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HomeMy WebLinkAboutMiscellaneous - 78 PHILLIPS COMMON 4/30/2018Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Property Address: Policy Number: Date/Cause of Loss: File or Claim Number: Mark & Nancy Ziel 78 Phillips -.Common BCGZZZ 1/24/2013, Water/Plumbing 27611-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. Ryan Werner On this date, I caused copies of this Notice to be sent to te person named above at the addresses indicated above by First Class Mail. d Date ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 .PO Box 1098 Londonderry, NH 03053 C3c SM CLAIMS DEPT. January 28, 2013 Ccmmerce Insurance - The Commerce Insurance CcmpanySM Citation Insurance CcmpanySM Members of The Commerce Group, Inc. - 11 Gore Road, Webster, Massachusetts 01570 (508) 949-1500 www.Commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL NORTH ANDOVER MAO1845 RE: Our Insured: MARK ZIEL / NANCY ZIEL Property Address: 78 PHILLIPS COMMON Policy#: BCGZZZ Date of Loss: 01/24/2013 Filek CRPK90-XVVJ72 Board of Health or Board of Selectmen Town/City Hall Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. JOHN E RICHARD Telephone: (508)949-1500 Ext: 15984 Clm Representative II, Subrogation Toll Free: 1-800-221-1605, Ext: 15984 On this date, I cause copies. of this notice to be sent to the persons indicated above, at the address above, by first class mail. CIC 254 (Rev. 4/95) January 28, 2013 Cc11 MCIrc Ccmpanles .... COME GROW WITI US MAH- I50 ';r /,:'- ::g:- 4,19 Date......... ......................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... ................................................................ has permission to perform-,.,.,..--,., .... ..... wiringin the-buildili Of ...................... ............................................................. � �/- - "4 at .......................... ............ ..... ........ ... ... 7:-��`Nortb Andover;,Mass. Fee..................... Lic. No.. .. ..... .. ................ .......... ........ . ELECTRICAL INSPECT R// Check # .9.045 It Commonwealth of Massachusetts Official Use Only Permit No. l U yU ISIXEMW Department of Fire Services )w Occupancy and Fee Checked C?tY BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MECJ 527 CMR 12.00 (PLEASE PRINTININK OR 7TPE ALL INFORMAHON) Date: �d a --0 1 City or Town of: Po- )�n AQ -/e lr To the Inspector of Wires: By this application the undersigned gives no ce of his or her intention to perform the electrical work described below. Location (Street & Number) %�' t h r ��t�j�S ( . yji ,%Pdo Owner or Tenant /V4I'1C�/�G Telephone No. %%8`-61- 3(6 Owner's Address ZiAe- Is this permit in conjunction with a building permit? Yes M No ❑ (Check Appropriate Box) Purpose of Building l F-aYq , l i d / I)n jj Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �% X I urs RLi'/Girfvt ComDletion of the following table may be waived by the Incnectnr of Wire.c No. of Recessed Luminaires No. of CeiLSusp. (Paddle) Fans o. of T=a Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires BoveIn- Swimming Pool rnd ❑ rnd. ❑ o. o mergency ig ing Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and InitiatingDevices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers eat Pum Totals umber. ___. ons o. of Self -Contain Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:" No. of Devices or Equivalent No. o aterKW Heaters o. of o. of signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total BP Telecommunications inng No. of Devices or Equivalent OTHER: Re- PI. 3 "' r, -XL v -5 T jA n S .3 A,- TA /s. - f- Gu/rc 57-c4 ft, Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: ' v r' (When required by municipal policy.) Work to Start: 1/6 .-a _ Q 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penables of perjury, that the information on this application is true and complete: FIRMNAME: Focus Electrical Corp. LIC. NO.: Al5394 A -vP skwe#- to r i Licensee: James M. Conlon Signature(�,yr -'/�t� �LIC.NO.: E33632 (If applicable, enter "exempt" in the license member line.) cl-11, Bus. TeL No.: 9 7 8 - 9 5 7 - 2 3 8 9 Address: 62 Pine Valley Drive, Dracut MA 01826 Alt. Tel. No.:508-328-1901 `Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one)E]owner owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ �2� i. ._. ' � Ili Fy � •jam .. ' � � "-.'