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HomeMy WebLinkAboutMiscellaneous - 76 GREENE STREET 4/30/2018Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................. has permission to perform ..... . . ...................................... wiring in the building of ........ .................................................... at ................ .7Ze— Mass. ........................ North Andover, Fee.5�0 .0.......... Lic. No.,; ...... I�CTRICAL INSPECTOR Check # ,9362 i o N� a y44 ea m� M "N'w° d 3 N cco 4) 4 r2 Q om P. 13 Int, •° In, w o ° pp q� cV �' tU. N N m •CC o pA� O .-i .O C C N cy .••i ,N. '�'' y r3 by •� ' i UU r w y a0i a N w •��' .c U G4 3a° O��vi a Al b W C b U v: U N O N y0. .fl b i z .aid A�QW) U U °�" cd O D y `oi q0 N `ui C 'CI �a w b• O c�V O to) W cmni�m.a�[a o'"by o vmr ° ci ya,� a„a N aha ti C is N .0 pp v bA UL cu -1°0CG o w F MM.. bA 42 404 ig vio b b N N cCG U U U O Ei R Ei .'J U •w N tiN N O 7 bA w a .moo° '20- 3 o�cva y O � � U .°. Iaa�a�h a"o °a°o y A P1 Op, �N •O -ii N C U O N 4. ¢. � •C N. �.•q ,C N as 0 o 0 G. 0 ca °: F+ 4 a :... �I Om �-� Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 13 Occupancy and Fee Checked :ev. 1/07] (leave hlanlrl APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) City or Town of: NORTH 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) _7(0 `rert SA Owner or Tenant Dqy C_ `p e\ , n Telephone No. Owner's Address S, me- Is e Is this permit in conjunction with a building permit? Yes Purpose of Building Sir S. Le- M;% )/ Eidsting Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead [:3 Undgrd No, of Meters No. of Meters r; Lam, �Se�cv. --••� ­t"t&tvri"I ue1ut[ y aesirea, or as required by the Inspector of Wires. Estimated Value of Electrical Work:(When required by municipal policy.) Work to StartInspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) . I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: 7_0S2o A Licensee: �C tL Pitt -c)1 Signature LIC. NO.:�ctpa9 (If applicable, enter "exempt " in the license number line.) Address: _ t y Gec / oc�e_ Q_D 5c �g q tuS rY1(� Cj\ q O Bus. Tel. No.: 013/-13)7 *Per M.G.L c. 147, s. 57-61, security work requires Alli Tel. No.: r N - 7Gol n q Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner E—] owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: $ 1.4 L` I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pj U Ct) t _Ute. k_ C, L Address: l A Crrey S�00e. R_D `, C.Q qJ City/State/Zip: E>cy 5uc, U\ °IU (p Phone #: 13 -7 Are you an employer? Check the appropriate box: I am a employer with.. 4— 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* ❑ I have hired the sub -contractors . am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] ❑ 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. ❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other . --- -t �•• u• ••+a.��=..:.:. w:, r1 mLL5L 2!18() 1111 OUL We Section bejoR' Shol., ri.^.�^ their workers I compensation policy fora.9tion. t Homeowners ho 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 isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:_ Yy^&,t f ce_ , j, r S Policy.# or Self -ins. Lie. #: Expiration Date:_G 3 \ 1 p Job Site Address:_7(o Gre vie npf-A Y � 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. Ido hereby certify under twins andpenalties of perjury that the information provided above is true and correct /, 1 Dignanare: / &".r - Date.: 7 /� Phone #: 7 �11- i?,-/ L! - n D 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)"said "person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-72.7-7749 Revised 5-26-05 www.rnass..gov/dia NORTq Of O F .. ;,SSACMUS� Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that F� .4�... /�7r-c.4�,, �. ....... j ..... has permission to perform .C�.- .��f.�C�rl.c1 ..'............ . plumbing in the buildings of ...................... at ...77 ,5,T/.......... I North Andover, Mass. Feeefe.... Lic. No.. ......................... . PLUMBING INSPECTOR Check # �7 4* MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Lel Building Location l Permit # f Amount Owner a >) All New Renovation Replacement Plans Submitted Yes No FIXTURES (Print or type) �f /J ,, %� r Check one: Certificate Installing C y Name / ' ' L° ` �' Corp. P�)Address Partner. Business Telephone 7 K0 Lum1Co. Name of Licensed Plumber: Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnityrl Bond ❑ Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent El I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts ftle P1umqi1ijCode, d Vpapter 142 of the General Laws. By: 7ig—naure oi Liemist7iMEMO Type of Plumbing License Title 3 City/Town Eicense Num= Master n Journeyman Ld APPROVED toFFicsusE oNLY �--+ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, 1114 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):45�� Address: ff City/State/Zip: � 1 1V1 �'fphone #�_o3 Are you an employer? Check the appropriate box: L ❑ I am mployer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 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. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other —1 ­­ -4:. rL 1ULL5L neso ru: out tae section eeeow shor^ng their worke s' compensation policy information. 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 isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A 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 fete 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. Ido hereby ce u�Cd r the i and pen ties f perjure that the information provided above is true and correct Si ature: �� f� e - Date: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Permit/License # Contact Person: Phone #: 0 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town the,, the application for the pernait 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 bum leaves etc.) said person is NOT required to complete this affidavit. 