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Miscellaneous - 80 PEMBROOK ROAD 4/30/2018
i N � O O W N g 0 N i� ��o �� 0 �_ Po Box 55098 --�-----..–�---- – --—.--8ostan,-MA022fl5=5098------_----- 617-951-0600 Form of Notice of Casualty Loss to Building. Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 - RE: `Insured: - DEREK MCMAHON and BONNIE MCMAHON -- Property Address: 80 PEMBROOK ROAD, NORTH ANDOVER, MA Policy Number: HMA 0237440, Claim Number: BOS00061356 Date of Loss: 5/22/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Allan Leavitt Claim Examiner 5/27/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3213 Fax: (617) 531-8891 Email: AllanLeavitt@Safetylnsurance.com PO Box 55098 -Boston; MA 02205-5098 617-951-0600 Taim- Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS. Ch. 139. Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 RE: Insured: - DEREK-MCMAHON and BONNIE MCMAHON Property Address: 80 PEMBROOK ROAD, NORTH ANDOVER, MA Policy Number: HMA 0237440 Claim Number: BOS00061356 Date of Loss: 5/22/2015 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 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 number. Anne Dunphy Claim Examiner 5/26/2015 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 AddalkL pw- Safety Insurance Wo. . Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Seca 3B' To: Building Commissioner or Board of Health or Inspector of Buildings Board.of Selectman City Hall City Hall NORTH ANDOVER, MA 001845- NORTH ANDOVER, MA 001845- " RE.' w Insured: ' _- DEREK MCMAHON-and BONNIE MCMAHON" Property Address: 80 PEMBROOK ROAD, NORTH ANDOVER, MA Policy Number: HMA 0237440 Claim Number: BOS00045138 Date of Loss: 9/6/2014 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. 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 number. Lisa Monette Claim Examiner 9/9/2014 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (857) 2331-8618 Fax: (617) 535-5833 Email: lisamonette@safetyinsurance.com Date ....� .. � ... . :rr NORTH 3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a. This certifies that ............ ..... J has permission for gas installation ....... /y� i:4 ............. in th�4e7 buildings of ...... at North Andover, Mass. Fee../?t�. �.. Lic. Noz/.3� 5.�.. / ��� .. ............ J / GAS I vSPEGfTOR Check # 5532 NiASSAU SETTS UNIF'ORNI APPUCATON FOR PERNIrr TO DO GAS FPI nNG (Type or print) NORTH ANDOVER, MASSACHUSETTS Date %-k Building Locations ci:,c) Permit # 16�5^15 Amount $ , zz V Owner's Name New❑y Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type)( C one: Certificate Installing Company Name C� --t -��1� El Corp. Address `�` �❑ Partner. Rusin Telephone T- -177 35 D Firm/Co. Name of Licensed Plumber or Gas Fitter 1(\Aky-9 �\A1LL— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No [3 If ou have checked yes please indicate the type coverage by checking the appropriate box. y❑ Liability insurance policy In Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ t 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 :111 plumbing work and installations performed ander Permit Issued for this application will be in ccmpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town ,\PPR0VED,0FF10E rLSE ONLY" Signature of Licensed Plumber Or Gas Fitter ®Plumber�Lti� Gas Fitter • tcense : um er Master Journeyman A •1FLOOR KE----_--�--_--____�_� (Print or type)( C one: Certificate Installing Company Name C� --t -��1� El Corp. Address `�` �❑ Partner. Rusin Telephone T- -177 35 D Firm/Co. Name of Licensed Plumber or Gas Fitter 1(\Aky-9 �\A1LL— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ® No [3 If ou have checked yes please indicate the type coverage by checking the appropriate box. y❑ Liability insurance policy In Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ t 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 :111 plumbing work and installations performed ander Permit Issued for this application will be in ccmpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Title City/Town ,\PPR0VED,0FF10E rLSE ONLY" Signature of Licensed Plumber Or Gas Fitter ®Plumber�Lti� Gas Fitter • tcense : um er Master Journeyman Date ..... TOWN OF NORTH ANDOVER PERMIT` FOR WIRING Az -e-7- ,nr co This certifies that .................................................... e ........................ has permission to perform ................................................................................ wiring in the building of.. -AVtWFI? ez> A, 9 ...................... ........................................................ at ...... Yo ...... ......... ... ......... .... ............... North Andover, Mass. Fee �.Iy/ ....... Lic.. No - ELECTRICAL MpEcib R Check # 6676 DIFNJMW 0FJ`EWX3UW Farads Na 6c- 7� 0=P=7 Fes Chwjmd APPUCATTONFOR PFRWTSO PERFORMELECTR =MWORK Am WORK To BE PERM® FOREr ACCORDANCE WITH THE MA33ACHUSST3 PL6 MXAL CODE, 527 CMR 12:00 (PLEASE PRWr IN DM OR TYPE ALL DMRMATION) Date- Town ate Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street i Number) Owner or Tenant Owner's Address I is this permit in conjunction withhaa Purpose of Building _— J Existing Service New S Ampa� Volts Amp. %ZSJI�;1 a' Volts Number of Feeders and Ampecity Location and Nature of Proposed Electrical Work To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. No. of Mleters Na of Usti ft Outim Na of Hot Tubs Na of Motors Na of naffs on om Told SOTHER* KVA Na of UBbdol RIMS - 3wiromi W Pool' Above Blow Oeamatow KVA No. of Recepheb Outlet No. of Oil Bum= Na Of Etomgeney Uowns Buttery Unite No. of Swiwh OetWe , No. of Cho Boman FIRE ALARMS Na Of 7.ora3a Nof Randa Con. TOW Na of Ab CoTold TM Na of Det W= and N R Dispos& Na d Hod TOW ToW Puma Tone Kw to &ft pais Na of Sounding Devices No. of Diahweebm Specs Ara HwWnB Kw Na of Sdf CunohW C Crts ED Otl - Na of Dryms Haft Devka KW No. of Water Heaton KW Na of Na of � 3 Bdlede � .Hydro Maeeaae'Ibbe £ 1hraaamit l IoaolcicAAi - yB9 NO 1hmsubrrtiMdveidpoddswneblle0ffiMY$9 jZ-1–� Bav 0mm o WodcloSM ' 15— U iapeofoll Rayfestld pmo u Ca.(; �a`'�cf�lWok s si�redtrtds PtratltbofpatJuq► Find % _ �yNtI' - (z �t e �Y`I �j FRtMNAM E Lst LioxwNa (aW "_A4Vq,. aIIhMTaliva owl�it'SIlV3[MWALVPItm thttlleLioQgedies►asarnewiearits#araryiiecfivat�taeta}it dbYssaGis�iLaris arddAffW*PA=cna�hperrd.phsliaawai – impho art (Please check one) JZ] Agent Telephone No. �Kaignamfe or UwW Of cb 'Z �pmt*r FEE 3 Na of Motors TOW HP SOTHER* 1hraaamit l IoaolcicAAi - yB9 NO 1hmsubrrtiMdveidpoddswneblle0ffiMY$9 jZ-1–� Bav 0mm o WodcloSM ' 15— U iapeofoll Rayfestld pmo u Ca.(; �a`'�cf�lWok s si�redtrtds PtratltbofpatJuq► Find % _ �yNtI' - (z �t e �Y`I �j FRtMNAM E Lst LioxwNa (aW "_A4Vq,. aIIhMTaliva owl�it'SIlV3[MWALVPItm thttlleLioQgedies►asarnewiearits#araryiiecfivat�taeta}it dbYssaGis�iLaris arddAffW*PA=cna�hperrd.phsliaawai – impho art (Please check one) JZ] Agent Telephone No. �Kaignamfe or UwW Of cb 'Z �pmt*r FEE 3 DENJUNWOMBUMW BLNRDOFF=PR9VF11t1IgIV�Sa7C119t12� �`"'ttrto Occupancy & Feu Checked APPUCATIONFOR PERMITTO PERFORM ET, CTRIC,AL WORK All. WORK To BE PERFORMED IN ACCORDANCE WRTH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 ` (PLEASE PRINT IN INK OR TYPE ALL WFORMA170N) Date Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perforin the electrical work described belo*. Location (Street & Number) lne i Owner or Tenant '? r ``(i ' '/j �_ i✓t Owner's Addressj. / is this permit in conjunction with a building permi4 Yes Purpose of Building S-? I Cid C', W QJ<,(1 'd Existing Service Amp�� offs New Sem Vic' Amp �s'/' �Volb Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �-/6 No E3 (Check Appropriate Box) Overhead Utility Authorization No. Underground U No. of Meters No. of Meters I No. of UgbttnH outim No. of Hat Tuba No. of Trwbtmsn Total KVA No. of Lighting FIMM Swbnndeg Pod Above Babes' ciwerstws KVA No. of ReupucY OWW No. of OI Haemes Na of Emergency Luting Battery Units No. of Switch Oetleu . No. ot On Barnars FME ALARMS No. of ?arm No. of Ranger Ne. of Air Conti. Tolal Tana No. of Debetioo and. of Dbpouk No. at Haat Told Tot .. Ton KW .. Wdades Devices No. of Sotmding Dsvloes No. of Dishwasher Space Mea Hatiry KW No. of selfCat"Insd DaWdmMo-ding Devices Lwd Cor is 0 Oth'— No. of Dryers Hating Devices KW Wow No. of Hamm KW Na of No. of Sion siissis No. Hydro Massage TAs No. of Motors ToW HP 0 0SON MINU t�reddr�ttre . 24SLRANCE"M WMD D tue p WakiDSoet 6 �, lirQa tDoe�� Rough lsj(y (L0,�,(� VatzsofF�ddarivlkdr$ ,Sppp��� l:[ds�p Pbl��p�.. („�,G�� (_..Jd . � ✓� �� ,� ' /. and�trrzj+sierilaemlhbpeanit�piatiimvi�itstif mblannt (Please cbeck one) Owner 1 Meat Signawn or Owner or Agm bra Ina m LaL NQ I U/j/4_ AL Td No, park g�Yastec}aedbyMes®dria� t3�rnrrlL r' Telephone No.{�pgRarrr FEE S m 0 w CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 508 (1/27/2006) Date: November 16, 2006 THIS CERTIFIES THAT THE BUILDING LOCATED ON 80 Pembrook Road MAY BE OCCUPIED AS Single Family DweWmg IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Andover Construction & Dev 51 Thistle Road North Andover MA 01845 Building Inspector ;lt;Cf7;j �Q ��i Lap rb ��•'� APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # dfe� F ADDRESS/LOCATION OF PROPERTY: ?U ePe_A�1//r a11f Or J Map 3 Parcel 9- f Lot Number /0/ SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE NOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING C0NST ER`.ATI0N PLANNING DPN - MATER METER SEWER/WATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYfINSPECTION_ REQUEST File: OC form revised 2006 re / — 7— e� m m m //m YI m y m C FA - 03 d CD 'C O St Z y 0. O = . ICU C CO) a� .o o oo� CDCL O Q CD CD 0 CD C CD y CD-• nC H CD 5 v y O � Z CD � o CD c CD (I V I C) O A O I- W cn -i O z cn C 0 O Z 0 m 0 m 0 In CL CO m 0 0 y N CO _y0c a0 am a. cc, rmi,mct.c 9 .�O • y = a�a o .�O Lcl� co • 0 c m o�ME=r 75L a o 9 '� CL s � m y O 0: CL CO IS .: 0 y CL C7 H.?,Coo m y 10 0 COD � n a oma. „F 0 . CD ca Go Wim: a3 rT y Cl) Wim: Im so CL= 0 sem: 1 � \ M%, b7 0 z �jd �7 r w C ?f 0 o m p A 'orl aq S oV ro �1 V 1 S4 -t _. Date . � /� ©l`'. . e HORTp .. Oft �w ,�'fh ,o? .�� _„ ., oo� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING t This certifies that .. f has permission to perform• .................... . plumbing in h-e+uildings of ..-r �-�^ �.. !f/! ............... . at ..v . ............. Q .... , North Andover, Mass. Fee'-�eW .... Lic. No.......... PLUM 91N eNSPECTOR Check # ���V/ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS nn Date Building Location �6J 09-"'Ab"opg-. Permit # / 771- Amount Owner >��.�\ �• �\�0�,(�C.. New ® Renovation D Replacement D Plans Submitted Yes No -.�--.---�--------------- (Print or type) Installing Company Name CoKVA� -7-CCU _ Address W Check one: Certificate D Corp. �7 Partner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity D 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 Signature Owner D Agent 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 State Plumbing Cd e and Chapter 142 of the General Laws. By: Signatur31 cel se riumDer Type of Plumbing License Title 1i3 City/TownIc�ense um er Master ® Journeyman D APPROVED (OFFICE USE ONLY Date ......°G:.......... TOWN OF NORTH ANDOVER i p PERMIT` FOR WIRING This certifies that ....... .................(2 ............................... has permission to perform wiring in the -building of ..'' at ...``.............:...................... ...... , North Andover, Mass. Fee /!X-? .............. Lic. No. /� .. �. � .. ...................................................... i 1 ELECTRICAL INSPECTOR p �+ `-„'Check # 6587 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. to -S—IT7 Occupancy and Fee Checked [Rev. 9/05] leave blank) 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 IN INK OR TYPE ALL INFORMATION) Date: City or Town of: y. ,9,yz26ry f 1Z 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) ,F -d �--PM ,�,,OF f ,l� Owner or Tenant 4/1/ yd V c Can/S 7- - Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ©' No ❑ (Check Appropriate Box) Purpose of Building 0!�Le 447 ;e -1 a-, / Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters s Number of Feeders and Ampacity J Location and Nature of Proposed Electrical Work: ,y Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In -No. rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Number ' Tons KW No. of Self -Contained Totals 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. of Water K`,`, No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No, of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 6 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 cover e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [ BOND ❑ OTHER ❑ (Specify:) I certify, under the paints and penalties of erjury, that the information on this application is true and complete. FIRM NAM E:Sv M UCT "V • / LIC. NO.:g vs- e -- Licensee: Rp1ze.,-7e-' /7, J—Lj /�j Va Signatur d,�6w,/. w LIC. NO.: --2.,-2 % /) (If applicable, enter "exempt" in the license number line.) Bus. Tel. No..f2,14 S:2-1, Address: 27 /%%/�/ice" Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enfer the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. 1 am the (check one) ❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. FERMI T FEE: $ Mr. Gerald Brown Inspector of Buildings Town of North Andover Building Department 400 Osgood St. No. Andover, MA 01845 6/23/06 REE: Sac-actural Inspection of Installed engineered Components 80 & 84 Pembrock St., No. Andover, MA Dear Mr. Brown: Pursuant to Mr. Scott Peter's request I inspected the referenced properties on June 23, 2006, with him. The purpose of this inspection was to review the installation of the engineered lumber; steel beams. and associated hardware in compliance with the approved plans at the referenc4addresses. In my professional opinion, the engineered structural components of these residences were installed in compliance with the design and the requirements of the Massachusetts State Building Code. If I can be of any further assistance, please call me. Resp lly, Donald A. Georg , CC: Scott Peters Location a 4 b No. '7' lU! Date MORTPI TOWN OF NORTH ANDOVER •• •. p • Certificate of Occupancy $ a� _ sCMUs t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # �—' Building Ins &or BUILDING PERMIT NUMBER: SIGNATURE: TOWN OF NOR'T'H ANDOVER BUILDING DEPARTMEN'I' D/ DATE ISSUED: //-c2 p, Building Commissioner/IREL=for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: C) Vvy 6: Historic District: Yes No 1.2 cAssessors Map and Parcel Map Number Number Parcel Number 2.2 Owner of Record: Name Print Address for Service: 1.3 Zoning Information: -Zoning District Proposed Use 1.4 Property Dimensions: Lot Area a - Fronts 11 1.6 BUILDING SETBACKS ft Not Applicable ❑ Front Yard Side Yard Rear Yard Required Provide 'red Provided . Required Provided Registration Number Address 1.7 Water Supply M.G.1-C.40. 34) Pubes ❑ Private ❑ 1.5. Flood Zone Information: 1.8 Zone Outside Flood Zane ❑ Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record pp y Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Srgnature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.11 Licensed Construction Supervisorr:/ 1)/9- a/ is, %. C, Licensed Construction Supervisor: Adda'5��Z447 �rt�/�� SignatureTelephone Not Applicable ❑ License Number 0 0 �FU' oZ.'9 Expiration Date �r// 217 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date " Signature Telephone 00 M 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 it. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 0 Woos,& / 57-v x i/ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated CostDollar ( ) to be� Completed by permit applican 1. Building . � � i�'�����OEFIyCIAL (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee ($) 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> t ,�/ �tJSJ1 " Owner% thorized Agent of subject property Hereby authorize v �' %� e to act on My beh al a elative to wok authorize by this building permit application. Si afore 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 Ient Date NEW NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1sr2ND 3PD SPAN DRAENSIONS OF SILLS DM ENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealtlit of ,'Massachusetts y.{1 Department of Industrial Accidents Office of Investigations 600 Washinton Street g .tK Boston, MA 02111 s u www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nathe(13usincss/U1-11aniralion/IndiviJual): t11 Address: ��/$7V4�--- City/State/Zip: tirPhone 7 Are yo an employer? Check the appropriate box: 1.I am a employer with 4. ❑ I am a general contractor and employees (fill] and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 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.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § ](4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Any applicant that checks box if I must also till out the section below showing their workers' 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �j /! y �61 1111— _ Dicy,4or Self -ins. Lic. #:��T Expiration Date:_ g/0�94 T_ Job Site Address: C7 Groh '4J Ci /State/Zi Jc 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 line 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 tine 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 certifj;wt fler the pains and peyralties of perjury that the information provider/ above is true and correct DlJic•ial use only. Do not write in this area, to be completed by city or sown 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 #: l m o0 @ �00 U L0 'IT F- d N c U O 0 w ,3 N (� N N U .m. O 'O m O N 0 X12 3: n Z j O m U Lll LL Z O O N> oo ," lr! O� o n. 00 9 RFs _ o c } 0-0 Z 'OD c c.. O� �� �a -i O� x_.. C) N Z i° Z U F- ONQ o LUCo QJ�0 Y aiU 0)� Qoo mdU Z m LL � V ZN(O 00 r w �, Z z �} O _O Lo wQ (hM Z LU04 m R OOOO (��d}m��000 J 2 cn J v # 0 O o.�. o J m p p L1L a N `4° n=..m�ma 00 U p' vv W 1co 0 FT> o am � � � � d Gm c mcu xCLi0 mm)0'0a (n (n (n (n C� W U O o CD VH Q d ? 0 Q N N m N N - d O 0 M (on TZ Z in (n U = �F-NG (MMXW2 m m N O O a)Q 76 m co O a0 O N CD O _m = U c U V O N N O U') a) nm (L o a 0 a> w W U C a) a) N Q N m a m m Q EC9 p>omh� ii Em zQ h:; nin y C (n U Y O 0= w 00 Co) O'2(n000r�- O O_ N U')O LL O LL Z N Q Q O O a O m 00LL n F- Q _� m@ o W (2 �m •. NU - m o N v E E� cQ CQ c m _ m-0 00 C7 u LLc ti LL c ii } O C� U Q ma�co ami o�U `o 2 (n O N 2�Q�F- W}C7U�o 1 LL P:Z Q !— N LLQ 0 7 N F- F- O LO ♦� V M LL Z It ao Z m LL O W (n O y LL .. C.± (n LL m tf) LU Z < 2 F5 O O m m c6 C7 U �_ CD (D @ Q N 0 ct 0 � Q R' W W ��mm00w �Y E EU (Lim O N w O O 07 to 0 F-MLL=W M2 W MM< LL m dUdYO LL Qo C) Z N — (� N U 2 0 Z 7 d Z (n (n Y c0 Z E M N N m �cme� Fd FY- cuNi 3-0-0 a�9C 'a -I.; Om 2 =3 O m W2 o o a) n(nww2LL 2LL �U o LL N00¢Q Town of North Andover Building Department 400 Osgood Street North Andover MA 01845 Tel: 978-688-9545 Fax: 978-688-9542 DEMOLITION OF BUILDING AFFIDAVIT tie9/0i /v e0- NORTFt O� I- ' T ° CDCNIC Nl WKM V rEo SSACHUS� 3-�71 LOCATION OF PROPERTY TO DEMOLISH , , ,� X( CONTRACTOR'S NAME & ADDRESS �ev%tea 37/ 5t DEPARTMENT SIGN -OFFS - DUMPSTER - ONIOFF STREET I C) S -:F S -1-A r. & J% DIG SAFE NUMBER ot, 005-- Z5-6 6 DATE REC'D Building of Building Affidavit revised 11.5.04 BLDG. INSPECTOR -31-05 rA rAr W Y cn V) � O w w v U w x 0 w iz. x U oG «(��� w CJ V r� G w W 7 w o cn cn _ H C** W LL W C.i H Ea CE ?w o c� o ` isg C H O C CD CJ V o o. CL C mm CD C C � V O Cc O m _ H C** W LL W C.i H O CM I O � y O �O CID m � 0 43 1.-_ CL 3.a cm a� G3 L Cc O a a- cma Ca S .c ♦'' Cc CL a CDv C Z tsCLO V y � c c_ C CIO Ea CE 0 0 isg o o. C C � V O O C E H o m O pr N N r„ m3�p 45 cm C J C co • m O C N C N A O •Em � Kos o On y O m 'D CCn_ a m O V ' •N` Z O o. cm p m S CLS N O CO •N m C r O C O .E O.t 3"r m •N w ca 2 O a m m� g A i �•� O .2 4- aim � O CM I O � y O �O CID m � 0 43 1.-_ CL 3.a cm a� G3 L Cc O a a- cma Ca S .c ♦'' Cc CL a CDv C Z tsCLO V y � c c_ C CIO Location _t No -y Q o Date NORtM eTOWN OF NORTH ANDOVER Certificate of Occupancy $ p ,/� Building/Frame Permit Fee $CL _ �./ 'll b+Anofes`` Foundation Permit Fee $ CMusEth S Other Permit Fee $T Sewer Connection Fee $ Water Connection Fee $ TOTAL $' 0 Building Inspector Div. Public Works Location No. 1'0 4 Date a HoRT01 TOWN OF NORTH ANDOVER o ... o� F p Certificate of Occupancy $ x*> � � ; x Building/Frame Permit Fee $ foundation Permit Fee $ s�CHuse Other`Permit Fee $ .: C+ Sewer Connection Fee • $ M Water Connection Fee $ TOTAL $ Building Inspector 11603 Div. Public Works. W V n. Y 0 0 m W < �.W N m tol .A _d Q Z p� W ui Z > �0 0 z Q LL 00 FA p _ m _W ac0 0 ¢ o O Z W H m 0 k d 0 ¢ O N i Z I J m 0I H W CL cc 2 Z O io ~ Z U F- a OJ CL I Q 0 � z o I F- m O tn O 1 VV m i p Z t O Z < 0 0 a a F- ¢ ¢ p d Z U z i F No JO 0 0 I n Oi W a IL M O W v z 0 X W Z E Cl = Z .0 ti 0 k J IL < 0 ¢ W W N h m I Wo, 0 u U.0 I] v a EF9 11:3 J J m ] ] J m m J 0-1'_" 131 c � I t Z 0 z F I W L u • v N W Z u p W � O J U ? Z O a 2 2 U m I O � O J O � a F j 5 . F, W 0 t (�W a W _Z �`` - a Z - • Z 0 i W m F < a J 3 W Z W < O O ] 0 - V Z Z 0 W IL < (! a U. 0 W t a W W W J ¢ U U U LL O Z Z z 0 < F < ] J F<- W¢ m ] a a e m a O O < Wo, 0 u U.0 I] v a EF9 11:3 J J m ] ] J m m J 0-1'_" 131 c � I t Z 0 z F I W L u • v N Z Z 0 W � O J U H Z O Q zo U 2 2 U m I U O N O F j A 0 t Z - a Z - • Z 0 i W m F W W p S O0 m W ] 0 - V ] O N tl W 0 r U c F W W < < J a 4 d W t W � W U Z O Q zo U 2 2 U U = III �IIIIIII I [TI 00 m -1 FI—FTI- .<.. Q N U. vi � ¢ O d W W I 1 I V S L' U Y 0 m 0 W i O f{Z IL VI .- `a oc _ IL 0= O 0� u Z—Z Q 3 u, a . 0Na C7 J�►- LL Z N�a D ., r Omu _ f rZ�g w0a r t,W 4 Zm;.. P� p.N °U mi:= QZH r X W 3owr `', Go 0 Ina- - W ;., w W ro z<V' 0U . u til r; r r„ W Z to N fY 2 0 < V- J LC =nIIIIT Z W UWN v 0 ~ z _ �< o > z Z - p O U m Z a - a z N S d O O I �''a I I �I O O U z z JO <.LL z W o Zliaa N 00mv O III �IIIIIII I [TI -1 FI—FTI- .<.. Q N 2I V � ¢ O d tl I 1 I L' V v a a = LL� Y 0 m Za° Ou W i i a U< .- `a 86 a Z Z x W T! o I � r N Y Z X x O -0 Nm0"c� p<a °aVmpZjvxia < We �° < > �aJo.