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Home My WebLink AboutMiscellaneous - 90 WINTERGREEN DRIVE 4/30/2018 (4)9 Location No. 5 W Date I J TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee / $ Other Permit Fee rpo 1 $ _--�—=— TOTAL $�' Check # —59,03 14282 /)P///// Building Inspector 1� s 0 d 0 z M 90 0 Mn3 r -C O M r r z TOWN OF NORTH OVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING f3' BUILDING PERMIT NUMBER: o DATE ISSUED: /b �a 0 vo p SIGNATURE: Building Commissioner/I or of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Tr,J M Num Pa ( Nuffiber lob g� 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Di;—&ic—t Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required— Provided Required Provided l30j 3 llsU 'r-0 /v„ I 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: I 1 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record 1i1ct v rr11 l ✓1 ® a� 4 t ti W 1� W 1 T ►i Zl t.� �— ne f-r,�-1 P� Name (Print) �Address for Service: g-& S --G- Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ °"kilos 010 330 Licensed Construction Supervisor: License Number Address ll,,,4 ,,�V/ Expiration Date nature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Pli —j-^ Company Name Registration Number 4 �Z v2-Iz-a� Address 7 �^ 6 �� Expiration Date Sin Telephone 1� s 0 d 0 z M 90 0 Mn3 r -C O M r r z SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 & 2506) 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. affidavit Attached Yes ..... No ....... ❑ —Signed 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: SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant.["','. OffTCIAL.USE 1. Building (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 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS ORCONTRACTORAPPLIES FOR BUH.DING PERMIT IAGENT I, G as Owner/ � subject property Hereby authorize P" 4- Pil to act on MyehaIf, in all matt re at e t work authorized by this building permit application. 2.1 Signature of Owner Date SECTION 7b OWNER/ AUTH IZED AGENT DECLARATION I, ca as Owner/ razed A e f subject property Hereby declare that the statements and in o ation on the foregoing application are true and accurate, to the best of my knowledge and belief j G t e_ " P. r Print Name JJ Si ature o Owner/A ent K Y3 Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 RD SPAN DIWNSIONS OF SILLS DINIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUU DING CONNECTED TO NATURAL GAS LINE C�—, MOUE IMPROVEMENT CONTRACTOR Registration 118204 Type - PRIVATE CORPORATION Expiration 02/12/01 I FAMILY POOLS 6 PATIOS INC GLEMN RIGGIN n� - BROADWAY ADMIN191 R LAWRENCE MA 01843 1 A& A. M+i►l w,+►a of . a�lrraea.r�au�91 60MW OF BU LMOG WGUl.ATOW Uatw: COOOiAUMM SUPEE YMM MCS MGM 0bg1MiM: O mo"sm Ems: 07e1w"I 'V, no: 448 Rssoicbd'f& 00 VA UYYM C Plomas _'/ 92 3 HROADM1� V , cz., `ei 4sw UW043M MA Of ata Adflw4W*W i NOME IMPROVEMENT tONTRACTOR Registration 118204 Type - PRIVATE CORPORATION Expiration 02/12/01 FAMILY POOLS I PATIOS INC WILLIAM C, GIAMOPOULAS ' BROADWAY ADMINISMAWR LAWRENCE MA 01843. PIZ VATv jumlxrr ja o 74EI: .. 1 03/28/2000 (PROOUOER617)846-SOOO FAX (617)846-sloe Zh i rill' I n1a I.C.11 I IFIGA r C. 13 mou IKMA I PUN 1110t. Whittier, Hardy & Roy ONLY AND CONFERS NO RIQHT3 WON TWE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTI!Nb OR Insurance Agency, lnt, ALTER THE COVERAGE AFFORDE10 BY THE POLICIES BELOW, S7 Putnam Street COMPANIES AFFOROING MUM! Winthroa, MA 02161COMPANY, Transcontinental 1 11 n s Co.'. .............. . .... ... . ....... Aft' Daneell Scarrozza Ext, 125 A Abdib...................... .. .......... . .. ...... ....... ........ ... _. ......................... - ...... .................................................... .......... .................. ........... COMPANY Transportation ins. Cc. Family Poo'. & Patio Co., Inc. 92 South $roadway ............... ... ..... .......... . .. I—— ... ............... Lawrence, 14A 01841 COMPANY C ... .... .... .. ........... .................. . ..... ....... ............... ..... .... D n• it LCW HAVE SEEN IS8UiFT:'0'!"+`H!yF INSURE6 NAM' Agmf�MLIVPERIOD INDICATED, NOTWITHSTANDING ANY AECILiAVAGNT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTWITH PE$PEOTTo WHICH THIS 109"FICATIS MAY BE ISSUED OR MAY PERTAIN, ThE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEARIN IS SUBJECT TO ALL THE TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOW-4 MAY HAVE BEEN REDUCED BY PAID CLAIMS. ................................................ ........... ........... CO TYPE OFINSUR,(NCE POLICY NUMDER LIR ! ....... ......... ........ . .... ... F*OLICYI1?R=VZ POLICY EXPIRATION: CATI IMMA)OfYYI CATE1.11IMMOf"I LINITIS OCH&PAL UADIUTY COMMERCIAL GENERAL LIABILITY PRODUCTS - COMPIOP AGO 1 CLAIMS MAD! X OCCUR .......... ............1...000000 PERSONAL& ADV NJUR.. ...........0A 50000 12/31/1999 12/31/2000 OWNER'S &CONTRACTORS PROr �a HO NOSYI 500000 .......... ................ FIRE DAMAGE (Any on* f1rol 9 0 0 MED SXP (Any ww psmon) 5000 AUTOMOMILZLIABILITY ANY Auro;COMBINED SINGLE LIMIT 1.000, 000 ALL OMW AUTOS .......... ....... BODILY INJURY X $CHSDVLED AUOS (Per Psreon) A :3038607 X WIR60 AUTOS 11/31/1999 12/31/2000 ......... ............ ..................S.... ................. BODILY INJURY x NONIOWNEDAJJTOS PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY - SA ACCIDENT 4 ANY AUTO OTHER THAN AUTO ONLY: ..................... EACH ACCIDENT; I ............................... AGORGOAT4 VICM LIABILITY EACH :1 61M00.61,LA FORM .00CURRENCE ............. ... ............ . . AGGREGATE OTHER THAN UMORELIA FORM ..........I............. ............... W"AfRS COMPENSATION AND OPLCYOW LIANUTY X 8 THEPROPAVOW �CC155942897 EL EACH ACCIDENT 1 100D00 12/31/1999 12/311/2000 ix INCL PARrNERSI9X901MVG ...... E. DISEASE -POLICY WMIT 4 500000 O"ICIRS AREPXCL; , . .. .. L16: E 0 S 1 AS EA E . 6 , M F , IL 0YE. . ff 3 ................ 100000 3111RIFTI n OF 1LrXATION31VE•MICLEaf3PLwCIALITfUS R5 `q' -1111-.-.:Pffil� W., SI YOFTHEA BED POLICII ELLED 31faft THE XPIRATION DATE THEREOF, TN M►ANY WILL EN VCR TO MAIL WAI"ll ECEIR AM60TOTWILIVII, BUT f1A1 $A ON I 082 IGIATION OR UASIWYY KIN U 1" :1 Insured's Copy Paul Roy 11 *R%244 t� I - - - t- 66 Y-3 C- -1,Derw A Poe J FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. Issssrrrsss■ r■ssss••ssss•■■■sss••rsss•rrs••ssa■■rrsrssssssr■■rs■rsrrrrss■ss APPLICANT PHONE ASSESSORS MAP UMBER LOT NUMBER SUBDIVISION LOT NUMBER k) '�� L� n p a STREET _ �(� STREET NUMBER ! �rrsrrsrr�i i■rrrr'TiTTY�'rararTirssrrrrrrisrrrrrrrsrrrrrarrrar r rrrrrarrrr■ OFFICIAL USE ONLY. RECOMMENDATIONS OF TOWN AGENTS •■•ssrassssssrsssrssrssssarsssssrssssssssrsss■rrrrrsrrsrrr■ yr rsrrarssssssa �� S DATE APPROVED CONSERVATION ADMINISTRATOR n DATE REJECTED CO M6 l'1 Ly v� DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS_ DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED Mlvo n SEP INSPECTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER ! WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPART ENP DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE E R. CT 2 E E t,,1 DfZ1V F �QU/2�i1.1�11�7' ........................ 4T/ON ATIzy.Qq .(TOP OF STONE). ;;TIOAIS N 4T �EQU/PED Flu. ............................. DES/�N QS OO&T //OUSE Nk z IZ`.o3 F TQNAV D. BOX 3. IZL E 1017-1.0-1 �O/v E BE N/S N07--,4 iI14,e1e4/VTY SYSTEM BUT .4 11E,2/F/C,47_10N OC.4TION OF TWE E,1'/ST/lv,�; FS qs BU/Lr., SUB-SU�PF,4CE c SYSTEM /N F02 1LY1Lvc NLE 14 AN N�-44 5C.4LE: C,1E/ST/'1NSEN ENS 7 N6, /NC. 0/4 1<'EN02,4 .4 VE., W4 5LOPE 26:01111FE t. ENT - r Y ' (150)x =15030= .5 ........................ DE5/6N EL EV4T/ON 4TrLIA M .(TOP OF 57 -ONE) _ ... � 3 : �� EX/5T/N� ELEWT/ON 47 ......... l2EQU/eEL�- D Flu-- .............. &E-4T/ON.5 DE5I4iN 4.5 BU/LT INV PIPE OUT OF,UOUSE INV P/PE INTO T4NK INV PIPE OUT OF T,4Nf � INV PIPE INTO D. BOX Z; //VV PIPE OUT OF D. BOX INV END OF PIPE z a� GV,1 TE1C EL D14 TION ,4 VE ?,46E STONE oEPTN .47 1,01E05E NOTE.- T1115 PZ-,dN /S NOT ,4 W4,P,P,4NTY OF THE SYSTEM BZIr ,4 AE1e/F/C,47-10N OF T11E LOCATION OF T11E EEXI.S T/NC S7-lPUCTU2Z75. ,45 BNZ�' SUB-SaPF.4CE SYSTEM /N FOR =�tcvc_ `_�NLe la nn SCALE .- 1`7:1-\o CIlte/ST/,4NSEN ENC, /14 XENOZA .41/E., A,, LQ Hcr,' � L U) m M U) 0 m CO) 'O C d � d O C9 Z y CD O �. CL C'! CZ _• CO) o p CD CD o CL c� =r "C m CD CD o CD C C CD y� —• CD CL0 CO) O I COCD F p CO) O O CD O CCD c c_?� O d = O -• y O C' ti 3 d0 trS�' •0 y -� - m C2o !7 'O00.C.) m Z y =r'fl CA �a,00 1-0 d 0 Er CD �o an d o y h O 'O "o j O ?C 0 = 0 0 0 0 A O mIm O, 0 ••► 0 GO a SAO r� to 0 ?�s 4c CD cnO m m •�t OCLHIm ?� � a 0 , CAv = .* * CD: Go o` Soo OO O z D 0: cn O � � z cnto C3 oq CD �. o C m . 4L (/) O cn a ai ?f w x T F : G r b Z CA 00 b ro Mo x � � z I1 y 0 Woi 2 5 8 8 Date ...................../.......... NORTH °a<�``° '•�"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatnn ( ...!\....�.tG.k�G:.......�........:.�?°.C".................... has permission to perform � /-i // �J��.�..//....... L....:............�........ t� wiring in the building of .....��.1!.. NJ `:!.!!..!° S .` n (� �fn at�6':....��r......�,n��.:.?..�r.'.....!1.�:........�� ......:...........`NorthAndover, s. Fee:..v..k<. .... Lic. No../ 9) .... .�?� �s... ...��..... ELECTRICAL INSPECTOR Check # J� ✓ WHITE: Applicant CANARY: Building Dept. PINK: Treasurer �✓�Yy�G�/�i1�.�P%�f a� ilz�ss�G�s��s De�iantar:eort °b �u�lce Sa�etq BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only rQ' Permit No. rS o Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date I % 1 �-- b 0 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & / V Owner or Tenant P3' 6?rI yI±P Owner's Address Is this permit in conjunction with a building permit Yes 0, --"No ❑ (Check Appropriate Boxj Pu ose of Building_ h S /�C nc ,c-, Utility Authorization No. ------------- Existing Service Amps Voits 1 Newtervice Amps Voits Number of Feeders and Ampacity Location and Nature of Proposed Electrical fB� Overhead ❑ Overhead ❑ nL Sv./ Undgrnd ❑ Undgmd ❑ No. of Meters No. of Meters No. of Lighting Outlets No. of Hot fuseTotal No. of Transformers KVA Above ❑In No. of Lighting Fixtures Swimming Pool grnd ❑ grnd Generators KVA No. of Receptacles Outlets .No. No. of Oil Burners of Emergency Lighting Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone etection and Devices ounding Devices L No. 'f Ranges Total No of Air Cond Tons No. of Di osal Heat Total Total No. Pumps . Tons KW No. f Dishwashers S ace/Area Heatin KW Self Contained n/Sounding DevicesNo. of Dryers Heating Devices ❑ Municipal ❑ Other KW Connection No. of Water Heaters KW No. of Signs No. of Low Voltage Bailases Wirin No. Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES = NO = 6�have-subrrrliied�valid proof of same to the Office YES = NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. N BOND = OTHER = (Please Specify) Estimated Value of Electrical Work$_ 7,,9 . Qy (Expiration Date) Work to Start Inspection Date Resquesteds/�� C,::;7 �/ Rough Final Signed underthe�jenalties of penury: ; /Q'� FIRM NAME /t I C 110r r �f LIC. NO. ., 8 % Lrkensee JS 1( �qyp� �j� tyles Signature��c? v LIC. N0.13(T ��& Bus. Tel No.. 7,!?, Address�/ Alt Tel. No. F-7, OWNER'S INSURANCE WAIVER: I am aware that the Licens s does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) �`� • `� (Signature of Owner or Agent) Telephone No. PERMITTEE $ N2. -I / 3 9 �Date...... . .. CAS ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4L This certifies that ............ I* . ............. has permission to perform-.,....................... .... . .................. ...................................... wiring in the building of.............. . at ............ North Ando, Mass. ............. ....... ............... ]i ree ............... Lic. No . .... ................... al .......... ELECTRICAL INSPECTOR 06/28/99 13:24 35-00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer U Office Uv 0.1c The Commonwealth of Massachusetts pr. it No. f�39 Occupancy k Fee Check.d �'a rtment of Public Safety /; 3/90 Oan%w bianrl OA RE PREVENTION REGULATIONS 527 CMR 12fl0 ICATION � MAP U FOR PERMIT TO PERFORM ELE ICAL All work to be performed In accordance with the Ma"achusetes Electrical Code. S27 C (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of %A . 4:nd over To the Inspector of Wires: RFC CPY The undersigned applies for a permit to perform the electrical work described below. Q ',1V RCT ACT Location (Street & Number) CID V�e Own e r or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No 1� (Check Appropriate Box) Purpose of Building 11D_5'1 de (4� C_( Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meter. New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of rieters N=ber of Feeders and Ampacic)r Aacion and Nature of Proposed Electrical Work ,AIo. of Lighting OutletsNo. of Hot Iubs No. of Transformers iota! k -VA No. of Lighting Fixtures Swia�ing Pool Above ❑ In- ❑ grnd. grnd. Generators KVA No. of Receptacle Outlets No. .of.Oil, Burners No. -of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE. ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. ,of Self Contained Detection/Sounding Devices Local ❑ a Other Connection No. of Ranges No. of ,lir Cond. local tons No. of Disposals Total Iota! No. of Pumps KW No. of Dishwashers Space/Area Heating KW No. of DryersMunicipal (Heating Devices KW No. of Water Heaters KW No, of No. os Si s Ballasts Low Voltage /�� Wiringf7lc M tNo. Hydro Massage Tubs INo. of Motors Total H? 'f071? rR: INSURANCE COVERAC'c: Pursuant to the requirements of Massachusetts Ceneral Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES F� NO [] I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE � BOND ❑ OTHER F-1(PleaseSpecify) ' !Expiration Date) Estimated Value of Electrical Work S Work to Scart Inspection Date Requested: Rough Signed under the penalties of perjury: Final FIRM NAME_B r�D, ks �a SG � LIC. 011. C IS l Y Licensee /� 4rjs J Sy l Ve.S JSP Signature I WW J LIC. NO. C, IS lL Address ISS W=i S} Sti. AS r Bus Tel. No. 'Y —GSA �OyH ` Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts Ceneral Laws, and that my signature on this permit application waives this requirement. Owner Atzent (Please check one) BC .44A Telephone No. Signature of Owner or Agent PERMIT FEE S 0 Location-/, f---' No. Dated DD- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Buiiding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $5r i Check # 0 ' Building Inspector= D" TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERIVIIT NUMBER: > j DATE ISSUED: a o C. SIGNATURE: Building CommissioneEftEtor of Buildings Date I SECTION 1- SITE INFORMATION i 1.1 Property Address: Winl Nil 1.2 Assessors Map and Parcel Number: Map Number Parcel Number d Address for Service 17th -55�s FSgn-fi lephone 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Frontage ft 1.6 BUILDING SETBACKS 00 Signature Tele on Front Yard Side Yard Rear Yard Required Provide R red Provided R red Provided 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone 1.7 Water Supply M.GL.C.40. 54) I.S. blood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHMAUTHORIZED AGENT 2.1 Owner of Record t�{ a e Name (Print) . Qm�� d Address for Service 17th -55�s FSgn-fi lephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele on SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Tele hone l 6 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 au a Ucable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: I SFCTTON 6 - F.STTMATRD CONSTRUCTION COSTS 1 Item Estimated Cost (Dollar) to be Completed by permit a licantu Out ng �. �,�. AR USE�QNLY�'M , a �;�� , 1. Building (a) Building Permit Fee Multi lier 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 d Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT IY(j l? PSS as Owner/Authorized Agent of subject property Hereby authorize to act My be in all matters r t' e to wo authorized by this building permit applica�onon. ✓/ D / Si na of Owner Date SECTION 7b OV4WNER/AUTH6RIZED 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 knowledge and belief Print Name Signature of Owner/Aent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This. does not relieve the applicant and or landowner from compliance with any applicable requirements. ■■■■■■■■■■■■■■■■■■■■■■..■.■■■.■■.■■■■■.■■■■■■■■.■■�■■■■■■■■■■■■■■■■■■■■■■■■ APPLICANT ASSESSORS MAP NUMBER ��' `� 8 LOTSNUMBER SUBDIVISION// LOTNUMBER q STREET -IJ i /11'{'r�li zed �rl Ve STREET NUMBER i.ago .■ owe .n.■..n.n....■n..was n..■■ass .■..n■ mug museum memos .■...........■..■ OFFICIAL USE ONLY ■....■.....■■..■■......■..s■.....■.■■■.■...■■■...■■..'■.■■..■n■..■.■....■■.■ RECOMN4EN1DATIONS OF TOWN AGENTS igrow ....... wagon .....n■■......n.n■■■.■.■■■■.■............■......*..■.■..... /-9✓4� DATE APPROVED �_ �! CONS VATION ADKff111STRATOR DATE REJECTED COrRvIENTS o s C l DATE APPROVED TOWN PLANNER DATE REJECTED CO;\Rv1ENTS DATE APPROVED /66D INSP OR TH DATE REJECTED DATE APPROVED S 7Z INS CTOR - HEALTH DATE REJECTED COMMENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DA D. Robert Nicetta Building Commissioner (978) 688-9545 -. (978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street . North Andover, MA. 01845 o "UnTF, -N N - a HOMEOWNER LICENSE EXEMPTION Please print AV % DATE �/ o JOB LOCATION Number 4i„ eet Address Map /lot "HOMEOWNER v 60 /%/1 ti° (5i l /'J /7PS'J• � 7A Name .' me Phone ` Work Phone PRESENT MAILING ADDRESS City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeQwners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1 j DEFINITION OF HOMEWOWNER: . Person(s) who owns a parcel of land on which he(she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or fans structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" eowner' assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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