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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... �%....�. G ..... .
has permission to perform .....7. -,:;,5 !L v
wiring in the building of ...... n! ................... .
at .i/. C C S✓L ....�
Fee .V573.0?�. Lie. No. \S—' J :3 5Y'44.7'.. .
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Check# —
11264
North Andover ass.
ELECTRICAL INSPTO�R
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BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. _
Occupancy and Fee Checked _
[Rev. 1/07] (leave M-1-
APPLICATION
lkAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perrormed in accordance with the Massachusetts Electrica4Code C),5 7 CMR12.00
(PLEASE PRINTININK OR My E' INF dATION l�Date:City or Town of: 02 / d D U 2To theor of Wires:
By this application the undersigned gives notice of his o hGr 'ntentito pe the electrical work described below.
Location (Street & Number) i / �f r
Owner or Tenant
Owner's Address
ci f
Is this permit in conjunction with abuildt'nWermit? Yes ❑
Purpose of Building �1M. 1p f�.,�,k--L�
Existin Sc
Telephone No.
No �X (Check Appropriate Boz)
Utility Authorization No.
g rvice Amps ! Volts Overhead ❑ Und rd
g ❑ No. of Meters
New Service Amps _ / s Volts Overhead
❑ Uadgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 1;...
Con, letion of the olloivin table m be waived b) the Inspector of 11 Cres.
No. of Recessed Luminaires No, of Ceil. Susp. (Paddle) Fans °• of Tota
No, of Luminaire Outlets Transformers KVA
No. of Hot Tubs Generators KVA
No, of Lundnalres Swimming Pool Above In o. o mergency ,g ,ng
grad. ❑ erns_ ❑ u„ff��..:.
Attach additional detail if desired, or as required by the Inspector of JFires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 0- Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the Iicensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cov ge is in force, and has exhibited proof of s 51e to the permit issuing o ce.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) ���� %Z J/
I certify, under the Darns a rd pert f of er ly, tl t t/te in rnration orr 11s a ltcatlb'f is true air ,
FIRM NAME, v PP d an eta
iC LIC. NO .
Licensee: � e h �./ •�
Signature �. LIC. NO.:
(Ifapplicable� "exem t " in the license number h .
Address: t J C3 Bus. Tel. No.Tel•
No
*Per M.G.L. c. 147, s. 57-61, security w requires Dep ent of Public Safety "S" License: Alt. Lic.�No..:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner
Owner/Agent El owner's agent
Signature Telephone No. PERMIT FEE: S
o. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS No. of Zones
No, of Switches
No, of Gas Burners
No. oetectton an
No. of Ranges
No. of Air Conti.
atar—
__Lni_tjyting Devices
Tons
No. of Alerting Devices
No. of Waste Disposers
eat ump um er
Totals:
ons
o. o e - ant due
No. of 'Dishwashers
Space/Area Heating KW
Detection/Alertin Devices
Local unicipa
Connection Other
No. of Dryers
0.0 ater
Beating Appliances
KW
Security Systems:
No. of Devices E
Heaters KW
o, of
Signs
No. of
Ballasts
or uivalent
Data Wiring:
Na. Hydromassage Bathtubs
No. of Motors
Total HP
No. of Devices or E uivalent
elecommunicat,ons Wiring:
iti
�.n......
No. of Devieec nr F nn;W.1..+
Attach additional detail if desired, or as required by the Inspector of JFires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 0- Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the Iicensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cov ge is in force, and has exhibited proof of s 51e to the permit issuing o ce.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) ���� %Z J/
I certify, under the Darns a rd pert f of er ly, tl t t/te in rnration orr 11s a ltcatlb'f is true air ,
FIRM NAME, v PP d an eta
iC LIC. NO .
Licensee: � e h �./ •�
Signature �. LIC. NO.:
(Ifapplicable� "exem t " in the license number h .
Address: t J C3 Bus. Tel. No.Tel•
No
*Per M.G.L. c. 147, s. 57-61, security w requires Dep ent of Public Safety "S" License: Alt. Lic.�No..:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner
Owner/Agent El owner's agent
Signature Telephone No. PERMIT FEE: S
1
Date . C . �. �
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies/
i
that. t/1....... .
F has permission for gas�installation ..�
in the build•gs f.^. ...................................
at ....! ........ � �. North Ando er Mass. M
Fee. ..... Lic. No. ....... .... .
GAS INSPECTORO
Check #
8472
11 \2 6 r-'- 5 c..ru c.,c�— &'V�" 4; �P_ Nk7N
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY _ �%/.� �' w my- m MA DATE %_`j PERMIT #
JOBSITE ADDRESS _ �.G �/ OWNER'S NAME �
OWNER ADDRESS ; ' TEL=--]
TYPE �OTR
—IFAX
OCCUPANCY TYPE COMMERCIALFJ- EDUCATIONAL ® RESIDENTIAL,
CLEARLY
NEW: RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES Q. NOD
APPLIANCES 1 FLOORS- BSM 1 1 2 1 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER I --A= (.
