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HomeMy WebLinkAboutMiscellaneous - 84 BRUIN HILL ROAD 4/30/2018K? i> C3 0 p 0 9,- -�>e,,- 0,9 Date.. ................. t&ORTN 41 6 TOWN OF OMM ANDOVER PERMIT FOR GAS INSTALLATION This certifies thaf---k--' ....... 0., has permission for I gas installation .............. in the buildings of�� ........................... at WI911-1 . North Andover, Mass. Fee.-).� .... Lic. No.&.;71J�S. . Check # 13,3\-<2 GAS IN OR I MASSAaiUSEM UNIFORM APP11CA-71ON FOR Pa&ff TO DO GAS FnTING (Type or prinp NORTH ANDOVM MASSAC C�, HUSETTS ate D Building Loqations 1+ �15 1�Ni Peffnit # ------ Owner's Name -6,,�AmountS New Renovation Replacernen 0 Plans Submi�tted[j S U B -B A SE—ME N B A S E M E N 2 N D . F L 0 O.R U A S B S T 2'N D E B A M F E L S N 0 M T 0 E N iNT. F R L . EFR 00 3 R -D F L 0 0 R 4 T H F L 0 0 FR T T H H -FLOOR 6 ji T H - F L 0 0 R T HV.— J, L 0 7T L 0 0 R 8 T*H .' F L 0.0 R (Print or tvPe) Name —1,A E* -,o zx4 Address. L1% usiness U z W p. z ;5 Name ofj_icens ed Plumber'or Gas Fitter (!&Le—ck one: certificate Installing Company M, Corp. ElPartner. Firm/Co. INSURANCE COVERAGE I have a current liability I' IN f -L or it's substantial equivalet Ch one: S'uranr h SU �A P , N e ' cu C" rm If you have checked as, tse, ini'lD'icy Yes t insur Liability insurance p" k -1-k Icate the.tYPe coverage by checicing the NOD olicy, appropriate box. Other tYPC Of indemnity D w wn'er's Insurance Waiver Bond M. us I. e . e am aware that the li 'e 40_2_�_701 have the insurance coverage requ, Mass. General Laws, and that my sip consL ature on this -permit aPp"cat"rl waives this requirement. red by Chapter 142 of the Signature of Owner Or Owner's Agent Check one: I hereb certilgi, 1, 1:11;:1 ............................ Owner ... .. .. .... . . ..... best o ii �� ls and infbrmatil!0`�' 1 � n;v`e s''u''D''M lite''Id, I (,or entmd) in 13 Agent 13 f my knowledge and that all Plumbing work and installations pLrfo above application -are true and accurate to the Compliance with all Pertinent Provisions of th rmed under Permit I e Massach S ssued for this applicati Code d r 142 On will -be in of the General Laws. tate camn S Title - -------- Ignature of Licensed Plumber Or Gas Fittetr zi Plumber ty/Tov�n., rl,) S S Gas Fitter Lic e ----------- be Master �PPROV, ED (oFFICE USE ONLn JOumeyman QJ Massachusetts -'EV, Departrnent of -f11d111t1izz1Acid,,,0 Invesvgations 600 wavk Znaton Street Boston MA 62111 Workers9 compensati., Insurance Affidavit AD ficant Informatioln -Rubders/CoUtrartors/Electri dians/Pimbers Name (B Llease Print L *blv us'rl�M/OrganizationlindiNeidual): 1� q7\-. S. Adldrtss: Phont c:rI8� In -skre.YOC ain employer? Oheck the appropriate box: an, a MnPloye� with -MPIOY—S 4. 1 am Type Of project a 'erlerzal cont -actor and I (required): (f"11 and/Or part-time). havt h'-- 2.0 1 am le proprietor or partner. ired'the sub-cotra=rs .6. Nel�v cOnstruction aso "Ste-cl an the attached sheet .7. Remodelino, ship and have no employees These s wOrking for me in any capacity. U"cOntractors have [No workers'. comp. insuranct s. worken, cOMP. insurance. E] Demolition r quired.] We art.a 0orPoration and it 9. [] ElLuilding addifion 1 arn a hOn'mOWner doino, ELI] work. offic=s have -Xmised.their .0 Electri g right of e cal repairs or additions . Myself [No work=' com Xemption Per mGL Pi=bingg repain P. C. IS2, § 1(4) or insm-ac-, required.] I t -employees. � and we -have no Roof additions [No workers� repairs Wmp. Insurance 13, 'Anv applicant thm chr Oth. rk, box HEIMMOWHeM who subinii tw& out tht seLlim btlow shcwi incl carilJ6 art a:,. 