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No.t
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Date 1011-7 Iq
► !
koRTM TOWN OF NORTH ANDOVER
p Certificate of Occupancy $
Building/Frame Permit Fee $ _
Eta' Foundation Permit Fee $
sACNUS
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
31-w,:44 50.00 PAID
:=
9302 Div. Public Works
V
PEWItIT NO.
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP 440.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE
ZONE
SUB DIV. LOT NO.—I
LOCATION fflfilSIS S�
PURPOSE OF BUILDING �tGhOD>✓L �y¢Ti�i���/ z
OWNER'S NAME �AGRr14��i'�1^i�% ��(��
NO. OF STORIES SIZE
OWNER'S ADDRESS
••7
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME �`�
SPAN
DISTANCE TO NEAREST BUILDING
_--
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
1
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yS
i
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY NQP
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MU C FORM TO STATE FIRE REGULATIONS
PLANS MUS E��FFI/I��L// A D APPROVED BY BUILDING INSPECTOR
DAT ILED
SIGNATURE OF
AGENT
FEE �y
PERMIT GRANTED
Z 1995-
C
3 PROPERTY 'INFORMATION
LAND COST
EST. BLDG. COST ��LLvL�L✓
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
LDING INSP[CTOR
OWNER TEL.# �94f065'3
CONTR. TEL. #
CONTR. LIC. a
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILYsrou1ES THIS SECTION MUST SHOW EXACT DIMENSIONSOFLOTAND DISTANCE FROM
MULTI. FAMILY _OFFICES LOT LINES AND EXACT DIMENSIONS OFkBU1LDINGS. WITH PORCHES. GA- i
APARTMENTS I I S. ETC. SUPERIMPOSED' THIS REPLACES'PLOT PLAN" -
x
N
i
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
3 1 2 13
PINE
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
V
HARDW D
PIERS
PLASTER
DRY VJALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M AREA
_
'/ 1/2 1/1
FIN. ATTIC AREA
N_O B M T
FIRE PLACES
_
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
B
1
2
3
_
CONCRETE
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
HARDNrJ'D
COMMON
ASPH. TILE
STUCCO ON FRAME
BRICK ON :MASONRY- ,,
BRICK ON FRAME
ATTIC STRS. & FLOOR (-
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I I POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I
I HIP
BATH 13 FIX.'
GAMBREL
MANSARD
TOILET RM. 12 FIX.'
FLAT
j
SHED
4
WATER CLOSET
ASPHALT SHINGLES
V
LAVATORY
_
WOOD SHINGES
KITCHEN SINK
SLATE
NO 'PLUMBING
TAR 8 GRAVEL
STALL SHOWER
_
_
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
_
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
GAS
ELECTRIC
` 7 NO. OF ROOMS'
a'M'T 2nd _
Ao 13rd I
NO HEATING
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TOWN of NORTH ANDOVER
AFFIDAVIT
Hze bMvm alt Qrtz tx law
S UDIMTt to Pamdt 4picatwn
.• a I I it i—z;r:l w • • w • .•:1 11••0:• 1 r, w • •• O: R -8
•a ••• n e• •
• ..Y • 3 •- •: • I •t •- • • • 0.•J -• 0. 0• •Pill ■rt 00, 1 r • ■
0• 1 011'
Type of Work: 2eH042F1-tA14 (5F F 71-AF0 017 Est. Cost
Address of Work �gr% 1 - S *(- -h-'( J T VO12- H
Owner Name: -(-
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000
Building not owner -occupied
=Owner pulling own permit
Other (specify)
Notice is hereby given that:
R2zit ND.
Dite
OWNERS PULLING THEIR OWN PERMTT OR DEALING WITH UNREGISTERED CONTRACTORS.--
FOR
ONTRACTORS.FOR APPLICABLE HOME IMPROVEWW WORK DO NOT HAVE ACCESS TO THE ARBITRA-
TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Sig -ed unler penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR:
'Notwithstanding the above no/ic
owner of the above propert
Date Owner
/ hereby/ply
�Lr
ame
for a permit as the
OFFI Es ot=: " ` ,: Towli Of _. _ i zo n Street~
.�PPE.�L S i - .... North Andover,
:., NORTH ANDOVER Massachusetts o l gas
BUILDING
CONSERVATION DIVM04*4 OF --
HEALTH -
Pt-,vNNINIG PLANNING & COMMUNITY DEVELOPSIENT
o-.. KARE's H.P. NELSOiN. DIRECTOR
In accordance with the provisie Ls of " I` c yr'. S Sy, a condition of Building Permit
`.
Number ���^�j is that the dcbris resulting from this work shall be
disposed of in a prcperly ac:: w solid waste c:is^=i :ac:iir. as c:e ::cdIII, S
by M 'GL c
t {t7A.
The debris will be disposed of i
Sicnature of Permi Applicant
�U
fl
Date
:TOTE: Demolition permit from the Town of :forth Andover must be obtained for
this project through the Office of the Building Inspector.
i
Location -�
No. �5z 4 Date �y
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
{ TOTAL $
Check #
16 4 �, 2-
�� Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
rt
BUILDING PERMIT NUMBER:(37p DATE ISSUED:^�a
P. �
SIGNATURE: Oil I
BuilAj ommissi n or of B uildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address:
Assessors Map and Parcel Number:
``
/1.2
Q
Map Number Parcel Number
1 ` til,
Y1 ��CaterM
1.3 Zoning Information:
1.4 Property Dimensions:
�GVr��y
Zoning District Proposed Use
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Reqwred Provided
Re aired Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone 0
Municipal 0 On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2..1 of Record
�Owm6l
\\
Name (P. -int) Address for Service
- 6b51 M 0, y�
Signature Telephone
2.2 ! ;
o'k X45 & C-e—cr's WOO & S�
Namnt (0`1 Address for Service:
i
Oa6ask M 0,
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Construction Supervisor:
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable ❑
\--wV�
Company Name
Sat–f V L a S-0
Registration Number
Add
Expiration Date
Si nature Telephone
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SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit st be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildi permit.
Signed affidavit Attached Yes ....... No ....... ❑
SECTION 5 Description of Proposed Work(check au applicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s)
Addition ❑
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:�,7 (
f1 S 1v C't�i G�
.
0.3 L
~SECTION 6 - ESTIMATED CONSTRUCTION COSTS
It81m
Estimated Cost (Dollar) to be
Completed by permit applicant
OFFICIALUSE-CENLY
,
1. Building
3 D oc)
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
Building Permit fee (a) X (b)
��-
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
000
Check Number
SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
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, �C,t,\ uko1 e, 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 Na
Si ature of Owner/A ent Date L
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR T \dBERS IS17 1S172ND 3 RD
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS 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
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_ Hoard ut Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 126893
'y Expiration: 8!3/2004
Type: Supplement Card
Home Depot At -Home ServlCes
PAUL VENTRE
3200 COBB GALLERIA PKWY #26
ALTANTA, GA 30339
Administrator
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
r
Not valid without signature
Play 13 03 11:00a
Liberty Ubet,'ty Mutual Group
m1 t uiu„PO BOX 7077
Portstrtoath, NH 038(Y-1-707.7
TdV110ne (quo) 6.134893
May 9, 2UU3 Fax (603) 431-5693
lk c C llffi cafe d, Wcocers Cod gLC046014 frisur;tttuy;
106uft d; RMA H0.1� SER1�dG:ES .:
2('tt COSS GAL LERJA PKWY STE 20U
ATLANTA, GA 30339
Policy Nuit!ber' WC, -. Effective; 1 /3Uf21J(13 >=s
P
_ .... .. _ adat' 413()R004
Cov(Xagc sllorded wider Workers Colloonsatlon I:aW of tate fellixVing state(s): MA
EtreploycrE L.iabililw
EiadiJv Injury 13q Ac�deatt: $ J(It),()pU Each Actidtau
Bodily Injury by Dis&Au.-: $ JQ?tl,Ot)t) Each Pepkiii
Bodily 113jttry by Diso'ege: 500,009) Policy Llutits
As of this date;, iht above -ref r(MC6d Policyholder is insured by LM litsaraltcc Corpoi�itlmt under the policy
listed above.
Tree istUALLU afforded by the 1,s4td policy is subject LO 2) l rite tolans, e�e[usaorts incl cir+ditlqus, olid it not
aiterbd by :rut rcquiremdtt, ttdte nr catrditlon of :uty or cher domIntntt wrdt resp�*ct to wJsdrli thls Ctxfi6t:ite
may be issued.
This cirri-rttt is issued as z malar of irtibituatiev, eAdy wed onfdrs ao riglu uptut you; the certificate hotdtx.
Thi3 ctrtifisatt is not sit insurance policy raid dM not mend, omt;ard, or alter the coverage affo'detd by the
policy fisted abuvc —
If this policy is rutcrited bdrrire ttie stated 6:pirat iou d tw, Ubeivy ; .Jutuai will endeitvct io ftofflfy You of such
Canctuatlon.
»,;=. M.
,4t)'1'HUIt .t:i] 1t1!PAESLN7A1'f:'l.
LIBERTY Mt;teaL lhsuXANCE MoUp
'Elul CWW!�w w �,+ lod by ralat:;t'rY M4'l'ttAL D46UUNCE <AiUue:= i anau antif I Y NI:9Kt of i►u$�tticd �.Yih��awiiauinl� c,
CC: Insured.
RM.A HOME SERi1'jCf.S
3200 C.Q$B GALLERIA YKW'i STE 200
ATLANTA, GA 30339
9947-k.
h-o:ducar of Rtcoad`
SI EPARD do SCOTT CORP
10 WEST 1 ND AVE
SOMERVILLE, NJ OU76
- Ze 39vd 1101is aNv gdvd3HS tt%669LSt366 Et':LZ Coa3-/LT/So
�..ti:�� ✓/tt (�4llt�R6?vllQ¢�� U��.KCIaSQ� MS
' r Board 44 Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 126893
'y Expiration: 8/3/2004
Type: Supplement Card
Home Depot At -Home Services
PAUL VENTRE
3200 COSS GALLERIA PKWY #26
ALTANTA, GA 30339
Administrator
0
FiR
License or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
Not valid without signature
May 13 03 11:00a
Liberty
It�iut���
May 9, 2UU3
RE, C91%MIC41te of W(wkerl ComplegSaition Imuratnw
Insured: - RMA H0.1E SEit>,�dt 1 5.• : ...__
.12('(1 COSS GALLERIA PKWY STE 200
ATLANTA. GA .330339
Liberty Mutwal Group
PIO,HOx 7077
POrtstno(ctlt, NH 0380-2-7077
rdV1,9ne (2100) 653-7893
Fr -y- (603) 431-5693
POLICY Number: WC5-:i5 3 27514)13 Wecuve; 4/3012003 )T20U3 ExpirLtD(t' a /3()/:(W4
avesdgC 4rded uttder workers Conomnsztlou Law of die tollolviitg staters):
�tiFQloYCtE Lldbil'JIY'
Bodily hrlury by Accident: S!(1(i,i)p(i Each Accidcxti
&dity Injury by Diieie:: S IUlu. 00o Each Perspu
Bodily YI}jll[Y by Disease; $ 5()tl,iltie) Polsq Limits
Ab of this date, thQ above-ref&r6ti ed Policyholdvr is insured by LM klstYrUlcc Corps aiiolt under the policy
listed above.
Tlie insura,tcc afforded by the lis;iod policy is su iect to all cite terms, cv kuslotta ctrl our giitions, aLui it not
alter% d by any rcnu'trement, ttriu or condition of any or other doc sstrents with Ye3p= to which this C1xli6cate
maybe issued.
This certificate is issued as a 11"Wer of itt'ormatica, guy Id coltfers no tight upon you; the cerci icatehotdsx.
Th y cc tifisate is not act ir,surattce policy and docs not amend, amwld, or alter tie coverage &0 ded by rite
po'l ey listed abuvt: — -...
If thisall P y
p sY is ctttcetled before %tie statsti r~t ictitiou dt:e� t itieri Mutual well rucie:tv5r to liotliy you of such
autcellatton.
AUJ'mov .ED 11FJ'R&'WVTAT1VC
LIEERRTY MLwALJaWfkANCZ (*OLT
'rhix vciY:Yi•-tn i. u.,+.u:�;i by Idlal:ii'IY M4:'ItiaZ rNbl:t41N%b CLLiu:3Y:,a i.ahaw s�ti71A'.wf.V,C! Fii i>, uYtttticJ 6N1h�ia W` iuniui.
r
N; Insured. i'loditccr of'Recoad°
RNIA HOME SER",'lCES Sl tEPARD & SCOTT' Cckp
32410 COBB GALLENA FKW'i STE 200 145 %'VEST END AVE
ATLANTA, GA 30:33, SOMERVILLE, N1 OW76
ZA 3�t�d J.1Q:lS ci►Vtl Q�t1d3H5 It:a69LS89� ib:ZZ EOEZ/�T/5^�
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Double Hunq - Vinyl
Low E (SC) -Argon
Fenesaationag Cmid
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while podud amW vatmom WX ratings are determined fw a toed set or ernirorune W
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Central
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D PC IND: REIN 00/GLASS DS/H-R25
J Test Size: 48 x 80
Order 0:2754289010004 50274 PM