HomeMy WebLinkAboutMiscellaneous - 72 STERLING LANE 4/30/2018Date..`. `.: Z/Z ........
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TOWN OF NORTH ANDOVER
• - PERMIT FOR GAS INSTALLATION
This certifies that...
has permission for gas installation
in the buildings of ......................
at ...f. �2.. fir!' � ..4r� ...... , No:t%onover,, Mass.
Fee. ` OU. Lic. No. z,G!'�3, �%c,kf ....... .
GAS INSPECTOR
Check # /%-0 7
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town:_ N h�jc"I' __,MA.
Date• 0309b0l'4- Permit#
Building Location: -10 1 ��
��Q.
Owners Name: �1
Type of Occupancy: Commercial ❑
Educational ❑ Industrial ❑ Institutional ❑ ResidentialK
New Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No (x
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142YeNo El
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. // ll
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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this aaolication are true
- - - - -
11'y 1V1JV"'Wuyc 411U {11ar du PIUMU ng worK ana installations performed under the permit issued for this application will be in
compliance with all Pert!�pnt provision of the Massachusetts State Plumb Code and Chapter 142 ofthe General Laws.
By �,y /// /,/ v/5' Z_ Type of License: el
-
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Title M�GasMttrer Sign ture of Lice ed Plumber/Gas Fitter Z��/
❑ Master
Citylrown A40urneyman License Number:����
APPROVED OFFICE USE ONLYI El LP Installer
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Installing Company Name:
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Check One Only Certificate #
Address: %4i
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City/Town:
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State: VIN
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Business Tel:
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Fax:
Name of Licensed Plumber/Gas
Firm/Company
Fitter:C�
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142YeNo El
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. // ll
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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this aaolication are true
- - - - -
11'y 1V1JV"'Wuyc 411U {11ar du PIUMU ng worK ana installations performed under the permit issued for this application will be in
compliance with all Pert!�pnt provision of the Massachusetts State Plumb Code and Chapter 142 ofthe General Laws.
By �,y /// /,/ v/5' Z_ Type of License: el
-
�/ �� �(�'-—lueYA114
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Title M�GasMttrer Sign ture of Lice ed Plumber/Gas Fitter Z��/
❑ Master
Citylrown A40urneyman License Number:����
APPROVED OFFICE USE ONLYI El LP Installer
ALN\ The Commonwealth of Massachusetts
Department of findush iall4ccidents
Office of Investigations
..600 Washington Street
Boston, MA 02111
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Workers' Compensation Insurance Affidavit: Builders/C
Onlir-ant Tnfnrmo+; ." ontractors/Electricians/Plumbers
Name
- Address:
M
City/State/Zip; _�OC )tV _ V4 %0n�0:
Are you an employer? Check the appropriate boa:
L ❑ I am a employer with
4. ❑ I am it general contractor and I
(full and/or part-time).*'
have hired the sub -contractors
2Aemployees
I am a sole proprietor or partner-
// ``ship
listed on the attached sheet. t
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. ❑ am a homeowner doing
officers have exercised their
.I all work
right of exemption per MGL
Myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
*Amy applicant that checks box 41 mus[ also fill out the section bekow ! Axa
T
Type of project (required): •
6. ❑ New construction
7. ElRemodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
111$Vumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
13ome that
who submit this affidavit indicating they are doing all work and then hire outside Contractors musubmey it mo a new affidavit indicating such.
'Contractors
tors that check this box must attached as additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation
information. insurance far my employees Below is the policy and job site
Insurance Company
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 ofMGL 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 tk� U for insurance coverage verification.
I do hereby
- _//8 --G2,8 v
ofperju131 tha, i*e information provided above is
Official 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):
L Board of Health 2. Building Department 3. City/Town Clerk
6. Other
Contact Person:
3/G
correct
n
4. Electrical Inspector 5. Plumbing Inspector
— 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 6r implied, oral or written."
An employer is defined as "'an individual, partnership, association, corporation or other legal entity, or any two or more
of -the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer; or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than -three apartments and who resides therein, or the occupant of the .
dwelling -house -of another -who -employs persons.to_do_maintenance,..construction or -repair -work -on -such dwelling -house -- --- - ---
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 coinpliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub=contractors) name(s), address(es) and phone number(s) along with their 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 rat'urued to the city or tow that. the �p p uC� s t <n fGr the peix:3i� o: 1'S^?LSr is b. -kg requos"- ., not the Dopart—r-rg t of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' -
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be -used as a reference -number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a 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 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
60:0 Wastington Street
Boston., MA 02111
Tel. # 617-727-4900 ext 406 or 1-8.77 MASSAEE
Fax # 6.17.727-7749
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Date................................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
v
This certifies that ......b.L
............................................ .................
has permission to perform .... ...........
