HomeMy WebLinkAboutMiscellaneous - 845 WINTER STREET 4/30/2018Date. / //(). 3.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that XZ. 'If el ... 111-1CL.4h
.......................................
..
has permission to perform .. ��.6 ..... le111
..................................
wiring in the building of ... Ake'all ........... ............
at...., ...................... . North Andover, Mass.
Fee6-0....&7.) .... Lic. No.1..31--.,1.7?.
................
INSPECTOR
Check #
THE COMMONWEALTH OF MASSACHUSETTS
DEPART YIF NT OF PUBIIC SAFE1 Y
BOARD OF FIREPREVKV770NREGUTATIONS 527 cAm 12.E
Office Use only
Permit No. 0
rr
Occupancy & Fees Checke
APPLICATTONFOR PERMIT TO PERFORM ELECTRICAL 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 I��f! IJ , r�•�Jl i/ ,5
To the Inspector of Wire;
The undersigned applies for a permit to perform the electrical work described below.
Location (Street �
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes
Purpose of Building -5),(,, i e �A � ( / i - v
Existing Service AmpsVolts
New Service Amps / Volts
Number of Feeders and Ampacity
No r (Check Appropriate'Box)
Utility Authorization No. _
Overhead Underground No. of Meters 1
Overhead Underground No. of Meters
Location and Nature of Proposed Electrical Work f_t 2)Ae r -J RST F/_ A,OhI) l /0� I ell
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures Swimming Pool Above " Below r'—J Generators KVA
No. of Receptacle Outlets
No. of Switch Outlets
No. of Ranges
No. of Disposals
No. of Dishwashers
No. of Dryers
No: of Water Heaters
No. Hydro Massage Tubs
O I'HER
No. of Oil Bumers
No. of Emergency Lighting Battery Units
No. of Gas Burners
No. of Air Cond.
Total
FIRE ALARMS No. of Zones
Tons
No. of Heat
Total
Total
No. of Detection and
Pumps
Tons
KW
Initiating Devices
Space Area Heating
KW
No. of sounding Devices
No. of Self Contained
Detection/Sounding Devices
Heatin Devices
g
KW
Local � Municipal Other
Connections
KW No. of
No. of
Signs
Bailasis
No. of Motors
Total HP
Inst=)XGovaagee, R>tRWEDtherequtaneM4NIa%wh-isc%GerialLaws
IhawacunerltLiab>btykEw& o Pb ymckdmg(omplele CovaageorrtsRbsm le4w,alax YES NO
Ihavt:stlixiwdvandptoofofsmwtotbeOffioe YES FT ff)ouhaNechedodYES, pkaseindicatethetypeofcovwWby
chedarlgthe box 1..G/��....G���.3333
INSURANCE BOND m moz m, wase**) ZoR )C.q
EVirahonDate
e-� Val & 41 lec" Work $
WorktoSfatt 7� 1-y3 bspmfim *Rec�Cl Rough / l-� Fulal
sviru �
scerlsee �O`!1N f I"lAWR6 / signature
.-
�drltPcc / fA O(J( I /r lam? Alt Tel No. a-j�/� - `%%
)WNER'S INSURANCE WANUE , I am awate diatthelic� does not have the Havance comnge orits abstarttial o jlivalertt as regtmed by Massachusetts Ger � Laws
nd that my signature on this permit apphcation waivt:s this regtmern nL
Please check one) Owner O Agent
Telephone No. PERMIT FEE b
Signature ot Uwner or Agent
�drltPcc / fA O(J( I /r lam? Alt Tel No. a-j�/� - `%%
)WNER'S INSURANCE WANUE , I am awate diatthelic� does not have the Havance comnge orits abstarttial o jlivalertt as regtmed by Massachusetts Ger � Laws
nd that my signature on this permit apphcation waivt:s this regtmern nL
Please check one) Owner O Agent
Telephone No. PERMIT FEE b
Signature ot Uwner or Agent
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Location:
City Phone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company name:
City: Phone #:
Insurance. Co. Policv #
Company name:
Address
City: Phone #
Insurance Co. Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,Soo.00
and/or one years' imprisonment_as_vkell_as_civil.penattiesinsheform4 a STOP WORK..ORDER.,and_a fne_of.($1D0.0A)-ashy agaiW1_me_ 1
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of peijury that the information provided above is true and correct.
Signatu
Date li
Print name P_bone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
El Building Dept
r-lCheck if immediate response is required E] Licensing Board
F] Selectman's Office
Contact person: Phone #.• ❑ Health Department
Ei Other
., �.<. w -
Location U tkteAZ. &I—
No.
Date
&ORTN
TOWN OF NORTH ANDOVER
a
Q
a.
Certificate of Occupancy $
Building/Frame
Permit Fee $
�M�S
Foundation Permit Fee $
Other Permit Fee $
LO
t
Sewer Connection Fee
Water Connection Fee
l TOTAL
No - -, 9,63
_o
(n
Building Inspector
Div. Public Works
Location
No. C�e)(� Date
ust .!._
3
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $ �C
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
+ TOTAL $ S
_ .011 Building Inspector
231J5 11:15 150.00 PAID
r ��
7962 ' Div. Public Works
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zLocationy4
No. 05 G Date'
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit ee y
$
Sewer Connection Fee
$
Water Connection Fee
$ 1
TOTAL ,._,
$
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FORM U - IAT 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****/*************
!V 1
APPLICANT: �A�d �f JPy- a<1 • Phone UWS S%S'�_
LOCATION: Assessor's Map Number Parcel C; 0--?
Subdivision ]�Y VLA Lots)
Street ('�ju&oc sjrce 1- St. Number '8¢S
************************Official Use Only************************
RECOMMENDA,TIPN OF OWN ENTS:
Date Approved 4611�
Conservation,Admi istrator Date Rejected
Comments
X !2� Date Approved
Town Planner Date Rejected
Comments
Food Inspector -Health
__JA�'
Septic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved Q
Date Rejected
Public Works - sewer/water connections 60
- driveway permit -7:::�7 cd 3-?-��
Fire Department
Received by Building Inspector Date
q
FORM U - IAT 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****/*************
!V 1
APPLICANT: �A�d �f JPy- a<1 • Phone UWS S%S'�_
LOCATION: Assessor's Map Number Parcel C; 0--?
Subdivision ]�Y VLA Lots)
Street ('�ju&oc sjrce 1- St. Number '8¢S
************************Official Use Only************************
RECOMMENDA,TIPN OF OWN ENTS:
Date Approved 4611�
Conservation,Admi istrator Date Rejected
Comments
X !2� Date Approved
Town Planner Date Rejected
Comments
Food Inspector -Health
__JA�'
Septic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved Q
Date Rejected
Public Works - sewer/water connections 60
- driveway permit -7:::�7 cd 3-?-��
Fire Department
Received by Building Inspector Date
CERTIhED PLOT PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE: 1'=50' DATE: 3/29/95
$gott L. Goes R. P. L.S.
60 Deer Meadow Road
North Apdover, Mass.
0-
12.00
51
+20.40
LOT 2A
•x 6,Zx1._ -
0
oCt0 - -
V
O
. 35'+/-
HSE• FNS •
��
�X�gT
'00
LOT 1A
2.002 ACRES
1 CERTIFY THAT OFFSETS SHOWN ARE, FOR THE USE tM of
THE OFFSETS OF THE BUILDING INSPECTOR ONLY
SHOWN COMPLY AND SUCFY USE IS FOR THE
WITH THE ZONING PTERMINATION OF ZONING 1302
BY LAWS Or CONFORMITY OR NOWCONFQRMtTY
NORTH ANbOVER
WHEN BUWT WHEN CONSTRUCTED. q
3� �
Location S j-/ Z b(//A-)!
No. Date
TOWN OF NORTH ANDOVER
O? i • °L A
p Certificate of Occupancy $
41
Building/Frame Permit Fee $
bAna
��� IA
�ss�cNusEt Foundation Permit Fee $ N
�r Pefmit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
Building Inspector
C,l
r,Tp 8261
26q Div. Public Works
"ow y
y-'LAREN H.P. NELSQN • ear ° Town of
Director
�• NORTH ANDOVER
BUILDING
CONSERVATION •Ss„"�,c DIVISION OF
HEALTH
PLANNINGPLANNING & COMMUNITY DEVELOPMENT
CHIMNEY APPLICATION AND PERMIT
DATE — 1-61- 9'5
120 Main Street, 01845
(508) 682-603
PERMIT #
LOCATION IAV / /l= d- ZT -
OWNER'S NAME
BUILDER'S NAME 7°9 ak--
MASON'S NAME A- /7R w rl
MASON'S ADDRESS S'3 /� �-sem lyiT116-
MASON'S TELEPHONE 15- 7 ® 7 —
MATERIAL OF CHIMNEY! Fir
INTERIOR CHIMNEY S%Gy EXTERIOR CHIMNEY
NUMBER AND SIZE OF FLUES
THICKNESS OF HEARTH & /I
Will chimney or fireplace conform to requirements of the code and
have rules and regulations been received:
DATE
SIG14ATURE OF MASON
EST. CONSTRUCTION COST/CONTRACT PRICE
PERMIT GRANTED
CONTR. LIC. # 6 VO
FEE �5 L
ROBERT NICETTA, BUILDING INSPECTOR -0
0 INSPECTED
REMARKS
SOLID BRICK REQUIRED
THIS PERMIT MUST BE DISPLAYED ON THE PREMISES
I
0 )
-- - - - - - - - - - - - - - - - - -
Restricted To: 00
DEPARTMENT OF PU8LTC SAFETY
• CONSTRUCTION SUPERVISOR LICENSE 00 - None
Nusber: Expires: Birthdate: IA - Masonry only
CS 042529 121/16/1995 112/16/19415 IG - I & 2 Faiily Hoses
Restricted TO: 1,0
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-"
Date ...........
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that . i?it. �/ . �. C.!'��i�:. '�-... /. ......... .
has permission to perform ....Llk ..........................
plumbing in the buildings of � !..� ...................
at ..,Y-. C( �.... (".1. h. ./.:"... c............ , North Andover, Mass.
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Fee.Lic. No.. .
1 PLUMBING INSP TOR
Check # � � C'`� cE
5563
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)—��
IW aTH RN210yE1: --. Mass. Date ____-__J-2003 , Permit #
8�S G✓��1 1L- 57- Owner's tVante titO• Irl My ��c1�
- Building Location / /
Type of Occupancy Gs r fit / Ml
New ❑ Renovation ❑ RepiacemenOKC, Plans Submitted: Yes ❑ No
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STARK & CRONK PLUMBING & HEATING Check one:. Certificateinstalling Company Nam
Address Coipotation
308 MAIN STREET, GROVELAND MA. 2486 C
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❑ Partnership
Business Tdephon 978 372-6981 ❑ hmt/Co.
Name of Licensed Plumber
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch 142
Yes'& No O
If you have checked Les. please indicate the type coverage by checking the appropriate box
A liability insurance. policy -0 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the liicensee 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:.
Owner O Agent O
1 hereby certify that all of the details and intonnatiorr I have itted (or ent in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations under the it issued for this application will be in compliance with ail
pertinent provisions of the Massachusetts State Plumbi a and Chap of the General Laws.
lure umber
Title
. Type of License:ni
Journeyman ❑
APPROVED (0 r!C US ONL License Number1027
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STARK & CRONK PLUMBING & HEATING Check one:. Certificateinstalling Company Nam
Address Coipotation
308 MAIN STREET, GROVELAND MA. 2486 C
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❑ Partnership
Business Tdephon 978 372-6981 ❑ hmt/Co.
Name of Licensed Plumber
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch 142
Yes'& No O
If you have checked Les. please indicate the type coverage by checking the appropriate box
A liability insurance. policy -0 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the liicensee 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:.
Owner O Agent O
1 hereby certify that all of the details and intonnatiorr I have itted (or ent in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations under the it issued for this application will be in compliance with ail
pertinent provisions of the Massachusetts State Plumbi a and Chap of the General Laws.
lure umber
Title
. Type of License:ni
Journeyman ❑
APPROVED (0 r!C US ONL License Number1027
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that l.� Pf(..� ...V:.G
............. .........../..................................
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has permission to perform .............................................................. .
wiring in the building of .... `i...
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at......................../..+..??......1.............................. /North Andover ash
Fee ...l. s...:. %(!. Lic. No..A,
... ,47�6',`. ..... 1. Wi t.: ^ ....; ...................
4�LECTRICALINSPECTOR
Check #�
4450
0iir Tommonlurattil of fflassar4usrtts Official Use Only
�^ Department of Fire Services Permit No.
is -
%_ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
(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: Y— 7' 3
City or Town of: Alz I4� %i1i6vt4_ -
To the Inspector of Wires:
By this application of the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) _ �L%� f`�/h kl—
Owner or Tenantd_62 It" o%e�j Telephone No.
Owner's Address SceP
Is this permit in conjunction with a building permit? ❑ Yes Q -'No
Purpose of Building
Existing Service Amps / Volts Overhead ❑
New Service Amps / Volts Overhead ❑
(Check Appropriate Box)
Utility Authorization No.
Undgrd ❑ No. of Meters
Undgrd ❑ No. of Meters
Number of Feeders and Ampacity / J
Loctition and Nature of Proposed Electrical Work: ( p/•aaa 7���L t/ �vt !► `.
(completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above ❑ In- ❑
grnd. grnd.
No. of 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 ns
No. of Alerting Devices
No. of Waste Disposers
Heat Pumpl
Totals:
Number
Tons KW
No. of Self -Contained
Detection/Alerting Devices
I
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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
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. of 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.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may be issued unless the licensee pro-
vides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such.cov-
erage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 2'BOND ❑ OTHER ❑ (Specify:)
Estimated Value of Electrical Work: (When required by municipal policy.)
(Expiration ate)
Work to Start: iU— (% ; Inspections to be requested in accordance with MEC Rule 10, and upon completion.
1 certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: V.e LIC. NO.:
Licensee: If Signature LIC. NO.:E�/96
(If applicable, enter "exem t" in the icense nu ber line. Bus. Tel. No.: �� D
}��_ c�!
Address: %f , Alt. Tel. No.:
OWNER'S INSURA CE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally reqquuired by la yv By my
signature below, I hereby waive this requirement. I am the (check one) ❑ owner [I owner's agent.��5
Owner/Agent
Signature Telephone No. [PERMIT FEE: $11re"
GrIORA CD 11 We'MPC : %AIAOOCKI ._ DnCTI Al (OCk, nn,
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BELOW FOR OFFICE USE ONLY
PERMIT H DATE: IEEE Pte;
NAME OF OWNER: ADDRESS: +~-`
JOB COMPLETED & APPROVED
SIGNATURE OF INSPECTOR
'I'RENCI I INSPECTION:
TEMP SERVICE INSPECTION
ROL GH INSPECTION
PROGRESS INSPECTION
SPECIAL INSPECTIONS:
FINAL INSPECTION:
SPECIAL NOTES:
NEEDED CORRECTIONS:
POOL
WELL & PUMP
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Location y , �� [ �� e S4
M No. `J Date �
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TOWN OF NORTH ANDOVER
F R
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s ; : Certificate of Occupancy $
cHuU E<� Building/Frame Permit Fee $ 3 D D
Sws
,. Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # / L
16673
$ �0
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Building Inspector Inspector
I
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
>7,77-7777-A4" x� fb!'�iCiR)1 US ,lEiriRl �
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BUILDING PERMIT NUMBER: - DATE ISSUED:JJ
SIGNATURE: < C
Building Commissioner/Inspector of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Addr
aye �i%/�► � � QrF
1.2 Assessors Map and Parcel Number:
/
Map Number Parcel Number
1.3 Zoning Information:
Zoning District Proposed Use
1.4 Property Dimensions:
Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Required Provided
Required Provided
1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information:
Public 0 Private ❑ -Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Address for Service
Signature Telephone
2.2 Owner of Record:
qry
Nan e%Prin Address for Service:
Si nature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction rvis�v� �
Licenseed Construction Supervisor:
Address w
r ature s, Telephone
Not Applicable ❑
Lo
LicenseNumber
o s- Qsj
Expiration Date
3.2 Registered Home Improvement Contractor
Not Applicable ❑
Company Name
Registration Number
Address
Expiration Date
Signature Tele hone
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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 permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check allapplicable)
New Construction 0
Existing Building 0
Repair(s) ❑ TAlterations(s)
0
Addition 0
Accessory Bldg. ❑
Demolition 0
Other ❑ Specify
Brief Description of Proposed Work:
,c
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit applicant
6FFIC1CALUSE (?NLY
_,-
1. Building
/
C
(a) Building Pennit 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
Check Number
SECTION 7a OWNER AUTHORIZATION 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 al matters relative to work authorized by this building permit application.
Signature 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 ent Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TIMBERS 1ST2 ND 3
SPAN
DUVIENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
1EIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHEVINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
Rre
FORM U -LOT RELEASE FORM v
INSTRUCTIONS: This form is used to verify that all necessary er approvvals/
Boards and Departments having jurisdiction have been obtained. This does not lreliets ve
the applicant and/or landowner from compliance with any applicable or requirements.
FILLS OUT THIS SECTION
APPLICANT %
LOCATION: Assessor's Map Number gl
SUBDIVISION (5
STREET (1,) her
AGENTS:
PHONE o 40SI/P
PARCEL %--1 f
LOT (S)
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LL
ST. NUMBE=�
USE ONLY ********,,�**��*�**�
ON ERVATION ADMINIS ATOR DATE APPR6VED '�
.DATE REJECTED �
COMMENTS
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH
r
EPTIC INSPECTOR-HEALTH117
OMMENTS l SO^) d �da!,.
DATE APPROVED
DATE REJECTED
DATE APPROVED.
DATE- REJECTED
Ir
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
Revised 9197 jm
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::�7??,FET
NOTE: This mortgage Inspection was prepared
specificcily for mortgage purposes and Is not to
be relied upon as a survey4 EK SURVEY ac Wttr
no responsibility for ddmages
reliance by anyone other than the sold mortgagee
and Its oWgns In connection with its proposed
mortgage Rnoncing to said mortgagor.
CER71FICATION TO:
0 o Im -.
I FURTHER SATE THAT IN MY PROFESSIONAL
T1 �� OPINION the principle atruoturefs and accessory
RUDEL outbuildings, LdA)MgM
No. 36869 With the setback requirements Of the lot:ol
zoning ordlnanowk and that no snahroachmwds
SCG s1E�``� ��' of major Improvements either tray across
NAL LANOSJ� property lines except as sh"n,
®1. Property Is not In a Flood Hazurd Arta.
This cortifitatlon is based on the location of ssy markers r32- Property Is In a Flood Hazard Area
represent PAY Y• 0I information Is Insufffeloat to .datsrrnins Flood Hazard
of others., and does not seat a sures therefore Flood Hazard detatmined Show thvrlidivt Federal Flood
Pile show, arra not to be Nsed for the establishment of Insurance Rate Map Panalf g,6ZWg•q�77G
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 043390
I'
t Birthdate: 05/2611959
- 9
7 , Expires: 05/27/2005 Tr. no: 579
Restricted: 00
RICHARD J AVERSA
825 WINTER ST o -v
N ANDOVER, MA 01845 Administrator
n
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision 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 properly
licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A.
The debris will be disposed of in:
/0, ,
(Location of Facility)
Signature of Permit Applicant
c� O'
Date
NOTE: Demolition permit from the Town of North Andover must be obtained for this project
through the Office of the Building Inspector
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