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Miscellaneous - 75 LEANNE DRIVE 4/30/2018
33o Bear Hill Road Suite 201 Waltham, MA 02451 T: 781-890-1696 F: 781-890-3819 Date: 09/10/2015 Building Commissioner/Inspector of Buildings Town Office of City of North Andover 566 Main Street N Andover, MA 01845 Cunnin ham `% Lindsey NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 1.39, SECTION 3B Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed, $1,000.00 or cause Massachusetts General Laws, Chapter 14.q. Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section aB is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, and Cunningham Lindsey file number. Insured: Thomas & Eileen Kelly 75 Leanne Drive N Andover, MA o1845 Policy No: 2355822 Loss: Water stain on latchen ceiling Date of Loss: 09/03/2015 Cunningham Lindsey File No: 1oo85971$948 Jeff Hale Adjuster I J E? i i Date ..... .... ..'..... / TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING This certifies that ............ V Y /.'q/ ......... ........ �7/l.`. C....................... has permission to perform ............1. `�"�:..5�'%............................................7— .... v wiring in the building of ............ r.`.�L ��................................................. at ....7,...LE .....W ........................ . rth Andover, ass. Fee.. 3�.. Lic. NoA.Z 1 7Pf ............. . .... ... ....... } LECTRICAL INSPEC ICOR _ n v Check # .5 � �^ P. N ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the �rmit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an e trical permit shall be issued to the person, firm or corporation stated on the permit applicatlun. Such -entity shall be responsible for the notification of completion of the work as requirad in M'.G'L. c. 143, § 3L. Permits shall_be limited as to the time ofongoing construction activity, and may be.deemed_by-the.Inspector_of_Wires abandoned_and_invalid_ifhe—. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. Fl The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was 'In effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. Rule—Permit/Date Closed: — /_%� yy*** Note: Reapply for new permit El Permit Extension Act — Permit/Date Closed: The Commonwealth of Massachusetts Office Use Only Department of Fire Services Permit # d f BOARD OF FIRE PREVENTION REGULATIONS Occupancy & Fee Checked Rev. 1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code (MEC), 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of North Andover, MA 01845 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 75 Leanne Drive Owner or Tenant Tom & Eileen Kelly Tel. No. Owner's Address Same Is this permit in conjunction with a building permit: Yes 0 No a Purpose of Building Utility Authorization No. Existing Service Amps New Service Amps Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work (Check Appropriate Box) Volts Overhead =Undgrd =No. of Meters Volts Overhead OUndgrd =No. of Meters Finished Room in Basement Comnlotion nftho fnllowina tnhlo mm) ho wnived by the lncnort— nfWi— No. of Lighting Outlets No. of Hot Tubs No. of Transformers No. of Lighting Fixtures 5 Swimming Pool Generators No. of Receptacle Outlets 10 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switches 3 No. of Gas Burners FIRE ALARMS # of Zones No. of Ranges No. of Air Cond. Tons No. of Detection No. of Alerting No. of Self Contained Local Municipal F— Other r No. of Disposals No. of Heat Pumps kw No. of Dishwashers Space / Area Heating kw No. of Dryers Heating Devices 1 kw 2K No. of Water Heaters No. of Signs TV Device 1 Telephone Devices 1 No. of Hydro Massage Tubs No. of Motors Other: () 6 Attach additional detail if desired, or as required by the Inspector of Wires. .L Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: October 11, 2011 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 the exhibited proof of the same to the permit issuing office. CHECK ONE: INSURANCE r ^ BOND r OTHER # (Specify:) I cert, under the pains and penalties of perjury, that the information on this application is true & complete. FIRM NAME Dumais Electric LIC. NO. 12170A Licensee Mark A. Dumais Signature LIC. NO. 26665E (If applicable, enter "exempt" in the license number line) Address 8 Newport Street Bus. Tel. No. 978-683-9438 Methuen, MA 01844 Alt. Tel No. 978-685-4553 * Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: LIC. NO. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage normally required by law. By my signature below, I herby waive this requirement. I am the (check one) r— owner f owner's agent Owner / Agent Signature Telephone No. IPERMITFEE: 9005 Date . .... ..`. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING + �� , i This certifies that ................ a ...�. ��.t- ... � . `.......... has permission to perform . '-? :.�.{ �� ...4- (�.�!.�... ........ . plumbing in the buildings of ...T.?!.... k.k=. t �y! ............ at. S... e . h h .................. . North Andover, Mass. Fee O CA) .. Lic. No.. �.f 7 ?.3 ......C- ..... ....... . PLUMBING INSPEC Check # L� `� 3 S\_r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING VoriL4 Avl 004— f ) MA. Date: v///Permit# �� tion: / hPltyne 11�,Owners BH'�pancy: Name: Commercial ❑ Educational❑ Industrial❑ Institutional❑ Residentiaew: [] Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No Ej FIXTURES DEDICATED z Z SYSTEMS Hn� LU Y VO >LU Z z F¢- Q U FN- w C7 h O 0 Z z MZ ¢ ¢ w C W C Z Ln Q w o ¢ Z z x vi u X tr ¢ ¢ o LL F oC Z a .2 O C W () 0 Q W tn Z r.., U Z Q LL 3 d Y ¢ S W W H O > > O p Z Ln F- H W cei O w Ln W a ¢ ¢ h Z 3 m m o o LL x g N� 3 3 3 o I a u a . 3 -SUB BSMT. ¢ (7 C9 BASEMENT I FLOOR 2ND FLOOR 3RD FLOOR 4' FLOOR 57' FLOOR 6' FLOOR 7' FLOOR 3' FLOOR Installing Company Name: _ �lfh /'�li✓, � /4rh,b/, )I l�p� h Check One Only Certificate # AddrJU- Jh&4444 �`�' `0",�y `�J/� ❑ Corporation City/Town: r12C&t State!'/ n �y 1/� p. EJ Partnership Business Tel: i '/� �/7 � Fax: Firm/Company Name of Licensed Plumber: ir; M V O INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the .type of coverage by checking the appropriate box below. A liability insurance policy' PQ 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 Si nature of Owner or Owner's A enf Owner ❑ Agent ❑ 1 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 Knowledge and that all plumping work and installations perfiormed underthe per sued forthis application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 7 of a Generai Law . By Type of License: Title Si f Lic nsed Plumber ❑ Plumber City/Town ❑ Master APPROVED OFFICE USE ONLY ❑Journeyman License Number: 4 ;a,0 -D A CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDD/YYYY)ACORQ D06/15/2011 PRODUCER 978, 887, 4900 FAX 978.887.2404 Edward F. Sennott Insurance Agency, Inc. 16 South Main Street P. 0. Box 457 Topsfi el d, MA 01983 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Brian 1. Murphy Plumbing & Heating 395 Donohue Road Unit 4 Dracut, MA 01826 INSURER A: Norfolk & Dedham 23965 INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS Evidence of Insurance GENERAL LIABILITY R1172073A 06/10/2011 06/10/2012 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY AMAGE TO PREMISES Ea occurrence) $ S0'00( CLAIMS MADE Fi-I OCCUR MED EXP (Any one person) $ 5,00( PERSONAL & ADV INJURY $ 1,000,00( A GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 1-1 POLICY D PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULEDAUTOS (Per person) $ BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION- - AND EMPLOYERS' LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below I I I E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Evidence of Insurance Peter Sennott/LA ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A r LICENSED AS A.JOURNEYMAN PLUM 'ISSUES HE /jB�VE LICENSE TO t f.. a BRIAN J MURPHY 'a m 121 RESERVOIR _ST N. MA 01850-22 r`'= LQWELL 26783 05/01/12 79964.6 {_V ,C arm �' 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): rTaki Address: 39S_ .