�. r- .. i 1 •/� �, 1';I •, i..•a 1 z .t, n=1.:1..1; �, .it.;7^_•i 1 �f ` ., C ', 1, . 1. 'il i,. �f I •r , .! Fi �� •� 1 J 1, hl i i � .,, I' - 1 '� f .9•. ..- _�..� i' i 11'J 1, a - . - - � - _. _.� _..-� ..- - _..� � - -..... _ _.._...--. _ ._ 14.1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 6�)" `t 1,� e_ �dcvs F% GJ r -,-cc I Cor P' Va ley i _ City/State/Zip: >_C4Gy 1— �'( , ©f �� Phone #:—. % 7 3 F1 Are you an employer? Check the appropriate bog: 1. ❑ I am a employer with S 4. ❑ I am a general contractor and I employees (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 working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9.❑ Buil ing addition 10.ETI lectrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other y a-ypiivant t.;at cttecl S box'-: must --'So fill Out the section below showing their workers' comp =ationpolicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit'a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. // Insurance Company Name: / ke- / c Policy # or Self -ins. Lic. #: 03 MI C L B y3 6 F Expiration Date: Job Site Address: 7971r /1 r t PS t� /yt 1� Jyj City/State/Zip: Af0 • kndd✓tr_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct 10 _,�_ -_6 7 Phone #: 5fo Oficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• Information- and Instructions a 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 permittlicense 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. Once of Investigations 600 Washington. Street Boston, MA. 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia Date :�' L& 'Q a',".��T:�ho TOWN OF NORTH ANDOVER PERMIT FO�l PLUMBING 40AcwUS This certifies that i!� .. • . • • .... • . • . • t' has permission to perform ... CA'.0L 01/.u..r..', ......... . plumbing in the buildings of r./,." .. .......... , at ..�`i �,`�..�.�� �. , North Andover, Mass.. GG p > Fee.. tjrt PLUMBING INSPECTOR Check # t 8081 L :50 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date .. Z� '- O 9 Building Location I C? s CO N( j*,&>Js Name %1j4-" j4-"2—LQ L.. Permit # 7077— _ Type of Occupancy 5- F� M Amount G� New Renovation Replacement Plans Submitted Yes No IMMIRES MM --.---M...--.-...-.----.. .' mmm��W--M---�Mwmm - 11' -..-. 1 11' -M----------------------- :I 11' -.-M-...MW-.W-M.------.-. (Print or type)V V t' 4, �, / Check one: Certificate Installing Company Name eYL- � }[-� � �J j El Corp. Address D 4� -7 &. 0 F5 El Partner. <l'� oZc `Z C. Business Telephone Z d B,,Firm/Co. Name of Licensed Plumber: s1 N 1044.4Kt—_ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity rl 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 ❑ I hereby certify that all of the details and information I h in, (or entere in ab ve application are true and accurate to the best of my knowledge and that all plumbing work and i st on performed u der P it Iss r s application will be in compliance with all pertinent provisions of the Massa n r f neral Laws. By: igna ure Of (cense umber Title Typeto /�Pj�►jy�ng License t„J City/Town icense uu((m er C(Ap Master El APPROVED (OFFICE USE ONLY The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Alaslzina%n Street Boston, MA 02111 www massgov/dia . Workers' Compensation 1witrance Affidavit: Builders/ContractorsMiectricians/Pi mbers ipTlCant Informatinn Nanie (Business/Orpniration/Individual): Address:. D' e) City/State/Zip: I"4n_aDS e / Phone #:.r- Are you an employer? Check the appropriate box: 1.01am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* I am .a.sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. � s and have no employees These sub -contractors have working for me .m any capacity; workers' comp insurance workers' comp, insurance. 5. ❑ We are a corporation and its eq utred.] req. 3. ❑ I am a homeowner doing officers have Exercised their all work right of exemption per MGL myself [No -workers' comp, C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. isisuranee aired_] Type of prefect (required): 6. ❑ New construction . 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I bing repairs or additions 12.❑ Roof repairs feq 13-M Other `Any applicant that checks bob #I must siso fill out the section below showing their workets' ?compensation policy information. t Homeowners vino submit this affidavit indicating they are doing all work and then hire outside conttactors must submit a new affidavit indicating such. lconftc!tors that check this box must anaahed an addt'tional sheat showin. Ehe name ordw-b-eottttactots and their workers' temp. pr•indicating asuc I am an employer that is providutg:workers ' contpensadon insurance formy employees: Below is the policy area' f ob site . information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/%te/Zip. Attach a copy of the workers' compensation policy declaration page (showing Failure to sthe policy Dumber and expiration date). ecure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of crimina► 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 5250.00 a day aga st a violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI fo insurance coverage verificati� I do hereby certify u er t pains sad penalties fPedary hatformation provided above is teue and roerea Si Date: �✓ '�' '�--C.p r- (�9 Phone #: �� Cp _(J n '25 Official use only. 1)o not write in this area, to be completed b3' city or town. ociaL City or Town: Permit/Lieense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector .. �� Coniact Person: Phone #: Information and In"Structions 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, F express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two ormore of the'foregoing engaged in a joint enterprise, and includir><g the legal representatives of a deceased employer, or the receiver or trustee of an in partnership, associatiorn 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 shaU not because of such employment be deemed to be an employer." MOL chapter 152, §25C(6) also.states that "every statt'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.oe compliance with the insurance' coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither tiie 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 compimtely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), addresses) 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 lo,e sure to sign and -date the affidavit. The affidavit should be returned to the city or town that the .application for permit or license is being requested, notthe 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 nurberlisted below. Self-insured companies should enter their self -insurance -license number on the'appropriate Tine. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes 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 A-iII 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 infonnation (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 f iture 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 fait number. The Commonw6altb: of Massachusetts Department of lmdustrial Accidents Office of Investigations 600 Washington Street Boston, IIIA 42111 TeL # 617-727-4900 ext 406 or 1 -8.77 -"SAFE Fax # 617-727-7744 Revised 5-26-05 www-mass.gov/dia Location %_! 1-7/111_UP-� Coll79Mod i No. Z 2 1/ Date N°R7M TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 50 , o f7 �e Building/Frame Permit Fee $ / h o Q \AtmUSE�_.IeA-ve undatlon Permit Fee $ /00,00 G\IIV I Other Permit Fee $ op Sewer Connection Fee $ W te(, Connection Fee $ 1 Building Inspector Div. Public Works _ Location No. f 7 � Y Date pVM"fOWN OF NORTH ANDOVER `Wificate of Occupancy uilding//Frame Permit Fee &yion Permit Fee pSUNJ`Ie Other Permit Fee ® .4--Y-7 Sewer Connection Fee (j:5 Water Connection Fee TOTAL Building Inspector Div. Public Works PER111T N0.1 i� APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. j} v PAGE 1 MAS LOT NO. LQ I 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE NE SUB, DIV. LOT NO. a I T I LOCATION g._,_ PURPOSE OF BUILDING �- OWNER'S NAMEv„ -W I [{ s J /� p . — NO. OF STORIES �l I SIZE !1 �>�y (��2, OWNER'S ADDRESS � 33 I (�i.1r'Yl-� I r'/v j'1VY� BASEME OR SLAB ARCHITECT'S NAME�C W( � (gSSU C11 ^ 2ND Zx 3RD SIZE OF FLOOR TIMBERS IST �X /l/ „LJ\ _p ��A BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING qol ' p` DIMENSIONS OF SILLS 14 y fD � DISTANCE FROM STREET '1 o, POSTS (9L!1_�' DISTANCE FROM LOT LINES - SIDES r1 o I REAR,40 GIRDERS ��" x / Z AREA OF LOT /'"), <-U /" L l /-\ �T{� yO'` FRONTAGE 100 HEIGHT OF FOUNDATION ry jl THICKNESS / /1 X iV IS BUILDING NEW ,� C , SIZE OF FOOTING 1 /� I ZZII % .IS BUILDING ADDITION A) 0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION JVQ IS BUILDING ON LID R FILLED LTTAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE LfQS IS BUILDING CONNECTED TO TOWN WATER t�s BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE - CI '= INSTRUCTIONS t SEE BOTH SIDES �• PAGE I FILL OUT SECTIONS I - 3 PERMIT FOR FOUNDATION ONLY REGULATED BY PARA. 114.8•S. B. PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATE FEE PAID ATTACHLD GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED s l (7 /9 a - SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE 12-6'610-0 PERMIT GRAN ED G t 9l Z - PERMIT FOR FRAMUBUILDING DATE: 4"A EE PAID//68. OWNER TEL. #-W i CONTR. TEL. #-62. L/ _ CONTR. LIC. #� BLDG. PERIV T ME 1-697 °-o LESS FDA FEE.. DUE FRAME PERMIT e,o . -r 6z, w 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. //� APPROVED BY: BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN -BUILIDING RECORD OCCUPANCY., 12 •;THIS SECTION MUST SHOW. EXACT DIMENSIONS OF 40T �,k LOT LINES -0 1. ­ AND DISTANCE FROM ,AND EXACT'bi*lffNMdr4s � 0: bUtLOINGS.' WI -Hi GA - FS. ETC: -SUPERIMPOSECY..THIS REPLACES,PLOT PLAN-V- fV, 0 ti 0 ITAO 1, U al 9 01 r, M, RiAl ya GRALlu 0 lAq 333 3TAO z SINGLE FAMILY sroRlEs MULTI. FAMILY OFFICES APARTMENTS COP�STRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 1 2 3 PINE CONCRETE CONCRETE BL K. BRICK OR STONE HARDW D —7 PIERS PLASTER DRY WALL -�NFIN 3 BASEMENT AREA FULL FIN. B M T AREA 114 FIN. ATTIC AREA NO BM T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 77, FLOORS CLAPBOARDS if B x— 1 2 3 q DROP SIDING WOOD SHINGLES CONCRETE HEARTH ASPHALT SIDING ASBESTOS SIDING )AARDV."D COMIACN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MA§YW� I ATTIC STIRS. & FLOOR BRICK ON FRAMEAT CONC. OR CINDER BIK. WIRING STONE ON MASONRY', STONE 6N FKAME" '-' SUPERIOR POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH Q FIX.) GAMBRELIMANSARD FLAT I TOILET RM. (2 FIX.) 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 I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER EMS. &'COLS. STEAM STEEL BMS. & COLS. HOT W*T'R OR VAPOR WOOD RAFTERS_ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS B'M*T 2nd %, 1st 3rd I GA OIL ELECTRIC PE NO HEATING SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PER HENT AD STREET, APPLICANT DATE OF APPLICATION FOM U TOWN OF NORTH ANDOVER LOT RELEASE FORM TOWN USE BELOW THIS LINE PLANNING BOARD TOWN PLANNER CONSERVATION COMISSION Miamfmxf #I avoggg ��� PHONEbJ2—//3L,8--' DATE APPROVED DATE REJECTED .DATE APPROVED G/ DATE REJECTED i BOARD OF HEALTH 'E APPROVED untE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS �( t TIRE DEPTJ. Y �erEee�Ten �! v.�i9'L �/l✓ �yG�� RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. ;1 ,047-70 � a r� MAY 181992 BUILDiNG DEPARTMENT PN/GG/PS �pm�O,v M F�iJri � r/ON " � /3 z68S,F ��O• = 0.30SAC , ll�N IN5-%2u�EN7- �/ SI&Ie �S 1/E.RE6i- CECT/FY 70 7,Y.-7,Y.-7-174--7-174--jt/SU.eD,P qN0 RG. O / " P4 4.v Tr% THE BA.V.r TNgT TNEOwELG/•u6 /S LOCATED OA// TiyE La7'./S S/4C/YN ANO T�G4T?OGS G'O.f/FGtP/!1 /N JY/TH T//ETOWN' OFtit7. A,vDovE� ZON/ivG ,�E6vLATilJit/S ,�6�O.P0/NC's JETBAC.t'S F•�OM ST•QEET.S !COT U•aES. 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