119 th=ir wo Polic�, infannation. tilis*box Tn wwtc additional sh= show- --rd h irl- G 0ontraciun; 111US[ hr b"i 111g, the na-e; Of th.- sub -c U nm affid"'it contmet d ffi a" eMPLOTer Mat is providing woI,_,x, co, Oman I MrWon='coMP-POlic�'inforn�on. cr'satior irulzrancefop ng, emplopEm Beiow Insurance amparty Name: is the Poficy andjob site 4 Policy # or Self�ins. Expiration I Date: Z) Job -Sitz- Address. 14 - Attach z copy Of the workerg, compensatio, city/S=2/zip Failure.to Policy declarati Pa.e- (Showina ffie policy secure cOverage as required under Section 25A of M 0 number and expir-jtion fine up to S1,500.00 and/or one-year GL c. 152 can lea� to the imposito d2te). Of UP to .3250.00 a day n of criminal pana*s of a Imprr7sonment as well as c'vil Penalfies in the form ao--a= the Violator. Be advised that a of a 97'OP W0RK ORDER and a fine Ptions ofthe DIA for insurmce 6v- copy of this Statement rage ven Icati011. maY be forwarded to the Office. of I do here carzt�) Under Me Si--natu . re: enaidai qfperjurj� th'z the infornzatian provided abovc is true any co,,= Date- Phon k: QVT off1cial use Onk Do not write ij7 g& arcz; to be — ------------ tOW07 VffLCWZ Cr ty or Town: Issuing, Author1177—, Permit/L. 4 ty (circle one): 'cease Board of Health 2- nu"diaft" Department 3. city/T.,. 6. Other Clerk 4. Electrical Inspector S. Piumbift" Inspector Contact PersGrr- Phone fi- JAILVI MaLIVu i=wnu -Lustrucrions Mas=husetts General.LaNks chapter 152'requires all eTr1-;=P.1pyers to provide workers' compensation for their empi oy-es. Pursuant to this statute. an employee is d-efined. as "...'vtr-Y pemon in the smim Of anothe'r under any c�ontract of h ire, express or impliedL. oral or writtm" kn employer is dtfined as "an individual, partnership, aa -r_-- , - C)ci6on, corpomtion or other legal entity, 07 any two or, mc)Tr of the foregoing engaged in &joint enterprise, and includ--i-ng the legal r r.' ep sentativm -of a dzmased employer, or the rccewer or bustee, of an individual, partnership, assOciati <:>n or other legal entit 0 ms. However th-e owner of, R dwelling house having not more than three ap, -u-trn' y, employing Dmpl y ents and who rmiLes thertir� or the occupant of tim dwelling house of another who employs persons to do Mz:*_:int=nance, construction or repair work, on such dwellirig house or on the groun& or building appurtm-nant thereto shall nc:>t becaust of such -employment be deemed to be an ernploy=r." MGL chapter 152, §25C(6) also states that "everY state tDo- r local licensing av gency shall wkthhoid the issuance or renewal, of a license or pennitu operate a bn�siness or- to co "a nftmd bufidiftln, iD the commonwealth forany ppli6ant who ha� not produced acceptable e*idence "f COMPHRuce Vlqfi the insurance coverage requirecl." AdditionaDy, MOL chapter 152, §25C(7) states "Nerther The irommanwcafth,nor any Of its political -subdivisions shall erder into any centract for the pmfonrance of public warl< tmtil ac=ptabl' evid�ence of e compliance, with the inwance requr=ents ofthis chapter have been presented to the Dc- vTMdcting authority.", Appficants PleaSt fill out the workers'comprensation affidavit compl-etely, by cher-Icing the boxes that apply to yo1r situation and, if necessary, supply sub�cbntractor(s) na=(-s), address(es), awd phone n Umber(s) along with thei cerd-ficate(s) of insu=ct. Limited Liability Companies (LLC) or Lirnft�_-� Liabilt, Partnerships (LLP) vAth