HomeMy WebLinkAboutMiscellaneous - 793 WINTER STREET 4/30/2018WE
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DFPARTAEVT0FPUBLIC&4FM Pertnit No.
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Occupancy & Fees Checked
APPUCATIONFOR PERMIT TO PERFORM ELECTRICAL WO
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACIiC1SSTS ELECTRICAL CODE, 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat
Town of North Andover Z21 To the Inspector of Wires:
The undersigned applies for a permit to perform the work des bed below.
Location (Street & Number) CLK
Owner or Tenant . aci C -.P
Owner's Address
Is this permit in conjunction with a building permit:
Purpose of Building
Existing Ser vice/
grnp'/� yolks
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
No. of Lighting Fixtures
No. of Receptacle Outlets
Swimming Paul
No. of Oil Burners
No. of Switch Outlets
No. of Gas Burner
No. of Ranges
No. of Air Cond.
Yes
DisposalsI No. of Heat Total
No. of Dishwashers Space Area
No. of Dryers Heating Devices
No. of Water Heaters KW No. of
Signs
No. Hydro Massage Tubs I No. of Motors
OTHER
IhaveammagLlabtTdyltut ==pbfig,itt j&WC.al
Iha�esubtttidadva6dptoafaf bthe06m YES
IlV.AJRAI�ICE BOND
hWeCttol D*Rgpe*d
�uttsmysgrtaaaeont�spt�app�rn� thstaquiar>t?tt
(Please check one) Owner Agent
No (Check Appropriate Box)
Utility Authorisation No.
Overhead Underground No. of Meters
Overhead Underground a No. of Meters
No. of Transformers
Generators
No. of Emergency Lighting
FORE ALARMS
Total
No. of Detection and
KW
Initiating Devicei �, `-
KW
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
KW
Local Municipal
of
Connections
HP
Ifj uha%edzJWYES,
rice( Wade $
FkW
KVA
KVA
Units
No. of Zones
a otne-
0
Lio�eNo
Blsin�Td.Na
._ AkTd'Nh
Telephone No. PERMIT FEE =4(f
PERAfIT NO.
1
s
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
/ PAGE 1
MAP a40.
LOT NO.
2 RECORD OF OWNERSHIP (DATE
(BOOK '.PAGE
ZONE
I SUB DIV. LOT NO.
LOCATIONM / �\ L\f� Sp
4 �] 1�� �J��
PURPOSE OF BUILDING �u y �Q O
OWNER'S NAME Y�j, M .n 1 e�5 O r/
'T ,• `VC7
r
NO. OF STORIES SIZE I
OWNER'S ADDRE 5
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS /STI 1,/� O 2ND 3RD
.
BUILDER'S NAME �` P `
SPAN ' a
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
aX _
DISTANCE FROM STREET O O -�
POSTS
DISTANCE FROM LOT LINES - SIDES REAR i Cj U
yJ tQ 1 (
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION l C LTHICKNESS
IS BUILDING NEW
SIZE OF FOOTING I y- X
o
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION e,6
IS BUILDING ON SOLID OR FILLED LAND
v
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER c 1ft t e [
J
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER N
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
DATE FILED
SIGNAT E O pV�HORIZED AGENT
1
FEE 12*Ls-^ "
PERMIT GRANTED vY
19
G
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST Q A o
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
ILDINo INSP[croR
OWNER TEL. # 5�,� 4
CONTR. TEL. # 6 t51V _3 Lf
CONTR. LIC. # y v 36-5
H.I.C.# �o O b a
1 OCCUPANCY
SINGLE FAMILY STORIES
MULTI. FAMILY _OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION —I 8 INTERIOR FINISH
CONCRETE 3 2
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
DRY WALL
3 BASEMENT II
10 PLUMBING
AREA FULL
I
FIN. 8'M'TAREA
_
'/. 1/1 1/.
GAMBRELMANSARD
FIN. ATTIC AREA
NO BMT
TOILET RM. (2 FIX.)
FIRE PLACES
_
HEAD ROOM
SHED
MODERN KITCHEN
_
_
ASPHALT SHINGLES
WOOD RAFTERS
LAVATORY
4 WAILS
I 9 FLOORS
CLAPBOARDS
KITCHEN SINK
RADIANT H'T'G
B
_
1
2
�_
3
_
_
DROP SIDING
7 NO. OF ROOMS
CONCRETE
WOOD SHINGLES
OI l
EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
HARD"✓'D
COMMGN
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. &
FLOOR
_
BRICK ON FRAME
I
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
5 ROOF
10 PLUMBING
GABLE
I
HIP
BATH (3 FIX.)
PIPELESS FURNACE
GAMBRELMANSARD
I
FORCED HOT AIR FURN.
TOILET RM. (2 FIX.)
TIMBER BMS. & COLS.
TL_ATj
STEAM
SHED
STEEL BMS. 6 COLS.
WATER CLOSET
_
ASPHALT SHINGLES
WOOD RAFTERS
LAVATORY
AIR CONDITIONING
WOOD SHINGES
KITCHEN SINK
RADIANT H'T'G
SLATE
NO PLUMBING
UNIT HEATERS
t -
BUILDING RECORD
12
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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
GAS
OI l
B'M'T 2nd _
1st 13rd
ELECTRIC
NO HEATING
0I Building Inspector
ol
i 9 4 7 Div. Public Works
Location t� W�
No.
Date
Z
t 1
4'
TOWN OF NORTH ANDOVER
3 ;
Certificate of Occupancy $
y
* ; +
Building/Frame Permit Fee $
sCMUS CHU E `y
JAt
Foundation Permit Fee $
Other Permit Fee $
i
Sewer Connection Fee $
Water Connection Fee $
a
`
TOTAL nj�, $
0I Building Inspector
ol
i 9 4 7 Div. Public Works
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FORM U - LOT RELEASE FOR14 -
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: Roga-t:, Ty- sox. Phone
LOCATION: Assessor's Map Number Parcel
Subdivision
Street
Lots)
4+ W St. Number
************************Official Use Only************************
RECOMMENDATIOYF7 A S
s
- X�
r Date Approved 1111/ S`
Conservation XaminIs-it-rzkor j r Date Rejected
Comments ` ! tw exr`� d�� �iCwt _5. /00/
WO&,�-s e6(4 01� 4W*V�J - d4v-,r(.
Town Planner
Comments
Food Inspector -Health
—,dz 2L�L -
vSeptic Inspector -Health
Comments
Public Works - sewer/water connections
- driveway permit
Fire Department
Date Wproved
Date Rejected
Date Approved
Date Rejected
Date Approved �
Date Rejected
Received by Building Inspector Date
'MOUSE
S17w-R
'TAyK
INLET
i ANK
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DAVE REITANO
REMODELING & CO.
G'l..&w "d wooGm—ao
at a Semddk ,mice
56 PLEASANT STREET METHUEN, MA 01844
617.688.3944
JOB
SHEET NO. OF
CALCULATED BY DATE
CHECKED BY
SCALE
DATE
PRODUCT 204-1 � Inc.. Groton, Mass. 01471.
DAVE REITANO JOB
REMODELING & CO.
Qw ty and Wodm",hip SHEET NO. OF—
at a-%Nddee Page CALCULATED BY DATE
56 PLEASANT STREET METHUEN, MA 01844
617.688-3944 CHECKED BY ^) DATE
• N
SCALE
PRODUCT 204-1ees Inc., Groton, IV— 01471.
...
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PRODUCT 204-1ees Inc., Groton, IV— 01471.
- -I - " '- ' ' --
0
2844
"A6
Date .....
... ... .... g.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that.....................
has permission to perform
�/" . . .. ..............................................
wiring in the buildi y ig of ..... .. /.. .........
a, ........ I.q-3 ..... !l1. f... ......... ................... . North Andover, Mass.