4The 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 021.11 Tel. # 617-72.74900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 vrww.mass.gov/dia ie__1 Town of North Andover o`,40 TH Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street ` 'r North Andover, Massachusetts 01845 'Ss�CHUS t D. Robert Nicetta Building Commissioner Any appeal shall be filed within (20) days after the date of filing of this notice Notice of Decision Year 2004 Telephone (978) 688-9541 Fax(978)688-9542 in the office of the Town Clerk. Property at: 76 vreene atreet NAME: David A. & Christina M. Logan HEARING(S): March 9 & May 13, 2004 ADDRESS: 76 Greene Street PETITION: 2004-007 North Andover, MA 01845 TYPING DATE: 05-17-04 The North Andover Board of Appeals held a public hearing at its regular meeting on Thursday, May 13, 2004 at 7:30 PM in the Senior Center, 120R Main Street, North Andover, MA upon the application of David A. & Christina M. Logan, 76 Greene Street, North Andover, requesting a Variance from Section 7, Paragraph 7.3 & Table 2 for the rear setback; and a Special Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to extend a pre-existing, non -conforming structure by constructing a proposed 1 story addition for kitchen, `/2 bath, and breakfast nook on a pre-existing, non -conforming lot. The said premise affected is property with frontage on the East side of Greene Street within the R-4 zoning district. The legal notice was published in the Eagle Tribune on February 23 & March 1, 2004. The following members were present: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. Upon a motion by Joseph D. LaGrasse and 2°d by Richard J. Byers, the Board voted to GRANT a dimensional Variance from Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of the rear setback of 17' in order to construct a proposed 1 story addition for kitchen, '/z bath, and breakfast nook; and GRANT a Special Permit from Section 9, Paragraph 9.2 in order to extend a pre-existing structure. on a pre-existing, non- conforming lot per Plot Plan of Land, location 76 Greene Street, North Andover, MA prepared for David A. & Christina M. Logan, date: October 22, 2003 by Frank S. Giles II, PLS #49793, Scott L. Giles, Frank S. Giles Surveying, 50 Deermeadow Road, North Andover, MA 01845. Voting in favor: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. The Board finds that the applicant's agreement to run the proposed drain pipe (dotted line) from the left front corner of the existing house to the Greene Street catch basin satisfies the provisions Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. , Board of<Vpeals 978-688-9541 Pagel of 2 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 I Town of North Andover Office of the Zoning Board of Appeals Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (978) 688-9541 Fax (978) 688-9542 Furthermore, if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Page 2 of 2 Town of North Andover Board of Appeals Walter F. Soule, Vice Chairman Decision 2004-007. M43P25. Board of Appeals 978-688-9541 Building 978-688-9545 Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 915 HORTp Of�.�•o ..�ti0 O p �SSACMUS� Date../*)7... 7..1 /•/ TOWN OF NORTH ANDOVER FE PERMIT FOR WIRING This certifies that .........' 42�ss . ........................................................ �3 has permission to perform .......! >Cz ..k d4� .... f C . ......................� /2c�17o/J � IC . ..... wiring in the building of ...........Y.... ..... ........... at .A0.. �'P,����?....�•?! f���..................... . North Andover, Mass. .r c7'b e13!5 . ...... Lic. NOF;z . ............................................................... �. ELECTRICAL INSPECTOR / HITE: Applicant CANARY: Building Dept. PINK: Treasurer u4t &wmonwttlo of Mago#uot i9epartment of Puhlir afetu - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Office �� Only Permit No. JJ°° Occupancy A Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00q (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 67: (%1* or Town of NORTH ANROVER To the Inspector of Wires: The udersigned applies for a permit to Location (Street &Number) Owner or Tenant Owner's Address the electrical work described below. D r- ti ) C� Is this permit in conjunction with a building permit Purpose of Building Existing Service Amps _�� Volts New Service r Amps/ JQY-0 volts Number of Feeders and Ampacity Location and Nature of Proposed I Yes ❑ No (Check Appr �_ Utility Authorization No o Overhead Undgrnd ❑ No. of Meters /_ Overhead l-- Undgrnd ❑ No. of Meters OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws ^ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES C NO I have submitted valid proof of same to the Office. YES = NO Z If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND OTHER G (Please Specify) E t' Date) Estimated Value of Electrical Work $ _ Work to Start ,��6 y Signed under the Penalties of perjury: FIRM NAME Inspection Date Requested: Rough j (rxppiraa oo 7 Final `'=�—� 2 LIC. NO. Licensee t r J / Signature I - - LlC. NO. - Bus. Tel. No. Address Alt. Tel. No. OWNER' INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws and that my signature on this permit application waives this requirement. Owner Agent (P s heck one Telephone N " PERMIT FEE S (Signa ure of ner or Agent) x•6565 Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures g 9 Swimming Pool Above In- g grnd. [I grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners a Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of, Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals Dis p No.of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Local ❑ Connection ❑Other t No. of Dryers Heating Devices KW ,r No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws ^ I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES C NO I have submitted valid proof of same to the Office. YES = NO Z If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND OTHER G (Please Specify) E t' Date) Estimated Value of Electrical Work $ _ Work to Start ,��6 y Signed under the Penalties of perjury: FIRM NAME Inspection Date Requested: Rough j (rxppiraa oo 7 Final `'=�—� 2 LIC. NO. Licensee t r J / Signature I - - LlC. NO. - Bus. Tel. No. Address Alt. Tel. No. OWNER' INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws and that my signature on this permit application waives this requirement. Owner Agent (P s heck one Telephone N " PERMIT FEE S (Signa ure of ner or Agent) x•6565 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ec or Use Qlsl BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioneffl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: T ( 1.2 Assessors Map and Parcel Number: z Map Number Parcel Number �- 004,174 04,174 1j'AJr0Vr--1Z. M.lJ 10 4 1.3 Zoning Information: R Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record A' N(111) A. Name (Print) Address for Service '611,1%, Iiob Signature Telephone 2.2 Owner of Record: Name Print 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 ❑ Company Name Registration Number Address Expiration Date Signature Telephone �r 1 SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all b'cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: l utjzac lb0 or- Ao inwj w.P hTwr-m IC x 2-1 ► 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building 15.000 (a) Building Permit Fee Multiplier 2 Electrical (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 AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on y bel f, in a Matt s relative to work authorized by this building permit application. �(J p I I (1 4 )MM3 Signature of Owner Date SECTION 7b OWNER/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 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND3 RD SPAN DM ENSIONS OF SILLS DM ENSIONS OF POSTS DINIFNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUU DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE „ORTff pF t�eu r6 �'y0 ry �gA'po �I�''yaCJ �SSAGNil9E;( Zoning Bylaw Review Form Town Of North Andover Building Department 27 Charles St. North Andover, MA. 01845 Phone 978-688-9545 Fax 978-688-9542 Street: to C9 r`e e- (\., e Map/Lot: L431 as - SApplicant: Applicant: -D f D 0- e rIS (4) Lm. , Request: t 4o",-- 101 ' +l — K 4 eA e o to J (- Co--> Date: I f - 1) - v 3 Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zanina OP - Remedy for the above is checked below. Item # Special Permits Planning Board V Item Notes Site Plan Review Special Permit Item Notes A Lot Area Parking Variance F Frontage Lot Area Variance 1 Lot area Insufficient Height Variance 1 Frontage Insufficient Variance for Sign 2 Lot Area Preexisting '-1 e- g 2 Frontage Complies Special Permit Non -Conforming Use ZBA 3 Lot Area Complies Earth Removal Special Permit ZBA 3 Preexisting frontage Ll �e 4 Insufficient Information Special Permit for Sign 4 Insufficient Information Special permit for preexisting nonconforming B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies e 5 4 Special Permit Required L4 e S 3 Preexisting CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 j All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies K.�e S 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient oh A44t acv 4 Insufficient Information 5 Rear Insufficient t Building Coverage 6 Preexisting setback(s) 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting 1 Not in Watershed 4 Insufficient Information 2 In Watershed j Sign X) q 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 1 More Parking Required 2 Not in district `jeS 2 Parking Complies 3 Insufficient Information 3 Insufficient Information 4 Pre-existing Parking Remedy for the above is checked below. Item # Special Permits Planning Board Item # Variance Site Plan Review Special Permit Q_-4 Setback Variance Access other than Frontage Special Permit Parking Variance Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Permits Zoning Board Independent Elderly Housing Special Permit Special Permit Non -Conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Development District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Zvl Special permit for preexisting nonconforming Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies, misleading information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative” shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file. You must file a new permit application form and begin the permitting process. Building Department Official Signatuf�e /,)—/y a3 Application Received //-1q -o3 Application Denied Plan Review Narrative The following narrative is provided to further explain the reasons for DENIAL for the APPLICATION for the property indicated on the reverse side: Referred To: Fire Police Health Zonin Board Conservation De artment of Public Works OtherPla Historical Commission Other Buildina Deoartm.n+ 3893 'Lo o ar• "ppm TOW O � P49 ER ,SSACMUS� This certifies that ... ........... , .. . ,� ... .......... . has permission to perform . plumbing in the uildings of ..................... at.. 7401. ........... ,North Andover, Mass. Fe�-� G. -':.... Lic. No....... . Date N OF NORTH ANDOVER MIT FOR PLUMBING g PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer N N sirr yam. MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO SFITTJ.N, lint or Type) Mass. Da 1 : 8uldhw Location=,�"'•fZ-p_v�Owner's Name Type of Occu New O Renovation p Replacement WO/ Plans Subn*ted: Yes(] ' No,p Installing Company Buskmm T N w,ic d Licensed Plumber or Gas Filter puzaim min, _____ Check one: Corporation O �P rtnerft D 7 Fkm C )n ;URANCE COVE GE: I ve a curre It j iy Insurance policy. or As substantial -equivalent which meets the re ukements of MG Yes 09' q 1..:.. No O. , 11 you f►>tw441ckedy.Yples� hal a the type coverage by checking the appropriate box, A Other type.o(,IndemnNy ❑ 8ond. O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage.requlred,by. Chapter 142 d the Mass._ General Laws. and that my signature on this permit application waives this rgquk ,ement, Check -ane: s Signature OwnerO Agent 0 } «'.ownW s en ' 1 hero (`� •� �, a ` A �. by aeand t at aM.ol the delaNs and inlwmalion t have submitted (or entered) in above application are true and aceurate to the best of my lnowtedpe and that ap umbing work and Installations performed under the permit Issued for this amllcatlon MAIi be In oedinent prod� the Massachusetts Stale Gas Code and Chapter 142 of the Ge Laws. complar" W10 T4 of License: title dumber na ure o ce um of s u Gaslilla li :if /T� aslor Ucense Number LAZ -7 V irk , Journeyman y a . . y W X N y y oc r, y rc U o � rn h x Oc a U• 3'• O Y �• ,O C N o b N YI !-• < _ 2: t. y 0cc C f - • Y W W id + h N CC O > VL ia N J W ' 'o v OX a' tw o u y a` o awe awe e°c sue—esMr. BASEMENT 1ST FLOOR t 2110 FLOOR R SRO FLOOR 4TH FLOOR t F= STH FLOOR 4TH FLOOR �r TTH FLOOR STH FLOOR ; 1. Installing Company Buskmm T N w,ic d Licensed Plumber or Gas Filter puzaim min, _____ Check one: Corporation O �P rtnerft D 7 Fkm C )n ;URANCE COVE GE: I ve a curre It j iy Insurance policy. or As substantial -equivalent which meets the re ukements of MG Yes 09' q 1..:.. No O. , 11 you f►>tw441ckedy.Yples� hal a the type coverage by checking the appropriate box, A Other type.o(,IndemnNy ❑ 8ond. O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage.requlred,by. Chapter 142 d the Mass._ General Laws. and that my signature on this permit application waives this rgquk ,ement, Check -ane: s Signature OwnerO Agent 0 } «'.ownW s en ' 1 hero (`� •� �, a ` A �. by aeand t at aM.ol the delaNs and inlwmalion t have submitted (or entered) in above application are true and aceurate to the best of my lnowtedpe and that ap umbing work and Installations performed under the permit Issued for this amllcatlon MAIi be In oedinent prod� the Massachusetts Stale Gas Code and Chapter 142 of the Ge Laws. complar" W10 T4 of License: title dumber na ure o ce um of s u Gaslilla li :if /T� aslor Ucense Number LAZ -7 V irk , Journeyman 61 1 Ir' ::i�gnk!'lo-W'�:`.1: l+rt-•. l:r� j;v."ur' ' ' Ix i i ' �. �. �,. !� • f :. . 1.1 r �J t s 1 i f• i ?' 1 tll.1 {•'•!• bN !�� •. 1' , "."fit . IA � o OIA o Y� w h 4 �s �t� z Ix i i r �J tll.1 {•'•!• bN !�� •. 1' , "."fit . IA � o OIA o Y� Ix tll.1 {•'•!• bN !�� •. 1' , "."fit . tll.1 {•'•!• bN !�� •. 1' , "."fit . Y� Location 7/, No. /i -/.3 -,;15' Date X5 T1y,. TOWN OF NORTH ANDOVER n��1 v! `T4 6.537 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation, Permit Fee Other Permit,Fee / �+'i�irer Conne6tfop-Fee -�.W`a` *ConnectioiSr eJ, TQTAWI y4 �i9e o� Building Inspector Div. Public Works fsEB�tIT*NO. `7 D APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. I - It IXPAGE 1 MAP qlb. I LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK '.PAGE ZONE SUB DIV. LOT NO. — LOCATION j� ���`fI ( `T PURPOSE OF BUILDING w OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS ^? (V\ L�Ct(. I �J 7 f BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME J SPAN DISTANCE TO NEAREST BUILDING --- DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 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 OWNER OR AUTHORIZED AGENT FEE 6) PERMIT GRANTED LZ 13 19� KER TEL. # KKR. TEL. # NTR. LIC. # Osi g D 1/ 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN Mum"IND INwr9CTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 2 13 PINE CONCRETE CONCRETE BL'K. BRICK OR STONE D PIERS PLASTER DRY WALL _ UNFIN. NFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/1 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 WOOD SHINGLES CONCRETE EARTH HARDVJ'D COMIACN ASPH. TILE ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 6 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR 1-1 POOR _ ADEQUATE NONE 10 PLUMBING 5 ROOF GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOAL B'M'T 2nd _ 10 13rd ELECTRIC NO HEATING 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. . A OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING �rl.UWL -UL-, :N NORTH ANDOVER DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street North Andover. Massachusetts o 1845 (617)685.4775 , In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number y0 / is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (\1kojAc4.J � 'VV Ak? (Location of .Facility) Signature of Permit Applicant _ %1f 3193 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. N Suggested Affidavit for Home Improvement Contractor Permit Application For omce Use only NAME OF CITY/TOWN Permit No. Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c.142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition, or construction of an addition to.any pre-existing owner -occupied building containing at least one but not more than four dwelling units .... or to structures which are adiacent to such residence or building" be done by registered contractors, with certain exceptions, along with other requirements. ' r Type of Work: N Lo �C Est. Cost 12"00,00 Address of Work —% Owner Name:, 0` S . U •/ Date of Permit Application: 9 / 13 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 _Building not owner -occupied _Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name OR: Registration No. Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: D to Owncr amc W o z m v� u aG O v o G GO z z Q a C ° O v C C C x z z W to O C o W � H U O 0� v v C/) C 4. x o U z d O C z Q w ° z I D O E004 LU z c y- o as c c � O i C CO) O C "~ O 4 C.) U •ate c Cc ' o c co • � ti L ' as t s � � d H E c L yc� 1% cm c ca cc CD L CD 73 CL HA go O L H ♦+ C_ O J N O C m O Ny C c � o E m L CD o m mu L ai N CD ; S � c CL O � a� c � m vHo L Q Z o c_ H N CL a7 c C S m ._.. p M CL ~ y CD z coea ,a-) .. c LA. CO) 'D CO CL= �° c Z °C•E co, � y o v Lm o m� c y = O'O O.0 S CA 0 R y�0 C F- = sawm �y. U `IO Cf) 114, L f-� M U CD cm co CDCO) co — mCD 0 co m CL ~ � = R � .F.r O i CD O G O _R O CL CO) O Cqu CJ J -0 •a. o as C Z Q 0 CL U CO) R C •C C R CO2 0 CD Z_ z z J CL ►- J Q z LL cr LL Q LL LLL U. Location 'XI No. ` / Date TOWN OF NORTH ANDOVER • O AM' "M Certificate of Occupancy $ �7s'"•° Building/Frame Permit Fee $ sACMUs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 655� ` Building Inspec TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ».#ort "il a T3�e oily BUILDING PERMIT NUMBER: DATE ISSUED: 17 _e!t3 C SIGNATURE: 41ULZ Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 7 5 G reene 1.2 Assessors Map and Parcel Number: 03� .0 c i q - Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: I -:�. 3 Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R 'red Provided Required Provided 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: Public 0 Private ❑ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes —No 2.1 Owner of Record LA('0yjd Name (Print) Address for Service: 'A�� C"CK Signature ia Telephone 2.2 Owner of Record: Name Print 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 ❑ Company Name Registration Number Address Expiration Date Signature Telephone Ma M X Z O v n m SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all a licable New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ ( Demolition ❑ 1 Other ❑ Specify R�1 Brief Description of Proposed Work: {� 1 , I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building (a) Building Permit Fee Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) Q Ov 4 Mechanical HVAC 5 Fire Protection 6 Total., 1+2+3+_4+5 C;C Q Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ff�t c9Via (.�ltij as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; mall matters relative to work authorized by this building permit application. Signature of Owner iJ 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/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvOERS 1 ST 2 ND 3 RD SPAN DM ENSIONS OF SILLS DIN ENSIONS OF POSTS DIIVIENSIONS OF GIRDERS DIGHT OF fOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH ANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Tel: 978-688-9545 Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print.. DATE ` &,AL7,:i JOB LOCATION Number Street Address Section of Town "HOMEOWNER -ZAMe _ Number Home Phone Work Phone PRESENT MAILING ADDRESS 5AKE 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL 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 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 t 1 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Date.Aw TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... . 1.UJJz lz..........- .................... has permission to perform .......... ..... ...................%............ jz ..................................................... wiring iu�thebuilding of/Ail(:.�( ? �..�J Z- ......... North Andover, Mass. .... ....... Or / Fee..qt�i ;11*1110a ... Lic. No . ............. .... 1 '7 / ELEcrRICAL INSPECfOR Check 4 7e� a /� p // OFFICI C�o�nrrconuieaCE o l�a66tzchu6ett6 'hcc�� cc77 Permit No. erar en.f o� }ire �¢ruice3 Occupancy and Fee Checked , o BOARD OF FI E PREVENTION REGULATIONS [REV. 11/99] LEAVE BLANK APPLICATION OR PERMIT TO PERFORM ELECTRICAL WORK All work to be erformed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 PLEASE PRINT IN INK OR TYPE ALL INFO MATION: DATE: (�'� ( 65 City or To of: a e- To the Inspector of Wires: By this application die unde igned ;gives notice of -his or her inte.16611 to perform the electrical work described below. Location (Street & Nu ib r)` -7& GVAee_✓lk ?-. i RIZ% Owner or Tenant (Sh ito ' 7Ay tcL L o4ajc, Telephone No. QVt _(a iqo F Owner's Address SSP_I'YIIZ Is this permit iri conjunction with n buildinb permit' Yes © No ❑ (Check appropriate Box) Purpose of Building Utility Authorization No. l i.? 19 0 2 Existing Service amps I Volts Overhead ❑ Undgrd ❑ No. of iilleters New Service Amps I Volts Overhead ❑ Undgrd ❑ No. of Nleters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: k dUC,ryL " L V1(TM_ J L1 Ctrl ( GLA V IA- Completion o(the following table tuay be waived by dre Inspector o%litres. No. of'Recessed.F-Utures /C) INo. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators K'l'A No. of LightingFixtures5 a Swimmingb Poo1 Above ❑In- ❑o. grad, rad. o Emergency Lighting Battery Units No. of Receptacle Outlets 6 No. of Oil Burners FIRE ALARMS No. of Zones No. ofSwitches (� No. of Gas Burners I o. o Detection and Initiating Devices No. of Ranges No. of.Air Cond. Tans No. of Alerting Devices No. of Waste Disposers Hent Pump Totals: i 'umber I Tons 1KW No. of Self -Contained Detection/Alertine Devices = I No.. of Dishwashers SpacelArea.Heating KNV Local[] unicipal Connection C] Other No. of Dryers Heating Appliances Klp Security Systems: No. of Devices or Equivalent No. of WaterNo. Heaters I'll of INN. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No: of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: /d 6 f a-0 '�-t e- Y Ca Attach additional detail Y -desired, or as required bv.tbe Inspector of kvires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability utsurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Wor3c to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cert1fy, under il;e pains and penalties of perjzay, that the information all this application is irate and complete: FIRM NAME: LIC. NO.: Licensee: I C� A w a-(, Signature ��� LIC. 'N 0.: (Ifapplicable, enter "exempt " in theccnse n: rber line;) Bus. Tel. N o: r a Address: IL-1 iTl'tH 5kJ� t GL �M,tQ•t �� MA 619U Alt. Tel. No.: � OWNER'S INSU `ICE 1VAIVER: I am awa a that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, l hereby naive this requirement. I am the (check one).[] owner ❑ owner's agent- Owner/Agent T Signature Tcicphonc 1o. P.uRA11T TWE: S 36 ELECTRICAL PERMIT FEES statutory reference(s): Mass. Gen.L. c143 a. 3L., 527 CMR 1200, Ordinances ofthe City of Chelsea, 3.4-50 Residential Electrical Permit Fees Permit Fee Basic wiring - with 100 amp service (including meter) $ 50.00 Each additional 25-100 amps 20.00 Each additional meter 20.00 Underground trench inspection 20.00 Basic wiring - 2 inspections 40.00 (sub panel - additional charge) Services Temporary service Service change (relocation) (with meter) Service Upgrade Per 100 amps Each additional 100 amps Add public panel Add public meter Alterations - remodeling - miscellaneous Sub -panel Siding or signs Electrical Outlets - devices - fixtures. etc. 1-10 11-25 25 - Over Major Electrical Appliances Dryer - electric range - hot water heater - disposal dishwasher - window air conditioner - other Electric heat - per KW Central air conditioning or heat pumps Gas or oil burner Alarms, fire and burglar (2 inspections) (with panel) plus devices Fire and burglar detectors - each (without panel) Motors - each horsepower or fractional Generator Low voltage wiring - per device Swimming Pool Wiring Above ground In ground Take - over permit - rough - service - final (each) Reinspection permit for defective work Renewal Permit Commercial and Industrial Electrical Permit Fees Permit Services Upgrading per 100 amps 101 - 200 amps 201 - 400 amps 401 - 600 amps 601 - 1200 amps 1200 amps and over (per 100 amps) $ 25.00 Meter 25.00 Sub Panels "r YJt 69/199 amps (each) l 4t F.,,�,•F/ -�:.