no = y - m embers or. partners, are not required to carry workers' c- C) m. - . . pio. -es other th= the pensation insurance. If an LLCpr LLP does have employees, a policy is required- Be advised. th� this affid-avit maybe submitted to the Departrn ent of Industrial Accidwits for conifirmation of insurance. coverage. Also lbe'sure to sign and date the. afficiavi.L lbet-afficlavitsbouid be. returned to the city or town that the applicatioD for the permit or hcmseis -ing rcqucste�d, not the 13--partment of be Industrial Accidents. Should vou.haveany qi�eiti I cyns MP24-rdingr the ia%v or if you are mquired tD obtain a w comr-nnsabon riolicy, pLease call the Depwtm-znt at the nULMb=r1is�5d below. Self-insurcd companies should enter their self-�nsurance license n=bl_r on the aMrop-nate line. City ar Town Officials Please be sure �iat die�irffidaxht -is complete and Pmnt5d,le­szibh1. -The ep D artment has provided a spare at the bottom of the affidavit f6ryDU to fill Out in the event the Office Of' Investi gations has to contact you regarding tht appiicanL Pimaie. besureto fill inthep=iMicense numbtrwhichvN�11 btus' ed as a reference ri�tmber. In addition, an applicant 'that must submit multiple, ptrmit/license applications in m -r.), given yew, need'oniy submit one affidavit indizating, curm-rit. po-iicy information (if necessary) and undzT "Job Site AdAx-ess­ the apphcant should write ,a locatiom in town)." A copy of the affidavit that has be n officially s6a�pt . d or marked by the city or town may ' _(city or be provided to the applicant as proof that a valid affidavit is� on file for future Permits or lic--nses. A new affidavit must be filled oig each yew. Vrh=r, B home owner Or citizen is obtaining a licens� 07 permit not related to any business or commercial venture (i.e. a. dog license cyr permit to bum lmves etc.) said P-Moli is NOT required to complete this affidavit. The Office of Investigations would like. to -thank you. in a(i-vance for your cooperation and should you have any questiorLs, please do n(3t hesitate. to give us a call. 7he D--partm-ent's address, telephone and fay, nurnber: T -he Commonwealth Of M=achus-ett Departmimt of Lmdmtrial Accid= OMM of lEvvestigations 600 WashLffigtoi2 st-jt M -A G21 I I T51. 4 617-727-4900 C= 406 cr 1 7 7-M LASSAFE Revised 5-26-45 61 7-r-7-7749 VWRI.Mazs. aov/ciia Date. / ......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION C. 14us* This certifies that ....................... has permission for gas installation 1/2 ( , ( 117�- , .......................... in the buildings of ... 13. .............................. at... (..( ........ North Andover, Mass. Fee. Lic. GA� INSPECTOR Check 4 i 37-8 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO,GASFITTING (Print of Type) N, � �3 DO V E (2% '-7;-30 vir 20-6-1 'Permit o _.Mass. oate I Building Location TLk e)Aui/h Lik Name GEOFFREY 6uck *qM91 Type of Occupancy New Renovation [3 Replacement C] Plans Submitted: Ye No InsWing Company Name AMERIgas PROPANE CO INd Address 215 Boston Street ToRsfield Ma 01983 Business Teleohone 978-887-2353 Name of Licensed Piumber or. Gas Fitter Check one: 12 Corporation 0 . Partnership 0 Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. yes Xj No Ll If you have.checked Yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy X1 Other type of indemnity 0 Pond 0 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 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 the permit issued for this application will be in compliance with all perbrient provisions of the Massachusetts StateGas Code and Chapter 142 of �lhe Ge yrall Laws, By T12e of Ucense: ILJ Mumber Watufe of Ucensed Plumber or Gas Fitter Title slitter Master Ucense Number City/Town �=neyman El MEN InsWing Company Name AMERIgas PROPANE CO INd Address 215 Boston Street ToRsfield Ma 01983 Business Teleohone 978-887-2353 Name of Licensed Piumber or. Gas Fitter Check one: 12 Corporation 0 . Partnership 0 Firm/Co. Certificate INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. yes Xj No Ll If you have.checked Yes. please Indicate the type coverage by checking the appropriate box. A liability insurance policy X1 Other type of indemnity 0 Pond 0 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 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 the permit issued for this application will be in compliance with all perbrient provisions of the Massachusetts StateGas Code and Chapter 142 of �lhe Ge yrall Laws, By T12e of Ucense: ILJ Mumber Watufe of Ucensed Plumber or Gas Fitter Title slitter Master Ucense Number City/Town �=neyman Date.... N2 2605 This certifies that ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING has permission to perform ............................................................ �yiring in the building of... ........................................ at .... .................... North Andover, Mass. ......................... Fee..2 ...... Lic. ..... z Check # -`�'—ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer U I E CA OM WOME 4 L TH OFAM &" aK SE 7 7 S Off -ice Use only DEPARTA1EVT0FPUBL1CS4FM Permit No. C77a o BOAMOFFMEPREYE7MONMGMTIOAN527CMR12�00 Occupancy & Fees Checked APPUCATION FOR PERW TO PERFORM ELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 cMR 12:00 (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 perfbrm the electrical work described below. Location (Street � Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes q No r7 (Check Appropriate Box) Purpose of Building M GA"OUIVAJ Coo L P0QX- Utility Authorization No. V Existing Service Amps 410 /1 V Volts Overhead Underground No. of Meters 1:3 LJLJ New Service Amps Volts Overhead M Underground M No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 111,41� Aal-,L� I'll C., No. oftighting Outlets No. ofHot Tubs No. ofTransformers Total KVA No. ofLighting Fixtures Swimming Pool Above Below Generators KVA ground ground No. of Receptacle Outlets No. of Oil.Burners No. ofEmergency Lighting Battery Units No. ofSwitch Outlets No. ofGas Burners FIRE ALARMS No. ofZones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. ofDisposals No. of Heat Total Total Pumps Tons KW frutiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. ofSelfContained Detection/Sounding Devices Local Municipal M Other No. of Dryers Heating Devices KW Connections No, of Water Heaters KW No. of No. of Signs Bailasis No. Hyq#ro Massage Tubs No. ofMotors Total HP 0 T`HEQ lns==Ca6tr� Laws -1 NO UmeaametLiah*h&r&=Pobcym&d%Cm#AkOpwad*cmCDvmWcr�smbsbride*ivakrt YES F Iha,6eabnitWdvaWpmofofsamtodxOffm YES 0 NO F-1 If�cuha%eduiWYESpkmmdc*thetMxcfwvamybydnkirgft Mxqxi*bcx NSURANUE Z BOND r-1 GMER [::] ftweSpeffy) X�� AA=kATa&-1 WO&OStut 20/ - 0-0 h;pec6mD&-RaqtxsWd M EshmAdValixotBecatalWak $ � Fmal SigrWUrnX7lePtV1tks paw. FIMNAME P-64ZUIZ41 uomseNv 8-T'2 0 F0 Aftu;�.6---d &Z74&,q, AlTel.Nh OMINMSNSURANCEWAIVM-lammmtotbcLimmdbmrdtowdri&==amaWoritsaksmnWafnalatasm#Wby&bmfucasCoedLam "dVtmy . sovmmcnlhspanawpkabmwa,rcstzmw,wnem (Please check one) Owner M Agent 1:1 Telephone No. PERMIT FEE $ Location :23 T, U to No. Date 1 -0 -Do 0.1 40RTN .1 TOWN OF NORTH ANDOVER Certificate of Occupancy $ HU Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee P>00� $ TOTAL $ (3c> Check # 14156 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCr REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ke Offic .1j BUILDI-NG PERMIT NUMBER: DATE ISSUED: SIGNATURE: /A/\Ak �,_C�� Building Cornrn�ssioner/lnspector of Buildings Date 4F M M X M -Mi z 0 IA R 0 z M 0 M z 0 SECTION I- SITE INFORMATION 1.1 Property Address: r4 V3 o- 1.2 Assessors Map and Parcel Number: 1eq A CAB Mal5 Number Parcel Number . 1.3 Zoning Information: nct Zoning Dist— Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Reqwred Provided 1.7 Watey Supply.M.G.L.C.40.5 54) Publ - ic 0 Private 0 1.5. Flood Zone Information: Zone . Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System C SECTION 2 - PROPERTY OWN-ERSHEIP/AUTHORIZED AGENT 2.1 Owner of Record Ar AJ) �,Name (Print) Address for Service 0 C. -7 2-- 63-61 - 9ZV( 7 f3 V2_?&)) Signature- 10, Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: �Address Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number Address Expiration Date Signature Telephone 4F M M X M -Mi z 0 IA R 0 z M 0 M z 0 I I SECTION 4 - WORKERS COMYENSATION (NLG.L C 152 § 25c(6) I .I - 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 ....... 0 SECTION 5. Description o Proposed Work (check applicable) New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) tion 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: C-1 U A- 3qx 17 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant A 1. Building 201 (a) Building Permit Fee Multip ier 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 rr 1, ir 5. s LOwner�uthorized Agent of subject property HerebV authorize to act on My behal�' in all nigttera relative to work authorized by this building permit application. , - 0!9�� -�� ?/43&P Signatur� oKNAiier Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my "owledge and belief Print Name Signature of Owner ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGFIT OF FOUNDATION TfUCKNESS SIZE OF FOOTING X MATERIAL OF CI-IDANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE C/) m m M m m :1) cn m Cl) 0 m Cp CO) CM) CM3 cop) F-* CD C* CL 0 CL q CA C* C.) CD CD CL cr =r CD Er T CD 0 CD W:lm a. S CD cop) — CD CL Cl cop) CD S7 M CO) 10 CD z CD CD I cn C/) n 0 z w -*'go =r -i C, C:r CO) C:, CD 10 ca =2 CL 0 CD C") cc — 0 C2 -% C) Cl CL C2 m CD . = z =rlo IV go —, (A 0 = -o CD — -n =r CL CL 0 10 Fn- , =r CD CA CO2 P.o 0 col CD 0 9 a CD CD " *Mp --' (a cc, co 0 z cl) 1 0 C2 to ;& CD V =r ='O: ca CL CD cc 0 CD C a L CA 0 it =r cr CLW CL 4 3* am CA CD G, 4c ca C/) V) 3E CD w Cos I'M wo =r CD CD CA 'd. C. Cl) es C42 CD 4L WN = CL. - 2. C04 AUX dob Cl) 0 s 5 cn 0 per, cn 't M r- :) Oil t2l r- C>fl RL T Irt, A 0 09 z n Ilz ro pr Or- :1 CL to z ro 'a F. C/) 0 CL , to w W 1� z 0 k 11*4 tj e oil 0 4li CD 01 7V 7:41�- 727 7.',wv .494,ve 7xio7, fv�—,mv-arz4AW le 40e-4y;rO aAl 7A4W7-//—.PO4-Zr ex�wlrdzew Z4Wl.Vd AVIdAi�4rA34(S eAr ZIAIZ�S gW7WeA- C--A-71A-Y 7A?47- 7;�" OW3rCd1AW IS.AlOr 4iI447MO /A/ rYO-r Ae 10 7 C - lee Jr w .47 -IOW 17-4&ZT-41 AAMOW '"'ag V Ole TO 194 0 r AIV Ae,4ieAl /&2::W (�fb to tNo T)O() -Ne FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments havig jurisdiction have been obta mied. This does not relieve the applicant and or landowner from compliance with any applicable requirements. IN am No a am 0 a 0 an a a no a a a an a won NON a am am MENEM ME NONE 0 0 0 ME a a a a am 0 04ME so raff a APPLICANT G el*riprx-f- 4- �VHONE 611 6q3 ct'72?-'g Cw) ASSESSORS MAP NUMBER LOT NUMBER C) SUBDIVISION NUMBER STREET 1- v'I v, REET NUMBER q &6h Ail OFFICIAL USE ONLY RECOMA4ENDATIONS OF TOWN AGENTS U:W�a 40mm-n 5 DATE APPROVED SERVATI . ADMMSTRATOR DATE REJECTED TOWN PLANNER CONBAENTS DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSPECTOR - BEALTH DATE REJECTED DATE APPROVED SEPTIC ,KAECTOK - MAI�W----- z�- / DATE REJECTED COMMENTS ,;>.zD An, tz < e le -c- -D -20L- -k> PUBLIC WORKS - SEATER WATER CONNECTIONS DRIVEWAY PERNIIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED CON0,4ENTS, RECEIVED BY BUILDING INSPECTOR DATE ry (•. I?.4 cc, 7 /,m 0000 00 0-) 1?j Irl In C !'J (-- "t N i Irl r� r1 cr, • . -� -, - tM - I rJ `fl <r ^}• 11 J tl I IY1 YJ lYl Irl I:YI CrJ �J 1?j t'J tl rj 'fi •41 'Q •a I fl.'CJ ••O "-Cl '�I y l '1:1 •ti _ Z � H �, • ♦SI i 1 f_l w F�.-1 .. • • • . • • • • • , • , • • , III J 111 = tl y. • • • • , • , y • , LLJ -1, Z .I L 'T_1 0 III C l C - -- 4+C dI a D 4-' i].I LM .- - Ll C i 3~ o o' I +, t- C itI IJ� u. 7 C C Lm M, Q -att -M i fl 'J c I t: ^+ ,� v C 0 _I I_I -. J 1_I 0 If) I I SI = - o - - - L _ - �- LL !- F- n v + 1_I Lb ,. W = Li] i; ,. 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' ' "s' s $�` a` ` - �` ,QM ° {1. J,€ ` 'if ' J,2 "3'�;31.'� , `�1. t, r r �� x r ; `$ `JNii3 '`k yy ) N Y.+ .r it - Z p i J! G ik11-1- ... .. ...-- Location ey 3/?V//0 //,// /-?C/ — No. 0601 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ CR Ll Building Inspector '1330 808/16/99 14:34 25.00 PAID— Div. Public Works I :2 V, "I ICAI m r) 0 U� M, 7 - Ln Dq� C30 S c Zt :2 V, "I ICAI m r) 0 U� M, 7 - Ln L4 Dq� C30 S c z 1� z 7\1 nt Ln L4 Cl) m m m m m m Cl) m Cl) 0 m COF) "0 CD cl) z F; 0 CD CD CL cr CD 0 a: I= to CD co C-) C3 rA * 10 CO) CA W-1 co 0 CD CD a r4 . CD CO) ;7 -A- CD CD 0 = --I cr (A W CD no C-) C- CSDI cc, =M -0, 7!2. cO) r ca. ca 0 CD 0) -* W m 6-4 ��= r 0 --1 C- CD C.. 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Work phone Name- Home�p�one-� PRESENTIMAILING ADDRESS Bvl�f 0q, 71 Citv/To 'ri- 'State. Zip code W The current exemption for -"homeowners" was extended to inchide'dWiaer-occupied dwellings of six units or less and to allow -such homeowners to en -a -e an individual'for hire who does not possess a license, provided- that 1he owner acts as supervisor; (State Building Code Sec - J_ tion 109.1.1) DEFINITION OF 140JIMEOWNER.: Person(s) who o,,vn-s a parcel -of land -on which he/she resides or inte n -ds to reside, on which there is, or is intended to be, a one to s ix familv dwellin,,, attached oi detached structures ac- cessory to such use and/or farm structuxes. A person who cons-tructs more than.-o'ne'home in a two-vear period shall not be considered a homeowner . Such "homeo w-ner" shall submit to the Building Official, on:a: form acceptable to the Building Official -that-he/she shall: be responsible for all such work performed under the, building permit. (Section 109.1.1) The undersi-ned.'