. ............ .....c-z�...................
�0.�
wiring
7 in`the building of........................................�...................................
.�/� L- North Andove Mass.
t........................................... .................... .
Fee .... T. �' .......... Lic. No. a. D 5y 6o ................. r........
e ELECTRICAL INSPCTOR
Check #
10715
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Permit No.. -71 �-
p=W end Fm ChOcAmd
BOARD OF FIRE PREVENTION REGULATIONS . tro7} bW*
APPLICATION FOR PERMIT TO PERFORM[ ELECTRICAL WORK
au wot as boa is •f& dW MW= W cm 17-00
(PIWIRP)MMrNx oR rPP��Ir, nvFoRm7r0t0 Dares : 2/Z�J1Z
(Sty or Town of:. No r-� Mrd vwer To rlte &Wador of WS,
By Itis mon the =Wa=Vwd 8yw notice polona the ekcWW wV& dscribcd below
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:oma o� Tar><nt C��Qh n copy °-
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Is this pwmk is c "a m cdon wn a
permit? Yes ❑ No ❑ (Check Apprepriate Boz)
Purpose of Building ,- th►abccad ❑
Overread ❑
Utility Audwhm6m No.
Edsiog Service Amps _ / _vow
Sarioe Amps / Yolts
Number of Feeders and Ampsdty -
Ua�gmd ❑ No. of Meters
Uadgrd ❑ ?(*.of Meters
_s,_ _-_.,.. •J,. dm._ LceffiftmrdWirs
if o. of Recessed Lunfasires
No. of Cei480sp. (Paddle) Fars
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INA
Generators
No. of Luminaire Outlets
No. of Hot'nffis
•
eft. of I�
Surl�g Poul ❑ ❑
Units
No.of Roceptade Outlet:
No. of On Bursas.
ALARMS
o. of Tioaa
No. of Sebes
No. of Gas Burners
o. and
No. of Ranges
W of Air Coad. TOM TOM
of Akrftg Devices
No. of Waste Dlspomrs
Torsi:: Beat ora
9t:�ioes
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Na of or
No: of DMWashw
Soac4Acea Nexftg 1CW
Na of Dryers,
Heaft.Appdanca 1CW
o.Of Water -KW
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Data wkftv
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No. of Motors Total WrNoL
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W«t to Star± ?,1, 1_Z 1.topectiom to be sewm1ed in am=ftm with bM Ruk 10. and upon COUVWOM
Lx WRANC&COVERAM a waived by the owacr, no permit for dee pe fmonoce of dccUN l tray ince udm
the limsee pmvxi s p =f of Ii*9ay- insa mnee =*Ang"wopleted opctaa W or ds tint equivateet. 'iSe
asadasignai certifies that sues oavenw- is is ftce,; pad bas achbited proof of stmme ro the permit itsoing ofiioc.
CHECK ONE: INSURANCE BOND ❑ OTHM ❑ ft=W-)
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OWNW-S VMRANCE WAIVER: I am aware drat the Ucco0w cdow sot 1xWC the Iiab - ins mmr P: coverage uornIONY
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Town of North Andover, Massachusetts
ROARD OF HFAI TH
Form No. 2
DESIGN APPROVAL FOR
SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM
Applicant-... A -Z r— Test No.
Site Location < e,
Reference Plans and Spec
11
ENGINEER `� DESIGN DATE
Permission is granted for an individual soil absorption sewage disposal system to be installed
in accordance with regulations of Board of Health.
Fee
CHAIRMAN, BOARD OF HEALTH
Site System Permit No. /
CERTIFICATE OF USE & OCCUPANCY
Towyn of North Andover
Building Permit Number Date oZ
THIS CERTIFIES THAT
THE BUILDING LOCATED ON �� y 922�-
MAY BE OCCUPIED AS S //V �j JE77A7742/ X, ��� / �'U `l IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
�pO in, 3 j3. ��i� o? Sia// o vdef—
CERTIFICATE ,ISSUED TO ro o )l c) y 6,V ��, L o "/0
ADDRESS �%� 04 ���� rZ LS
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''�CHUS Building Inspector
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3365 Date . /I `..' �G....... .
P NORTH TOWN OF NORTH ANDOVER
6.
` � PERMIT FOR GAS INSTALLATION
F
This certifies that ../�?. .ti .' "�,l" ...........
I has permission for gas installation ..., . ` <.�,—,-^..........
in the buildings of . ( -A ..........................
at ... 7 ............... Iv
North Andover, Mass.