��. each additional 100 amps l; l'ln bll-r�; t 3 �.e 240 volt machine $ 25.00 A/C unit - heat cool unit (each) 20.00 Window air conditioner 25.00 Lighting - outlets - devices 25.00 1 - 10 11-25 26-100 $ 20.00 101 and over (each device) 20.00 Transformers / Generators 0-10KVA 11-50KVA $ 10.00 51 and over 20.00 Vaults and equipment 30.00 Carnivals, fairs, circus, etc. $ 15.00 5.00 25.00 30.00 30.00 2.00 2.00 25.00 2.00 $ 40.00 50.00 $ 25.00 $ 25.00 $ 25.00 Annual continuous maintenance permit (exception: major renovation) Demolition $ 40.00 60.00 75.00 100.00 200.00 25.00 25.00 $ 25.00 15.00 $ 40.00 25.00 $ 15.00 30.00 40.00 1.00 $ 40.00 60.00 75.00 75.00 100.00 $ 150.00 $ 40.00 Explanatory Notes 1. If work is started and a permit is not obtained on or within five (5) days or without the consent of the wire inspector, the fee will be doubled. 2. Tenant wiring in a commercial, mixed use building requires a separate permit. 3. Minimum wiring permit shall be $40.00 r Demolition Permit$ 25 00 {,� eY. a p xrC �+,%. R f '...w"ry t" t [{ '+ q4- N "r YJt r �..+ V..y!'3`�' l 4t F.,,�,•F/ -�:.��. < +f�, �..' 1"fix l; l'ln bll-r�; t 3 �.e 44Pyx � i.:�..ut ti»`h 4. }�.�..h -1 ~ ��� x.14 ', �t �. � V tah fi i'�' ��w. 5�5 ,;� t'. qY � T 2 �i� 1 1{-�C�. yX�'„ �, 'S" F"Pd .�.' .4` !`�C. {`.t ? fir?. � ,� 3 Sr � ��•A.: 6.AS.t F iY t r�1'..'i �;.� s C. .: Y x.i 'S^iA. � 'P:'21:'t�'"i! x.'i. R j xY � : a.' `� 4`L�: �'>�.r "� .'� r� .i' ti:i'Y" .'{ ...� -,<fk.. .'.h ..:k... .. 4 ti� ♦ . , -' y. ?.. .. ! f•"i * . �."5..,..' r; Y:t. . t '.. fir. ,'b r . x@anatory Notes Minimum wiring permit fee shall be $ 25.00 Permits Expiration dates are: New work - one (1) year Remodeling - six (6) months Pool - three (3) months Minimum 200 amp service required for three family residences l_ OM.Monweah of MaidacLieth =+ �L Jerar ;en.f4 Jire Seruiceb BOARD OF FI E REVENTION REGULATIONS APPLICATION All work to be PLEASE PRINT IN INK OR TYPE ALL City or Tov1i of: Permit No. upancy and Fee Checked 11/99) LEAVE BLANK R PERMIT TO PERFORM ELECTRICAL WORK ed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 ' DATE:IaO1 65 4-Y 1 vt e - To the Inspector of Wires: By this application the unde fsigned ;gives notice of leis or her intention to perform the electrical work described below. Nu Location (Street & ibfr) -76 6-KP_cYu S4 (';2u� - � �j' � Owner or Tenant Xy t(t L o4a—r , _ Telephone U Owner's Address ASCI I'YC Q 4;, Is this pennit iii conjunction with a building permit? Yes © No ❑ (Check appropriate Bos) Purpose of Building utility Authorization No. Esistirib Scry ice turps I .` ' Polls Overhead ❑ Undord ❑ No. of tllct rs , New Service Amps I Volts Overhead ❑ Undged b ❑ No. ofiYleters Number of Feeders and Ampncitti• Location and Nature of Proposed Electrical Work: k oucm L O (fi'Vt 1 Le (JY((0'L 01A,_ L/Le Vl ` P;64- i1 07)yn x k 10 CCc t, R U v I Ce Completion o/'the folloniit.e table may he sacred hu the 1wmee-mr of 11 rres- No. of Recessed.Fixtures jD No. of Ccil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators K'VA No. of Lighting Fixtures 5 Above In- Sivinuning Pool grnd. ❑ rnd. ❑ o. o inergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS Flu. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of.Air Cond. Tons No. of Alerting Devices No. of Waste Disposers Heat PumpIN Totals: ber I Tons I KW No. of e - ontained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW il❑ Other Local ❑ Connection No. of Dryers Heating Appliances K"y Security systems: No. of Devices or Equivalent No. of Water KIN, Heaters No. oC IN 0. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total fiP Telecommunications icing: No, of Devices or Equivalent OTHER:A)b(O-d Ste-YjCe 71 Attach additional detail if desired, or as required bv.tlie Inspector of Jrires. INSURANCE COVERAGE: Unless waived bythe owner, no permit for the performance of electrical work may issue unless the Iicensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuinP office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify.) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, udder the pains and penalties of perjuzy, that the information on this application is true and complete. FIRM NANNIE: LIC. NO.: Licensee: PI CCt,I d ( Signature __?/12-- LIC. i`i0.• (lfapplicable, enter •'erempt"in rhe�jccnseM#�yerline-) Bus. Tel. No.;U' Address: LL Cs1'tU 5K -4k _ K CL l )aa. �t lhkA A DI oLe Alt. Tel. No.: U �Ol OWNER'S INSURALNCE WAIVER: I am awaQQe that the Licensee docs not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ mviier ❑ owner's a(_,ent. Owner/Agent r Signature _ Telephone No. —PERMIT FEE: S � T ^ SEa�v 2 - 2-75, o P✓�7" I J -r SEPTEMBER 9, 2004 SCOTT L. GILES FRANK S. GILES SURVEYING 1 INCH = 20 FEET 50 DEERMEADOW ROAD 0' 20' NORTH ANDOVER, MA 01845 TEL. (978) 683-2645 H V CERTIFIED PLOT PLAN OF LAND LOCATION 76 GREENE STREET NORTH ANDOVER, MA PREPARED FOR DAVID A. & CHRISTINA M. LOGAN S 61014'0" E �* 211 MAP 43 F PARCEL 251 LOT 21 2.5' FRANK S. OF M ' L' vL'1iu i�Lr r lir l\t r.1 _A2 , MAP 43 PARCEL 25 I� 76 GREENE STREET w 93 A TTI 27' BK. 5240, PAGE 258 N N 4 o Z i 2.5' FRANK S. OF M ' L' vL'1iu i�Lr r lir l\t r.1 MAP 43 PARCEL 25 76 GREENE STREET 93 AVID & CHRISTINA LOGAN BK. 5240, PAGE 258 SEE PLAN #409 N 61045'3011 W 67.13' WOODBRIDGE ROAD ZONING DISTRICT R4 2' zi MAP 43, PARCEL 26, 10 WOO BRIDGE RD DIRESTA, DAVID M I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF NORTH ANDOVER, MA, AT THE TIME OF CONSTRUCTION. THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORMITY OR NON -CONFORMITY WHEN CONSTRUCTED. SEPTEMBER 9, 2004 SCOTT L. GILES FRANK S. GILES SURVEYING 1 INCH = 20 FEET 50 DEERMEADOW ROAD 0' 20' NORTH ANDOVER, MA 01845 TEL. (978) 683-2645 CERTIFIED PLOT PLAN OF LAND LOCATION 76 GREENE STREET NORTH ANDOVER, MA PREPARED FOR DAVID A. & CHRISTINA M. LOGAN 61014'0" E ;p 72.21' MAP 43 F I PARCEL 25 � LOT 21 w 27' o N N 2.5' J N 61-45'3010 W 67.13' FRANK S. OF MA rJvrsa. X% r MAP 43 PARCEL 25 > 76 GREENE STREET 93 AVID & CHRISTINA LOGAN A I,wo �. K. 5240, PAGE 258 SEE PLAN #409 ZONING DISTRICT R4 13' I WOODBRIDGE ROAD N MAP 43, PARCEL 26 10 W00 BRIDGE RD DIRESTA, DAVID M I CERTIFY THAT THE OFFSETS SHOWN COMPLY WITH THE ZONING BY LAWS OF NORTH ANDOVER, MA. AT THE TIME OF CONSTRUCTION. THE OFFSETS SHOWN ARE FOR THE USE OF THE BUILDING INSPECTOR ONLY AND SUCH USE IS FOR THE DETERMINATION OF ZONING CONFORUM OR NON -CONFORMITY WHEN CONSTRUCTED. C HORTM � 9 SSAONUS� Date/,!9-.,P : o `/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. , .Z-.7.. //1 <C'/ ................. has permission to perform ......P.61 % ............. plumbing in the buildings of .................... at .....