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HomeMy WebLinkAboutMiscellaneous - 757 FOREST STREET 4/30/2018N_ O � -4 O ti ciiO . v0, o 4 r7 O o M m . o M o Date .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies thatSf Z--� has permission to perform.%f........................ . plumbing in the buildings of .. %"'"�................. . U at .7 %.. -r�-- ................ North Andover, Mass. /� !Q �. . Fee./.�.,..... Lic. No .......... .... ...... .. �.............. . �PLLUIVIT-1 G INSPECTOR Check # G/ 5;47 N� MASSACHUSETTS UNIFORM APF V%nt at Type? QCc4`ih A 0,I)eIr . Mass. New [� Renovation O PERMIT TO DO PLUMBING �_ Permit # l> 7 _Owners Name t'1S'naB S �.-ivlc�ac� Type of Ocapanky, (Zed ti ehT�v�� O Plans Submitted: Yes O No FIXTURES Installing Cornpatty kA Check one:. Cettffiate O Corporation 'O Para Business O hwoo. Name of Ucensed Plumber 1hovYNOL5 01-O vI vIo-c- INSURANCE COVERAGE: I have aily insurance policy or Rs substantial equivalent which meets the requirements of MGL Ch. 142. Yes OF� No O N you have checked jo. please Indicate the type coverage by dheciMg the appropriate boot A liability Insurance policy t/ Other type of Indemnor O _ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does riot have the Insurance coverage required by Chapter 142 of the Mass. General taws. and that my signature on this permit application wahm this requirement. Chedc one: Owner O Agent O t hereby awtiy thst ali of the details and information 1 hays a 6a tted (or entemdl in stone Wficmbm ue true and amore to the best of my Iamon bOp and that all piumt4rmp work and mdabb ms perbmwd wider the permit mod for this application will be in oornpfmm with call pwtinWd WOVI ons of the Massadneeds State PkM tmhmg Cods and Chspter 142 of the tieneral laws. Title . Type of Lima: blaster Of .lomaneyman O Rowe t WmW Number M. P ( o k (o C) COMMONWEALTH OF MASSACHUSETTS \ IN PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THIS LICENSE TO THOMAS P OCONNOR �Q ;m 728 FOREST ST NORTH ANDOVER MA 01845-3321 10160 05/01/04 546225 Location— (9 � ocation(9� a Date tom' I yP AO3 No. _, MORT�y, TOWN OF NORTH ANDOVER - s Certificate of Occupancy $ Building/Frame Permit Fee $ �Or� �c14Us Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3(0 9 3 168'! 5� �t� C�-•--- '� J Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING. BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: fes. Building Commissioner/I or of Buildings Date SECTION 1- SITE INFORMATION l; 1 Property Address:l� 1.2 Assessors Map and Parcel Number: -757 �or�i �' 0S /-7 /- N�t� / 1� -Z--W Q, 1 � Anhye, A ®' �� � Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 water Supply M.G.L.CAO. 54) 1 5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record io Nnn,,s S. j 1 Son `757 rre4 St. N rint) Address for Service .2 or Signature Telephone t 2.2 Owner of Record: 1 Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ �i'fl �(• MOrli0437 ed Construction Supervisor. � 4� 0 4 3 / l i�License Number Address eO�' 179- 111-3 Expiration a ( O xp D to Sig Telephone 3. istered Ho Impr ement Contractor Not Applicable ❑ r Company kfame Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 $ 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... ❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7ddi tion Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: MA h ez14'n home wk,c� Will kl u t C4 r � �Xf ' �I l��e►�{ 1'a(Ak � ''Doyk- 0A �- SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to beTw Completed by permit a licant k,a 1. Building q, OQ 0OD'00 (a) Building Permit Fee Multiplier 2 Electrical 101000,00 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGEnNTn OR. CONTRACTOR APPLIES FOR BUILDING PERMIT NT I, , I, I L11 Sonas Owner/ uthorized Agent of subject property b thorize to act on er ive to work authorized by this building permit application. 