecs No. o_ S�::c` Qatlets No. o°-:r.sts No. o_ Disposals No. of Dish =skiers No. o_ D:-yc=s No. o: Sate= dear_=s r" FC,j ?yd=o t'-Ssase Tubs C'"_._. Above g=::d. C g-- ❑ CX Oil �u—ers I\o_ C_ Gas ISc_ c. Ai= C="d `o- o= ? _-mss -ens Spaet/.eta reac'_ag .eat:n .. lV�Ces notal S `a, K" C: I`to, of no. o: SiY-s 3allasts Iy vett=s =cC:l -o. o. Gz1e=::o-s 3atte=Y d- cf I d L sayY __z `NC., o: SCcad'=g .reviccs 40. o: Seii° Cant:i-e= Detect`_o: /Sov.d�.g :rvices 1 Local [► C--nr.e p__ l-❑�G e= Il.ov Yoltavt ui-, n2 I o: r rlr - .._-- - 'ice inc__dr•:3 G--c__Ced C1c=atioas Cc•:c_:3t or r- s::'_s:_..t_ _ Z kava a e_==eac -y - cy -., r rr_. r -'h: S'o f-1 ti.Ya^S•� _� __ed Va�1 '�::0: C:I S:_L ... . s CS ecuyou have checked �=, please :he cyst e_` cove_z;t by check'_:; the TNScr�l.`IC= l� 3CN� � C � I I (? __sse cpeci';•} � _ �/ ^ 7I�d �/ -SC—ted Value a- :lectrical i;o-k 5 Stork to Start _ns_eetion Dart _Requested: ?.ough U) J LL - C-4 - - Zl. Stg:ted under the pc: -aloes o° ie= iu=y: � L' - �`Z�cEf/aRD w, C��'Ul�AL_T � S1& -•.a:_ -e ( �j, _ L C .`.a. ,ce^see No. % a C/�EUL1SFoR� ii4 a r�=6 3 ams_ iel Address Kl f3� b b�2 /U• Alt. =el. No. GS.: "�' S L'iS�r�AX=_ S:AI Z :�_re that the Ltctnsee dxs nor- have the i =r=aree cover:.._ e: Its s-o- scanCial equivalenC as required by hmssachuscC--s General and C.%&t ay s=s•-1-,-re on th!s ?C =1= applic.zCioq waives this requi=_ent. Owner Ase nt (?lease check one) ( Sele?hone No. - Signar-ure of owner or Agenc) LocationO? No. .5 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ SA -1 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i 17 Check # 300 3624 Building Inspector v � z V) L :J W z N Z v J u 3 x x = C - (J J - _ � Q L G Ch z "X r'+ f_1 - O r— z C � 2 U � � z IL W <`7 - Ln _ N n z � z :J W G - N Z v J Z . L e u 3 x x = - (J J - NJ Q I 'k 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, j7t��1�c �� S _ `i--� v R-�.a \� 2 PHONE +S•?095S LOCATION:' Assess&s Mac Number I PARCEL' 6 sueDlvlsloN �- LOT psi 'STREET /3 NJ s f el!77, �, rF-���L ST. NUMBER OFFICIAL USE ONLY I C k"3 i�00/��� RECOMMENDA 110NS OF TOWN AGENTS: _ 148"V38' 1N real CONSERVATION ADMINISTRATOR DATE APPROVED [r?zo cq DATE -REJECTED COMMENTS r TOWN PLANNER COMMENTS d0CTOR-HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE E REJECTED DATE APPROVED DATE REJECTED PUSL1C WORKS - SEWERWA T ER CONNECTIONS DRJVEWAY PERMIT FIRE DEPARTMENT 1 RECEiVEJ EY EUILDING INSPECTOR DATE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print C,- Name: Location: City IN(y ti� �� ��o <<� rhe _ Phone 'c� 9 - (p 3 - 0 gJ� am a homeowner performing all work myself. 01 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 name: Address City: Phone #• Insurance Co. Policy # Company name: Address City: 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 ($100.00) 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. 1 do herby certify Signature_ the paigs and penalties pf perjury that the information provided above is true and correct. �nt name__ /oif %121, e- -, ,;) fi �_ �,�, ,��� Phone #. Official use only do not write in this area to be completed'by city or town official' ❑Check if immediate response is required Building Dept Contact oerson: ok,.,... 