%. 6 ..6f r' `.-I ........... North Andover, Mass. Fee. : ?Lk. Lie. No. .. ....... i PLUMBING INSPECTOR Check # 6206 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location -2,6 — 61,f e n J*/6 of New ©/ Renovation rl Replacement FIXTURES ,q Date /0 G`�1 Permit # p I Amount .ice Plans Submitted Yes No ❑ (Print or type) Installing Company Name Address n rr r. Name of Licensed Plumber: 4 ` C Check one: Certificate Corp. Partner. 7 S. 1rm�C0. Insurance Coverage: Indicate the t of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 11 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed und sr Permit Issued for this application will be in compliance with all pertinent provisions of the Massaci etts�tateP �r n SCh pte of the General Laws. y: APPROVED (OFFICE USE ONLY pe of Plumbnjg License icense um er-r(r Master ❑ Journeyman The Commonwealth of Massachusetts nfftct Lsvonly Deportment of Public Safety PYralt No. chocked BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (t.+Y1 Occupancy 4 rot GTocked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK NI work to be performed In accordance with the Mawchuserta EJeetrieal Code. 527 C R 12.00 NT (PLEASE PRIIli nM OR E INFORMATION) Date 2 City or Tova of D owed To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant v .Q Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization N0. Existing Service -----Amps / Volts Overhead ❑ UndgTd ❑ No. of Haters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work v ���02 //0 No. of Lighting Outlecs No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- rnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Baste Units NO. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal ❑ Other Connection No. of Ranges No. of Air Cond. Total tons No. of Dispoials No. of Neat Total Iocal Puros Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, nof Ballasts Signg Low WirVoltage No. Hydro Massage Tubs No. of Motors Total HP wrizwrc: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent. YES Er NO I have submitted valid proof of same to this office. YES E NO If you have checked YES, please indicate the type of coverage by ,checking the appropriate box. INSURANCE t BOND ❑ OTHER ❑ (Please Specify)_ (T W j Estimated Value of Electrical Work S �Exp ra ion ace) Work to Start Inspection Date Requested: Rough Final Signed under the -�enalties of perjury: /1 _ FIRM NAME/lJi�/' �G�C`TLIC. N0. Sym? Licensee S �% /4/�5� �/2 Signature LIC. NO. AddressJ369 ,rte �r G�/�y us Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts Ceneral =11, and that mysignature on this permit application waives this requirement. Owner Agent (nesse check one) f Telephone No.. PERMIT FEE S Signature of Owner or Agent Location 171r" No. IF F, Date g b r ' MORTq TOWN OF NORTH ANDOVER f P 410 0 Certificate of Occupancy $ s � a Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �. Check # G Building Inspector TOWN OF NORTH ANDOVER ' BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING y- $ ?116E1ulle�1ld BUILDING PERMIT NUMBER: DATE ISSUED: , SIGNATURE: Building Commissfoner/InEeEtor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property 1.2 Assessors Map and Parcel Number: Address: S4�,4— )d 0` Q0 zy Map Number Parcel Number 1.3 Zoning Inform/anion: 1.4 Property Dimensions: 9r� 65-D L/ y, t L C—I Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Provided 1-1 Z.a a so )3 1.7 Water Supp ty M.G.L.C.40. 54) 1.5. Flood Zone Infomntion: 1.8 Sewage Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal On Site Disposal System SECTION 2 - PROPERTY OWNERSIIIP/AUTHORIZED AGENT Fi1bLU11U LJ16UJUL. 2.1 Owner of Record Name (Pri ) Address for Service: Pignature 6 Telephone ��=- 2.2 Owner of Record: Name Print Address for Service: Tele hone –SipAature SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor. li Gt License Number Address bl 2 - Expiration Date Signature Telephone 3.2 Registered Home ImprSovement Contractor Not Applicable ❑ Co _ pany Name Registration Number ,. 6 �- �v >•— _ .o �-,.,,rpt— �.�- /�.il�.._.,. Address ~'J 3 Expiration Date Sig)uwur—e Telephone Ma rn X Z O SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) " Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ...... NNo....... ❑ SECTION 5 Description of Pro osed Workcheck all a livable New Construction ❑ Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: Ate.,,,., Fler- --1- (2) A l�aec, fL �(Ooq— oaf SECTION 6 - F,STIMATF.D CONSTRUCTION rncTc Item Estimated Cost (Dollar) to be Completed b permit applicant OFFICIAL USE ONLY 1. Building li vl% (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing ----- Building Permit fee (a) x (b) 4 Mechanical HVAC .._5 ------ 5Fire Protection 6 Total 1+2+3+4+5 iv u Check Number ar,%-11V1\ IH Vw11MIK AU InVK1,LAI IV1N 1V ISE UUMYLE IED WH.N:N OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h �c.v� e� +�..e,� ee.r..► as Owner/Authorized Agent of subject property Hereby authorize to act on [M' f, in a matter lative to work auth by this building permit application. S � a e of e Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, &'�wL-..,_._� 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 P'ntN 3a U� N�Sign e of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS ,z 1 2 ND�---_� 3 RD SPAN DIN ENSIGNS OF SILLS — d- DMNSIONS OF POSTS DIMENSIONS OF GIRDERS }� HEIGHT OF FOUNDATION ` THICKNESS ®`` SIZE OF FOOTING X 2— MATERIAL OF CHIMNEY ray IS BUILDING ON SOLID OR FILLED LAND sok—k/0 IS BUILDING CONNECTED TO NATURAL GAS LINE t. H1 V +4 FORM U - LOT RELEASE FORMS 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 ,�,,,� _ _ c� ,...t �,..� PHONE 6 �/6''3'� LOCATION: Assessor's Map Number Ok 3 PARCEL t& OD-�,� SUBDIVISION LOT (S) STREET ST. NUMBER_ ************************OFFICIAL USE ONLY************�*********** NDATIONS OF T- W,N AGENTS: ADMINIS COMMENTS TOWN PLANNER COMMENTS DATE APPROVED W O DATE REJECTED DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT, RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm ff The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02911 Workers' Compensation Insurance Affidavit Name Please Print Location: �� E= 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. Address Citc. `n .