�ngkwc • Uiu(7L City/State/Zip: >*C- R �/� d /t.) to Phone #: ✓ 7f _S,4 � ��, Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2.4 I have hired the sub -contractors am a sole proprietor or partner- listed on the attached sheet. t 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. ❑ I 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 required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other "..r urr=,, _" 11111L uunc" oox if i must also nu out the section below showing their workers' compensation policy information. t 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 check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of 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. I do hereby certify er t�es an les ofperjury that the information provided above is true and correct. Si nature: p� Date: Phone #: 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -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 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 7766 Date.. 7-.. � .-. A I ....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... �.� ?.�^... `.1 ........ has permission for gas installation or in the buildings of .. l . o. /V\... .�. �. �. y ..................... at r. . !0q'!'.t......... North Andover, Mass. Fee ri U .. Lic. No. � 6.7 6 3.. �zk I-,-_:,;�,. . GAS INSPECTOR Check # t-/ S % j CIvTI loco co W W Z MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: Ivor MA. Date: Permit# Building Location: / S ElYith �r� Owners Name: //V IX Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residentialx New: ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No ❑ CIvTI loco co W W Z IX Cd N M = W U UO co h� = O = ce W 00 (W' Z Z O z ae W R O 1• co U Z W C7 W O w CoW 0.~ Q WIX H = X u_ W ~ Q W W Z a -jfA Z W } re U)) _j f- F- O m = z-1 0 z F- LL I-- 00 LLI = w� p W w F.- v O o i=i C9 z= > 00 W Z z w H SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5TH FLOOR 6 FLOOR 7 1H FLOOR -6-FLOOR Installing Company L.'Lfah W Ruh }�, �` � � t Check One OnlyCertificate # Address 4le , �(►. / City/Town: State: /� ❑ Corporation /J dhh � .717/� �7-WFax: Business Tel: ❑ Partnership _� Name Licensed J?yVa� 41 Firm/Company of Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy XC 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 Signature of Owner or Owner's Agent Owner El Agent E] By checking this box ❑; I 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 Knowledge and that all Plumbina work and installations marfnrmPrl :intim fha .,or.,,;r i..—A .. :: .:__ rompnancewnn all Pertinentprovision of the Massachusetts State Plumbing,06dgodnd Chapter 142 of the General Laws. _ Type of License: By ❑ Plumber Title ❑ Gas Fitter Signature of License umber/Gas Fitter ❑ Master City/Town ❑Journeyman License Number: APPROVED (OFFICE USE ONLYI ❑ LP Installer 5 N2 4794 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . S_21. 1_ .//. . .moi f/ 1.. • "•'• /Z:. ....... • has permission to perform .... A.� t. �` . f�� Y?' .r ............... �vires plumbing to the buildings of ....��.. ....................... . at ...?. f -. "r . b!? .......... • .. North Andover, Mass. Fee.? fl)... Lic. No...'� �.�.?. PLYMBING INSPECTOR Check # - %u WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) ' Z a , Mass. City, TOwra Building 6 II Location L6k LP961a A kA , New RenovatioY► ❑ Dat e-o�d/-._.._.—+9—.— Ower ' s i a m eUl��.._ _�3_.._._.._._ Tyle of 0<-t-t11,<ttlr,y: Replacement: ❑ Plans FIXTURES submitted: Ye, ❑ NO ❑ { (Print or Type) CheckOn Certificate ` ,; Installing Company Namc �5' X004 _ Corp. �� C :1 :Address _U"t4i�►t l�� ----- ❑ Partnership 6'��SCo ;! < �'`—•__. �� � _ ❑ Firm/Company rAq1 ` ,o Business "telephone � �� Name o licensed P tuber or G• slitter i r off 1 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 t, € ..knowledge and that all plumbing work and installations performed under Permit issued for this application will he in compli:mcc with all pertinent provisions of lite Massachusetts State Gas Code and Chapter 142 of the 6encral 1 aws. 1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage. (. 1 have a current liability insurance policy to include completed operations cotl�llvd OW er: t< . By_--- -- ----- . sign:iiure, -of l:icc sed 1'htnaber 'I itle "1 -v— --- - Type of Pum ling license City/'town ---- — ---- b Alaslg ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number Vmm 1240 Homs dINAnnfrl.IW, 1989 z z z Vl 19 a h V/ N J to O V z a z W W W No be J N a h y Z O O O Z rn pC a ¢ "' = w z ac m H to w x y cc ►- x V < cc W rn N— >< a oc to d a r, z a d z a 3 h x v_ O O y t W> W .Tt h t rn W z o a w Z a s ac u W W N N cc J a W p m W h V : h O Y d O N z O p t/1 z Z W f- O �d V Y a 3 f- is 4 x y a a 0 a J J a¢¢ a a 0 a h J m iA o o J;= h td u, o a 3 a m 0 SUB- BSMT. BASEMENT _ t IST FLOOR 2ND FLOOR Li 2- 3RDFLOOR 3RD FL00 4T11 FLOOR ± ISTH FLOOR 6111 FLOOR 7TH FLOOR STH FLOOR { (Print or Type) CheckOn Certificate ` ,; Installing Company Namc �5' X004 _ Corp. �� C :1 :Address _U"t4i�►t l�� ----- ❑ Partnership 6'��SCo ;! < �'`—•__. �� � _ ❑ Firm/Company rAq1 ` ,o Business "telephone � �� Name o licensed P tuber or G• slitter i r off 1 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 t, € ..knowledge and that all plumbing work and installations performed under Permit issued for this application will he in compli:mcc with all pertinent provisions of lite Massachusetts State Gas Code and Chapter 142 of the 6encral 1 aws. 1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage. (. 1 have a current liability insurance policy to include completed operations cotl�llvd OW er: t< . By_--- -- ----- . sign:iiure, -of l:icc sed 1'htnaber 'I itle "1 -v— --- - Type of Pum ling license City/'town ---- — ---- b Alaslg ❑ Journeyman APPROVED (OFFICE USE ONLY) License Number Vmm 1240 Homs dINAnnfrl.IW, 1989 Date.�f:f�. G"/..... r oZ.,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION \fin_ • . ._ This certifies that ... S .c .. r . z. f r / G �: has permission for gas installation .14,. �. �... /fG ,,,-,-:..... . in the buildings of c ` yl e C,L at .' ...... .......... A `.:... ........ , North Andover, Mass. Fee.?."�c " .. Lic. No... ..`.. it _.. �— :�...... . GAS INSPECTOR Check # /� 3616 MASSACIIUSETTS UNIFonM APPLICATION FOIZ PERMIT TO UO GASFITT!f G (Pipit or Type) Date -_/-- - - - 1 Building Perm' l �t „ flcty ,[ l cnc)vc,tinn i; Replacellv..:it I_l I'luns Stlbn, (tr:,l Yes (� Na l Ij I I I r'' K Ifl ( to [u j I v, (In y o ] rn v L U� n. p- 1 >- .Z Z p t- o' rA }, In U >E� z)N w H 7rr g K `y s t r 01 tsuraSSMr:. EASEMENTI- .I I ST ft ' lr IIrLR rO00i - I ._ I 3RhrrooR I i r! I rt-oc.R I I I i its ` I S7t.1 1-1 . 00R,I I j I ; I to Rill r,tItrl.cna i 7111r!.00l. Plllrr,oR--) Check cmc. 1()";lollingCr,mpany F lame � ` - -`5 --------- l/ Corp. Xdrl�__ ress ---- w`�._�-s.-�—^-------------- - r7 Parh1, rshit: Finn/Co. Bu"incss Telephone------ t`11m:te of Li::ensed PlUrrrl)er or Gas Fitter------- IMSU ZANCE COVERAGE: Check. one I have a current liability insurance polioy or its substantial equiVolcnt. Yes 177 No (-) if you have c[tecked yes, please indicate the type covelage by checking the appropriate 'bux. '�rrtitiCa:)le A lichility insur-nnce policy ❑ Other type cf indemnit,,, p Bond [� OWNER'S INSURANCE WAIVER: I am ownre that tyre licensee ('foes not hove the ins!Ironc:, coverage rc(.t!_!irccf by Chopic: 1.(1) of the Mass. Genc;ol Lows, and that my si(7nolure on this ))elrnit opp.licatiu-, w. -lives this requirement. Check ofrr.;: -_-- ------ -- ---- - - -- ---- -...--------- Owncr ❑ /hent (] 'ir, n.ilwr of nwnrr nr r)wnrr'+. A(Irnt 1 h^�rl+y ccrtlty Ihot All nt thr details and lWom,allon I I+ave suhndtlyd Inv cr,lrrrdl in the Above aPplirntir�n nrr_ iru.- .!+rt A".