1 (V;Ld q-9 ❑ Building Dept ❑ Lincensing Board ❑ Selectman's Office ❑ Health Department 7 Other O FMM4 0 z A O� �¢ w d m c � O u° v V) GL C4 O z A 7 w .0 U G w 0� O w°' co w P4 O w U W rLw7 ' is z ¢ 0 a w w A w Vn O cn E CL N 0 N C a> m Q1 m 0 cm c 'c 0 CD L O Z O C .s m U6 0 . -�C) V CO O CD C: O O D y .E O Cl O C O CD m CL y O H C O •C _cc Q. CO) LLJ 0 Cn LLJ Cc W w Ir c o c ' c h vU ; a• c • ev cv m c � : O R LN w E< I Co L V .. fj: .� o a a+ N C E — o = 2 o m c L N c-": m� O L •: L � C n ev m "'o �-�2.0 �T C, c Q N CD >Z ev M 2 coao ts Qm .�;mc Wui •N C r O � G.L O c� 0 m O -0 Q, CSW.) �CL � c ILI) CALCL y O D F— t O. �_.. CID E CL N 0 N C a> m Q1 m 0 cm c 'c 0 CD L O Z O C .s m U6 0 . -�C) V CO O CD C: O O D y .E O Cl O C O CD m CL y O H C O •C _cc Q. CO) LLJ 0 Cn LLJ Cc W w Ir V I 0 0 y O y 19 I raw � I 111 /Pt, I 73.9' o, Vrj 11� to '4�' ' O c 24' O . NCO O V I 0 0 y O y 19 I raw � I 111 /Pt, I 73.9' o, Vrj 11� to '4�' ' c 24' O"'yin o� Location�A tot` +� �t ► Date MORTq TOWN OF NORTH ANDOVER +oa Certificate of Occupancy $ Building/Frame Permit Fee $ ;�s',^••''<�' JAC MUst Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ { TOTAL $ Building Inspector I Div. Public Works ,Location • �^ No. - Date TOWN OF NORTH ANDOVER o?.:., ''•°off A Certificate of Occupancy $ + ; Building/Frame Permit Fee $ �'�S''••° ESQ' Foundation Permit Fee $ SAC Mus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL � $ � 11:37 fi5. d0 PAID 'Building Inspector Div. 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ZONING BOARD OFAPPEAL S DATE OF F/L /NG . OQTE OF HEAR/NG: DATE OF APPROVAL.• PLAN OF LAND /N NORTH ANDOVER, MA. e BOXFORD, MA. PREPARED FOR OWNER e APPLICANT: PAIR/C/A S. FERNANDEZ 0 MLE 5TPEET WING I/ELLING \ '0.' 58 �\ ._Mo. BUTLER RUSSET JUNN E MARIANN MUCC1 CDEVELOPED WAYS LANE U. -POLE N 29° 46' 5� --EDGE OF PAVEMI T� \p �c o� ^ a MAP 104 f h PARCEL 6 44, 185 f S. F. '0.0Q' — 1 \ � EX40; X/5T/NG. WELL ING\\� PROPOSED I6,x It 06' ADDITION BOXFORD MAP /2 LOT 7 60.00' _ 5 33046'00'E .a— i1 APPROXLOC'�II SEPTI 5Y5TEM ` _l 110.60 5 39,26/00"E 0� nNo 1 6p EX, Dip . N MP JOHN 4 R0: PARLOCK 60 aweN jauM a}eQ :)(jadojd - anoge-agl jo jauMo aqj se ilwjad a jol Aldde Agaiay I `aol}ou anoge aqj 6ulpue}sujlnnl0N '2Jo 'ON u0llejisl6a8 aweN j0}0ejlu03 ale(] :jauMo ay; jo jua6e aqj se Ilwjad a joj Aldde Agajay I knfjed }o sallleuad japun pau6!S W17L '0lJA 83Nn (INid AiNb'6vns 8o m8eo8d N011V8ilgiJV 8Hl Ol SS800V 3AVH lON Oa )iaOM 1N3VY3 2 dA1 dAOH 818VOI�ddd 2JOd S80iOVLNOO a8681SI93bMn HlIM JNIIt/8a 60 ilM3d NMO H18H1 JNnind SH3NMO a}ea ON Ilwad Alu0 ash aoigo aoi 0094 SOD ISS :}eql U@Alb Aqajaq Sl a040N (Apoads) aaul0 Ilwjad uMo bulllnd jaunn0 paidn000-aaumo jou 6uippq 000` �$ aapun qor noel Aq papnloxe �joM 114 (s)uoseaa bulMollol au} aol paainbaa jou sl uol!lealsibeH :legl /gpao Agaaaq I uoljeollddy Ilwaad Jo aleQ C'M cyAt�s 'S' :aweN J@UMO c" -d �.355��I -74 �JOAA 10 ssaappd �joM jo ads i -s}uawailnbei jay;o 411M 6uole 'uolldeoxe uleliao ullM 'sjopeiluoo paja}.sl6aj Aq auop aq „6ulpllnq jo aouaplsaj yons o} lueoefpe aje goigm sainlonjis of jo... silun bu11laMp jnol uegj ajow jou Inq auo Iseal le bululeluoo 6ulpllnq paldn000 iauMo bul;slxe-aid Aue of uol;lppe ue jo uol}oni}suoo jo 'uogllowap 'Ienowaj 'luawanojdwl 'uolsjanuoo `uollezluiapow 'jledej 'uollenouai 'uoijejalle 'uollonj;suooaj„ aqj 1eu3 sajlnbei y Zy[ •o I0A uol}eollddy }lwjad of }uawalddnS Me- joloejluoo luawanojdwl awoH IIAVa1=1:]`d NaAOaNV HIMON d0 NMOl �O E_ This Is to certify that twenty (2C; do have elapsed from date of decision id --d uiLhout filing =�— U9. Joyce A. 81fideaw Tcwn Clerk Any appeal shall be filed within (201 days after the date of filing of this Notice in the Office of the Town Clerk. TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS RE JOYCE 2R.40:ii'�w TOWN CL.r-r.