��–.v�i�w.,► �'�._ Phone* 533 Insurance. Co. Policv # l� �L L4 q-7 Company name: Address City: Phone #: Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment_as.w.ell.as.chni.penaltiesinlhefnrmnf-aSTOP WORKORD.ER.and..afire cf.(.$1.L)0.DD)ajday.agakW.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby-Xertify un a pains nd perip ies of pellwy that the information provided above is true and correct. Print name � -�� Li PL's Phone # Official use only do not write in this area to be completed by city or town official' City or Town PermKicensing ❑ Building Dept ❑Check if immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other Town of North Andover a•`�_ N Building Department o� ' 27 Charles Street Y �, North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot "HOMEOWNER Name PRESENT MAILING ADDRESS City Town Home Phone State Work Phone . • The current exemption for "homedwners" was extended to include owner -occupied dwellings of two 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 108.3.5.1) 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 or two family dwelling, attached or detached structures ac- cessory 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. 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. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC Zip Code 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: ,I'� ( L D .0u3 of Facility) Signature er it Applicant L 1 ate►► Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector MORTH Town of North Andover ,,'„ Office of the Zoning Board of Appeals _ - Community Development and Services Division ♦ o� r" 27 Charles Street �, •0;,;,; North Andover, Massachusetts 01845 'ss�c►+uS�� D. Robert Nicetta Telephone (978) 688-9541 Fax (978) 688-9542 Building Commissioner chis is to Comity that twenty (20) days have elapsed nom date �edslon, flied without filing of a PP as Fete Bradshaw Any appeal shall be filed Notice of Decision aoyoo within (20) days after the Year 2004 T&M Cletk date of filing of this notice in the office of the Town Clerk. Property at: 76 Greene Street NAME: David A. & Christina M: Logan HEARING(S): March 9 & May 13, 2004 ADDRESS: 76 Greene Street PETITION: 2004-007 North Andover, MA 01845 TYPING DATE: 05-17-04 The North Andover Board of Appeals held a public hearing at its regular meeting on Thursday, May 13, 2004 at 7:30 PM in the Senior Center, 120R Main Street, North Andover, MA upon the application of David A. & Christina M. Logan, 76 Greene Street, North Andover, requesting a Variance from Section 7, Paragraph 7.3 & Table 2 for the rear setback; and a Special Permit from Section 9, Paragraph 9.2 of the Zoning Bylaw in order to extend a pre-existing, non -conforming structure by constructing a proposed l story addition for kitchen, '/z bath, and breakfast nook on a pre-existing, non -conforming lot. The said premise affected is property with frontage on the East side of Greene, Street within the R4 zoning district. The legal notice was published in the Eagle Tribune on February 23 & March 1, 2004. The following members were present: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. Upon a motion by Joseph D. LaGrasse and 2nd by Richard J. Byers, the Board voted to GRANT a dimensional Variance from Section 7, Paragraph 7.3 and Table 2 of the Zoning Bylaw for relief of the rear setback of 17' in order to construct a proposed 1 story addition for kitchen, '/2 bath, and breakfast nook; and GRANT a Special Permit from Section 9, Paragraph 9.2 in order to extend a pre-existing structure on a pre-existing, non- conforming lot per Plot Plan of Land, location 76 Greene Street, North Andover, MA prepared for David A. & Christina M. Logan, date: October 22, 2003 by Frank S. Giles II, PLS #49793, Scott L. Giles, Frank S. Giles Surveying, 50 Deermeadow Road, North Andover, MA 01845. Voting in favor: Walter F. Soule, Ellen P. McIntyre, Joseph D. LaGrasse, Joe E. Smith, and Richard J. Byers. The Board finds that the applicant's agreement to run the proposed drain pipe (dotted line) from the left front comer of the existing house to the Greene Street catch basin satisfies the provisions Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Pagel of 2 PEST: 'rue Copy U. :'own Clerk „; i- Town of North Andover f NORTH Office of the Zoning Board of Appeals o o''��� Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 D. Robert Nicetta Building Commissioner Telephone (978) 688-9541 Fax (978) 688-9542 Furthermore; if the rights authorized by the Variance are not exercised within one (1) year of the date of the grant, it shall lapse, and may be re-established only after notice, and a new hearing. Furthermore, if a Special Permit granted under the provisions contained herein shall be deemed to have lapsed after a two (2) year period from the date on which the Special Permit was granted unless substantial .use or construction has commenced, it shall lapse and may be re-established only after notice, and a new hearing. Town of North Andover Board of Appeals Walter F. Soule, Vice Chairman Decision 2004-007. M43P25. Page 2 of 2 < Cd 0,�jt o ro: Q U 0 t u- qtAq ML? o o d! �; V E ai �umVra s rn W�D �'Ilk W� _ D 0 � 3 W N 4- ` 3 0 C oc m u a ca a 2 W - ° or o >• .s.2 c W > x Q Q c cCL m ac yNj C H V O O O O W. 01 C � !'+ O �C C \/ � E o. � -6 O E /\ U a as W N t° a a5 a N tiL+ O A t 2 m O w Z O O L- ai u g o L aj :. ` O 46 1 Cd i� 0 z ui am N E _W c •=..N= oa LL iA g W W - •dam C O Z a CJao=o�gN.�; • O.y '� x y x m = � � = c /. V a A v � w U) c3i U w C7 CP -4 � w� o � cn o cn ui am N E _W c •=..N= "r LL iA g W W - •dam C O Z CJao=o�gN.�; • O.y '� y x m = � � = c /. V A y 2 a CA y E CL 0 a� _O CO) O Q CO2 C.3 ev �C cc CO2 r�lft1 3� CD o L L O C' cmcc ��•p+ cc ..1 .O O Z tS coCLCIO c W 0 LUN Y/ W LLI 19 ujW U) ORT" 4L Ar. 667 Date�7—A.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. . .... ............. . .................... has permission to perform .......... ............. ..................... ............ wiring in buildi g of.. . ..... .... . . . ..... ................ at ....... I .. ..... ...... ........ . North Andover, Mass. Fe... ............... Lic. No . ............. ........................................ ****'***'**"***'*** "' ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer