HomeMy WebLinkAboutMiscellaneous - 94 MEADOWOOD ROAD 4/30/2018Date...- �.I....
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that ... : �� ... �?�.... ..'...<`... ... .
has permission for gas installation
in the buildings of ... ! O.W '�................... .
at .. `� . �`p....�W °.. . ...! •, North Andover, Mass.
Fee... 3 P./ Lic. No. . X 3.5. �.. l�`�? ? 1 1#04j:1
-e.
i GASINSPEC OR
Check # cP- 7 3
4673
0
Date../d- . //..lC).. -
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .....✓7 m.n, ........ c.. . �A ...............
has permission to perform ......
.....................
wiring in the building of ...... / ......
.....................................
at .... /M North Andov6jr4/ ass.
OU —
Fee .... . . ....... Lic. No.A..K*1qP..
JEL , EcrRiCZiN-S* P**E* C**T* 0- R**
Check A -
4873
MASSACHUSLTIS UNIFORM APPUCATON
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building Locations OM nyO-&114\r44z)1
New �9 Renovation ❑ Replacement
PERMTTTODO GAS FfYMG
Date\ ZnwCGcN amL\
Permit #
Amount $ 49
Plans Submitted ❑
Name or type) N�" "y �� c Ch ck on Certi e Installing Company
Co
Address � % ❑ Partner.
Business Telephone X11 "1"1`1- '1� O ❑ Firm/Co.
C.".&\ *-X35C%
Name of Licensed Plu ber of Gas Fitter QuL�. J `-►�� `��
INSURANCE COVERAGE unec ne: .
I have a current liability Insurance policy or it's substantial equivalent. Ye El No ❑
If you have checked yes, ple se indicate the type coverage by checking the appropriate box.
Liability insurance policy ID Other type of indemnity ❑ Bond ❑.
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
i hereby certify that all of the details and information 1 have submtttea (or enterea) in aoove appncauon are true ano accurate to me
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachtt &. tate Gas,,,Code fid Chapti� 142 of the General Laws.
By:
Title
City/Town
OVER (OFFICE USE ONLY)
/'l
Signature of LicenS& Plumber Or Gas Fitter
Plumber 3-)--�s
Gas Fitter T71cense Nurwer
Master
❑ Journeyman
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SUB -BASEM ENT
B A S E M ENT
1ST. FLOOR
2ND. FLOOR
FLOOR
4TH. FLOOR
5TH. FLOOR
I53RD.
6TH. FLOOR
7TH. FLOOR
STH. FLOOR
Name or type) N�" "y �� c Ch ck on Certi e Installing Company
Co
Address � % ❑ Partner.
Business Telephone X11 "1"1`1- '1� O ❑ Firm/Co.
C.".&\ *-X35C%
Name of Licensed Plu ber of Gas Fitter QuL�. J `-►�� `��
INSURANCE COVERAGE unec ne: .
I have a current liability Insurance policy or it's substantial equivalent. Ye El No ❑
If you have checked yes, ple se indicate the type coverage by checking the appropriate box.
Liability insurance policy ID Other type of indemnity ❑ Bond ❑.
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
i hereby certify that all of the details and information 1 have submtttea (or enterea) in aoove appncauon are true ano accurate to me
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachtt &. tate Gas,,,Code fid Chapti� 142 of the General Laws.
By:
Title
City/Town
OVER (OFFICE USE ONLY)
/'l
Signature of LicenS& Plumber Or Gas Fitter
Plumber 3-)--�s
Gas Fitter T71cense Nurwer
Master
❑ Journeyman
f TRE COM(NIDD WEALTH OFM4,SS4CHU,SE7TS Office Use only
DEPAM MENTOFPUBIICSAFElY1 Permit No.
BOARDOFFMPREVEMONREC-MU0///NS527CMR12 M
Occupancy & Fees Checked
APPUCATIONFOR PERMIT TO P REORMELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSA, ELECTRICAL CODE, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) U Date ",-Ilk
Town of North Andover To the Inspector of Wire:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) q Lr Mea n t LA t)
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes ® No F-1 (Check Appropriate Box)
Purpose of Building 4 rjw ;L R 1°f i pe r<,- Utility Authorization No. _
Existing Service p' Amps / Volts Overhead r7 Underground =1
No. of Meters
New Service Amps / Volts Overhead M Underground. No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work m04 i i 61 C5711) 4- .4 : .,r, /.w
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
'o
ground
round
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 Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Othe
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER•
h>sutar=CoWrdW- lam
IbawaamaltLiabibtyhmmwPbhcylnckdmgCml)iet CoverageorgsabsU legtwmbt YES NO
IhavesubrniWdvaWproofofsmrtotheOffim YES fET If)ouhawdrd dYES,Pk%eir>�thetW0fCDVeWby
dred�rg the box �J 1_i
INSURANCE BOND M OTHER Q (Please Specify)
Fsfim&dVahreofF tlWWodc $ `O p so' s -b
WorktOStatt Der, �kgectionDNeRequested Rough ty i �A-1 1 Final
Sri � Pt�rattiesofperjtuy: 14 D
c LiwwNo. I7r'A �q-1
scensee Li .03 VM C. OSignahue �6(MC, LicerseNo
% BtressTel No./ —meq
1'A W N a 8011 �1 f AIT111-relL� —�
)WNER'SPiSURANCEWAIVER; Iamaware thattheLioam does, nothavetheinstuancecovangeoritssu�tialequivalcntaswqurtcdbyMassachusettsC neralLaws
nd that my signahueon this pwnt application waives this requiternerrt
Please check one) Owner O Agent
Telephone No. PERMIT FEE
rgnature 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
Name:
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. Policv #
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 $1,500.00 J
and/or one years' imprisonment_as_well_as.civil-penaltiesinSheSnfm-afa_STOP WORK..ORDERmd.a fine_of.($1D0.00.)-adayagainst_me. l
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date.
Print name
Official use only do not write in this area to be completed by city or town official'
City or Town PermitiUcensigg
FICheck if immediate response is required
Contact
#
❑
Building Dept
E3
Licensing Board
F-1
Selectman's Office
F,
Health Department
Ej
Other
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-OF ELECTRICIANS
REGISTERED MASTER -ELECTRICIAN
ISSUES THIS LICENSE TO
.JAMES VCDO.3LIGH ,!m
JAMES M ?�i'GI�t�A;st�UGH 110
I MEADOW GROPT RD
BURL INGTON KA 01803-1019
8292 A
location C/q Ole IV 00GQ 1?
No. � Date
NORTH TOWN OF NORTH ANDOVER
pi 4«90,,h�O
_ ' L
.. 9
Certificate of Occupancy $
NUS Building/Frame Permit Fee $
AC
Foundation Permit Fee $
Other Permit Fee $
TOTAL $'
-Check #
6896 J Building Inspector
• TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT EMAI& RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
'�Y ."I� CFaN'.. t '4 ya ••^�;n. L SFYF 4'3kH«�° ,.:2
"�-"?r�'T, �' Crd,-,. _ _,� _ _;-. n Y i_� 's' •, _ s *„ .t r�`Y` tau Cn
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE: ✓Iii �f.�
Building ConfmissioneELwLxdor of Buildings Date
SECTION 1- SITE INFORMATION
1.1 Property Address: //
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
1.3 Zoning Information:-fal�
ZoningDisUid Proposed Use
1.4 Property Dimensions:
I Lot Area (so Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard
Rear Yard
Required Provide Regutired. Provided
Required Provided
t.54)
1.5. Flood Zone Information:
1.7 Water Supply M.G.L.C.40.
Public ❑ Private ❑ Zone Outside Flood Zone ❑
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
Historic District: Yes No
2.1 Owner of R
;�Z
Name (Print) Address for Service
�2L
Signature Telephone
2.2 Owner of Record:
Name Pont Address for Service:
Signature Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor:
Address
Signature Telephone
Not Applicable ❑
License Number
Expiration Date
3.2 Re ''stered Home Improvement Contractor
Not Applicable ❑
Company Name
•
Registration Number
Address
Expiration Date
Signature Telephone
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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 all applicable)
New Construction 0 Existing Building 0 Repair(s) ❑ Alterations(s) 0 Addition 0
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
17 A� � �1,,�� � Ot
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
: ' UNCIAL
Completed by permit applicant
1.
Building
/
�C
(a) Building Permit Fee
iP
Multi Tier
2
Electrical
(b) Estimated Total Cost of
Construction
3
Plumbing
Building Permit fee (a) x (b)
�Q
Q
4 Mechanical HVAC
5 Fire Protection
6
Total 1+2+3+4+5
Check Number Ito (o
Cl
M HUN 7a OWNER AUTHOR1ZATi TO BE COMPLETED WHEN.
OWNS, SIA,G�ENT OR CONTRAC LIES FOR BUILDING PERMIT
I, `'"" ` _ �" `"� as Owner/Authorized Agent of subject property
Hereby authorize to act on
y behalf, in all matters r ative to wor authorized by this building permit application.
Signature of Owner 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 knowledge
and belief
Print Name
of Owner/,
Date
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR MMERS 1ST2 ND 3 RD
SPAN
DEVIENSIONS OF SILLS
DRVIENSIONS OF POSTS
DIN ENSIONS 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
Tel: 978-688-9545
Please print.
DA
JOB LOCATIO
X"HOMEOWNER
Town of North Andover
Building Department
27 Charles Street
North Andover MA 01845
HOMEOWNER LICENSE EXEMPTION
Number
SGne.
Number
PRESENT MAILING ADDR
City Town
Street Address
Home Phone
State
Section of To
Work Phoi
Zip Code
The current exemption for "homeowners" was extended to include owner -occupied dwellings
of 1 or 2 units and to allow such homeowners 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)
DEFINITION OF HOMEWOWNER:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which of two
there is, or is intended to be, a one family dwelling, attached or detached structures
accessory to such use and and/or farm structures. A person who constructs more than one home in a
two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official,
a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the
building permit. (Section 108.3.5.1)
The undersigned "homeowner" assumes
Applicable codes, by-laws, rules and regi
The undersigned "homeowner" certifies
Building Department minimum inspectic
comply with said procedures and requir
HOMEOWNER'S SIGNATU
APPROVAL OF BUILDING OFFICIA
compliance with the State Building Code and other
nderstands the Town of No. Andover
and requirements and that he/she will
Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with
State Building Code Section 127.0 Construction Control.
Revised 4.30.03
Home owner Exemptions Form
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 a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
(Location of Facil
Signature of Permit Applicant
Date
NOT!; Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
FORM U- LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary. approvals/permits fry
Boards and Departments having jurisdiction have been obtained. This does not retie
the applicant and/or landowner from compliance with any applicable or requirements.
I *****************************APPLICANT FILLS OUT THIS SECTION
APPLICANT 4v( /tio��, `fPHON �l�I�1-12Q
LOCATION: Assessor's Map Number C2PARCEL /
SUBDIVISION �yw/, p % LOT (S)
S T AEET A `� A W n d �C �� ST. NUMBER-
USE
VUMIBER CY/
-_
USE
RECOMMENDATIONS OF TOWN AGENTS:
--------------
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS s�
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH :"ATE APPROVED
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE ,DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
Revised 9197 jm
2r3
DATE
is -
- cel A Stephen Schiffer
r;,
/re Project Manager
wtection, inc.
Sprinkler Sa1es/Insta11ation/Service
I IA Industrial Way 1-800-537-3331
Salem, N}I 03079 1-603-890-3331
Sprinkler Contractors Lic. 3858 Fax: 1-603-898-9999
Cell: 1-603-231-2016
wmv
m q
Fire Protection
215 Concord Street
P.O. Box 681
Peterborough
N.H. 03458 JEFFREY G. DENTS, NICET LEVEL III
Tel: 16031 924-6696 Design and Operations Manager
Fax: 16031 924-6691
email: jgd@lifesafety.mv.com
S p r i n k l e r S y s t e m Design 6 ins t a i l a t i o n
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Location k -T i5 " F� 41cr-6DoLj,,c b K -b
No. 1 g Date / //0A;,3
r
,►ORTH TOWN OF NORTH ANDOVER
? e O
p Certificate of Occupancy $ FV
__-QuijdinglFrame Permit Fee $
9L 2 ,IrO
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
&r Connection Fee $
i ITOTAL
Ck#12v(P
6181
$ P ( S �.=
,,;,6�t )
Building Inspector
Div. Public Works
Location�`/,MI-Ar.��
No. �' Date
M°"T",
Ot �O
TOWN OF NORTH ANDOVER
"`O '•
? i • O
I. ; %
Certificate of Occupancy
$ Jy�
41
•
Building/Frame Permit Fee
$
,sSACH USEt�
Fougdafibn Permit Fee
$
Other'$ermit, Fee `
$
"3
Sewer 6 hriection Fee $
atgr Connection. Fee $
II a V
Building Inspector
Div. Public Works
r
Location.,' 94 A' -� IeqwQ`J(
No. Date
a
VA
/0- - 1.�5-
.5- -d41,-9?
TOWN OF NORTH ANDOVER
Certificate of Occupancy-
Building/Frame Permit Fee.?1"
Foundation Permit Fee $����'���—
'^✓
Other"Permit Feet/ 4�ect
�S67 Sewer Conn&' �±
-4d" ZS 3 Water Connection Fee
del'
r� ,
"-T,� ja 644
$ X42
TOTAL $ 26 d 0, vo
y & ilding Inspector
DIv 4Pupiic Works
P1
ERMIT NO. APPLICATION FOR PERMIT TO BUILD - NOR7H ANDOVER, MASS. 3 �� PAGE 1
J
MAP 4-40.LO'f
ZONE I
NO.
SUB DIV. LOT NO. /C9 7
2 RECORD OF OWNERSHIP DATE
BOOK 'PAGE
LOCATION
PURPOSE OF BUILDING
OWNER'S NAME_rte
wL/
NO. OF STORIES C12�� IZE
OWNER'S ADDRESS
25
`
Ke -
EMENT OR SLAB
ARCHITECT'S NAME -ranZ7�
BUILDER'S NAME j J0i�
u
an%
SIZE OF FLOOR TIMBERS IST /1 2ND !�l%�
SPAN /
3RD
DISTANCE TO NEAREST BUILDING
�/� /
DIMENSIONS OF SILLS
DISTANCE FROM STREET
�/1 /
((11C
POSTS
DISTANCE FROM LOT LINES - SIDES
/ REAR /Cj/
�J
" GIRDERS Sx Xg
AREA OF LOT ,5i�jO'�
G/iVV
FRONTAGE C %
l�
HEIGHT OF FOUNDATION Q / THICKNESS
IS BUILDING NEW
SIZE OF FOOTING L/) X
IS BUILDING ADDITION A10
MATERIAL OF CHIMNEY Mi
IS BUILDING ALTERATION O
IS BUILDING O EEID R FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /J
C�
IS BUILDING CONNECTED TO TOWN WATER '
BOARD OF APPEALS ACTION. IF ANY
,Q
I
IS BUILDING CONNECTED TO TOWN SEWER G
✓
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES��`
LESS FDA ITE
PAGE 1 FILL OUT SECTIONS 1 - 3 DUE t'u(E FRAME �M ��i /(l� 2 '�-.'9
PAGE 2 FILL OUT SECTIONS 1 - 12 ;ju
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
1 DATE FILED
1 SIGNATURE OF
d
ENT
FEE IV v v
&
PERMIT GRANT
o,?b/ 19�
kj
VAY2519M
OWNER TEL. # Z *Zw
CONTR. TEL. # 2O
CONTR. LIC. #�
cam► 2.0(-:,
& I!F�I
3 PROPERTY INFORMATION
LAND COST.. o - Z)
EST. BLDG. COST d L/, LG Q, �yd
EST. BLDG. COST PER SQ. FT., y�
EST. BLDG. COST PER ROOM �lI'/�%3/�
SEPTIC PERMIT NO. ! [�[�.✓
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
/A 104-1z,� -
BUILDING INSPECTOR
L
_,BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
MULTI. FAMILY _
STORIES
APARTMENTS
_OFFICES
_
CONSTRUCTION
2 FOUNDATION
I
japll
8 INTERIOR FINISH
3 1 2 13
PINE
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT V
AREA FULL
-FIN. B M AREA
_
V. 1/1 /.
FIN. ATTIC AREA
NO BMT
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
4 WALLS I
9 FLOORS
CLAPBOARDS ` n I
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
B
x
1
2
3
CONCRETE
EARTH
HARDIIl D
COMMCN
ASPH. TILE
STUCCO ON MASONRY',
STUCCO ON FRAME
_
BRICK ON MASONRY
BRICK ON FRAME
TATTIC STIRS. 8 FLOOR _
CONC. OR CINDER BLK.
WIRING
STONE OPT MASONRY
STONE ON FRXWr `
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
HIP
BATH (3 FIX.)
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
A
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. 8 COLS.
XSTEAM
STEEL BMS. 8 COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
OIL
7 NO. OF ROOMS
B'M'T 2nd
ELECTRIC
1st —I 3rd
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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FORM U - LOT RELF.ASS 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 lair,,.
regulations or requirements.
****************Applicant fills/ out this section*****************
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APPLICANT: coda wc) ��U it,� CjO,-�J Phone 75- 1126
LOCATION: Assessor's Map Number Parcel
Subdivision kfto6wb6 Lot (s) _
Street /v[f4AQLQ,,),ne4 St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
�E'C Date Approved 2�
Conservation Administrator Date Rejected
Comments
Date ApprovedYJ
Town Planner Date Rejected
Comments
Date ro
Health Agen Date ed
Comments &ZI61
Public Works.- sewer/water connections
- driveway permit -2
Fire Department
Received by Building Inspector Date
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 181 Date SEPTEMBER 1, 1993
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 94 W"WOOD ROAD (lot #15)
MAY BE OCCUPIED AS SINGLE FAMILY DWEII,ING W/1 CAR GARAGE IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED TO Meadowood Realty Corp.
•' " 733 Turnpike S t .
{ ADDRESS North Andover, MA r
s,US Building Inspector
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NOR7M C
TOWN OF NORTH ANDOVER }
PERMIT FOR WIRING
,SSACMUSEt nl
M
This certifies that �/
.......... y ..............................
has permission to perform ...... k.!..���........................................................CU
..2................. q �'✓�...................
wiring in the building of .....};!................ �\ ......................................................
at'
.......�..V.......a!�!t.�?. u G! �y14�UI"dG....... �............. . North Andover,
',r,Y� . i C ...............%........
ELEMICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
ktj�\ Office Use Onln� o
014e &MMV11Wea1t4 of Massar4usetto Permit No.
19epurttnent of Public bufetp Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMA 12:00
(PLEASE PRINT IN IN 0 TYPE AL NF RMATION) Date
City or Town of OETo the Inspecto of Wires:
The udersigned a
Location (Street P
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit:
Purpose of Building
Existing Service _
New Service _
Amps —I Volts
Amps —J Volts
Number of Feeders and Ampacity
t`
Location and Nature of Proposed Electrical Work
Yes ❑ No �10 (Check Appropriate Boz)
Utility Authorization No.
Overhead ❑ ' Undgrnd ❑
Overhead ❑ Undgrnd ❑
No. of Meters
No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
Elgrnd. ❑
grnd.
Generators " KVA
No, of Emergency Lighting 4
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones _
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Loca Municipal ❑ Other
No, of Dryers
Heating Devices KW
Connection
No. of No. of
Low Volta
No. of Water Heaters KW
I Signs Ballasts
Wiring �G � 1,4"e
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES 0 NO ❑ 1
have submitted 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.
INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify)
Estimated Value of Pie t 'c t Wo c $ %1ji:� 6
Work to Start Inspection Date Requested:
Signed under the Penal es of perjury:
Rough
(Expiration Date)
Final T
FIRM NAME LIC. NO. 1231C
Licensee —_ Dnnal d A. Brooks Signature _ LIC. NO. 1211r
Address _- 111 Morse Street, Norwood, MA Bus. Tel. No. (413) 737-4400
All. Tel. No.(7�?7$-1 1'A1
OWNER'S INSURANCE WAIVER: I am aware that the Liconseo does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please chock ono)
(Signature of Owner or Agent) Telephone No. _ ."_ PERMIT FEE $
X-6565