<< NORTH ANOO`, ER GFR ZZ I 1 14 AH ' �b NOTICE OF DECISION Property: 72 Russett Lane, North Andover, MA NAME: Patricia S. Fernandez DATE: 4/21/98 ADDRESS: 72 Russett Lane PETITION: 009-98 North Andover, MA 01845 HEARING: 4113/98 ATTEST: A True Copy 4. 7bivn Clerk The Board of Appeals held a regular meeting on Tuesday evening, April 14, 1998 upon the application of Patricia S. Femandez, 72 Russett Lane, North Andover, MA, in the R-1 Zoning District, requesting a Variance from the requirements of Section 7, Paragraph 7.2 & 7.3 for relief of street frontage, and relief of a side setback for an addition of a library and storage area, and for a Special Permit from the requirements of Section 9, Paragraph 9.1 & 9.2 for an extension of a structure on a non -conforming lot. The following members were present: Walter F. Soule, Raymond Vivenzio, Ellen McIntyre, Scott Karpinski, George Earley. The hearing was advertised in the Lawrence Tribune on 3/31/98 & 4/7/98 and all abutters were notified by regular mail. 500. sate^ a me r 'JU r, Z_ ate Upon a motion made by Scott Karpinski, and seconded by Raymond Vivenzio, the Board of Appeals voted to GRANT a Variance requested from the requirements of Section 7, Paragraph 7.2 & 7.3 for relief of 25' street frontage, and side setback of 3', and to GRANT a Special Permit as requested to add an addition of a library and storage area, to an existing non -conforming lot. Voting in favor: Walter F. Soule, Raymond Vivenzio, Robert Ford, Ellen McIntyre, Scott Karpinski and George Earley. The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local, state and federal and building codes and regulations, prior to the issuance of a building permit as requested by the Building Commission. ml/decoct/4 BOARD OF APPEALS Ar�`�� Walter F. Soule, acting Chairman L ESSEX NORTH REGISTRY F DEE S LAWRENCE, MASS. A TRUE COPY: ATTEST: Mlod %4EGISTER OF DEkV i' � ''?„V vm�/ 3 L sS"' E W- 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�/�/ LOCATION: Assessor's Map Number. SUBDIVISION STREETPl %2✓SST r7 44-. Z, PHONE PARCEL LOT (S) ST. NUMBER � ******"*****OFFICIAL USE ONLY*********************************** COMME )ATIONS OF T07N AGENTS: - ENATION ADMINITRATOit DATE APPROVED/�� DATE, REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED fr j COMMENTS FOOD INSPECTOR -HEALTH INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED_ PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT ft FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE UL II qtOI^ t O L l - - - - - - - --- - l 1 1 I 1 I t I I 1 I I 1 I 1 I 1 1 1 I I 1 I 1 I 1 1 1 1 I 1 1 1 1 1 t I I I I I I 1 1 I 1 1 I 1 I I 1 1 1 1 I I 1 I 1 1 1 I 1 1 1 1 1 I 1 I 1 1 I 1 1 1 1 I L _ J LO ; 1 iiT W fJ i ' D 3 -+ Fi-mr n _i T71 s 3� n °gym ch - lob n c 70 = C +n '_' V � �' c _ cn 3 IS �(O qcq++ Z W Q a per, W QF [Ln (p a c E 's -+r eft \i 00 T f (o (D lbii n �= O ^ CA w � m ce Cb ' -0 q!- �o 26 n G s � c < Cks 9 Q, Ch RL T11 n° p < n e d (b RL 0-0 !T :3 0 r= :I- Cb — (S < (D (b I- Lr- CP o. 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