Fee.7. U .... Lic. No... / U.r/ ) ....�,..L 1. rt ..�,.-..... .
`GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNWORM APPLICATON FOR PERMIT TO DOG -FiTTIl G
Type or print) Da f �7 `6V 19
NORTH ANDOVER, MASSACHUSETTS
Building Locations �� I L likIll Permit # 334) --
Amount 34)/Amount S
Owner's Name�F
New Renovation ❑ Replacement ❑ Plans Submitted ❑
J
;Print or type)� 9 /t /pNt� Check one: Certificate Installing Company
Name / (� C� // / Corp.
F
4ddress D 7 14-1
` artner.
3usiness Telephone C/ 1-7q �fl, 79—./Gf /7 r Firm/Co.
\lame of Licensed Plumber or Gas Fitter{
NSURANCE COVERAGE' ' . Check one:
have a current liabihity.lnsurance policy;o'it's" substanttai'equivalpnt. Yes ❑ No
f you have checked ves; please indicate the type coverage by checking the appropriate box.
_iabiliry insurance policy❑ Other type of indemnity ❑ Bond ❑
Dwner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
vlass. General Laws, and that my signature on this permit application waives this requirement.
signature of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
)est of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
:ompliance with all pertinent provisions of the Massac�,4setts Yt+'i'te Gs C,,e)and Chapter 142 of the General Laws.
By:
Tide
try/Town
APPROVED WFr!C1: usE ()NI.Y)
❑ Pignature of Licensed Plumber Or Gas Fitter
lumber - 67/-7
❑ Gas Fitter!VL erase INumber
ff4i'laster
❑ Journeyman
1
;Print or type)� 9 /t /pNt� Check one: Certificate Installing Company
Name / (� C� // / Corp.
F
4ddress D 7 14-1
` artner.
3usiness Telephone C/ 1-7q �fl, 79—./Gf /7 r Firm/Co.
\lame of Licensed Plumber or Gas Fitter{
NSURANCE COVERAGE' ' . Check one:
have a current liabihity.lnsurance policy;o'it's" substanttai'equivalpnt. Yes ❑ No
f you have checked ves; please indicate the type coverage by checking the appropriate box.
_iabiliry insurance policy❑ Other type of indemnity ❑ Bond ❑
Dwner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
vlass. General Laws, and that my signature on this permit application waives this requirement.
signature of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the
)est of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
:ompliance with all pertinent provisions of the Massac�,4setts Yt+'i'te Gs C,,e)and Chapter 142 of the General Laws.
By:
Tide
try/Town
APPROVED WFr!C1: usE ()NI.Y)
❑ Pignature of Licensed Plumber Or Gas Fitter
lumber - 67/-7
❑ Gas Fitter!VL erase INumber
ff4i'laster
❑ Journeyman
I
N2 2656
� Ir,
Date................ ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that Z�L ..........................
............
has permission toperforms"
,--C-1'Z) ..................................................
*.*....A',.-.-.-., ...................................................
wiring in the building 2 ...................
at J.; ................... . North-A-h-dover, Mass.
Fee `�Lic. NX.�r�-IeC
...... ......
.. ..............
Check #:7�52y/
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Service
c7t ht Cgommonwtaltll of Mus$a r4usetts
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Final
Office Use Only
Permit No. C7
Occupancy 6 Fee Checked
3/90 Ikave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 /� +
(PLEASE PRINT IN INK OR TYPE ALL INFORfy/,1TION) Date ''��/
City or Town of / f / /
The undersigned- applies for a permit to perform the
Location (Street & Number) fav y
Owner or Tenant
described below.
A
To the Inspector of Wires)
Is this permit in conjunctions with a building permit: Yes LJ No LJ (Check Appropriate Box)
Purpose of Building 1 p�-��' ,��' Utility Authorization No. ! i D 7/ q(+�
Existing Service Amps / Volts Overhead ❑ Undgrd 11 No. of Meters
New Service Amps /JQ / - Volts Overhead ❑ Undgrd lJ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insura Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO 0 1 have submitted valid proof
of same to this office. YES tT NO U
If you have checked Yplalease indicate the type of coverage by cher 'ng th appropr'ate bq�
INSURANCE BOND OTHER❑(Please Specify)
(Epiration Date)
Estimated Value of Electrical Workk$
�/f U
Work to Start o Inspection Date Requested:
Signed under the penalties of —Lz" perjury:
FIRM NAME � C e)CIfA1,0'16— C(6C• ,.00
Final
LIC. NO. /4 Q 7 Q
Licensee t ature — `— ��—` LIC. NO.