5be Sign i ra ur Owner Date t SECTION 71b OWNE AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent NO. OF STORIES Date SIZE BASEMENT OR SLAB SIZE OF FLOOR T fflERS OT 2` 3RD SPAN DITVMNSIONS OF SILLS DIMENSIONS OF POSTS DEVIENSIONS OF GIRDERS . 1-IEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ■M r Loc DEF_ p.5' /*G -+9N * //S//O P19Ar oI= .19 A-' / N IVoR rhH fl N D Cr VEA �`1Ass. Soma vEYED FOA /< REAL.Ty TR vsT SC 9LE 1"= *o -5 r0klERS 19 SS OCIfdTES -r NG- .%14NfJ/9.R Y /992 RErr. L g vo .SSR vEycp r767'N L, -- /Vj /I A SS. +5066e64720 i!r�HEF: 035 PO r � .41 lw ff 7 .1i• � ,sem - �• ��,��;: r 9 1'� � �_ d7 ..Mr / � 4.v "✓ 6✓'� 1' F,xt e'�a,f i ,, � y, � 44�`. •�'� J irgHY0W9bWRIWWrM .. +\ {u . .. fi.ti �� V y.yF y r '4 .r � aJ'L'+ >" r'�a..' .*1• w � ��+°\ I _.....� e. f ' ��, O � � .$ � ' � p 6. F! 6i l CSM � ',(�, M't .4 4rV ''�V ��. y i 'I �. 4f I^4 +,✓ f�i�' �i E 5 ,Mr, X03 r ♦ �. Y �� �`J W4i & cE. f Aw R t H b45 +. ♦. i e W."` r +.n. ... rf .y y ♦ a N W Y a' t Y! O ��;�'• _ I t � 4`—�'..�4.yy. CWu �paW�'pytM aR/Te�'T p��M1Pj� p , � .6 MW .f• fJY YID YW �ri •F S� _ rw� ' 364 * 1r .� • �'M� i r 'p ✓ %' ,�� 9t .�•. • r � �� S� `"` qtr � le If r +✓ i ! / •� gpy�a� �y � �wwrr.�waw.n� ..ten.-.- ..r�,�.. � V R" � � � ��4•V..y aT 7t + �.. � �a} t 2'3 GAGE — C. 2 I 1 ' I � I I I I _' _ .. i i I I - _. _.. _ . __ I i � ��. I i _ _ I __..�_ _.._.., __.r_. �_ I I 1 _ T I I � 1 � I 111 t � I I i r 'N, r �. � , ��. - s, i ., I I i I I I I j I I I I I 4 I ( ^ I I I I I I 777 _r f I I I I I I I T. . I SEP -11-2008, THU) :25 A&K FOULER IBIS. 4 ` A & K ;r'owlsez STasusaraee Agency 200 Park Street North lead: n q. �M 01964 i Juan Morin Construction 45 Simone St. j COMPANY— Methuen, MA 01644 I 3 . 8 TC� . €P t -F A'7L=!- u LAGS IJtl. JN9 YCG U,", cv Sc:v` fi �dvt 3VE'' 165UED TO TWE INSURED NAMED ABOVE FOR T -HE POLiCY PERIOD INDICATrD. FICrTL"J T. ;..Tt .Cs. ANY g .0., REQ °E!„. TV -RN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT:F;;;.Al _ MA” 3 5:iUEL? C'? PE-TA;"a, -!-:E 114URAN; E AFFORDED 9Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALC. THE TERMS, _ i:xCi Siv:' 3 Miyv :'::D Ti`vF 3 rJr AUC i POLlCI�.S. -114-S CHOWN MAY HAVE BEEN REDUCED 3Y PAID CLAIMS. COT_..-----.` POLICY EFFECTIVE Y EXPIRATION POLICE IMMIDCI7Y) QTR I TYPE OF INSURANCE OOLiC" NUMBERI DATE (MhUppry'{) �TLINUT8 (FAX)978 664 2209 P.002I003 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A Preferred Mutual Insurance Co. COMPANY 9 —NGENERAL ._IABILITY Y _ i 2/0403 204/04 I CENERA 2,000,000 I PnMOUCTS,.. COf "WCP AGG S 2.000.000 �'�^ iCl°.I rt7S?1747` -x oc---on •' — PI CRSONAL6 ADV IIJJURY OVriER'SJ� wOrST �.AC:TOR',r,P�t)T I EI ACH OCCURRENCE $ � fIREDAMAOE{Any arenre) �1,000,000 { 5 5p, 0�0 __ � - i - j - Is - -- S.000 I S MED EAP {Any or* Person) COMMNED SINGLC U.Mm I IAUTOMOBILE `� —I LIABILrrt A-41 AUTq i 1 iSCHECULED ALL OWNED AUTO` AUi'U ; I DODILY INJURY I (Per person) S i MIRCO ALITOS NON-OWCED AUT';`:; I BODILY INJURY (Por acci4ann $ �— I PROPCIr Y DAMAGE $ CARACE LIABILITY `-1ANS AUTO Ii mi K)ICVSO LIABILITY �• • -.� VMI'RELLA FORM I OTHER. TMAN UMERELLA FORM I _ WORKEhSCOMPENSATION AND i EMPLOYERS' LIABILITY TI•EPROPRtF10R1 J PARTNERSIEXCCUTIVL �-- 1'JC:L OFFICERS ARE: xC�L ! - I I vrnth - ----- I 1 I I I � i I ^ESCAiPYrON OF 4F'EAAtip,J8i10CA710- SIVEMICLk insuxanzc verifi=tYAn i ITEMS AUTO ONLY - FA ACCIDF•NT $ I j OTHER THAN AUTO ONLY I EACH ACCIDENT S EACH OCCURRL-NCE S AGGREGATE S S EL EACH SE O NI POLICY s EL DISEASE - EA EMPLOYEE S .rtTiFlCA7rtiYJLbi R Or�iV SMO LP ANY THE ABOVE DESCRIBED' POLICIES BE T • ,(. ! NE Town of Middle�on EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Middleton,'Ma 01949 1 18 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, j DJT FAILURE TO MAIL SUCH NOTICE SHALL IMPOBF NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE COMPANY. 170 ACENT8 OR REPRESENTATIVES. AUTHORIUD REPREBENTAYWE Kgrz�. A Boutin, CIC CISR r r�c3 g7Y11 93 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 084437 Birthdate: 12/11/195o Expires: 12/11/2006 Tr. no: 84437 JEAN N MORIN Restricted: 00 143 HUNT RDS i EAST HAMPSTEAD, NH 03826 Administrator � I i Tel: 978-688-9545 Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE 9 JOB LOCATION "HOMEOWNER Number Street Address Number Home Phone PRESENT MAILING ADDRESS Gity Town State 0S� /P SP Section of Town 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) Work Phone Zip Code 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 min comply with said procedt HOMEOWNER'S SIGNA 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 Numberis that the debris resulting from this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits frorr 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 tkAf)1S S: J 1 ` 0 h PHONE % _ S �� LOCATION: Assessor's Map Number---/ OSI) PARCEL- j7 SUBDIVISIONS 1 LOT (S) 1"9STREET-------------- TOWN AGENTS: CONSERVATION ADM!1 #§TRATOR DATE APPROVED_, �� DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED LNJ S 1SZ SE 1C INSPECTOR -HEALTH DATE APPROVED. 0 ` L DATE REJECTED _ r COMMENTS ✓ S ^� . �iC� SF � �wv F- rJ lJ v ( Due A,�> 0 a,- eT °I 2ti 0 PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9W jm Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to INCLUDE SPRINKLER PLAN AND CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT be returned) TO HYDRAULIC In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. O z F� .� w .V. ti O w° C3 V) w Z C w° ppp p a; C U G ii w O w id G x W O C's C ° U Ow z O ro C w d AM 0-4 p co O u cn p U) z 0 W w P-4 F- C/) O U 0 O U 1� I-1 0 A rD M a 0 CO Ir Vj CC U) c o : (D C N �, , C ' ci V d� ev M. 1 44 �N -co =a *�a 1. V co EQ L m cg . o c. N �Ec • oL CO2 c :mm CL t Qf c M.0ZIP y C O C ww I1 N ! E O 2 �y mCD cm A% Z O 07 aCt m V O 0. c Q IC m� m i0O c O = �.... aQ+ CO. N m m L V� cot F- °� N E •a= c v� �•N Zo LU C3 cm C40 Z a A O.- Q; i N =O O z 0 W w P-4 F- C/) O U 0 O U 1� I-1 0 A rD M a 0 CO Ir Vj CC U) 7� 11MTTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Punt or Type) NORTH ANDOVER, , Mass. Date Ig 9 a` Building S 7 - Location Permit # —00,6 �v 53� Owner's )OCC C o g l� Name New Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No El Check one: Certificate Installing Company Namer'14xrr k PyN 0 Corp. Address I C up P) E P, 3-rVFlrmlco. rtnership M E -f/-/ Business Telephone Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: : Check`o have a current liability Insurance policy or Its substantial equivalent. 'Yes Q' No O If you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of .Owner or Owner's Agent Owner 11 Agent 11 I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pwUnent provisions of the Massachusetts State Das Code and Chapter 142 of the General Laws. BY T f Ucense: A / Titleumber nature o umber or as eFTIf r asflller aster Ucense Number % 3 C� Cfh'/Town D Journeyman MPNOW D (OFFICE USE ONLY) Nunn Ij MEN mono Check one: Certificate Installing Company Namer'14xrr k PyN 0 Corp. Address I C up P) E P, 3-rVFlrmlco. rtnership M E -f/-/ Business Telephone Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: : Check`o have a current liability Insurance policy or Its substantial equivalent. 'Yes Q' No O If you have checked Ye, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of .Owner or Owner's Agent Owner 11 Agent 11 I hereby certify that all of the details and Information I have submitted (or entered) In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance with all pwUnent provisions of the Massachusetts State Das Code and Chapter 142 of the General Laws. BY T f Ucense: A / Titleumber nature o umber or as eFTIf r asflller aster Ucense Number % 3 C� Cfh'/Town D Journeyman MPNOW D (OFFICE USE ONLY) m s� I a z A � r N v m x O m _ N ?r. C_ t. . o s 1 M z M , i • E I a z A � r N v m N X E In c x m N P t. . M M , 'O n b Qt O p 33 v = O M r -� c O N o fq 0 0 , z Q r s K it N M o r E Date .. / . ..... . NORTI{ TOWN OF lal6 THS ANDOVER- 0 ANDOVER•--O4��E0 �6 q�OOT •L � ' i.. .�... '. p PERMIT FOR GAS INSTALLATION �q,,.o SSAC HUSE This certifies that.. /z, ......... ..... .:.. . has permission for gas installation . f t`. in the buildings of .t. ............................ at .... !..-"....... , North Andover, Mass. Fee. 2�45 .-:''Lic. No..q�........................... �0 -1 }0 GAS INSPECTOR WHITE: Applicant C C,`CANARY: Building Dept. PINK: Treasurer GOLD: File Location No.�-� y Date i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ R a v�� N9,I- Sewer Connection Fee $ ater Connection Fee $ TOTAL Building Inspector Div. Public Works APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP KVO: 106 LOT NO. I 2 RECORD OF OWNERSHIP DATE K 'PAGE ZONE plslaentlo1l SUB DIV. LOT NO. OEM,!;OII� G4 a i on 9� 5Y71 13 LOCATION �� �_j.. PURPOSE OF BUILDING A Ac +A R�r 1 of Roost OWNER'S NAME Dein\S l. SIZE / x+ NO. OF STORIES Dre- Qo/ of OWNER'S ADDRESS 'ri ,S+, �JleC'.j-J SL,BASEMENT { OR SLAB /1,ST ARCHITECT'S NAME SIZE OF FLOOR TIMBERS Yg4g-"' 2ND 3RD BUILDER'S NAMEb , , SPAN 5 arj 1^� DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET IN � � g POSTS DISTANCE FROM LOT LINES - SIDES 369. 70/ REAR a0o " �� GIRDERS AREA OF LOT / ,10W pp FRONTAGE C?O HEIGHT OF FOUNDATION NQ THICKNESS IS BUILDING NEW SIZE OF FOOTING onvi, X IS BUILDING ADDITION pC MATERIAL OF CHIMNEY one IS BUILDING ALTERATION Pees- IS BUILDING ON SOLID OR FILLED LAND solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER 0 BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER o IS BUILDING CONNECTED TO NATURAL GAS LINE o 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 FILED AND APPROVED BY BUILDING INSPECTOR SIGNATURE OF OWNEIFOR AUTHORIZED AGENT F E E PERMIT GRANTED 19 OWNER TEL. ►� 6 i��'7� CONTR. TEL. CONTR. LIC. # 3 PROPERTY INFORMATION LAND COST one EST. BLDG. COST "�FQQ` 00 EST. BLDG. COST PER SQ. FT. 5A EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY . BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN 1 OCCUPANCY SINGLE FAMILY STORIES MULTI. FAMILY OFFICES _ APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PIASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/ 1/1 '/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD\!✓'D ASBESTOS SIDING COMMON VERT. SIDING ASP.. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ 1K SUPERIOR POOR ADEQUATE I -i NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) — FLATGAMBREL MANSARD �I TOILET RM. 12 FIX.) — FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY BUILDING RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. SLATE NO PLUMBING D� TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ Wag TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM _ STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ 7 NO. OF ROOMS RADIANT H'T'G UNIT HEATERS GAS OIL B'M'T 2nd _ Isr 13rd ELECTRIC NO HEATING d® 26 M 0 z 2 CrLw 0- F" LU LLI lad a � � 109 109 i� O Z1� I•, I V r r.. � +0. o. O ,_ O• jo. nr 40 • V C6 y CMD 4 40 40 h 0 as °4 O CO c e . 6► a V O i Q .0 • �h u ° W O C O F p y w C y a EGo c a z O O C 96 V Z = Z CL o Z � � W o O V 0 V H W o z z u ? oc Q O CID mL C j L ma L 0 t m Z 0) C6 0) W 0) .' c C t Y O C C 4) C C Q U ii OOC ii w U. Q U. m Lo T V) J J ZD Ml S v* a � � I Q 0 i� O Z1� I•, I V r r.. � +0. o. d H C ,_ O• jo. nr 40 • V C6 y CMD 4 40 40 h as °4 O CO c e . 6► a V O i .0 • �h d ° o C O F p y w C y a EGo c Lo T V) J J ZD Ml S v* �Q m i� O Z1� Z I H O 4 a c .0 C O � L a EGo c a O O C 00 V Z = C CL o a) � � o m V 0 �Q m O Z1� Z I 03%25%92 14:44 V617 893 7091 AMER. SURVEY CO. 444 MURRY MORRIS RIF:. WI= t�c'4 WF Ci I LSC IZ-r ! F Louul L_ Cl'i Is ..Scale: l,►! Sot ERICAN SURVEYING- G(V1PANY I _. '•/o a , 5 . L+ =u r y 7 u w E um o Suite i* . WaYhant: MA 02154 (61 i) 893-64T7 A:REGISTERED:LAND' SUF.VEYOP, ,Avenue, :.. 06 •He4tB.Y;:CERTIFY THAT �TH:E'- ABOVE- M©R.TGAGB'- INSPECTION- PLAN WAS "PFiEPAPED FOR , CONNECTION WITH A. ..NEW. DATE �-�el..�?2. RECORD ED AT EX N- COUNTY RPGISfRYOFDEEDS MORSGAGE'AND lS IVCrf INTENDED _ ,.CUEIJT iv? :1 ice. rg`� BOOK. =241 • PAG.E ._l.3 t L.C. Cert. # 'pR 9EPR1=5Er4TCQ.:.iO%8E:.A L:Ah€D,'..'CLIENT REF. �tL�=��`- _as_ REFEREIVC.E;_1I�_ .OR- •P•ROPERTY• `UNE SURVEY: ANO' JA's I.fJO.t3 C ,PLAN DRAWN PER Ttrnriq OF ASSESSOR'S COf�I�IEF3.R�NERESET.I►CJ,NNOI`'B'E` MAP #•- PARCEL # DATED USED-.FOR..F_STABL•ISHING'•FENCE.• THE LOCATION OF THE .ORIGINAL. -ADDRESS: HEDOE•:RH':RUILDING LINES.;THE:' .DWELLING SHOWN -HEREON- EITHER I:ib k100'41= LANDIASSHOWN'HEREON.IS9ASEr7: WASIN'C.OMPUANCEWTTH r-IELOCAL 'BOAR .OWES: W _z,��-�31'r�' ON CLIENi FURNISHED_INFORtifiA� :AeP.gcft Lp ZONING. BYLAWS IN I TION AND• MAY BE SUB'.'IEGT TCI+ '.,EFFECT WHEN. CONSTRUCTED (WITH ' SUB'JEC% DWELLNG•LIES IN FLO00 ZONE C: FURTHER OUTSALES.. TAKINGS. `.RESPECT TO HORIZC>NTAL DIMEN- AS SHOWN. ON NATIONAL. FLOOD INSURANCE PROGRAM FLOOD EASEMENT RIG}iT$'OF:WA`C` ,SI014°At:'REQUIREMENTS ONI-Y). ORIS INSURANCE RAS MAP GATED .► V .'