Fee... Z�r-�.'.. Lic. ..........................................................
ELECTRICAL INSPECTOR
OMI /% 11:52 25- 00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Gibe �f mmonwza- n of flusadpmitts
1tMt nz= of Vublic
BOARD OF FRE PREtlEjMON REGULATIONS "M CMR 12:00
Coles Uss
Permit No.
pU
C=pancy A Fee Checked
ygQ peave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in ac. rrdance with the Massacnusetts E:ectricai Code, 527 C� R t :00
(PLEASE PRINT IN INK OR TYPE ALL INFOR �1ATION) Date
MQ or Town of NORTH ANDDVER To the Inspector of Wires:
The udersigned applies for a permit to pe&orm the eiectricai work described below.
Lccation (Street & N,uq,mjJbed /� U> V 16 -' 7 -
Cwner or Tenant ,`� rt + 1i S,�yC �C ll i✓
Cwner's Address to/ 127-r
Is ;`its permit in ccniunction with a building remit: Yes Y No - (C`eck Apprccrtate °cx)
Purccse of Euiidinc ApE5 /Dga lc Utility AutMcrization No.
j e O� Amps r NlC .S Cverf eaC _ Unccmc r--! No. of Meters
czis;Ing arvic _
Ne,. -.r Ser -Ace Amps r `/Cits Cverreaa - Ur•c_rna No. at deters
Numaer at Feecers arc Amcac:ty
"c WINE- Abbilla
L.....:ticn arc Nat,re zf rrcccsec ==c
Tota.
_:grnng Cut:els
No. c. --. =s
No. _. 'ansicrmers:�
No. ct :grrng = x::res
Swrmr-tog -_ct—
�..
_ c. — I Genera:crs KVA
I No. or _Tergency '-gnting
,No. _t Czecec:ac:e Cut:e!s
No. _. Cii =.•-ors
i 3arerf Units
No. of Switch Cutlets
No. or 'Z as 8_.-_._
I F.n= AL -ARMS No. of Zones
:at
NO. --f-eleCnon anc
No. of .9anges
No. - .r --• a. _-s
I inmaung -Cavices I
No. ,]f Ciscosals
ea: c:at
1
No. ot pu- - g ons
C
Tc:at
�:: No. z' Scuncing 1:evlc85
No. of Sell Contatnec
No. of Cisnwasners
ccacerArea =ea^.r
C:! ( Oelec::onrSounetng Cevices
No. of rvers
Heaanc rev:ces
Munlc:aat C:ner I
t:� _=cat ' Connec::on —
Nc. or 1+0. of
I Law voltage
No. of Water :-seaters
1 S-.cns _a:9as:s
•,Vir.ng
No.wcro Massacs u=s -
No. cf %. ,,.cis - •'•
I
-- !
C—. _...
tiVSURANCc CC'lE=AGF_. Pursuant :o the recutrerrents ct aassacn:.sars general taws
YES NO I
I nave a current l.iawky, Insurance Ponc/ 'nC::c:ng Car-=:etec C=era: cos -overage or its sucs:antral ecutvatent. _ _
Y_S. -,tease 1natcate the ryCe of coverage cy
nave suerninee vauC pr -"t of same to the Cf'cs. YES = NC = f
ycu nave cnecxec
cnecxtng the aocrocnate oax.
INSURANC = BONO = OT V;
_
_ tPeeass Saec:`!t
(Exctratton Oatet
36�
s::matec value of:err• at worx S
.Vcrx :o Star, 2
Inscec^_en :: a:e Raeues:ec
Rcug.^. Il) (L(_- C %L F,+nal
S'-gnea cancer ms Peraittes of perjury:
UC. No.
=�=M NAME
LA�/1[1G
T_ S -a' -re
'C. NO. Z
_censea U/d 17AJ/f
S
Sus. :el. No. _601:����
ACcress _r
CWNER'S INSURANCE WAIVEa: t am
aware tttaz:r-e'-'Ce--see _ces Met nave :me insurance coverage or; Its suostantrat eeutvatentt es�`e-
9
General Laws. ano tnat :-Ty s_Sran:re cn =s
=err.:t application waives tnis reoutrement. owner
ouuea oy Massacnusetts
(P!easa cnscx ones
erecncne No. PERMIT F$c S
isignature of Cwner
or agent
"" B
_ . 2154
Date .-3:-. / 0/.-. `ie ........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ! .... t� d . t7` ...................
has permission for gas installation .. �.' .�'.: '4 : !z.......... .
in the buildings of .. ).Z7 P— ............................
at . .. 7 ! k. �t (x ............. North Andover, Mass.
Fee.?�,��." ... Lic. No..�.�- Skj% 15A7....... 25;00* * PAID .......
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
2 �-, -•
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTI iv
(Print or Type)
NORTH ANDOVER Mass. Date C
f§uilding Location 7 q lN�luI-- Permit #
Owners Name (1 C 0r(/
Y_
? New Renovation D Replacement �] Plans Submitted D
•• FIXTU°-G
(Print or Type)dcrlulcl-�.
n Check one: Certificate
Installing Company Name /- Q Corp.
Address 2 AB2aZZ - - 5T Partner.
l-AWRFIt-cC- / /#s S (2 V y� Firm/Co.
Business Telephone: 9-? /3 to
Name of Licensed Plumber or Gas Fitter J -1 -:FF IA..)l C/C
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy ®Other type of indemnity = Bond D
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 coverages.
Signature of owner/agent of property Owner 17 Agent 0
1 hereby certify that all of the devils and information 1 have submitted (or entered) in above application are true and accurate to the best of my
knowledge and Mat aU plumbing Work and installations perfomrcd under Permit isseed for this application will -be in compliance Pith aD perUnent
provisions of tho Massachusetts State Gas Code and Qsaptes !42 of the General Laws. A /J .
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
lumber
Gasfitter
Master
ourneyman
S;414fure of Licensed
Plumber or Gasfitter
1�-t 13S/
License Number
N
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2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLQOR
(Print or Type)dcrlulcl-�.
n Check one: Certificate
Installing Company Name /- Q Corp.
Address 2 AB2aZZ - - 5T Partner.
l-AWRFIt-cC- / /#s S (2 V y� Firm/Co.
Business Telephone: 9-? /3 to
Name of Licensed Plumber or Gas Fitter J -1 -:FF IA..)l C/C
Insurance Coverage: Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy ®Other type of indemnity = Bond D
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 coverages.
Signature of owner/agent of property Owner 17 Agent 0
1 hereby certify that all of the devils and information 1 have submitted (or entered) in above application are true and accurate to the best of my
knowledge and Mat aU plumbing Work and installations perfomrcd under Permit isseed for this application will -be in compliance Pith aD perUnent
provisions of tho Massachusetts State Gas Code and Qsaptes !42 of the General Laws. A /J .
By
Title
City/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
lumber
Gasfitter
Master
ourneyman
S;414fure of Licensed
Plumber or Gasfitter
1�-t 13S/
License Number
r
Date . �2.. C
2839
�'< •° .1ti TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .. 4 .!(7e. � f.' ... %� .'?�..................
has permission to perform ... %9.e ?�-A .
plumbing in the buildings of .. d.eAt o.+,%- .................... .
at.. ... North Andover, Mass.
Lic. No.. . LFee. �J !~
I.........
PLUMBING INSPECTOR
03/01/96 10:20 35,00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print of Typal
NORTH ANDOVER, Mala. Data) - � 10=
3J(
Bu+lding Pemll s 2 L 3 2
Location
es
m
NNe
�7LSN Sac)
New p Renovation [/ Reptacementt ❑ Pians Submitted: Yea ❑ No ❑
FIXTURES
Installing Company Name leu%A)l c l i P 7'
Addresa -:2 4. 14!313 0 I—T !2T
(, )1 L- F-rL< /`1/J r, S
Business Telephone
Name of Licensed P
Check one:
❑ Corp.
❑ Partnership
M,FKrm/Co.
INSURANCE COVERAGE: cjlecx one
I have a current liabifty Insurance pollcy or Rs substantW equivalent. Yes 8-' No ❑
It you hive checked �Lej, plesse Indicate the type coverage by checking the appropriate box.
A liability insurance p Alcy CJS Other type of k-)demndy i] Bcnd ❑
CartiRcate
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
59natu's of Owner or Umet a /dent Owner ❑ Agent C]
I hereby csrtity that all of the delalls and Information I hays tubenMed brr entered) in above tion at trw and scamate to the bast of my
knowledge and that all plumbing work and Inslallstlons performed under the perrnA Itsued a ap t)on Mai be in compflance with M
pertinent provisions of the Massschusstts Slats Phmnbirg Code and Mapter 112 of laws,
By
Use o n mora
TitN
1Scernta bei �> -� tS
CtylTavrn
Aff nDAD (OfF)CE USE ONLY) Type of Plumbing Uonsa: Master ❑ /
Journeyman
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•ASCMINT
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3RD FLOOR
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4TH FLOOR
11TH FLOOR
ITH FLOOR
I
1TH FLOOR
ITH FLOOR
Installing Company Name leu%A)l c l i P 7'
Addresa -:2 4. 14!313 0 I—T !2T
(, )1 L- F-rL< /`1/J r, S
Business Telephone
Name of Licensed P
Check one:
❑ Corp.
❑ Partnership
M,FKrm/Co.
INSURANCE COVERAGE: cjlecx one
I have a current liabifty Insurance pollcy or Rs substantW equivalent. Yes 8-' No ❑
It you hive checked �Lej, plesse Indicate the type coverage by checking the appropriate box.
A liability insurance p Alcy CJS Other type of k-)demndy i] Bcnd ❑
CartiRcate
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
59natu's of Owner or Umet a /dent Owner ❑ Agent C]
I hereby csrtity that all of the delalls and Information I hays tubenMed brr entered) in above tion at trw and scamate to the bast of my
knowledge and that all plumbing work and Inslallstlons performed under the perrnA Itsued a ap t)on Mai be in compflance with M
pertinent provisions of the Massschusstts Slats Phmnbirg Code and Mapter 112 of laws,
By
Use o n mora
TitN
1Scernta bei �> -� tS
CtylTavrn
Aff nDAD (OfF)CE USE ONLY) Type of Plumbing Uonsa: Master ❑ /
Journeyman
Location
17`13 llx,� fE --
No. 80 Date
TOWN OF NORTH ANDOVER
Of'"o •,ti0
�? 0L
� R
9
Certificate of Occupancy $
cHBuilding/Frame Permit Fee $
s�►us
Foundation Permit Fee $
Other Permit Fee ! v/ $ Al 04*"-
r
TOTAL $ ��----
Check # 16-d9
18442 (C9-�
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
TWs: Section forO>1 Use Oni
BUILDING PERMIT NUMBER: a
DATE ISSUED: �.
SIGNATURE:
Building Commissioner/IkEtor of Buildings Date
.�u�. aavri l— Ja a G uir vanirata i avtI
1. l Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information: �1.4 P opexfyDimensions:
a 1,27'
Zoning District Proposed Use 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 S N M.G L.C.40. 54) 1.3. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ( Private 0 Zone Outside Flood Zone Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service
Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature T
SECTION 3 - CONSTRUCTION SERVICES
jt3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature
Telephone
3.2 Registered Home Improvement Contractor
O' /,, ,
Companv Name
re
T,
Not Applicable ❑
License Number
Expiration Date
Not Applicable 0
Number
Expiration Date
M
M
X
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) �Y.�J �� �/�✓l2
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......0 No ....... ❑
SECTION 5 Description of Proposed Work check aU applicable)
New Construction ❑ Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition
Accessory Bldg. 0 Demolition 0 Other .0 Specify
Brief Description of Proposed Work:
I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I
Item
Estimated Cost (Dollar) to be
Completed by permit applica t
4 s "" �41f 0, SE ONIG'St
1. Building
J�/Ov
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) x (b)
J
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
as Owner/Au4wawA-Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
I, 452&'x; '—�13B t3 as Owner/Autho ed ^;gent of subject
property
Herebv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief
Print Name
Si at of Owner/Agent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TENIBERS 1 ST 2ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CFHMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
FORM - U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
............................................................................
APPLICANT "'-130VA6- A',� ffk30 PHONE 61g- a ,Yr
ASSESSORS MAP NUMBER Po q•F LOT NUMBER LW
SUBDIVISION LOT NUMBER
STREET ► n1 L STREET NUMBER %
OFFICIAL USE ONLY
A IONS OF TO GENTS
DATE APPROVED
�C ERVATION T R
n DATE REJECTED
TOWN PLANNER
COMMENTS
FOOD INSPECTOR - HEAL
SEPTI SPECTOR - HEAL l
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DRIVEWAY PERMIT
DATE APPROVED
FIRE DEPARTMENT
DATE REJECTED
COMMENTS
RECEIVED BY BUILDING INSPECTOR
.. • .bsi0'�h .. "rY Ys.....• ....�. T wW._.v.«. . rI -y
A S E u LT
wINTE R ST. No. ANoovER� 1`'1ASS 1'1a,RTIN
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-S969
Date ..... r'. ...............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
'T'his certifies that ..... .... ....
...........................
has permission to perforni ............ ........................................................
wiring in the building of. .....................................................
at ... y ........ . .... . ..........-40 ...... i�:Y3 ....... . North Andover, Mass.
I -,/ -A
Fee ................ ....... Lic. NAS ..... .
..... ................... li��z
ELECTI�i��Z!Vnf ............
Check
11iL W1II1 riVl 1//i�f J{/lil Vl 1/JLJL1Ri(A�A-u AA" �••.�� var u)
DEPARTAfiNTOFPUBLICSAFM Permit No. v C(p
BOARD OFFIREPREVEM70NRECU AT10N5527CVfR12:00O
Occupancy & Fees Checked
APPLICATIONFOR PERMITTO PERFORMELECTRICAL WO
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 a
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) �C't°�
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes Ef No
Purpose of Building 4, 'D/ti S /-P
Existing Service Amps / volts
New Service Amps / Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
%9,3 -
(Check Appropriate Box)
Utility Authorization No.
Overhead [:3 Underground
Overhead r-1 Underground
No. of Meters
No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
ground
Below
ground
Generators
KVA
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
P s
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
110, of Water Heaters KW
No. of No, of
signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER'
-- --orEr NO
Iha�eaaaiartLiabtldylrmrarePbbcytrtcJ�'¢>gCrntplele �s�>>i� YES
Iha&submit dvatidptmfof totheOfoa YES a If}wlmedwdwdYES,omi dXtW0fw�erdWby
apprup � p
uv DURANCE BOND r7 OTHER (PkmSpaay) vL JZ ! Q,�
l VahteetE]achica( Work $
WcrkiD%rt hwmfimD*Re*xsWd Rough �/L l ( Fatal
FIRMNAME U C/ �ZLioaseNa �
OWNSUSINSURANCEWANER;Iammn1heLitxmdmnothe
andiatrrysg�n(xlttaspan>tap)l admvm' sdnsm m mtt
(Please check one) Owner Agent a
Ix�eNo
BIsir=Td.Na
.� A1tTd.Na
Telephone No. PERMIT FEE $ Z5