—ata In Ilm rd,sl n3 ety ;"' knr I L:r rnr! tI,A1 all 1+Iun,birp work nnrl instnl!aiion; prr(nu++rrl r,rtder the prvmil lav,e(I lot Ibisanpllc:+'inn e!tl be in rnn,;,liance wi!1: al! prerfinmrd -' pr.w r.�nns nr the hln"lclm-fts ' (Iale Gns Cnao and (.bnpter 142 of the General Lnws. Af'i (iOVE:D (Office Use Only) Cl'- f'luntber (� Gasiitter -gl attire of Licensed Plcl �r or Gas Fiber M115,N)aster _I Journeyman License Ntimbor►---...--- TOWN OF NORTH ANDOVER BUILDING DEPARTMENT en APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR I&VO FAMILY D LLING w ` :.Tis S for Eiffjci [3iR _ _y . BUILDING PERMIT NUMBER: DATE IS rn SIGNATURE: v � Building Commissioner/I-10r ofjVdingU AInt 0Z SECTION 1- SITE INFORMATION �p 1.1 Property Address: rn 1.2 Irassors MapqWTNumbertj Map Number �Parcel Nu n N^� c� �%\ 4s �_E-)ANtJC 1.3 Zoning Information: 2 —3 Zonin District Proposed Use Name (Print) 1.4 Property Dimensions: a 5y63 Lot Areas I'zeC?� Frontage ft �)_ ±Lrm.' `f 1.6 BUILDING SETBACKS ft Signature Telephone Front Yard Side Yard 2.2 Owner of Record: Rear Yard Required Provide Required Provided Required Signature ele hone 304- 2 0 22 3c G 90 1.5. Flood Zone Information: 1.7 Water Supply M.G.L.C.40. S4) � Public ❑ Private ❑ Zone " Outside Flood Zone ❑ 1.8 Sewerage ' Municipal 0 On Site D I S SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT rn 2.1 Owner of Record d�p __T_Vk0M'AS --F- c� �%\ 4s �_E-)ANtJC Name (Print) Address for Service : �)_ ±Lrm.' `f Signature Telephone 2.2 Owner of Record: Name Print 4A Address for Service: rn Signature ele hone SECTION 3 - CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 1 l LKS Licensed Cobtruction Supervisor: N - v tY ovt, 2 Z CJUIMWt-i� ��J'V`�� O � License Number ress zS( qiglnle!�_l �l ✓ U G��� 72 ) D ic Eviration Date Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v rn Company Name Registration Number r Z Address Expiration Date /) V Signature Telephone --a :.SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Alhrkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result iiHhe denial of the issuance of the building permit. Si neif affidavit Attached Yes .......❑ No ....... ❑ , SECTIM 5 Descri tin of Proposed Work check all a cable New Constfittion ❑ n Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ ❑ a TAddition Accessory Bld*. ❑ Demolition 11 Oth"efi d ❑ Specify BJef Description( of Piapbsed Work:+A `o Yq.aA + �L 4 �` l A t, �-\ ` Y 11. , O rne` ..i � rel (Z %P' e S s �, x (O . PL'A 1- JUSE� ,r OR- Cb-11(D2L-l� SECTION 6 -' S•T0 TED CONSTRUCTION COSTS tem - Estimated Cost (Dollar) to be OFI'I+ CIAI USE ONLY Completed by permit applicant 1. • .Building, •, , (k Agww (a) Building Permit Fee Multiplier * Electrical, ' w f M 1 ,'O0 rd (b) Estimated Total Cost of 4'" .'""' �' Construction 3 Plumbing _ ':. t 14 Building Permit fee (e) X (b) 4 M finical HVAC p+ 5 e Fiot tian 6 ' TotMI 12+3+4+5 15.-o 'D Check Number SECTI01%,1a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, '� as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to ork authorized by this building permit application. -Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/Aent Date 1 11111, NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS OF GIRDERS 1IEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE � �,� y ,� /Vc) C) I ^ d 0 qs FORM U -LOT RELEASE FORM GNSTRUCTIONS: 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 1 Kni -� EI L NsZt✓� LOCATION: Assessor's Map Number SUBDIVISION N-- R \7ACtC- �ST►� � STREET -S L0Nr-�0 C- PHONE 9A-�S PARCEL_ LOT (S) ST. NUMBER ************************************OFFICIAL USE ONLY********************************* L REC IMENDATIONS. TOWN AGENTS: CONSERVATION ADMINISTfj�K`TOR DATE APPROVED �- DATE REJECTED f :l COMMENTS -A6_! Finn. W&D s t.�&ofbrcater 11,¢, Swn1e f, 0-t L � tt `` L v IVI i1GT ��1�QCt¢CQ. U! a.na AG n3 CCn f�fnnQd w/ Ole, !Wp) ta„+ On DPS,} CC,)Cf:sn i 1— PLANNER 8/D DATE APPROVED DATE REJECTED p 5/11103 i g�R,� COMMENTS A'*3O,9r- S ,l/o �l I-1, �Ir� r- a t, /41i �,% �1 �.,.sV , �`'f ✓elf �5 c� J: ZO/U ey 1 ',V(fl,.,.i -Fl-k 0ro,tl< mAY 9- t onn; 1 S I n /I,416 k b. FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVEDK'�- . DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm AN 0 H&B Survey Service 219 Salem Street Andover, MA M 810 978-475-8232 J. Justin Woods North Andover Planning Board 27 Charles Street No, Andover, MA 01845 Re: 75 Leanne Drive — Lot 5 North Andover, MA Dear Mr. Woods: Attached is site plan with a proposed garden shed (6'x 8') and footbridge (16'x 4') outlined in red. The garden shed will not have any gutters or downspouts. It is my opinion that no new surface or subsurface discharges are proposed with the construction of the shed and footbridge. If you need any additional information feel free to contact me at anytime. Sincerely, Henry R. Himber J)" . E. W&WREO FES -08-2001 1.0:25 AM MARCHIONDA&ASSOCIATES eo9,16-100 n�76 D 4 •10'42 " �d°r'gg LEANNE 6 Q.4160 58 p �' E VISI TNG DRAINAOE SEIMEN T 781 438 9654 P.02 S244 39'25"E 265,06' e'plo, 91 DRIVE /ssui�,b 4-0-ot --rmA,sP-med -7-0/ N24'39'25"W 352 76.64' ,V 125.10' Ex. Foundation A 17 46 7V fti o 1 0 tap0,66 Ac LOT 5 HERITAGE ESTATES NORTH ANDOVER, MASSACHUSETTS DRAYM FOR BROOKVIEW COUNTRY HOMES, INC: P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS m� MARC IONDA + A OC,,L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (7B1) 438-6121 SAX (--'s 1 ) 4 3`� DATE: 2/6/01 SCALE. 1"a40' EXIStTNG fjo CUT EASEMENT .. x.....33.66 :. 114.40' sr� * a EN M. �% 7Yd N20'S7F34. °w 72.70 ' N � iia y �1g'42'20 � � 66 ., 38 � �� , 5•p7' 1WE 14mv-Z HEREBY CERTIFY THAT WE HAVE EXAMINED (7 f THE PREMISES AND THE DWELLING IS LOCATED THIS PLAN IS INTE=NDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY, IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A,/H,U.D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANEL NO.250098 0006 C SHOULD NOT BE USED FOR PROPERTY DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED LINE DETERMINATION, IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. Cr=FMFIED PLOT PLAN LOT 5 HERITAGE ESTATES NORTH ANDOVER, MASSACHUSETTS DRAYM FOR BROOKVIEW COUNTRY HOMES, INC: P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS m� MARC IONDA + A OC,,L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 (7B1) 438-6121 SAX (--'s 1 ) 4 3`� DATE: 2/6/01 SCALE. 1"a40' Town of North Andover Building Department 27 Charles Street North Andover MA 01845 Tel: 978-688-9545 HOMEOWNER LICENSE EXEMPTION Please print. DATE it la -11 ��- 0.00� JOB LOCATION S Lcvl"f Ne 'IF- J E OLDIE TDU6� cc -NTE -k - Number Street Address// Section of Town "HOMEOWNER _+S Lc_,6=�4E `►JR1J� (q�&�5S} -S+-6 Number �{ Home Phone Work Phone PRESENT MAILING ADDRESS 'T l^-L�9n�i�>� `�i2 I NO`S l� w 'C)O%ft-K I VA 4-0 IS -14J 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 that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. �p HOMEOWNER'S SIGNATURE % U • 9-P APPROVAL OF BUILDING OFFI Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. North Andover Building Department DEBRIS DISPOSAL FORM Tel: 978-688-9545 ; i -- In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) -9h,c�— F. Signature of Permi pplicant qa4- k lk QL Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector Name The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers' Compensation Insurance Affidavit Name: 00L)ci( Diq-l1�� Location: 75 I vie Drive Please Print � - 3817- -72,16 I am a homeowner performing all work myself. I 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. Policv # Company name: Address City: Phone #: Insurance Co. Policv # 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_wetLas_chdi4ienalties.iniheinrm4al;TOP.WORK.ORDFR..and_a fine_of_($1-00M)- day.againstme 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cert a pains and penalties of perjury that the information provided above is Prue and correct. Signature Date cs U✓� - 0 - Print Official use only do not write in this area to be completed by city or town official - # q7,,�( 3F17-- 7216 City or Town Permit/Licensing El Building Dept []Check if immediate response is required 0 Licens#V Board p Selectman's Office Contact person: Phone #. ❑ Health Department E] Other FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT 1�in�►,1 � h' JLgE� -44 y LOCATION: Assessor's Map Number_ 97 SUBDIVISION ��jTAirC� �S ,q TE STREET �j �G�NtiL �2�uC USE ONLY I RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED PHONE_?72— ` 57.14 PARCEL_ LOT (S) 5' ST. NUMBER_,,I� COMMENTS s' TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPE Revised 9197 jm DATE Q" Ap- - iP#3 HIGH YVALL C - a . j _ 31 X \ 6 PROF'. SF. DABL. } M1 PRM SP 229 T'24QO 1 , ? TF -2 CF-M2.5r 3 0 234 t LCAT_ 5_E Til ELi 6 r - 2, 9x5 777::. .ry ., _ � � a"-"' r„�,;�s..c' _:,_�••`�`.