�1 E (�+ IM � NCI-�RCSPO' NSIBILITY:IS-l= CTENDECY iE EMOrr- FROM VIOLATION ENFORCE- COMMUMTY --. PANEL # 2. � Co .4 c"I � C'x:1 f1 ft I iEREINtiTK) TEIE.:;IAND^OWIVEEI=OR'. MENTAGTICjriI UNDER MASS;G-L. T1TLE �EIDED-j-DE2kFTED. "CHECKED ' T. WW -OCCUPANT. UNTENDED Td VII: CHAP.' BEC 7, UNLESSbrrl4e'�- Bl! .J5 I T3� K.. YSG I PC ocnnmm=r% wiee klrrrrn nn--- . _ _ if= I" '9 a> vI if= I" r 00 le L 19 ^L N � T `y G C'S'7 r 00 le L 19 *% f- 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Phone LdRS -L29S LOCATION: Assessor's Map Number 1003 Parcel aaa Subdivision Lots) Street dt'eS�� ��. St. Number ************************Official Use Only************************ RECO#KENDA ONS OF TOWN AGENTS: X Date Approved f/ Conservation Administrator Date Rejected Comments Town Planner Comments Health Agent Comments Public Works - sewer/water connections - driveway permit Fire Department Date Approved Date Rejected Date Approved Date Rejected Received by Building Inspector Date (Please print) DATE Z�,,,1- \ \ \GCIa JOB LOCATION :'HOMEOWNER" Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption Number Street ress Name Home Phone Section of town (Lo \--z ) ay -1 - -F�,q o Bork Phone PRESENT MAILING ADDRESS " E>'j S+, Anaot2v— Vn\A ity/Town Laze Gip 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 HOMEOWNER: 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 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 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" zequirements. - HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING of Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING -F, I ly. r, ......... . ................................. This certifies that .......................... ..... ... has permission to perform .......A a ek , � � .. - ................................................................. A -P Cf C) -1 1 wiring in the building of ............................ _I ......... I .. 5 ........................... .... ... ... ..... ... 9.5.9 ...... q�'r.'Cj 0 at .... ............................................... N -rth Andover, Mass. !.( 0 Jk A .................. Fee ... 14b .. . .... Lic. NoA1.1.0 ......'• 'D t Check # _S�qg ELECTRIC&sncrOR 4860 T1&C0MM0A19 4LM0FMf DEPARTAIEUOFPUBLIC BOARD OFFIREPREVE MONRR APPLICATION FOR PERMFF' ALL WORK TO BE PERFORMED IN ACCORDANCE WITH (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover .SETTS' Office Use only Permit No. ' 527CMR12:010 Occupancy & Fees Checked RM ELECFRICAL WORK ELECTRICAL CODE, 527 CMR 12:00 Date The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wires: Location (Street & Number) "-I CS -1 -J::i-->,-f.-'V s- - Owner or Tenant 1C,-W_.f'\ T iS '0-` SVS,77 Owner's Address 1-l`J'1 �c��'S-E � - , ��\%�1�h / aAo�(.2,� =1�[1.A Is this permit in conjunction with a building permit: Yes ® No (Check Appropriate Box) Purpose of Building C \ W -,- «i V z? Utility Authorization No. Existing Service inn Amps / L olts Overhead � Underground M New Service ?an Amps4la�olts Overhead r--1 Underground 12r Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work AAA 77 No. of Meters No. of Meters No. of Lighting Outlets/ No. of Hot Tubs No. of Transf tmers Total (0 KVA No. of Lighting Fixtures Swimming Pool Above 0 Below M Generators KVA round Zround 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 i y( 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 `Y Detection/Sounding Devices Local Municipal Other No. of Dryers ` Heating Devices KW Connections No. of Water Heaters KW No. of No_ of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP ✓. " .. I I : I: I. ; I I I Ed o ♦ • I" I I dW. 1..:1- • * . 1 ons c : .' {. q .. Y.I L. :6 1 YES. - a r nn:1 .r1 1 •• • WI " 111 - •ilr :S T1 �%� •I • • :•r.1 •► I mac" 1 11• r l - 1 • •• 1 drddng the agmM2Lbt,.ox. INSURANCE Fq BOND • 1 I:' M ' . aq 1:1! Pio �<<.' i �. -..I. ul.r•' •.r •n .u:1 eo ec rl W01ktoSw 11-1k-03 Vq)ecdmDATTr-sled Rao Fmal s*neduncL-rTeP1-nr=jL j I' I A� LicaiseNo./ Signaaue • •1�, OWNER'SINSURANCFWJAIVFR;Iamawatedat6aLxteedoesnothai and diatmysigr>aauecnthbspmilappficationwamN hismgienialt (Please check one) Owner F-1 Agent Ignature or uwner or Agen moi.✓�/���:�`��LicawNo BuskmTelNo. AIL Tel. No. Telephone No. PERMIT FEE The Commonwealth of Massachusetts 5� Department of Industrial Accidents Office of investigations Boston, Mass. 02111 ~ Workers' Compensation Insurance Affidavit C Name Please Print Name: Location: Cit, Phone # 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: A%nAa Address 9d 16 CRT Phone #: - (RI -6613 T a Insurance. Co. CM-gz ds a h&zj Policy # Company name: Address City Phone #: Insurance Co. _ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to si,5oo.00 and/or one years' imprisonment.as vtelLas_cavil.penaltiesin2be%ncfa-STOP1I.V.ORK ORDFRAnd_a fine_of_($1nN).DD)-ajdayDgainstme 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification. / do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. r (� Signature Date f 1 Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina. Building Dept E]Check if immediate response is required I] Licensing Board p Selectman's ice Contact person: Phone #. Health Department - --�---Other- -- - - _ �A, TM COMMONIVEUTH OFA12 ` DEPARTAIDVT'OFPUBLIC BOAROOFFMEPREVEM ONREl TTS Office Use only Permit No. CMRl2.00 Occupancy & Fees Checked O APPLICATION FOR PERMIT T,O PE&ORMELECTRICAL 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)t Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. NP . Location (Street & Number) Owner or Tenant s S r k N-6- Y--- -j l�S�:� Owner's Address `-15`-1 � � � ��-t- . k,4 r%N °rid AvvAc Is this permit in conjunction with a building permit: Yes ED No (Check Appropriate Box) ` 1-� C� 3 $ Purpose of Building W e l l i _ Utility Authorization No. Existing Service in,—= Amps / olts Overhead UndergroundED No. of Meters New Service ?M Amps y /���olts Overhead M Underground ®V No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work - 1=17V -77r, No. of Lighting Outlets / — �(f No. of Hot Tubsn( 0 No. of Transf rmers Total KVA No. of Lighting Fixtures C Swimming Pool Above Below Generators KVA Ji rou ground No. of Receptacle Outlets ^ J 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 10 Tons No. of Detection and No. of Disposals No. of Heat Total Total jF Y' Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW ii 1 No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers ` Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP ME SAW X Wff, k1SWd"CovW,W- PI>t lttiothetequrtanays�N7a�ad>< 1sGaiaallaws IhaveacunatLiabl7ity7marloePbficyulcltzfulgCornplele CoNaagecri sstlbs arialegtrivalai YES NO IhaveabntrodvabdploofofSgMbDtheOlie YES ffywha%tdr lodYIES,plemir c*dletypeofooverWby dmddngthe box. BOND M OTHER r7 ft=,**) J2-23-03 ExDhafimD& C JJ:I Ili OWNER'S INSURANCE WAIVFR;Iain aware that die Lice Vw does not bai andthatmyVramonthispemritffhc mwaivesdmm m> mI (Please check one) Owner Agent Signature ot Owner or Agent •' I Alt Tel No. theinaltureooWrdgCoritsalbSMWegW alfrdasteg=dbyNt%sadmseMC,merILaws Telephone No. PERMIT FEE