Address` e`'r R` ' c , Bus. Tel. No.����d�
AIL Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE $
rGnnnrura of Owner nr Acent)
TOTAL
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers KVA
Above In,
❑ ❑
No. of Lighting Fixtures A
Swimming Pool grnd. grnd.
Generators KVA
No. o Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets t
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
lotal
No. of Ranges
No. of Air Conditioners Tons
Initiating Devices
of Sounding Devices.
Heat Total TotalNo.
No. of Disposals
No. of Pumps Tons KW
No. of Self Contained
Detection/Sounding Devices
N . of Dishwashers
5 acelArea Heating KW
Municipal
❑Other
Local❑. Connection
Iof Dryers
Heating Devices KW
No. of No. Of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws
I have a current Liability Insura Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO 0 1 have submitted valid proof
of same to this office. YES tT NO U
If you have checked Yplalease indicate the type of coverage by cher 'ng th appropr'ate bq�
INSURANCE BOND OTHER❑(Please Specify)
(Epiration Date)
Estimated Value of Electrical Workk$
�/f U
Work to Start o Inspection Date Requested:
Signed under the penalties of —Lz" perjury:
FIRM NAME � C e)CIfA1,0'16— C(6C• ,.00
Final
LIC. NO. /4 Q 7 Q
Licensee t ature — `— ��—` LIC. NO.
Address` e`'r R` ' c , Bus. Tel. No.����d�
AIL Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts
General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE $
rGnnnrura of Owner nr Acent)
�y
I �4�r
p • �U aa
i V 1�
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t
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o
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it
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r 4
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'did./- -� ..�. w,= e•e'\ 1� �..
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�-wf� ` "� l� � � k' ^' ,:'. VVI ✓/-S�'Si'r/,w/� l,.!_}-
Date /.-'.Y _ C U
N2 4619
0" TOWN OF NORTH ANDOVER
°oma
p PERMIT FOR PLUMBING
This certifies that ... `✓p,...C� ...4.0"�%l " j . •- ........ • •
has permission to perform ..... .............
plumbing in the buildings of ... Lt. S.-r..�G''` 4
at.49...r�� '% Z S��st << " , North Andover, Mass.
.........
Fee P. '.r . Lic. No... ! v 91.E
(/k;.... .. . ........
PLUMBING INSP &TOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PER TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date
Building Location �r/ �7 � ��`�''Ly` " Own Name //� Permit # e �7
Amount ?
Type of Occupancy S/��� }���/� y
New �✓ / Renovation Replacement ri Plans Submitted Yes No El
(Print or type)
Installing Company Name (.� / ►� //
Address lee) kk 751 d W tU j /M
Check one:
Corp.
Partner.
Business TelephoneX3'7 - % y 5 -1 11 Firm/Co.
Name of.Licensed Plumber. 111ja�f � i�7 0 0 ue"
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy F] Other type of indemnity 11
Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance k
Signature Owner 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
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 MateP umbin . Code and Chapter 142 of the General Laws.
BY Signature icens
Type of Plumbing License
Title '/.)2/-
City/Town icense 7 um er Master Journeyman ❑
APPROVED (OFFICE USE ONLY
I
_
MIM -33 Bel
(Print or type)
Installing Company Name (.� / ►� //
Address lee) kk 751 d W tU j /M
Check one:
Corp.
Partner.
Business TelephoneX3'7 - % y 5 -1 11 Firm/Co.
Name of.Licensed Plumber. 111ja�f � i�7 0 0 ue"
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy F] Other type of indemnity 11
Bond ❑
Certificate
Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance k
Signature Owner 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
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 MateP umbin . Code and Chapter 142 of the General Laws.
BY Signature icens
Type of Plumbing License
Title '/.)2/-
City/Town icense 7 um er Master Journeyman ❑
APPROVED (OFFICE USE ONLY
Location
No. ,-317 (/ Date 4e;
�ORTM TOWN OF NORTH ANDOVER
Of"•O '•,�O
r � • OL
n eel
' Certificate of Occupancy $—
Building/Frame /Frame Permit Fee $
s�cMust 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL
r
Check #
w
13 r, 46 .Buildingb4ector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
L,221w
BUILDING PERMIT NUMBER: DATE ISSUED:
C
c4A,,,�
SIGNATURE: zV
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
SOT
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
-�X,?33-
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.GLC.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone 0
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) for Service :
p //Address
Signature Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.11 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Construction Supervisor:
License Number
,S'TCCT
Ad ss
Expiration Date
9W -6k7 -,!11Q zb'
atu a Telephone
3.2 Registered Home Improvement Contractor
s
Not Applicable ❑
����j� j 7
Company Name
.0 _ /
Registration Number
Address
Expiration Date
Si ature Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the bu41ng permit.
Signed affidavit Attached Yes ....... V No ....... ❑
SECTION 5 Descripjion of Proposed Work check all applicable)
New Construction 9
Existing Building ❑
Repair(s) ❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
,O ICIAL USE:ONLY
� �
1. Building
(a) ding Permit Fee
MultiplierG
2 Electrical
(b) Estimated Total Cost of
Construction
r7 '�
3 Plumbing
Building Permit fee (a) x (b)
a
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 Owner Date
SECTION 7b OWNER(AUTHORIZED NT DECLARATION
Ow%ner/AAutthorized Agent of subject
property G 'tet Ld _r"iiiie—iiiiiii—
Hereby declare that the statements. and informatZhonVeforegoing pplication are true and accurate, to the best of my knowledge
and belief
Print Name
Signature of Owner/Agent Date
:I lliIIIIIIiII111i 41
NO. OF STORIES SIZE Q'0
BASEMENT OR SLAB �Q/� S�/''lC;P✓ %
SIZE OF FLOOR TIMBERS 1 � x /O 2ND 02 kio 3 X�
SPAN 14-1
DBAENSIONS OF SILLS x (o
DIMENSIONS OF POSTS Lac c, y
DM ENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS /li
SIZE OF FOOTING / 'X oZ X
MATERIAL OF CHIMNEY —
IS BUILDING ON SOLID OR FILLED LAND —26L/0
IS BUILDING CONNECTED TO NATURAL GAS LINE )
I'
The Commonwealth of Massachusetts
Department of lndustrial._Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name' �O()L/�/'�
A)
Name:
Location' �/D/ �/I/o6i/E2
Cit / /Vf1�%/i�//I/,C]O1/�� Phcre
E]
I am a homeowner pericrming all work myse!f.
aI am a sole proprietor and have no one workina in any capacihl
I am an employer providing workers' compensation for my employees working on this job.
Comoanv name LUQL/DCC
Address �/0//t�/'�1/�/i� ��� G ✓�
Citv7 ")OW / lVe—OdPhcne
# Lv / / — U//�D(
r„ ��/' /iJe % %i/CI/i%O�f/l'F ! _ l%_ Pclicv � T
ce
,.ddress
name:
Phone #:
Insurance Co. Pclic" #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition cf criminal penalties of a fine up to 51,500.00
and/or one years' imprscnment as we!I as civil penalties in the form or a STOP WCRK ORDER ano a fine of (S100.00) a day against me. I
understand that a copy of ,his statement may be forwarded to the Office of Investigations or the DIA for coverage verification.
1 do hereby certify under the pains and penalties of penury that the information provided above is true and correct.
Sionatu
Date
Print name i9t//O -Z/ 06' Phone
Official use only do not write in this area to be completed by city or town cmaai
C;ty or Toon Permit/Licensino
EJ -Che --k if immediate response is required
Contact person.. Phone m
v
Building Dept
[l
Licensing Board,
C
Selectman's Office
C
Health Department
Other
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that allnecessary 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.
*****************************APPLIC"ANT FILLS OUT THIS SECT ION***********************
APPLICANT/j� zq
LOCATION:. Assessor's Map Number .Mc -21 PARCEL
SUBDIV1SiON iLll SAA F PEsT �� LOT (S)_
STREET=�L /it/� /N� ST. NUMBER Z
USE ONLY*************************** *
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED ti ui�
DATE REJECTED
COMMENTS O_ W ��� V l ('� (03""
X TO W N PLANNER
COMMENTS
DATE APPROVED
DATE REJECTED
rt 9 ' all ECO N -,j 1 k o Cake -
FOOD INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH J DATE APPROVED D Ur
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER[WATER CONNECTIONS
DRIVEWAY PERMIT �,i Z7-77
FIRE DEP
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
The Commonwealth of Massachusetts
Department of Industrial -Accidents
Office of Investications
Boston, Mass. 02111
Workers' Compensaijon Insurance .4/id�wit
Name C'ONST/ 1671Oil% a Fle2s2 print
.:r
Location:
Cii Phone
F -1
I am a hcmecwrer Fericrminc all work myse!f.
F -1
I am a sole prcprietor and have no one-wcrkine in any capac:�t
/ I I am an e.T.Clever providing -workers' compensation icr ,.,y emplGveGs working on this job.
tCorr, canv narne
,'-'dress ZV Ayae-dW2 S/
Ci N; /I/l - AvzvVr-x HIy 411rys Phone T 9%j"�/�/�_ 6),
%0 /
InsuranceCo. �'��J�L%✓5C//e�/t/C� LG. Folici m
Comanv name:
Address
Phorp
Insurance Co. Fclici T
Failure to secure =verace :s recuiree uncer Seen 25A cr iV1GL 52 can lead to toe imccs:ticn or cnmiri penalties of a rine up to 51.500.CC
anc1cr one years' imp: scnr-ent as •.veil ss c:vii cenalties s !.he form cr a S TCF. Y`/CFK CFC -E::-1 :rd a rine cf (57CQ.C(D) a day 2-1ainst me. I
understand that a copy cf � is s:aement may ce forvarcea to the Office cif Investicaticns c.:`e -DIA for coverace verification.
1 co hereby cenry under SW d pe .hies or pe. jury that :he inicrrraticn provided accle is trve and =rect.
Sianature - Date /� ZG % C
Pdnt name o�i�1 /'r Phone f
O:fic: al use eniy do not write in this area to Ee comclered by c:-,/ cr :cvn cmc:ai
C:ty or i cvn P-�rmit,,Ucensirc
[Check d knmediate response is required
Cortacc ;.erscn:
Fhcne .r
Building Dept
Licensing Board
r
Se!ectman's Office
health Department
G
Other
I
MAScheck COMPLIANCE REPORT
Massachusetts Energy Cade
MAScheck Software Version 2.01 Release 3
TITLE-. Pim NO-.- 5516
CITY: North Andover
STATE-:._ Massachusetts
HUD: 6322
CONSTRUCTION TYPE: 1 or 2, Family, Detached,.
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE:- a-19-2000
DATE OF PLANS: 5-16-00
FRQJEC`P- INFORMATION-:
COLONIAL HOUSE 3562 S.F.
C:OMPAMY. 1Nx:C?RMALlUt� :~
BRUNO ASSOC.
28 BERKELEY ROAD
N. ANDOVER, IMA 01845
QQ1v1PL'r ANC:JL:-_ Passes
Maximum UA = 788
Your Home = 59=5 -
I
I
f Permit- ##
I
I Che'c�- lry-f Dat e
i
ti^vi$i'LiANCE STATEiiEN I Tile proposed huild'�ng deai n descriueu here IS
consistent with the building plana, spie ifieat o -ns, and other calculations
submitted with the permit application., The -.proposed building has: been-
de-signe& 'tu- meqet -the rel- nes- -of - the 3fa-s-sachu-setts Energy C-6�=
The heating .load -for this ;building, and. the cooling load if appropriate,
Ira -a- beer-deteratined us-i.ng,--the-a-pgli-cabsle-St=anda-rd Design Candit ons- found
in the Code. The HVAC equipment selected to -heat or cool the -building
shall be- no greater than 125% of the des gry load as- specified in
Sections 780CMR 1310 and J4.4. A
Builder/-D.esignex
Area ar-.
Cavity
Cont".
Glazcng/Doaf
Perimeter
R -Value
R -Value
U -Value
UA
CLETT TNGQ
15-2.
30.0
0.0
54
WALLS: Wood Frame, 76" n C
3ol4
ix. 11.
0.0
247
BSMT: Conc. 8=0' ht/7:01- bg/81.0'
inwul 20,341
19_.0
0.10
91
GLAZING: W,i.ndQw_5 or Doers
5.hZ
0-3:50
798
DOORS'
15
0_35i
5
HVAC EQUIPMENT: Furnace, 98.7 AFUE
ti^vi$i'LiANCE STATEiiEN I Tile proposed huild'�ng deai n descriueu here IS
consistent with the building plana, spie ifieat o -ns, and other calculations
submitted with the permit application., The -.proposed building has: been-
de-signe& 'tu- meqet -the rel- nes- -of - the 3fa-s-sachu-setts Energy C-6�=
The heating .load -for this ;building, and. the cooling load if appropriate,
Ira -a- beer-deteratined us-i.ng,--the-a-pgli-cabsle-St=anda-rd Design Candit ons- found
in the Code. The HVAC equipment selected to -heat or cool the -building
shall be- no greater than 125% of the des gry load as- specified in
Sections 780CMR 1310 and J4.4. A
Builder/-D.esignex
TITLE:.PLAN NO. 5516
MAScheck_INSPECTION CHECKLIST
Massachusetts Energy Code
MAS -check- .Software Version 2.. 01 .Reye jse 3
DATE: '5-19-2000
Hldg-.R
Dept.(
Use- } .
I
( CEILINGS.- .
[ 7 I 1. R-30
[ Comments/Location
I
WALLS:
[ ] [ 1. Wood -Frame-; 16" 0 . C . R-13
Comments/Location
( BASEMENT WALLS:
] [ 1. Come. 8. Q-' -. ht/7.0' bgt8-. &- insul, R-19 interior cavity
Comments/Location
I
( WINDOWS AND GLASS DOORS.:
[ } [ 1. U -value: 0.35
For-- windows -without 1-aliel-ed-Uvalues- de-s-c-ribe- features-: .
I # Panes Frame Type Thermal Break? [ ] Yes
Comments/Locati_on-
I
[ Df30R��-
[ ] I l.. U -value: 0.35
(- Coru�nts/Loeation
f"
I HVAC EQUIPMENT:
J I 1. Furnace, 98-:7 AFTc3E a -r- hfigh.er
( Make and Model Number
f
[ ] No
( AIR LEAKAGE:
C ] I
Jotnts-f penetrations a --n& all ot-he=r- such --openings in -the--building
( envelope that are sources o -f air leakage must be sealed. When
in -stalled in the- bui-lding-envelope-, -recessed lighting €ixtur_es .
i shall meet one of the following requirements:
} 1. Type IC rated, manufactured--wi-th- n-cF_genetratiorns- between t�e
[
..inside of the .recessed .Ixture and ceiling cavity and sealed or
1 gas-keted tor -prevent .arr- lea-.ka-ge into --the unconditioned -spice.
( 2. Type IC rated, in accordance With Standard ASTM E 283, with no
( more than Z:0 cfm (0:94'4 L/s-3: air movement from the the
i conditioned space to lth.e ceiling ..cavity... The lighting .ti-xtur-e
[ shall have }see -n te- teFd at- 7 -11 -PA or -1.5-7 lbs/ftZ pressure
( difference and shall b -e labeled..
[
J VAPOR.RETARDER:
k [ Required on the warm -in -wire -ter side- -o-f -all non -vented- f famed
( ceilings, walls, and floors.
(
�. MATERIALS- IDENT I-FICATI.QK:.-
[ ] I Materials and equipment must be identified so that compliance can
( be- --determined._. - MantL€ac_tu:re�r manuals: -for al -1 installed heating- - - -
y
G1
and caaling e-quipment--an& sere -k e water- heating- equipment mu --:4 t be
provided. Insulation R -values., glazing U=values, and heating
equipment, efficiency must be clearly marked on the -building- plans
or specifications.
DUCT INSULATION:
Ducts- shall be- insulated pe -r-. Table: J4.4.7.1.
DUCT' CONSTRUCTION :
Aid- aces-sible ,:o-i.nts-,, seams-,-. andcannection.s of Supp -1y and. return
ductwoik located outside conditioned space, including stud bays or
joist cavities/s-pa-ce4 uspd:. to:, tranasp-er:t air,. sra11: be sea? eco
using mastic and fibrous backing tape installed according to' the
martuta-rtur-er's.ins..ta-llation instructions Mesh tape may be
omitted where gaps are less than 1/8 inch. Duct tape is not
permitted. The H?rk-C_ system- mus -t provide= a. means: €o -r bala�cing
air and water systems.
TEMPERATURE CONTROLS:
Thex-mostats. are-. requiredfor eacli sep.a-ra.te HVAC system- A manual
or automatiq,means to partially restrict or shut off the heating
and/.of cooling - input to each-zG�ne..or. €:oar sha:ll_he. p:rov}ded.
HVAC EQUIPMENT SI-Z:FN:G>.
Rated output capacity of the-heating/cooling system is
not greater than. 12'S - of- the design- 10 -ad- as specified
in Sections 760CMR 1310 and J4.4.
SWIMMING POOLS:
PIPE-. S-IZES(in..-1.
NON -CIRCULATING
Ail_ hued_. swimming ng pools- mus -t_ . have= an on/ o -€_f_
heate-r-
and.
require a cover unless
over 20e of
the heating
energy
is from
0.5
non--dep-letabLe_ s tree
Pe&,I: pimp,
re -quire: a
time.
chock.
€ 0.5- _
HVAC PIP-ING INSULATION.
1.5-
100-130
0.5
0.5
0.5
HVAC piping conveying fluids above
120 F or chilled
fluids
bed.�x 55. F must. be' rr.�:lated- to- t a.e- fo -low ng
levels-
(+n. )
PIPE
SIZES-
(kn_)
HEATING SYSTEMS:
TEMP (F)
2" RUNOUTS
0-1"
1.25-2"
2.5-4"
Low p-ressure/temp
20-1-25-&
1.0
1..5
1.5
2.0
Low temperature
120-200
0.5
1.0
1.0
1.5
Steamscondensate
an,y
1 0-
1.0-
1.-5
2.0
COOLING SYSTEMS -
YSTEMS:Chi-11-eek-water
Chi -11 -ed- watero -r
4G-5-5-
0.-5
0.5
0.75
1.0
refrigerant
-below-40.
1.0.
1.0
1.5
1.5
CIRCULATING HOT WATER SYSTEMS:
Insulate= circulating .hoxt_lwate�,r_ ..pipes to the- leve1s, n.):
--NOTES TEF FIELD (Btrildi.ng Department _ilse- Only)
PIPE-. S-IZES(in..-1.
NON -CIRCULATING
I CIRCULATING MAINS &
RUNOUTS
HEATED WATER TEMi-
.(F-}:7 RUNOUTS- 0-1"
f 0 --- 1. 25'
1.5 2 .0"
2,. 0+"
170-180
0.5
1.0
1.5
2.0
14G-169
U_5z
€ 0.5- _
1-.-(1
1.5-
100-130
0.5
0.5
0.5
1.0
--NOTES TEF FIELD (Btrildi.ng Department _ilse- Only)
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GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT
TOWN OF NORTH ANDOVERBUILDING 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 req ested below.
otoS061 c3�
Permit App cant Property address Map / Parcel
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 ofthe Growth Management Bylaw. I also understand providingthis form 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 I understand that my interpretation of the exemption status is subjectto review by the Building Department and is only
officially accepted when the building 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 for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as
ofthe effediv to ofthis 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
CHE94CING OFF OF A ABOVE EXEMPTION WHICH DOE NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR
P
GRO SAL BY7 T BUI G NT TO ISSUE A B/U7zN
G PERM7. ^
(D
C SSI A DAORM BEA ACHED TIS BUILDING PE�PLICATION
NaRTH
Of .1'1 %' V' 0 16
? b�
.0 e O
O r^
?aOA�TtO rfP` ,��
�SSgcHusti�
APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION
ADDRESS/LOCATION OF, PROPERTY: p'�---0i ^ � #�J�T��/ //
DATE REQUESTED FILED/READY FOR INSPECTION/ AY afp a001
CLOSING DATE ON PROPERTY: ' /7u ,�
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK'AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME
FRAME. A RE -INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE
CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES.
SIGN
ROUTLNG
CONSERVATION a
PLANNING
DPW - WATER METER
NOTE
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED
PRIOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST
DPW 9 L�.,���/..
,o
Signature
File: OC form revised 618198
Location
/f v
No. ��� v Date
NORTH TOWN OF NORTH ANDOVER
i _' • OL
A
Certificate of Occupancy $
�SSACMUSEt Building/Frame Permit Fee $
/
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # //d
14103
�' Building Inspeetotr
i
LOT 5
STERLING LANE
INNI h LOT 4
\ EXIST. FND.
\ EL. =132.3'
REFERENCE PLAN NO. 13035
r`� 3i�-a8 00
LOT 3
�l
EASEMENT
1113'\
a+
50' BUFFER \
\
FOUNDATION LOCATION PLAN
CLIENT. COOLIDGE CONSTRUCTION CO., INC
THIS CDMnCAT7ON IS PUDE AND LIMITED
.TO THE ABOVE CIJENT.
LOCATION: MIDDLETON, MA.
1 CERnFY MAT 7HE MOM Snauc ME SHOWN CDAY S 7D
1HE 110AUGMJAL SETWOr IEOUN EMDUS OF YW loco
APFUCAMLE 2DAWN er-4AW3 IN EFFECT MEN COAMucnaL
(iHRT CCE7Pn mnCN ODES NOT COMSi M Alla OTMW
1�37RlC7ADMs stirlN AS COVE MWM
cillaw OF CDAaInGfI AM)
IM DM~ SHALL AW BE USED Or 71E WENT FGR ANY
PtaaFO W 01HER THAN 7HAr GUM MED AWW-EZCEPr W111 7HE
W MEN PENANSIDM OF CMab71ANSEAI t SERA NAG
FURYNE1i WK IM MWW 0 7HE COPMORNiED PROPEM
OF MESI1ANSEN & SOW Mr. AND ANY ~770FRED UM
6 PRO MEMCPA RSnA 601 & 309 TAKES NO RESRO AKIN
FGR 7/E LOWU OA M USE OF 71RS DAIAW/YW OR ANY WON-
w7>MII CIMANED NEW=
SCALE. I" = 50' DATE: 8/11/00
CHR/STIANSRN & SRRGI LAW SIMM"M
to SuAmm 3T NA"Au.NA. ofam 7M 078-373-010
WOW ff M" & Its, = DWG. NO.: 98024005
..............