-. ..-. �^ �{ yt' . Ir or. r r1' .,,.- -. .,"'�r,".�.►�+!c'�"i.,�4.""'+�....r .► r'� -:,;� -vh" ,� y h.� i .yy �e •; 1 � "'� _ {+rr� ,I '.. nW .,.`"rt, r �a ,.vr� '1 .. S r -.-. -+! _ -�- PROPOSED14 l �a tY� OK7iQ 0 �, F Swa fie. 3 d C�8 �1i)MF1fi'1$" fiC MH7_ ! t 14, i r, f WA Foundati 28 240. J 4 V)fief l {' ��� -�_I tom• _ 1 -) z / Date. �� .- . ..') .... rd....... 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This vertifies that ... ...... ................ . has permission for gas installation ....... .......... . in e6e buildings,of ... at ........... ....... North Andover, Mass. Iry Fee ;` ...... Lic. ............ GAS INS PECTOR Check # /0,:; 3599 ti1ASSACHUSETTS i3NF>✓ORh7 I�PPI.l+✓A�� aG�� �"O� Fl±�i~.�ti ; � C} �i� CSA-�F:}l"1 Ni r' (Print or Type) NORTH ANDOVER Mass. Date j $uiiding Location LQ u�nQ C. _ Pt;rrnit # :j.. E, L-,4 O Name�� 11��u3 v" New _ Renovation Replacement Plans Submitted (Print or Type) � ,V one: Certificate Installing Company Name_S�E`_��-_J�_ Corp. Address-- ��p� �"lQ,tt� C.�t . —_ -- — Partner._ t" lA? i�c" t )- -t • �C, b'b 5 _ CI Firm/Co. 3usiness i elephOne���'�����('� —_ Name of Licensed Plurr.ber or Gas r er sQ� � S ay' "7 lnsur3ncr: CO_v_er3r,e: Indic_.. or i^surance cov._. age by checking the'. appropr i3te box:-~" a k, Liability insurance policy [� Other type "or indemnity Bond S: Insurance Waiver: I, they undersicned, nave been made aware that the licenseCOf'"`' this application hoes not have arov .on,� or the aLove three insurance coverages. Signature of ownerlagent of property Owner L_j Agent Q '� I hetaby certiry that aU of the deudt and information l bare au-mittcd (or en(ered) in shove applic.tion arc true and accurate to tha bas( Oir ttY,� >i.: ,:• keowlc4ge and that ail plumbing wart and lnstatlauoas 7criormicZ under rursit iz:ecd for this application will be to eorapliaaas with'ti21 pet�atmt pcarisioas of the Maauchusetts Slate Gas Gide and (Saptcz 14Z ei ma Ccncrai Lava- , TYPE LICENSE: PIurr,ber GC/ l Gasri.tter Signature of Li ensei :haste r Plumber or Gasfittee journeyman L License Number N v N rn tr W 0 r.: p J WLLS = C F o w ? a t" w f Z N to to (A t`t r w ,, O - ►- 9) s CC ,;, } 1 r U) U4 cz La tr1 J '' 0 v S cc LU}-' a W E✓ LU --- Ci C. t- j w t q ? LL c s d a �i �� n�csl�� cry cz`CL rU'- o stua-85dtT. I ( ! S ► j I It ( BASEMENT { l IST FLOOR .I 1 ! I I f I I I I i i�_ i 2:N3 FL.00R sRn FLoaR I I l l i l {�I i I I I {� I ISI I I I I I i l h i I 4TR FLOOR 5TH FLOOR I I I I ! I I I I I I I I I I I ! I I ( I I 8TH FLOOR 7Tlt FLOOR I I I I I I I ( I I I I I I I ~I 8TH FLOOR ! I I I ! (Print or Type) � ,V one: Certificate Installing Company Name_S�E`_��-_J�_ Corp. Address-- ��p� �"lQ,tt� C.�t . —_ -- — Partner._ t" lA? i�c" t )- -t • �C, b'b 5 _ CI Firm/Co. 3usiness i elephOne���'�����('� —_ Name of Licensed Plurr.ber or Gas r er sQ� � S ay' "7 lnsur3ncr: CO_v_er3r,e: Indic_.. or i^surance cov._. age by checking the'. appropr i3te box:-~" a k, Liability insurance policy [� Other type "or indemnity Bond S: Insurance Waiver: I, they undersicned, nave been made aware that the licenseCOf'"`' this application hoes not have arov .on,� or the aLove three insurance coverages. Signature of ownerlagent of property Owner L_j Agent Q '� I hetaby certiry that aU of the deudt and information l bare au-mittcd (or en(ered) in shove applic.tion arc true and accurate to tha bas( Oir ttY,� >i.: ,:• keowlc4ge and that ail plumbing wart and lnstatlauoas 7criormicZ under rursit iz:ecd for this application will be to eorapliaaas with'ti21 pet�atmt pcarisioas of the Maauchusetts Slate Gas Gide and (Saptcz 14Z ei ma Ccncrai Lava- , TYPE LICENSE: PIurr,ber GC/ l Gasri.tter Signature of Li ensei :haste r Plumber or Gasfittee journeyman L License Number Date.,, 4764 TOWN OF NORTH ANDOVER 0 ' PERMIT FOR PLUMBING s � .�•'a SS US (((((( J..his certifies that ..:. . has permission to perform ......................... fumbing in the buildings of . �.�-� �-r ............- .. . at ..'��0. ^ ......................... `... ,North Andover, Mass. Fee ! 7 ..:.. Lie. No.x ............... !fJ — V , IVI 'ING INSPECTOR Check # L O —2 % v WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) X)Mass. Plass. 1,az Le .._.c.7 � (_..__ 19....----_..... City, Town -- Per.miL H 13uilc3ind Owner. .I't c-�IIfr , . 71 [ . Location TYtte of OCC111)AIWY:::S�_S, New nenovat•iolt ❑ Rel)].accuu�l)t: I1lilft:i FIXTURES 1;ubill 1 t1:c.cl : Yes El No 11 (fein( or'1)iv) C� Check91corp. Certificate Installing Con p.my Namc v_d•-�6�-- 5�--------. �.--------- Addiess _� V-L_r _ -- ❑ Parincishilt -- — - - --. �5_�S3 L�?_��--- � 1?J-- - --- ❑ Firm/company- Ilusincss'Iclerhont NatIc of Licensed I'll tuber or (iasfit I ltcmeby cc#lily that all of the details and information I have sulnninccl for entered) in above application are it tic and accuiaic to the best of my I,nowICJ ge and that ll11 plumbing work and iostallotions pet formed uudeI Pel olit issued for this application +%ill be in compliance wtth all IwmlincIll p...vkiml, of tilt Massuclntscmx Some Gm Code end Chepler 142 or ttme cv, tcrnl 1 aw•s. lime inlonned the owner or his agent that I do not have liability insumancc including cumplocd ope:mions cocemage. 5i/mlmC ut llru:rl Aevnl I have a comet liability imoamce policy to include comptcled operations c•o+eage. (] 'lids ---- - --- - Cify/Town+ ---- --------- APPROVED (OFFICE USE ONLY) I nnrn t740 I It+nn � a Wn111mkN, Inr: 19f19 r 'iguaturc of I.icenscd I'lunthcr-•-,--- ---�Type of 1'lutnh' +g I.iccnsc .. '�X,---_-._ �lustcr ❑ .luurneyntao License Number x z y z x Q y h W in Y .y J V) y O Z >` U d d ~ v' f• ?: l7 > W W y W OC y Z y Q cc K V) _ O u. z Z V' 4 O J V y y m y X y a W i•' 'd h y y xa z Q y 0 Q d ¢ Z w I O h O h " r Q '^ o 3 W J — y D d a _j ') Z sC K n mi oc K Q a LL s W h V Q X x O a Z [ h x a O ►' Q Z Z Q w F LL 1C w d ►' > Q h d O x y W 7 l7 d •( O Z Q O J Cm y Q cc cc W W, d O O V Q x h 3 X J m y O O J ;c Z ►- y _t u. O — 7 -- Q — d — a — m — O — — — — — — SUB—BSMT. — — BASEMENT 1ST FLOOR 2ND FLOOR _ '3RD FLOOR 4TN FLOOR STH FLOOR 6111 FLOOR ?Tit FLOOR BTII FLOOR (fein( or'1)iv) C� Check91corp. Certificate Installing Con p.my Namc v_d•-�6�-- 5�--------. �.--------- Addiess _� V-L_r _ -- ❑ Parincishilt -- — - - --. �5_�S3 L�?_��--- � 1?J-- - --- ❑ Firm/company- Ilusincss'Iclerhont NatIc of Licensed I'll tuber or (iasfit I ltcmeby cc#lily that all of the details and information I have sulnninccl for entered) in above application are it tic and accuiaic to the best of my I,nowICJ ge and that ll11 plumbing work and iostallotions pet formed uudeI Pel olit issued for this application +%ill be in compliance wtth all IwmlincIll p...vkiml, of tilt Massuclntscmx Some Gm Code end Chepler 142 or ttme cv, tcrnl 1 aw•s. lime inlonned the owner or his agent that I do not have liability insumancc including cumplocd ope:mions cocemage. 5i/mlmC ut llru:rl Aevnl I have a comet liability imoamce policy to include comptcled operations c•o+eage. (] 'lids ---- - --- - Cify/Town+ ---- --------- APPROVED (OFFICE USE ONLY) I nnrn t740 I It+nn � a Wn111mkN, Inr: 19f19 r 'iguaturc of I.icenscd I'lunthcr-•-,--- ---�Type of 1'lutnh' +g I.iccnsc .. '�X,---_-._ �lustcr ❑ .luurneyntao License Number Date ........ ...... �? A3 ........ ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....... w ............................................ has permission to perform ..... -- wiring in the building of.............. '/l.l ............................................. ...... at .... L Andover, Mass. Fee —3Q ...... . ...... ' Lic. N63J-P.&El ...... ..... ....... ELECTRICAL INSPECTOR _,..�^� Check # 5559 IIMUUMMU[VWPALJ11UP tj(/JL'11J Office Use only DF. %UN VTOFPUBIIC Permit No. BOA RD OFFLREPREVF.l ON O 127CMRII*00 i Occupancy & Fees Checked j' APPLICATIONFOR PERMIT TO ERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE ASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION,) Dates L Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electricaj w k described below. Location (Street & Number) Owner or Tenant ---L-- Owner? s L Owner's Address C-34V%A-(- Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service AmpsVolts Overhead M Underground No. of Meters New Service Amps Volts Overhead Im Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections a lNo. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- htAtrm=Coveage. PtusuantlD the fflVMnff& 0fM0SSXhJ9M Cm allaws IhawaamatLiibkykmrm=Pobcymk&gCmpieL,OpmbmCowWcritssisla<rialergivalart YES NO IhavesutxrimdvabdptoofofsametotheOfre YES IfyauhavedrdodYES, plea9 mdicaiethe typeofcovwWby d�edangthe box INSURANCE BOND (7 OTHER (Please Spey) wwwsw J6 �Av SignedunderlieRimesofpeW* - FIRMNAME 9 423-9?v i OWNER'SINSURANCEWAIVER;IamawarethattheLio wdoesmthavetheinsumxoover,WarilsabsUtulegtwmicitasmgtmedbyNbswd�C=alLaws arxidAmysgwimcnthispeurri 4#cabmwar.tsthistegtmmut (Please check one) Owner Agent -2 Telephone M. PERMIT FEE $ 5 signature of Owner or Agent The Commonwealth of Massachusetts Department of Industrial Accidents Office of lnvest/gatlons Boston, Mass. 02111 • Workers' Compensator Insurance Attidavit Please Print Name: el, A W 1 N S LDS 2, I am a homeowner performing all work I an a sole proprietor and have no one woridng in any capacity I am an employer providng workers' compensation for my employees working on this job. i, rA '•,a Fdkue to ascus coverage as requked under Secdon 25A or MGL 152 can lead to the knpooi lan of crknleal penal0es d.n Ara up to =1,500.00 andloroneye 'Im"orrnent.m.wel.as_cbAjwa Linin]beef,.ST.aPWDWORDER.aodaflaed.g1II0.0Maslayagriod.ma I undemWW that a copy d this stdoment may be forwarded to tla office of Inveogatlam of the DIA for coverege vwrc4dw. I db heroby cartrjr under ft pains and penitis orPedwy that the Intbnnaticn provided above Is true arra coned. Signature Date Print name phone # Offldal use only do not write In this area to be completed by dty or town d5dar City or Town p i []Check X Immediate response Is required Building Dept 0 LkensfnD Board 0 Selectman's Off/ce Contact person: Ph" #k 0 Health Department Other Irm q-Ulyunvly rrraLjzi UP MA)NICHUJEIIN Office Use only DERAMM ENTOMMICS4FEly Permit No. BOARDOFFIREPREVEMONRDGULWONSM70MI21W ' Occupancy &Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ®..No (Check Appropriate Box) Purpose of Building r " UtilityAuthorization No. Existing Service Amps /��Volts Overhead Underground No. of Meters New Service AmpsVolts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. or Lignnng vuueu No. of Lighting Fixtures No. of Receptacle Outlet No. of Switch Outlets No. of Ranges �jf Disposals ? f Dishwashers Dryers Water Heaters ydro Massae Tubs No. of Hot Tubs Swimming Pool Above ground No. of Oil Burners No. of Gas Burners No. of Air Cond. No. of Heat Pumps Space Area Heating Heating Devices KW No. of Signs No. of Motors IDthe01M YES No. of Generators iiia. or Cmergency Lighting Battery Units Total KVA KVA Total FIRE ALARMS No. of Zones Tons Cotal Total No. of Detection and Tons KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices KW Local Municipal Other Connections No. of HP e9uivalat YES 0 NO F1 >fycuhavedre.kedMplww dretMxcfwwgFby r� B� o � o> It E1hn*d VattedE1Xb3Cad Wak $ FvWRnalliesofpcijuty. Lice wNo. LmNo� Busk=TdNa LNiAllAlt Tel Na �3 -:� 2 q77 3 WAIVER;Iamawat dutheLinmedoesmth mftinstnatmawe jWails&&MnW MvalmlcasmgxedbyMmwtxwZ GffnW Lam gnaw on thispennitapplication waiter thistB#0nft 'lease check one) Owner Q Agent Telephone No. PERMIT FEE signature or Ownur or Agent 0.4Sk - A r* r f 01 m Date-?' ..: ... . °'< "o TOWN OF NORTH ANDOVER .` cN PERMIT FOR PLUMBING �P This certifies that J.- .. �_.%�. 7 ................ . 'has permission to performs !-:.`A.....� ....... ..�-. . wplumbing in the buildings of. 1..1.x. ..�'........................ . at ...% ..u—r:,w�_.e�(��.�.. ........ North Andover, Mass. Fee,.,.:' .. Lic. No../.�Jl... l .�w�����yy.� ....... . "!`PLUMBINGlfNSF�ECTOR Check #�f / 6333 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) . NORTH ANDOVER, MASSACHUSETTS Building Date C?,— Permit 7—Permit # Amount New 0 Renovation E ReplaceVett [� Plans Submitted Yes ❑ No ❑ FIXTURES (Print or type) Installing Company Name �J % , UlG, e, /✓ Address 3 o <-, /. n, j-, (A/ dol a Check one: Certificate ❑ Corp. Partner. LJ Firm/Co. Name of Licensed Plumber: u r c Insurance Coverage: Indicate the type of insurance co erage by checking the appropriate box: Liability insurance policy ET Other type of indemnity 11 Bond 9_ Insurance Waiver: three insurance I, the undersigned, have been made aware that the licensee of this application does not have any one of the above Signature Owner ❑ Agent 0 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 rermit Issued for this application will be in compliance with all pertinent provisions of the Massach et Site Plu i ode =Chapter 142 of the General Laws. BY ignS aturee of�icense um er��� Type of Plumbing License Title J City/Town icense (Numver Master Journeyman ❑ APPROVED (OFFICE USE ONLY r Location 0 rJ5 J--0�N�� �,�. No. Date %' o? g' b S - HORTol TOWN OF NORTH ANDOVER O f R 9 4. Certificate Occupancy of $ �'�s •"'°''t�' s�cMust Building/Frame /Frame Permit Fee 9 $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 0/60, Check # 1 7 $ 8 i��� '/�- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT EtAI& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING i t sedfelk fir1. e BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: KZ-tl- BuildingCommissioneffl for of Buildings Date JLL 1, l lvl'9 1- Jl l b 11r r UMMA IL UX9 I 1.1 Property Address: fi557 L-�KI nl N� i2y 1.2 Assessors Map and Parcel %'l Map Number Number: Parcel Nu ber (� 2.2 Owner of Record: t� Name Print ti 1.31 Zoning Information: Zoning District Proposed Use Signature Telephone 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided Cotrnpany Name Registration Number 1.7 Water Supply M.G.L.C.40. 34) Public ❑ Private ❑ . 1.5. Flood Zane Information: 1.E Zone Outside Flood Zane ❑ Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTIU14 2 -PROPERTY OWNERSEUP/AUTHDR'.IZ.ED AGENT UI� S.tY,3 2.1 Owner of Record I-bm 4 e I lGT�\) Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: t� Name Print ti Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Cotrnpany Name Registration Number A dress Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 2! Workers Compensation Insurance affidavit must be completed and submitted in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check a0 a ble New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ application. Failure to provide this Alterations(s) ❑ I Addition ❑ Accessory Bldg. ❑ Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: '�t9,�- - e P-1 c (Z 11 LAD c T1V7% /1nNC9D7Td'grTnN f'nQTQ 1 will result Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL USE ONLY . I. Building S� (a) Building Permit Fee Multiplier 2 Electrical s (b) Estimated Total Cost of Construction /7� ®4 ,— << 3 Plumbing Building Permit fee (a) x (b)� 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number fD SECTION 79 OWNER. AUTHORIZATION ru tse c uidsrL� i�u wnr n OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERNUT 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 nate SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 e:�1 60 I/ PP -S *�!a�_ as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Lrue and accurate, to the best of my knowledge and belief r Pros Print Name � � .�%lJ / [� 2-0o Si attire of Owner/Agentr�- NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND3 FD SPAN DIMENSIONS OF SILLS DUVIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE C.,.,,A4_1C"_-� Tel: 978-688-9545 Please print. DATE �&M JOB LOCATION Number q Street Address ) Section of Town ,HOMEOWNER Number y Home Phone Work Phone PRESENT MAILING ADDRESS 'T S 1-C_)q_1V1VC —bR) �E� N' i4tl]l DOV/C-X i 144n of AT Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION tkAlw4E 7)R I VE 04 � stf 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 that the owner acts as supervisor. (State Building Code Section 109.1.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner' shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures HOMEOWNER'S SIGNATU APPROVAL OF BUILDING OFFIC Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit AppfiFaint Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Name: Location: The Commonwealth of Massachusetts Department of Industrial Accidents Ofte of Invesdgedons Boston, Mass. 02111 Workers' Conipensattton Insurance Afdavit Please Print City Pftona 0 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity aI am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address Fdkwe to secure covenge • roqulred under Section 25A or MGL 152 can lead to the knposition of ahMd panallles d.a Ane up to $1,500.00 andtor one yen' Imprisomcant_as wd.as.cbA nndt esjo lhshm jaA STOP -VVDW ORDERmd.a.flae d.(3100AWAAM agd W_ma I understand that a copy of this statement may be forwarded to the Office of Invesagailom of the DIA for coveraps vwftdlon. f db hereby ce►* under the pains and penWfts d perjury that the lntbrmat an pm A*d above Is sue and coed. Signature Date Print name Phone # Oftkial use only do not write In this area to be camPleted by city or town dW@r City or Town P aim OCheck Mlmmedate response !a requied 13 Building Dept ❑ Lrcensmy Board [:]Se/ectrnen's Offke Confect person: Phone [] Heafth Department C] Other 5 19 1-t HSe��qJI 1 W A d� a� u u• o w a w° w°' ilull U w x w Tol x a aa y a C7 ca A roc d o FR 0 .v tj 96 F a CD O as • co z o, O H C C O 07 O � _ A O O '� m m CD a ~� O M: o a v�Q ca CD =� c ev M10 CL M C Z 0 CL ai C.3 N3 O C C ■ C c y G LLI 0 U) W W 19 W U) c c .m ui .: c :=o z CL Tol FR 0 .v tj 96 F a CD O as • co z o, O H C C O 07 O � _ A O O '� m m CD a ~� O M: o a v�Q ca CD =� c ev M10 CL M C Z 0 CL ai C.3 N3 O C C ■ C c y G LLI 0 U) W W 19 W U) c c .m .: c :=o Tol y • C �O vV •dam ; C m c Qo� CF c :oma =!bra. 4' r o z y y :s a4 g rf: yma o� c _ N CO m :oCO a o, c = m cc N W CO �wio c +• E COL. Cox L o y a �� o.S H y =aaZm� m EMM O FR 0 .v tj 96 F a CD O as • co z o, O H C C O 07 O � _ A O O '� m m CD a ~� O M: o a v�Q ca CD =� c ev M10 CL M C Z 0 CL ai C.3 N3 O C C ■ C c y G LLI 0 U) W W 19 W U) Location CIV '7 No. �l Date j i NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ 010 1 ;�s'•^^''t�'j Building/Frame Permit Fee $ Check # (O Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Locations �s �p�ti�� '-��2 No. a Date / - 0-6?- O TOWN OF NORTH ANDOVER Certificate of Occupancy $ 6-2� Building/Frame Permit Fee $ Foundation Permit Fee $ -/00 Other Permit Fee $ TOTAL $ 1,540 � i Check # 1�3 V 4.47 i kw �� Building Inspector SIGNATURE: Building CommissionW/I ' for oMuildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map PMap Number and Parcel Number: Parcel Number Signature V Telephone 1.3 Zoning Information: Zoning District Proposed Use 2.2 Owner of Record: Name Print Address for Service: 1.4 Property Dimensions: g6 3 /go" Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft SECTION 3 - C NSTRUCTION SERVICES Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 30' 7 License Number 3 h /rZ Expirati(on Pate 1.7 Water Supply M G.L.C.40. 54) 1.5. Flood Zone Information: Public Private ❑ Zone Outside Flood Zone 1.8 Sewerage Disposal System: Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.10 ner of Record led�VCEJ coo, Hon{5 s3% Name (P 'nt) Address for Service X207 Signature V Telephone 2.2 Owner of Record: Name Print Address for Service: Si nature Telephone SECTION 3 - C NSTRUCTION SERVICES 3.1 nsed Construction Supervisor: Licensed Construction Supervisor: /Q �ox S Addre !r an 6 �z Signa a Telephone Not Applicable ❑ License Number 3 h /rZ Expirati(on Pate 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone LAN SECTION 4 - WORKERS COMPENSATION (AG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work Lcheck all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: rry 1� 1 �;�� 11. v 3 P�� �A (11. SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICiAJ<. USE t}NLY 1. Building (a) Building Permit Fee Multi tier 2 Electrical(b) (} Estimated Total Cost of Construction 7 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total1+2+3+4+5 Check Number SECTION 7a O NER AUTHORIZATION TO BE COMPLETED WHEN OWNERS A N OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L�!T, as Owner/Authorized Agent of subject property Hereby authorize �� l S / ° p MA el r, f S to act on My behalf, in all matters r tive to work at orized by this building permit application. / is" v Signature of Owner Date SECTION 7b OW HOORIZ D AGENT DECLARATION ,JDA I, C �/ ` 5 r, " °" 4 ' C /U,4 Ce �� 5 ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my k„ owledge and belief - Print Name Si attire Date NO. OF STORIES SIZE BASEMENT OR SLAB q St M ev T SIZE OF FLOOR MMERS iST 2 X I 2 ND r o 3RD SPAN j DM ENSIONS OF SILLS X (� M ENSIONS OF POSTS Z a J( - MENSIONS OF GIRDERS X HEIGHT OF FOUNDATION %' /D " THICKNESS le SIZE OF FOOTING D ( 36 X MATERIAL OF CHIMNEY D U 0 IS BUILDING ON SOLID OR FILLED LAND S a , 0 IS BUILDING CONNECTED TO NATURAL GAS LINEe, FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT 6e06,0 11111,1-l' �v.v/o/ %7/® t f 5 PHONE —:0o 7 ASSESSORS MAP NUMBER / /7 LOT NUMBER SUBDIVISION��� �'� s �'' /� LOTNUMBER STan amREETmemo am �f•4�vi'yNone Boa ass so� i��'� !`� SNow EWE an am a a am WON am a a amTREET massNUONEMBERam Ono 75 am Nam a OWN—M OFFICIAL USE ONLY REC NWENDATIONS OF TOWN AGENTS �■ ■ ■.....■■■.T17 .....■.■r � t ^S ��-- DATE APPROVED CONARVATION ADMINYTRATOR COMIviEN'I'S FOOD INSPECTOR - HEALTH SEPTIC INSPECTOR - HEALTH e'4) DATE APPROVED // A 26 DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTI NS cis 104 DRIVEWAY PERMIT UL ,V . �'t l J? .r rr 0/ DATE APPROVED FIRE DEPARTMENT -Lje,0p;-nS(��•I>? DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE O A Lr; CC) Lu uz� It 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 requested below. * (/.f �T �e4lvlv( 1-2e. -Aviv- x H,,.-,, o _V/V Permit Applicant Property address -Map Parcel Z� - 8707 X Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this 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 subject to 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 of the effective date of this bylaw, provided that no additional residential unit is created. XThe 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 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 onetime 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 SIGNIW BELOW I ATTEST TO THE ACC ACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED SLICANTS TIS ALLOWED AN EXE I NAS CITED ABOVE. RSTAND THAT THE SItB AL OF MISLEADING OR INACCURATE INFORMATION OR THE F A ABOVE EXEMPTI0 ICH DOES NOT COMPLY, WHETHER DONE TO MY WLE E OR REFUSAL B T LDING DEPARTMENT TO ISSUE A BUILDING PERMI . zGNATURE DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Location: 7� �/ 14NG'e vrC i'!'I9 Phone Cifi� - am a homeowner performing all work myself. MI am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation formy Is employees working on thisjob. Comoanv name. /� �O� �v' c s/ C O k� ti ,,11 . ��..� Ps Address�'r .✓r C jYl.¢ d/�Si J� Phone vZo 2 Cit1r' _ Insurance Co. �'�s «N r '� "�� �� Poggy # Company name: Address City Phone # Insurance Co Policy # Failure to secure coy 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' imp n e as well as civil penalties in the f of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a c of h' statement maybe forwarded tooce of Investigations of the DIA for coverage verification. I do herby certify Of provided above is true and correct Print namev �y�`s dp `ASC 9 s Phone # /C/ Z//Q0 Official use only do not write in this area to be completed by city or town official' E] Building Dept ❑Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person:_ Phone #: [-I Health Department Other FORM WORKMAN'S COMPENSATION = ✓he Fromriranic�rll� n��-t��rzr,rtrc�rarP�3 ' BOARD OF BUILDItdG REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 073901 Birthdate: 03/11/1971 Expires: 03/11/2002 Tr: no: 73901 Restricted To: 00 CHRISTOPHER N MACENAS 98 MAIN ST N ANDOVER, MA 01845 Administrator r MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 CITYt North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 12-19-2000 TITLE: HERITAGE ESTATES BRENTWOOD PROJECT INFORMATION: BROORVIEW COUNTRY HOMES INC PO BOX 531 N ANDOVER MA COMPANY INFORMATION: J&J HEATING & AIR COND 17 ARLINGTON ST DRACUT MA COMPLIANCE: PASSES Required UA = 617 Your Home = 615 Permit # Checked by/Date Area or Cavity Cont. Gla2ing/Door Perimeter R -Value R -Value U -Value --------------------------------------------------------------------------- CEILINGS 1800 30.0 0.0 WALLS: Wood Frame, 16" O.C. 2479 13.0 0.0 2 GLAZING: Windows or Doors 510 0.400 2 GLAZING: Windows or Doors 96 0.460 DOORS 39 0.400 FLOORS: Over Unconditioned Space 1800 19.0 0.0 HVAC EQUIPMENT: Furnace, 92.0 AFUE -- COMPLIANCE STATEMENT: The proposed building design described here is -- consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date Massachusetts Energy Code MAScheck Software Version 2.01 Release 2 HERITAGE ESTATES BRENTWOOD DATE: 12-19-2000 Bldg. Dept. Use it [ l r J CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-13 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.4 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ j Yes [ ] No Comments/Location 2. U -value: 0.46 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ j Yes [ j No Comments/Location DOORS: 1. U -value: 0.4 Comments/Location FLOORS: 1. over Unconditioned Comments/Location Space, R-19 HVAC EQUIPMENT! 1. Furnace, 92.0 AFUE or higher Make and Model Number 2. Air Conditioner, 10.0 SEER AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, -recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 FA or 1.57 lbs/ft2 pressure difference and shall be labeled. A VAPOR RETARDER: J m -in -winter aide of all non -vented framed Required on the war J ceilings, walls, and floors. J MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can [ ] J be determined. Manufacturer manuals for all installed heating J and cooling equipment and service water heating equipment moat be J provided. Insulation R -values, glazing U -values, and heating J equipment efficiency must be clearly marked on the building plans J or specifications. J DUCT INSULATION: t ] I Ducts shall be insulated per Table J4.4.7.1. DUCT CONSTRUCTION: [ � � , and connections of supply and return All accessible joints, seams ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed J installed according to the using mastic and fibrous backing tape J manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. J TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating 1 and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in.): HEATING SYSTEMS: TEMP (F) Low pressure/temp. 201-250 Los„ temperature 120-200 Steam condensate any COOLING SYSTEMS: 1.5 chilled water or 40-55 refrigerant below 40 CIRCULATING HOT WATER SYSTEMS: PIPE SI2ES (in.) 2" RUNOUTS 0-1" 1.25-2" 2.5-4 1.0 1.5 1.5 2.0 0.5 1.0 1.0 1.5 1.0 1.0 1.5 2.0 0.5 0.5 0.75 1.0 1.0 1.0 1.5 1.5 Insulate circulating hat water pipes to the following levels (in.): PIPE SIZES (in.) NON -CIRCULATING Z ] Insulate circulating hat water pipes to the following levels (in.): ----NOTES TO FIELD (Building Department Use Only)------------------------- PIPE SIZES (in.) NON -CIRCULATING CIRCULATING MAINS & RUNOUT HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1_25" 1.5-2.0" 2.0+ 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- J.WILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 0 A A DRIVEWAY PERMIT DATEe Lem t Z ZoaO LOCATION 5 L e-< ;t Pee Ue BUILDER phone OWNER gr90&1'u,0 �$fi /LK4�16 hone 6� - C-5-58 THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Telephone (978) 685-0950 Fax(978)688-9573 10 1035 s 1631 APPLICATION FOR SEWER SERVICE CONNECTION e Z �� North Andover, Mass. L 1 - ' Application by the undersigned is hereby made to connect with the town sewer main in / C�� �%1� ,�/r'/Street, subject to the rules and regulations of the Division of Public Works. , The premises are known as No or su division lot no. s1 e-. /SBO 1/t 6} Owner Contractor Street i A PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to �1/ c�l� CQUK� l�'OrYlf� to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. Inspected by Date Division of Public Works By / See back for rules and regulations aj --i < z c ° O o n a O fD ° z O °j? -k azo m °� _�_ y n -n- N . - cD tD m m Co c 3 EPEP aai to � 0) O H =� O O. 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This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT 1 KaMWS -1 EI l I I� E1-�-i PHONE � �5 - S � b LOCATION: Assessor's Map Number i" PARCEL_ _ f __ SUBDIVISION 1 �T� �T�S LOT (S) STREET IS LgAI "C �� v� ST. NUMBER **********************************OFFICIAL USE ONLY********************************* AGENTS: CONSERVATION ADMINISTFj�(�TOR DATE APPROVED ((// DATE REJECTED A` COMMENTL a f S !�^ turiS�ic�ian� is � (.�ncc�rn W� '1'I1¢.�&A(-,e. cater ii t a 46. �nAl cw,�. + A�► fGd:S+n�n� �i.c,cl� �� 'DPW cc-L�dp / PLANNER COMMENTS' 10 DATE APPROVED DATE REJECTED <IJ 110-3 MAY 2 1 t6 � M,�+'l-� NOr4 H ANDOVER FOOD INSPECTOR -HEALTH DATE APPROVED �PtrnT!W! NT DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9197 Im DATE J. Justin Woods North Andover Planning Board 27 Charles Street No, Andover, MA 01845 H&B Survey Service 219 Salem Street Andover, MA 01810 978-475-8232 Re: 75 Leanne Drive — Lot 5 North Andover, MA Dear Mr. Woods: Attached is site plan with a proposed garden shed (6'x 8') and footbridge (16'x 4') outlined in red. The garden shed will not have any gutters or downspouts. It is my opinion that no new surface or subsurface discharges are proposed with the construction of the shed and footbridge. If you need any additional information feel free to contact me at any tine. Sincerely, Henry R Himber CAM . E. GUMOMEO R�176.03¢'10'42 " 14'99 LEANNE ., . 0 31.4' Ex. Foundotlon T,F. Eloy. -240,25 S24'39'25"E 265,06' pwlp lw o?l DRIVE /ssvcb 4 -&-of N24'39'25"W 35; 76.64.1 125,10' 46. DIV 4 � . G tr R-3 W 4 F, 0.58 Ac. EXISTING DRAINAOC EAS$MgNT ExIStTNG Ido CUt EASEMENT o �I:N M, � i� N N 19.42, 20, 7-17�f THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY. IT WAS PREPARED FROM EXISTING PLANS AND RECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION, 0'57,34"W 72. _,._ ,07, 35.* g568sys. 0,66 Ac N WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THE DWELLING IS LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALITY MEN • CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M,A./H,U.O. FLOOD INSURANCE RATE MAP, COMMUNITY PANEL NO.250098 0006 C DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. I CEFMF:IED PLOT PLAN I LOT 5 HERITAGE ESTATES NORTH ANDOVER, MASSACHUSETTS ORAYM FOR BROOKVIEW COUNTRY HOMES, INC. P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MAF ilONDA + - ASSOC,,LP. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE. SUITE I STONEHAM, MA. 02180 ( 781) 438-6121 !PA-/ (-+S;1 ) W 3/ GATE: 2/6/01 SCALE: 1 "n4 -D' IcGq 0 m M m m O m u 4 i C2 W d CO! C') CD MZ CA C. �. su O d CO) C2 CD CD cr CD CCD O CD C CD y —• CD C CA CD � v y O 'vCD Z St a O � A CD C c W� o -4 So MO y =�m0 m c•! Z • =rlo N --I O• ..r � w m H T � p m N O y N ? m m 2 > >� o n m �` O O y Is n a c � caca CL m o C?� � CD m H ;s : n'O : �r C d sob CD C C y y G :� C C36 CL �rm7 CDi o O W y Nl N y m:s Wai CD O r a 1 CO2 .4 b�. - s CD C-o L ^� "Fell �7 C 0 =2 W . C c c ay c O rD n gyp Z _ psi :o o �G x c� o' o w G ,. R., �, C" C� , a > w G r '"' b r" �� '�? o w `� n n- o o G G OC C R ar a co ` °' GJ cn � o - Un O n• A-. cn 7C t7 �7 0 •�,�- 17 fy� �n o l O ft z GOD .� �i� C' b C7 M N ,N\\ S_ 0 y 0 ate ,10 1 FEB -08-2001 10:25 AM MARCHIONDA&ASSOCIATES 781 438 9654 P.02 R �-�6 �s34'10'42 " 1b°f'9g LEANNE j/ S24'39'25"E 265,06' -kw C91 DRIVE N24'39'25"W 352. 125,10' EXISTNG NO CUT EASEMENT STEPHEN K No. �o°to N 19'42' 20 'Z17 6( THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY, IT WAS PREPARED FROM EXISTING PLANS AND RECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION, O 2$583 S' 0,66 Ac N2O'S 7'34°'W 72. i05" ' 4 � y � N s`'75'Q7 32"* WE HEREBY CERTIFY THAT WE HAVE EXAMINEE) THS PREMISES AND THE DWELLING IS LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALIT`! WHEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M,A,/H,U.O. FLOOD INSURANCE RATE !MAP, COMMUNITY PANEL NO.250098 0006 C DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE_ CERTIFIED PLOT PLAN I LCAT 5 HS:HTACE ESTATES NORTH ANDOVER, MASSACHUSETTS tIRAMN FOR 9ROOKVIEW COUNTRY HOMES. INC, P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA + A OC„L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE, SUITE I STONEHAM, MA. 02180 (781) 438-6121 DATE: 2/6/01 SCALE. 1"-40' 46. 1A Ex, Foundotion tr, Elay.-240,28 tr - \ 1 EXISIrNG DRAINAGE EASEMENT y CPO EXISTNG NO CUT EASEMENT STEPHEN K No. �o°to N 19'42' 20 'Z17 6( THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY, IT WAS PREPARED FROM EXISTING PLANS AND RECORDS WITH THE STRUCTURES SHOWN LOCATED BY AN INSTRUMENT SURVEY. THIS PLAN SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION, O 2$583 S' 0,66 Ac N2O'S 7'34°'W 72. i05" ' 4 � y � N s`'75'Q7 32"* WE HEREBY CERTIFY THAT WE HAVE EXAMINEE) THS PREMISES AND THE DWELLING IS LOCATED AS SHOWN. THE STRUCTURE SHOWN CONFORMS TO THE ZONING LAWS OF THE MUNICIPALIT`! WHEN CONSTRUCTED. ALSO, ACCORDING TO THE F.E.M,A,/H,U.O. FLOOD INSURANCE RATE !MAP, COMMUNITY PANEL NO.250098 0006 C DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE_ CERTIFIED PLOT PLAN I LCAT 5 HS:HTACE ESTATES NORTH ANDOVER, MASSACHUSETTS tIRAMN FOR 9ROOKVIEW COUNTRY HOMES. INC, P.O. BOX 531 NORTH ANDOVER, MASSACHUSETTS MARCHIONDA + A OC„L.P. ENGINEERING AND PLANNING CONSULTANTS 62 MONTVALE AVE, SUITE I STONEHAM, MA. 02180 (781) 438-6121 DATE: 2/6/01 SCALE. 1"-40' M01y O• ...e .• 1y0 o Town of NORTH ANDOVER f BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: ��S(GPw�C�e. C� &S? 'Fi'WDATE: UNIT NO.: FLOOR: WING: BUILDING NO.: REMARKS: l� C Excavation - depth and soil conditions Framing - Other: Date: "� —c- I Date: �� Date: Inspector .04C cr. _ Inspector /�' "C-1—Inspector Footings and foundations and drains - Insulation - Other: 2-- i ` Date: `'� cp r Date: `f'—� 7 ` � Date: � cc,_ -f "4-e `-*-" Inspector----*-' �^'` Inspector /f Inspector Electrical - rough - Plumbing and/or gas - rough - Other: Date: Dater ° Date: Inspector Inspector 6•� Inspector Electrical - final Plumbing and/or gas - n Other: Date: Date: ? �' Date: Inspector O Inspectors ��� Inspector 9re Dept - vil burner, tank, stove, smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: �! C of O Inspector Inspector ,4,4,4-f, -1116 101044��� Form #995 Action Press, 885-7000 Town of North Andover o& 00RTh q Building Department32 t1Leo ib �o t 6 27 Charles Street o North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �` a APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION J zCpti IVCADDREss LOT NUMBER SUBDIVISION DATE REQUEST FILED 7/ -/a l l " DATE READY FOR INSPECTION FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPEC E OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE r DOES NOT,4ET ALL APPLICABLE CODES. SIGNATURE 4 2!L -,4v � Z IC OFFIAL USE ONLY ROUTING CONSERVATION DATE r J PLANNING'--- DATE (Lb it l0 l U t D.P.W. — WAYR METER '^Z - 6 - 61 S�b- DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SPECTION REQUEST DATE. vL SIGNATURE / DP AUTHORIZATION 3008 rV; Thic c-o-rtifipc Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'has permission to Perform.,, -.'-7—.A ,.,e .................................................... wiring in the building ' of ......................................... at ....... ............... . North Andover, Mass. K FeeL?.b—..�.... Lic. No/g �& ........ /' ...... ............... ,71--tLEC'MICAL INSPECTOR Check # ---01 �0 — V/ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer C'6nvnonwsaR o` ///addacItud4i For Office Use Only (Rev. cc �� cc77 Permitt Number: cJ 1Jspatnasni o`}i►. �snricsd Occupancy & Fee BOARD OF FIRE PREVENTION REGULATIONS APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO BE PERFORMED WITH THE MASSACHUSETTS ELECTRICAL CODE 527 CMR 12:00) D PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: /D /® City or Town of: M r ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location: (Street & Number) 7y L &—hAN G ZU Owner or Tenant: 7�&-'(/U M U G L r G 4A.N Owner's Address: Is this permit in conjunction with a Building Permit? Yes o No o (Check Appropriate Box) Purpose of Building: Utility Authorization #: Existing Service: Amps / Volts Overhead ❑ Underground.❑ # of Meters New Service: Amps / Volts Overhead ❑ Underground.❑ # of Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Transformers Total KVA No. Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool: Above ground ❑ In Ground ❑ # of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners Fire Alarms # of Zones # of Detection & Initiating Devices # of Sounding Devices: # of Self Contained Detection/Sounding Devices No. of Switches No. of Gas Burners No. of Ranges No. of Air Conditioners TOTAL TONS: Local ❑ Municipal Connection ❑ Other No. of Waste Disposals Heat Pump Totals: Security Systems: Number: TONS: KW: No. of Devices or Equivalent f 0 No. of Dishwashers Space /Area Heating: KW Data Wiring, No. of Devices or Equivalent: No. of Dryers Heating Appliances KW Telecommunications Wiring: No of Devices or Equivalent: If No. of Water Heaters KW No. of Signs: # of Ballasts: OTHER; # of Hydro Massage Tubs No. of Motors Total HP 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 X BOND o OTHER ❑ Please specify: Estimated Value of Electrical Work $ �Q 4.00 (When required by municipal policy) Work to Start: 0 f Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the pains and penalties of perjury, that the Information on this application is true and complete. Firm Name: ,C�/l21 C'>17 ! �%7cZTjd--J LIC. It 3 !? Licensee: 49 f G 62q &A)Q) Signature: LIC. # I' 3 (If applicable, enter "exempt" In the license number line) » h. Address: Y` a3 GEW,4 �( �VVSO'U A /# O J0J-( Bus. TBI. # �Q3�� �`�VyS AN. Tel. # 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 ❑ OR Agent ❑ Signature of Telephone # PERMIT FEE: $ 's-0,061 F•• E~ � a� H z r W [-0QzV) z:aa tn o aM= z b aH w0ew'w LAJ 0zoW(]w: z W a z QU°�W o 'azo¢ QQC) z Q W 0 >U� m�¢w°x W j)�[/\§/\\ 2 < 4 0 Jf/) H «§Z o Z m»m94§ /§�§ /3/N g�§ � � �®/ k \\� <<//j c ~ ` 4m \\\/j \ r r ' COMMONWEALTH OF MASSACHUSETTS 'OF ELECTRICIANS F�REGISTERED SYSTEM TECHNICIAN ISSUES?MIS LtCr ;NSF, TO ERIC• R GAGNON 12 THIRD AVEC. ' REAR APT LOWELL,: MA 01554-2625 L, 1738 D 07/11/01 751811- L,,- - - _