� a ° < p O �a��p3<YzNf�- T z< ° p z a=W W u Z a s 0 0 E o= f N W oocf "� i2 >Z = a N N a o= 0 0 0 z Z 0 0 0 N 00 N o a O N 0 0 O V O 8 i m¢ I� 0 0 0 10<<< a vz O vo3 <a>NN mv�, up-a3r ii L' 86 a Z Z x W T! o I � r N Y Z X x O -0 Nm0"c� p<a °aVmpZjvxia < We �° < > �aJo.� a ° < p O �a��p3<YzNf�- T z< ° p z a=W W u Z a s 0 0 E o= f N W oocf "� i2 >Z = a N N a o= 0 0 0 z Z 0 0 0 N 00 N o a O N 0 0 O V O 8 i m¢ I� 0 0 0 10<<< a vz O vo3 <a>NN mv�, up-a3r ii Nl'WNZ, z O Of C C C.— �o Q 'C LA E mm CD 0 HZ Q O O d C2 c Q CD •v c ev C� h G3 Z tsm C _O C y c c o C CL c o c = o n, v q Ea w w r�4 U W. 0c 0. n°' w w � � C7 a�� w l � d cn vi Nl'WNZ, z 09-61, f.� Pi O Of C C C.— �o Q 'C LA E mm CD 0 HZ Q O O d C2 c Q CD •v c ev C� h G3 Z tsm C _O C y c c C CL c o c = o Ea CD 0c 0. E� :gym r=... Sol w o . s h oc E O 3 v, >cm .• .00 h O O m mo CL m N _ O CC OCD C O a 32 HZ V > O �C C p d CM a ymo = o o4VMS QC N CD t .y C O •� CL=O C.3 o C H COD> O I-- t $ a:E m � 09-61, f.� Pi w ai O Of C C C.— Q 'C LA E mm CD 0 HZ Q O O d c Q CD •v c ev EL v G3 Z tsm C v y c c C CO)CL w ai NpRTM °"•�" ""° Zoning Bylaw Denial Town Of North Andover Building Department ` `• - 400 Osgood St. North Andover, MA. 01845 Phone 878485-8545 Fax 8784;88-9542 Street Do �,� r�7o r Map/Lot 3--;z J a B Applicanlr A U / S/. //1107 i r e R nest: 5L;. bc& jdjs. l 4oj IN4o Z Lc+S -i"8 u(Id Q Dc; pled Dwellt uZ S Date: 3 /dt o'S Please be advised that after review of your Application and Plans mat your nppucanon is DENIED for the following Zoning Bylaw reasons: Zonin — Remedy for the above is checked below. Item * Special Permits Planning Board hem Notes Setback Variance Item Notes A Lot Area Common D ' Special Permit F Frontage Variance for Sign 1 Lot area Insufficient IndePendent Elderly Housing Special Permit 1 Frontaae Insufficient Earth Removal Special Permit ZBA 2 Lot Area Preexishng Planned Residential Special Permit 2 Frontage Complies s 3 Lot Area Complies e5 3 Preexists frontage 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies Lj e-,5 4 1 Special Permit Required `J V --S 3 Preexisfi2g CBA 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply --S 1 Height Exceeds Maximum 2 Front Insufficient 2 1 Complies Lje S 3 Left Side Insufficient 3 Preexisting Height 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient I Building Coverage 6 Preexists setbacks 1 Coverage exceeds maximum 7 Insufficient Information 2 1 Coverage Complies `i Cs D Watershed 3 Coverage Preexisting 1 Not in Watershed -t C- s 4 Insufficient Information 2 In Watershed j Sign A 3 Lot prior to 10/24/94 1 Sign not allowed 4 Zone to be Determined 2 1 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required 2 Not in district L{ es 2 Parking Complies d'_ S 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 Setback Variance Access other than Frontage Special Permit Parldng Variance Frontage Exception Lot Special Permit Lot Area Variance Common D ' Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit Special Perrnits Zoning Board IndePendent Elderly Housing Special Permit Special Permit Non -Conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Developmwd District Spechd Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Special Permit prescisting nonconformin Watershed Special Permit ar iekni -f The above review and attached er;ler -tin of such Is based on rhe pians and information submftd. No defirdUive review and or advice shall be based on verbal spMr>Mione by the applicant nor stall such verbal er; lastiffons by the appiicant serve to provide defnifive arswrs b the above reasons for DENIAL. Any inaccuracies, misleading kntomshlon, or other suixoquent changes to the Infa nalbn subm0 ' by the aI 11- mrnI shall be grounds far this review to be voided at the C118cr ion of the B►ilding DeperbnerC Tto sltsclns ' document tkled'Plen Review NsnOW shall ms atlachsd hsrelo and exxrorporated herein by reference. The building dopa term t wo nWn d pians and dommneminAion for the above file. You must file a new building permit application form and begin the pe ft process uildi g Delartmentlofficial Signature Applkation Received Application Denied Denial Sent : If Faxed Phone Number/Dete: Plan Review Narrative The following narrative is provided to further explain the reasons for denial for the application/ permit for the property indicated on the reverse side: Dm#mormbrl Tn- --Fire-- — 7777 Police Zoning Board