r
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS -
MAKEUP AIR UNIT __ 1 f
_
OVEN _ . { � _.. _... - {T-- � -- ( {..----- I� �.1
__ �_!
POOL HEATEROOM
/SPACE HEATER J I � J - �-� .� � I _. � ^
POOF TOP UNIT
.TEST
UNIT HEATER1
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 1[1NO�_I
1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY (�:_J OTHER TYPE INDEMNITY EA BOND�I
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 0 AGENT (�]I
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my kno edge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with I n royision e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUM BER-GASFITTER NAME�Et�j�/.�-`1.��� (LICENSE #`iaj SIGNATURE
MP M MGF F--11 JP ( JGF LPG] CORPORATION n—J# = PARTNERSHIP -IA#�._.__...__ 1 LLC ..-i#
COMPANY NAME: ADDRESS ff E
CITY'^_]TEL=__
��L I STATE ZIP
FAX:: w ._.'Z�� ELL `r✓1S %71 EMAIL C= L Up
11 \2 6 r-'- 5 c..ru c.,c�— &'V�" 4; �P_ Nk7N
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The Commonwealth of Massachusetts
- Department of Industrial Accidents
Office of Investigations
600 Washington. Street
Boston, MA 02m
www. mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: �/
C.
City/State/Zip: / '�rV phone #: f 2 T
Are you an employer? Check the appropriate box:
1. All am a employer with 1_
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I
have hired the sub -contractors
am a sole proprietor or partner-
listed on the attached sheet. I
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ 1 am a homeowner doing all work
officers have exercised their
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 reauired.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.'VE Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
i' Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
l am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:/CSC 1L(�rr��� do), tl
?olicy # or Self -ins. Lic. #: ,�/ .{ A Expiration Date: Z, 3
ob Site Address:_%7 l-7�G(11.5ti�f City/State/Zip: I /�
kttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
,f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
do hereby certify under theins a ppaltat the information provided above is true and correct.
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Issuing Authority (circle one):
L Board of Health 2. Building Department
6. Other
Contact Person:
Permit/License #
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Phone #:
P
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Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the 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 burn 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
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www,mass.gov/dia
COMMONWEALTH OF MASSACHUSETTS
U 'A
MBERA'ND G -S,SFITTER'
s
'LICENSED 'ASA MASTER PLUM
ER
$SUM
TH,E,AB0\!tt,1bENSEj,,
_
EDWARD A
w.
KELLEY
5.7 RD,
'MA 01810
ATMVER�
o5fol/14 183146
� of ` � `l ! •�• •` I -1 _
CbMMO WEAL-YF;~OF MASSACF�U§t:-
_= - . • r
• • • •
PLUMBERS AND,
)C�A�SFIT�TIERS�}
LICENSED AS AMASTER PLUFMBER`
jSSUEB THE ABOVE LICENSE TO
r a
E�bW AR D A KE L L
s
tl m
hL;N
57 MAR 'YRD
I AND1)VER'
MA 018Y�
f9:429 05/01/14 183146
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CONTROL #H391731
1 IMPORTANT
if this license is lost or destroyed, notify your Board at the:
Division of Professional Licensure, 1000 Washington St.,
Suite.710, Boston, MA 02118-6100:"
our board r
'It your name or address shown is changed ef°n mailing of next
s refer to your license num
of correct name or address to insure p ber.
Renewal Application. Alway
a This license is subject to the provisions of the Genera! Laws
personal privilege, and must not be loaned
as amended. It is a p person. ',' eeP this license on your
It I
or assigned to any other P law
} person or posted as required by,
WARNING Hl'; t�Ocut�EM1IT FIAs
ENHANCED $1 CURITY FrATURI S`_� —
- t
4 J:w
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t
LOCATION:
OWNERS NAME:
GENERATOR kw -
NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS*
CONTRACTOR: � (� I �/�Q_ KAAeA// �T in�'J/k �.129�FP� C'
PHONE NUMBER:
ELECTRICAL
RESIDENTIA
GAS
C ERCIAL
LOrA ION OF GENERATOR:
*ZONING DISTRICT:
*CONSERVATION APPROVA
TEMPORARY
Location—Y-6,
1`pF� 4 Z S//a14` /► /D.
No. 3 57y Date �LIS&I
ry
I
TOWN OF�ORTH ANDOVER
Certifica e " TZipancy $
B Acing ramp Permit Fee $
VFoundat kW rmit Fee,
0,PtifTNrmit FFe%;,.
Sewer Coo'46ction Fee
Vala e0Connection Fee
TOTAL $ o o"'
rAov�i �
s
Building inspector
Div. Public Works
PERMIT NO.
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP 4d0.
LOT NO.
I
2 RECORD OF OWNERSHIP JDATE
BOOK ;PAGE
ZONE 4'`
SUB DIV. LOT NO.
LOCATION
PURPOSE OF BUILDING ^
OWNER'S AME
NO. OF STORIES SIZE
OWNE ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME 0
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
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 X
IS 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
SE9 BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED_ "/-</
ATURE OF OWN OR A�T,HORIZED AGENT
,IA � .ri1 w I'U. 0„ r% -A ----. ..
F E E 17 4 tJ K--
PERMIT GRANTED
19
CONTR. TEL. #
CONTR. LIC. #
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST 1/' Q -
EST. BLDG. COST PER YYSIIQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
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Location 7.7 //f C C S 1 DC-
No. ` y" Date
0
TOWN OF NOgH ANDOVER
Certificattof Occupancy*,$
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Building/Fran e, Permi# Oe
Foundation Perm-i�ty Fee $ "
J "t "3
Other Permit Fee r
Sewer Connection Feee $
Water Connection Fee r2i $
TOTAL j $ /l g-0
Building Inspector
Div. Public Works
PERMIT NO. c D T
w
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE 1
MAP.K40. <f
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO. '&-Aacr
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LOCATI "7 ,/�I
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PURPOSE OF BUILDI
OWNER NAME/ Z� t7U Qn
NO. OF STORIES �. SIZE�'� /L
OWN 'S ADDRESS .. �. ��
BASEMENT OR SLAB
ARC TECT'S NAME .if /
�✓'
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BU PER'S NAME
SPAN
DI - ANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET -�O '9f'
" POSTS '
DISTANCE FROM LOT LINES - SIDES REAR do 0
J
" GIRDERS/1� 7T ®1
FRONTAGE
AREA OF LOT/ ✓' �YG
o
HEIGHT OF FOUNDATION,4 / THICKNESS Q71
/7 a
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND fi' l
C&h
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE S
A-
IS BUILDING CONNECTED TO TOWN WATER
t
BOARD OF APPEALS ACTION, IF ANY
BOARD
IS BUILDING CONNECTED TO TOWN SEWER Y
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FIL��D AN�AgPROVED BY BUILDING INSPECTOR
DATE OFIL r 9 /
SIGNA URE OF OWNER OR THORIZED AGENT
FEE
�a
PERMIT GRANT
2019
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST c l J
EST. BLDG. COST PER SQ. FT. l J
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
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FORM U.
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
SUBDIVISION
ASSESSORS MAP
SUBDIVISION LOT(S)l
PERMANENT ADDRESS (ASSIGNED BY -W-)
STREET
APPLICANT PHONE
DATE OF APPLICATION
TOWN USE BELOW THIS LINE
PLANNING BOARD
TOWN PLANNER
CONSERVATION.COMMI SION
CONSERQ91ON ADMIN.
BOARD OF HEALTH
HEALTH SANITARIAN
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT
SEWER/WATEK CONNECTIONS
FIRE DEPT.
DATE APPROVED
DATE REJECTED
DATE APPROVED $
DATE REJECTED
DATE APPROVED
DATE REJECTED
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Health Boards,
the Conservation Commission prior to the issuance of any building permits
for the subject lot. This form shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
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NORiN A�
KAREN H.P. NELSON. �9 Town of
Director
BUILDING
@@ACNUepSAO
NORTH ANDOVER
CONSERVATION DIVISION OF
PLANNING PLANNING & COMMUNITY DEVELOPMENT
Mr. Peter Coughlan
75 Hillside Road
North Andover, MA 01845
Re: Construction of a bulkhead
Dear Mr. Coughlan:
120 Main Street, 01845
(508)682-6483
As you are aware, I inspected your property on August 7, 1991
upon your request for a building permit to construct a bulkhead
at the rear of your home at 75 Hillside Road.It is my
understanding that the Building Department informed you that only
Conservation Department approval was required.
Wetlands protected under both the Massachusetts Wetlands
Protection Act and the North Andover Wetlands Bylaw are indeed
located at the rear of your property. However, because of the
location and limited scope.of your proposed work, no filing is
required with this office at this time. All construction
equipment and disturbence must be restricted to the existing lawn
area and care must be taken to ensure that no material erodes
into the wetlands at the rear of the property.
Please give my office a call when you are about to start
construction at 682-6483 ext.26 so I can meet with the builders
to ensure compliance. I apologize again for keeping you waiting
this morning.
Sincerel ,
Anne Kasprzy
Acting Conservation
Administrator
jl�, gq
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3e, Ar
Cvhc — /r—, — � 1. C
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74 L---)
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Ce C47.1? I Of-A,�,V45,
RQ S' /'Y7
Yi5
by,
Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE
JOB LOCATION
Number Street Address
.:'HOMEOWNER" 0�r-CpUC�?/•''/%j'S j Z� l�
Name Home Phone
PRESENT MAILING ADDRESS
ection of town
ork Phone
City Town 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
rthat the owner acts as supervisor. (State Building Code, Section 109.1.1)
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to
fireside, on which there is, or is intended to be, a one to six family dwell-
ing, attached or detached structures accessory 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. Such "homeowner" shall submit
,.to the Building Official, on a form acceptable to the Bulding 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
ll.:regulations.
The undersigned "homeowner" certifies that he/she understands the 'Town
North Andover Building Department minimum inspection -procedures and
.'requirements and that he/she will comply with said procedures and
requirements.
1 -HOMEOWNER'S SIGNATU
!.APPROVAL OF BUILDING OFFICIAL
'Note: Three family dwellings 35,000 cubic feet, or larger, will be
required to comply with State Building Code Section 127.0, Construction
Control.:
of