.'homeowner". assumes. responsibility for compliance with the S�a*te7Buildim, Code and other applicable cocies, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of 'qo a . Andover Building Department minimum'inspection procedures and requirements and that he/she will comply with'said procedures and requirements. HOMEOWNiER:S SICNATURE APPROVAL OF BUILDING OFFICLU Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Buildin- Code Section 1270, Construction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 1 Town of North Andover CMCE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 0 1845 WILLIAM J. SCOTT Director (978) 688-953 1 T 0 0 0 41 SAC Fax (978) 683-9542 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: 1�r,14)5 41 (Location of -Facility) //Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project throug-h the Office of the Building Inspector I V BOARD OFAIPPEALS 688-9541 BULDING 688-9545 CONSERVATION 683-9530' 1,EALTH 688-9540 PLA -"l !NG 68S -953S Lu r—. n to 0 I!-- � l'i"., � �--, 71 T 'I"! L to 70 Lq rn JL 01 t, 0 XP t,3 14A kA FORM U - LOT RELEASE FORM 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 andlor landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT '�CPHONE 92qy LOCATION: Assess&s Map Number 10q tPARCEL 216/104i_ A coelp o66o,d SUBDIVISION LOT (S) STREET W T. NUMBER USE z LRECOMMENDATIONS OF TOWN AGENTS: jeelnOOE-�-WEPJdCE /5/y36-2/ ,6 (I -V flz/k/ C)t, y _ - (_ r, 4 k-6') W ' I CONSERVATION ADMINISTRATOR DATE APPROVED '6 DATE REJECTED— COMMENTS -*-N 100 Mz) TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED 174- DATE REJECTED �4 7 '7— SEPf I'C INSPECTOR -HEALTH DATE APPROVED 9/7/ - 4 DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING liNSPECTOR DATE Revised 9�97 jm DUCK, /6 /V /)f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:- e?q AA -Aa Owner: Date of Inspection: SKEWI1 OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' "rA L4 /A- A- A �o �] i '10 2)q :PTH TO GROUNDWATER pth to groundwater: 14 -feet �'thod of determination or approximation: l�vised 11/03/95) 9 1 4 1 /,0/, F, W.Ae-A�' ee.,t7-,I-r 7-0 7We -17,--e 1A1s&oeacwo R4 0 r RZ o4AI 7Z7 7o4oW 04 -VV rM4;r eacArVwaw Yo+IC 4COr AS e"lazzelow ,Wlrl�, ZCWIWd 4WdFAtArA34& Awdwoepmw �re,7.94CAlr law" Irl-Z&Z-7s ll� e,07- xn"q '_- Aoe.roWor CCAP71.4rie rwr A#�re-,IAW IS V477' ,. oC oe.4j*'Aol I.&Me e-ev-4rmo /4/ JAtW#VAt dAo' vv a 7 e— 'Ce. S, eo 19"? 7 -4rlo-v -y-,4A'9--4V -AW,4f 00WW -M4W4-7- 1" 46 TO 39Vd 9NPJ33NIE)N3>i0VVIIaa3VJ BVPTSZ.V-GOS 9Z:60 L66T/9O/SO z Lo'bol-Vion N6. 2 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ 7"Kh", SY) Foundation Permit Fee $ Other Permit Fee $ 0KCbrinection Fee $ Water Connection Fee $ V,9_TAL A rA i, rN ZL Building Inspector Div. Public Works L;6tion LI. 'Z 4 R�,2f-,X' 0-., Al" t t 6,� Date -7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 4' Building/Frame Permit Fee $ MU Foundation Permit Fee $ Other Permit Fee $ Sewer ConnectiLonFee $ Water Connection Fee $ TOTAL $ -.4 Aiwuv%�-A Building Insp6c-t6r Div. Public Works L�� ation Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Buildind/Frame Permit Fee Foundation Permi't Fee $ 01 Other Permit Fee P A Nower'Goonne,ctign, Fee Water Connection 'Fed TOTA� 8 Wj oil Ct Building Inspector S biv. Public W6rks v ,Ing -APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. 004qN PAGE 1 INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 3 010A 05 0 PAGE 2 FILL OUT SECTIONS 1 12 o rmmff lvfi"�fll ON ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDIN11EQlp y ft .MB P 114.8-S. B.C. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND DATE FILED K — SIGNATURE OF OWNER OR F E E r7 6 -5 0 -* OVED PERMIT GRANTED 7171 19 3 17 121992 1�_k 04 ---- tr_s__bs_73 f E E PA I D PERMIT FOR FRAME/BUILDING DATE: FEE pAin. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 4,27,2,q q EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. -- 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BLDG. PERMFf FU t. LESS FDA FEE_* 00, oummmd- —mspriaroR DUE FRAME PERMITUA� - C- d> � c. 0, C -o . (--a I/ LOT -NO. 2 RECORD OF OWNERSHIP DATE BOOK '.PAGE ZON E I I ­_ SUB DIV.. LOT NO. I -_T,9-/m -e-r [OCATION 4f) )I 41-ef- PURPOSE OF BUILDING OWNER'S NAME j?jjf3- NO. OF STORIES SIZE y (o OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME LA_'11 I I -C h7);q�l SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET J-0 POSTS 07-)(,4 DISTANCE FROM LOT LINES - SIDES 410 REAR GIRDERS x ) AREA OF'LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS 0 IS BUILDING NEW SIZE OF FOOTING x c� IS BUILDING ADDITION /y MATER:AL OF CHIMNEY IS BUILDING ALTERATION /v IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE y -el _r IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY 40 IS BUILDING CONNECTED TO TOWN SEWER Wo IIS 13UILDING CONNECTED TO NATURAL GAS LINE /y �o INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 3 010A 05 0 PAGE 2 FILL OUT SECTIONS 1 12 o rmmff lvfi"�fll ON ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDIN11EQlp y ft .MB P 114.8-S. B.C. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND DATE FILED K — SIGNATURE OF OWNER OR F E E r7 6 -5 0 -* OVED PERMIT GRANTED 7171 19 3 17 121992 1�_k 04 ---- tr_s__bs_73 f E E PA I D PERMIT FOR FRAME/BUILDING DATE: FEE pAin. 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 4,27,2,q q EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. -- 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BLDG. PERMFf FU t. LESS FDA FEE_* 00, oummmd- —mspriaroR DUE FRAME PERMITUA� - C- d> � c. 0, C -o . (--a I/ tA 001 A(I ul .1. 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(1) :1) -n m 0 m CCD 0 (D 0 F3* 0 :7 0 0 c co c to m c w =r 0 :r (D r - m 0 > m z M 0 m In toi 4 M c9a M 0 m m M m m > ri 0 0 0 m m z =i P) CA 51 I�s 14 cl 0 .11 0 it cd9 NI P=q 0. :3 0 q< (ID pq FORM U - LOT RELF.ASE FORK 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. I ****************Applicant fills out this section***************** APPLICANT: coev J '-� Phone LOCATION: Assessor's Map Number Subdivision A2 Street - 4?11_U, 1-1 _/4 ; I / AA4 Parcel Lot (s) Z St. Number ************************Official Use only************************ RIECOMEENDATIONS OF TOWN AGENTS: X� Comments Town Planner Comments . 2 H�a_lih Agent Comments Public Works - connection#' - dri"veway permit Fire Department 611(> Received by -Building Date Approved 1-7 Date Rejected ? Date Approved J* .2J., Date Rejected Date Approved Date Rejected W M, G?4 dec-el,,u CA/1 FORM U — JA)T RELEASE FORM 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: -&vh CVLI-71-17�_C. Phone b LOCATION: Assessor's Map Number Parcel Subdivision ._ Lot(s': Street St. Number ************************Official Use Only************************ RECOMEENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Health Agent Comments Public Works Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected - sewer/water connections - driveway permit V/,/g A", Fire Department Received by Building Inspector Date �u C:) M 0, ar 0 -4 -�, r 13 L4 > 44 0 C') M 0 0 0 6-, z 2 0 z ILA 00 IF C3 U T 0, 0 kA 0 U) -4 0 r- M L4 0 z r- C:) --J < In m PO ;u z X o x o' C: m c m ;u -0 x (A l—, ril W - F I") -T1 w r(I C) A Z 0 C.) cu 0 (i :-4L C) U) m C) C) th T) Z 1: m fil m m u C) (f) P 0 -< n 0 u a] M n c- r- ci K u z C-) C) m ou m (1) 0 33 rn A m CE) v PLOTARLAN OF LOT Scale DANA PERKINS, CIVIL ENGINEERS and SURVEYORS READING - Te4i�,r-55,4,�MASS. 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