Conservation Deparbnent of Public Works Planning Historical Commission Other BUILDING DEPT C-ON)'CI '�0)10 OSLe /q, cicr' r' o� Vh c rh 4-14(t p (A /V iu (Al Q o � r o� A D N Zvti IN of /J PpovAV P 3 'y'yt u- ! l,o � r fo �o a v eS 6 4o �S Dm#mormbrl Tn- --Fire-- — Health Police Zoning Board Conservation Deparbnent of Public Works Planning Historical Commission Other BUILDING DEPT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR. RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 116 seftedim at' t #ode BUII..DING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/122pedor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: AZ 1.2 Assessors Map and Parcel Number. Map Number Parcel Number 1.3 Zoning Information: // P% �/��e/.sr�) zonmm stria 1.4 Property Dimensions: Frait� 8 1.6BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide 'red Provided red Provided C> �7 i� s20 30 - 1.7 Wats S ly M.G.L.C.40. 34) 1.5. Flood Zone Infomaation: 1.8 Sewerage Disposal System: Public P Private ❑ Zoae Otaide Flood Zone l3' Mnniaipal 8� On Site Disposal System ❑ +{ SECTION 2 -PROPERTY OWNERSIIQP/AUTHORIZED AGENT 2.1 Owner of /Record / 1 I c /moi /I - Lf-// Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Sismature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: or Licensed Construction Supervisor. L 0 Address • Signatu a Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M X z O v a m 0 z M PC ns�a s_ v M r r_ z 0 SECTION 4 - WORKERS COMPENSATION (NNLG.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 it. Signed affidavit Attached Yes ....... No ....... a SECTION 5 Description of Proposed Work check aH a ble New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: %v (70 V 5 C -4;' I SECTION 6 - F.STTMATF.n r0NCTR1TrTin1V rnc-rc item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building fa v 0 (a) Building Permit Fee Multiplier SIZE OF FLOOR TIMBERS I' �_ -Y 2 Electrical E .260. (b) Estimated Total Cost of Construction DIMENSIONS OF SELLS 3 Plumbing a A„ Building Permit fee tai X (b) DIMENSIONS OF GIItDERS 4 Mechanical HVAC , 5 Fire Protection SIZE OF FOOTING 6 Total 1+2+3+4+5 clod, Ali I- A{1)l�T1tfT • iT�fTTAflTrs Ci oza . . Check Number -------. .•• •� •. -.�•-� •-�• ����+-- aav1. av Dav \.v1Var LL' JL r" VT r=J'% OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION property ,as Owner/Authorized Agent of subject Hereby declare that the statements and information on the foregoing application are Liue and accurate, to the best of my knowledge and belief Print Name "-turewnerhA ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I' �_ -Y . '' - Y /(? 3 Ku SPAN �� O DIMENSIONS OF SELLS DIMENSIONS OF POSTS y �, DIMENSIONS OF GIItDERS HEIGHT OF FOUNDATION _ a THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND c, IS BUILDING CONNECTED TO NATURAL GAS LINE SECTION 4 - WORKERS COMPENSATION (XG.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 buildipg permit. Signed affidavit Attached Yes ....... iK No ....... 0 SECTION 5 Description of Proposed Work check a0 appUcable New Construction R" Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: / �- n z!;� ,_ ,-,. Vii; -Ys /4 U,- t SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant - 1. Building (a) Building Permit Fee 3 G U • Multiplier 2 Electrical (b) Estimated Total Cost of <d v U U . / Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC ;. cJ e":' v -� 5 Fire Protection 6 Total 1+2+3+4+5 :Z, G v;/ . Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 4,� 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 N Si afore of wner/. ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIB1 RS 1' �� SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS D.94ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO, NATURAL GAS LINE =S. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR. RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I ff-Buildings Date i SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 3a Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr�t>se�se Lot Area Fronts It 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided red Provided 1:3G ` 4"� 20 .3C 1.7 Water S ly M.G.L.C.40.t54) 1.3. Flood Zone Infotmatien: Zone 1.8 Sewe Disposal System: Public Private ❑ and Zona @� _ Municipal �/ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERS /AUTHORIZED AGENT 2.1 Owner of //Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele hone SECTION 3 "- CONSTRUCTION SERVICES--- ERVICES3.I 3.1Licensed Construction Supervisor' Not Applicable 0 6 711 /�1 Licensed Construction Supervisor. License Number / Address Expiration Date Telephone i3.2 Registered Home improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Si�lr atu-e Telephone r r r R I 7r, e CGSmcrwe-=I , of �VIcSScC� tU cc S C'epeltment of /rCusti.2r:-cCrce�cs Cf,- c:e c. Inues�•'c�tr'cns Ecstcr,. Mass. Q= t i i mare Ci-/_ al U v r 2 I+il�i .' 7 9— 7 r. - YY Gill r I IC•�i Nr.-..� L� c ..InC all CrK :7,%jSC!f. 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J i �i —0 I LL : a. -. a' � �hl.l !Y U' r� _ i C�1 2 � I N �► ' 3 LL i - N I Cl 0410 ViAl NAAU(JNV'N UVOUAIIINUM 8Z w SUINDiSla WINNISM vdd IV s3jLvi"ssv oNnse 'r *9 a ez 31vo 4, VW vv ry UV08 A313AH38 9Z S83NDIS30 IVIAMIS38 S31VI30SSW ON nue 'r 'a I cl I .' LOT #2 PLAN #1780 N. E. R. D. LOT #11 PLAN #1780 N. E. R. D. c 0 LOT #10'AA' 12,538 S.F. sa 3�/ pcoP° LOT #3 PLAN # 1780 N. E. R. D. PLAN OF LAND IN NORTH ANDOVER, MASS. OWNED BY ANDOVER COSTRUCTION AND DEVELOPMENT SCALE. 1"= 40' DATE.51M005 0f 40' 80' 120' Scott L. Giles R. P. L. S. Frank. S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. NOTE. SEE DEED BOOK #4306 PAGE #89. SEE PLAN # 1780 N. E. R. D. THE ZONING DISTRICT IS R-4. sa 6\1 � oq , o � LOT #4 0Nw PLAN #1780 N. E. R. D. `°q1{LOT #9'A�. wcs: N 6 ` 12,627 S.F. d d�epin9 J J.J 3 pt°pos oo ' °Sd a�ejlin9 prop I APPROVAL UNDER THE SUBDIVISION CONTROL LAW NOT REQUIRED. NORTH ANDOVER PLANNING BOARD DATE: LOT #8 PLAN #1780 N. E. R. D. LOT #5 PLAN #1780 N. E. R. D. 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OWNED BY ANDOVER COSTRUCTION AND DEVELOPMENT SCALE: I"= 40' DATE:5JW2005 01 40' 80' 120' Scott L. Giles R. P. L. S. Frank. S. Giles R. P. L. S. 50 Deer Meadow Road North Andover, Mass. NOTE. SEE DEED BOOK #4306 PAGE #89. SEE PLAN #1780 N. E. R. D. THE ZONING DISTRICT IS R-4. LOT #4 PLAN #1780 N. E. R. D. LOT #8 PLAN #1780 N. E. R. D. LOT #5 PLAN # 1780 N. E. R. D. LOT,#6 PLAN # 1780 N. E. R. D. I LOT #7 PLAN # 1780 N. E. R. D. THIS IS TO CERTIFY THAT I HAVE CONFORMED WITH THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS IN PREPARING THIS PLAN Commonwealth of Massachusetts Official Use Only Permit No. S� Department of Fire Services Occupancy and Fee Checked ' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) O 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 IN INK OR TYPE ALL INFORMATION) Date: y— / q — d /,. City or Town of. y. 191L.100 u f*JZ 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)Q Owner or Tenant ,,Cf 1tl L7d t/ F e Cpw _ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 2 No ❑ (Check Appropriate Box) Purpose of Building �� e1Ze_Z:;2,71i % 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: ,tzy U Coni letion of the following table may be waived by the Inspector of Wires No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above Ei In-. Swimming Pool rnd. rnd. ❑ o Emergency Lighting Batter 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 g No. of Alerting Devices No. of Waste Disposers eat Pump Totals: Number Tons KW o. of el - ontained Detection/Al-erting Devices No. of Dishwashers Space/Area Heating KW Local ❑ unicipa ❑ Other Connection No. of Dryers Heating Appliances Kin Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. o o. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecom munications Wiring. No. of Devices or Equivalent OTHER: t/ j- �G{f- /�I Vii¢ /L� ",ttach additional detail if desired, or as required by the Inspector of 41 gyres. Estimated Value of Electrical Work: /1 SOD (When required by municipal policy.) Work to Start: G�—/ % e) 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 cover =e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Q BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of erjury, that the ihhformatiohh of' this application is true and complete. FIRM NAME:,5D //1 UC N • y rev% LIC. NO.: gV,5'4'- Licensee: Alt94er-y 12. „fy /4 vet n SignatuLIC. NO.: --2.;2 c% 7,/? (1/'applicable, enter "exempt" in the license number line.) Bus. Tel. No.42,f ,S!%-6 9`�Q Address: ,,2:2 /1�1, '4 ,a 0' S'r. ,tt/� /�E/1J . F ��%/� Alt. Tel. No.: "'Security System Contractor License required for this work; if applicable, erifer 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) ❑ owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $