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HomeMy WebLinkAboutMiscellaneous - 95 LIBERTY STREET 4/30/2018Date .'/`� . � D . 0-q"paT„ TOWN OF NORTH ANDOVER , .. o • 11'O PERMIT FOR PLUMBING s ,♦ SS US y.�....��. This certifies that ........ `. ..............:.... . has permission to perform .... l!.............................. plumbing in the buildings of ..u- G!j�!` ................. . at ...�y�.:..�j. �A ty... fid`." ""....,North Andover, Mass. Fee.,.0. Lic. No..I?W .. ....... . ---1 ......... �UWING INSPECTOR Check #� NIFORM APPLICATION FOR PERMIT TO DO PLUMBING. CityRown:���r'Tf 1 C)VOY , MA. Date: o� �_ Permit# Building Location: Owners Name: Type of occupancy: Commercial ❑ Educational ❑ industrial ❑ institutionai ❑ Residential New. ❑ Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes ❑ No I have a current liabilityinsurance policy or its'substantlal equivalent which meets the requirements of MGL. Ch.142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ' ❑ Signature of Owner or Owner's Agent Owner E] Agent 1 hereby certify that all of the details and Information t have submitted (or entered) regarding this application ani true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this appPeation wilt be in compliance with all Partinent.provislon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. BY Type of License: Title ❑ Pi mbar Signature of License umber !aster I f . License Number: APPROVED OFFICE USE ONL ❑Journeyman fi p FIXTURES z t!f -Z O 2 V W i1C C m N to W y t- . ui N .a y y u 4 CJ 3 Z Q t - c ii a !n a o 0 Q tr W ? �, z Big QQV Q IL O O 0ice- y J '� 1% IZ ice— m m D O IL Ca'i = Y iat uZi H` O SUB BSMT. BASEMENT _!W FLOOR 44-- 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR B FLOOR — Installing Company Name: Check One Only Certificate ## AddressA2 /6-�n,/,12 .�,,/: orporation Stater r � Business Tel- 1.' ' • T <�, v ; pax. ❑Partnership {,� ❑ FinWCompany Name of Licensed Plumber: .. 1 j J,// )uy I have a current liabilityinsurance policy or its'substantlal equivalent which meets the requirements of MGL. Ch.142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ' ❑ Signature of Owner or Owner's Agent Owner E] Agent 1 hereby certify that all of the details and Information t have submitted (or entered) regarding this application ani true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this appPeation wilt be in compliance with all Partinent.provislon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. BY Type of License: Title ❑ Pi mbar Signature of License umber !aster I f . License Number: APPROVED OFFICE USE ONL ❑Journeyman fi p Location f � Lr P��`f S` No. 3 1 @- Date lo -,51-03 f MORTM '1 TOWN OF NORTH ANDOVER O�'••'e ,'. + , 0 0 P Certificate Occupancy of $ �'�s'"'•'�tt' s�cHuet Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ 3� Other Permit Fee c. $ - TOTAL $ -30— O—Check C A Check # 16854 Building Inspector e Town of North Andover Office of the Building Department Community Development and Services Division William J.'Scott, Division Director 27 Charles Street North Andover Mas a h —44q 01845 s c u e Telephone 978 688-9545 D. Robert Nicetta Fax 978 688-9542 Building Commissioner �� ��4- 54-r) 011�- APPLICATION AND PERMIT (� R 3 (• 0 a DATEel 30 4/ PERMIT # LOCATION 9S OWNER' S NAME y`^,� kl "'g BUILDER'S NAME ' MASON'S NAME MASON'S ADDRESS MASON'S TELEPHONE MATERIAL OF CHIMNEY INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE SIGNATURE OF MASON CONTR. LIC. # EST. CONSTRUCTION COST/CONTRACT PRICE PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES 13(}ARD OF APPEALS 688-9541 BUILDING 688-954.5 CONSERVATION 688-9530 HEAL 1-H 688-9540 PLANNING 688-9535 WOOD STOVE INSTALL4110N CHECKLIST p Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stover�� &6D A. New -(/— J ROII/�_Used. B. Type/radiant Circulating C. Manufacturer f 2 ._. —Lab. No- Name/Model No. i//4if _ CnIlar size 3" Dimensions/ Height _ I_•?ngth Width Chimney A. New Existing B. Size (flue area) _ C. Other appliances attached to flue (Number and flue size) D. Prefab (Manufacturer—name and type) E. Masonry/Lined Flue liner _ Unlined wpe F. Height (refer to diagrams) cap CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to diaoram) Clearances and Wall Protection (see stove installation clearances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE i conNER • t2�� Nllf(. 12 \ 'IN. Ig" MIN. ( rlJ 9L, A;�,H �LGc77 y1 HEARTH WALL/CENTER 4 1 0 i t a 14 14 i w° cin U CIS w° p w .0 U C X U pW,, a� p r�4 G ix a o W uA a W xm O a: chi co G is: O E, 2 o O 04 G h. F W � . A c 7 as co o cn 14 14 i c. o h m C C o it cc, N co a s� .n dC 14 14 i a y h i N C 0 v m cm CIO L cm C �C N CD Z O Z C) 3 0 F. I R a 2 O O O L O t7 Z °o CL O H 1 c Q' C O■� ca "0 O E mm CD CD O � i R O a CL a co Q C C� C.3 J •p FL o O go Z CD CL C..3 ca c C C _c 0. H w U) CD w W Cc uiW CD c. o m C o cc, N co a dC O O m C 1� ;= O cc o H � Ea m CF . = is C, a N o U �CM c ' N A :gym o �m�3p C" O J •: C C T •� 3e� � m . C N O E S 1� = c o 9 :C Q .O N ,C= y O C3O z 'C.�O n m C = m Le O ~` 1c ~ �0+ W VJ m .0 C ID Hh .E CLS= V fm7 LLIci cm C.3 CD COD K _ o h a y h i N C 0 v m cm CIO L cm C �C N CD Z O Z C) 3 0 F. I R a 2 O O O L O t7 Z °o CL O H 1 c Q' C O■� ca "0 O E mm CD CD O � i R O a CL a co Q C C� C.3 J •p FL o O go Z CD CL C..3 ca c C C _c 0. H w U) CD w W Cc uiW CD 4026 Date ........ /. %ORTpf TOWN OF NORTH ANDOVER PERMIT FOR WIRING *ATID SA ZTbis certifies that �.A4... .5E.0 ........ ... .............. has permission to perform ........ "MMA ..............5. .................. wiring in the building of ..... o ..................................................... at ...........c. ............Gr rth Andover, Mass. Fee ..O.: ...... Lic. No.0 .... ............. ... .......... ZE R Check # V 4 i Commonwealth of Massachusetts Official Use Only X/ Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Oev. 11 /99y and Fee Checked � 1 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC , 2 C rIR 12.00 (PLEASE PRINT IN INK OR Ty A INF RMATION) Date: ®a City or Town of: �_ To the Inspec r of Wires: By this application the under.gne gives'ootr'ce fhis or hetinten to perform the electrical work described below. Location (Street & Numbir) -� Owner or Tenant " -J Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system No. of Recessed Fixtures � ' r vcuvwtn No. of Ceil.-Susp. (Paddle) Fans 'eMay oe warvea Dy the Inspector of Wires. No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency ig ing Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total No. of Alerting g Devices No. of Waste Disposers Heat Pump Totals: NumberTons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E] Municipal ❑ Other Connection No. of Dryers No. o Water Heaters KW Heating Appliances KW No. o No. o Signs Ballasts Security of Devices or E uivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: uu y uesueu, or as reyuirea oy the inspector of wires. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) Estimated Value of E ctri 1 Work: "' (When required by municipal policy.) (Expiration Date) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th pat s and penalties of perjury, that the information on this application is true and complete. FIRM NAME:LIC. NO.: 15��f Licensee: John S. Bdssett Signature LIC. NO.: 1533C (Ifapplicable, enter "exempt" in the license number line) Bus. Tel. No.: 6n.1594 592$ IL Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid, see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ `/�/� '*3953' Date ....... Z6� `" �' TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. ..............5�......... ............................. has permission to perform.........��j .. /c? . -? ...... 44 ... ....................................... ..... ... ... wiring in the building of ............ ........................................ I 0 ......... ................... ......X.......5 ........ North And:io,,_ve ,M Fee..I..,,r ..... ....... Lic. No .. ... ........... ........ ' ELECTRICAL IN ­'S " CTO R'... Check �1 A 1 e Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC) 5;7 CMR 12.00 (PLEASE PRINT WINK OR TYP A L IN ORMATION) Date: �a City or Town of: n� To the -inspector o Wires: By this application the undersigned gives n ttce.of his her mtentt n to perform the electrical work described below. Location (Street & Number) ~-7 j , , Owner or Tenant �n [�L,L 1('� Telephone No. Owner's Address % Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps ! Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature. of Proposed Electrical Work: Yes ❑ No V (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters _ Overhead U Undgrd ❑ No. of Meters Installation of Security system I-,.,,., loti— fh., ! 11.».d.,., #-AAL ,., , t,,... .,..r L.. .i _ r.-----`- No. of 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 AboveIn- Swimming Pool rnd. ❑ rnd. o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I.Number I Tons I KW I No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or E uivalent No. o Water KW Heaters No. o No. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach aaaaronai detail g 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 issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) / 4# — (Expiration Date) Estimated Value of El etrica Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the ains and penalties of perjury, that the information on this application is true and complete. FIRM NAME:Security LIC. NO.: 15 _j_jC Licensee: John S. Bassett Signature llg LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 603 594 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Lic, see does not have the liability insuiance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ a Q Location �ta' No. '.i Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Founda ion Permit Fee $ Other -Permit fee'� Sewer Connection Fee Water Connection Fee $ d C� Building Inspector I�6203 Div. Public works PER11IT NO. J I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 AGE } MAP 4.10. LOT NO. 2 RECORD OF OWNERSHIP !DATE BOOK P ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING /U `V OWNER'S NAME ^ ` C l.� NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME i [� ( p n \J"c SPAN --- DISTANCE TO NEAREST BUILDING i DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES — SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY " IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 12 - ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATUR7 OWNER OR AUTHORIZED Ag ENT F E E + PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST i EST. BLDG. COST 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 UILDIN INfPECTOp WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer r 'NV -1d 101d S30V1d3M SIHl 'O3S0dW1H3df1S '013 'S39Va -VE) 'S3H02d0d H11M 'S°JNIO11f19 JO SNOISN3W10 10VX3 aNV S3NI-1 101 WOUml 30NV1SIO ONV 10130SNOISN3W10 10VX3 MOHSisnW N01103S SIH1 ZL C10DIN JNicmn9 - ONIIV3H ON D180313 _I P'E I ytl P.6 OOVO 3111 boold 3111 110 SWOON dO 'ON L SVO S3dnTol N83(JOW Sd31V3H LINfl `JNI300a 1106 _ 63MOHS 11VIS O.1.H 1NVIOV6 ONINO1110NOJ aIV aOdVA 60 6.1.M lOH WV31S _ _ S631JV6 OOOM 'S10D V 'SW9 1331S 'S10:) F SW9 839WI1 ON19Wflld ON 'N6f13 aIV 1OH 03D601 3JVN6(13 SS319dW 31V1S 1SIOf OOOM )(NIS N3HJ11)( 0NIIV3H Ll I ONIWVtld 9 'NV -1d 101d S30V1d3M SIHl 'O3S0dW1H3df1S '013 'S39Va -VE) 'S3H02d0d H11M 'S°JNIO11f19 JO SNOISN3W10 10VX3 aNV S3NI-1 101 WOUml 30NV1SIO ONV 10130SNOISN3W10 10VX3 MOHSisnW N01103S SIH1 ZL C10DIN JNicmn9 NONlWOJ H16V3 OOVO 3111 boold 3111 S319NIHS OOO.N S3dnTol N83(JOW 3130NOJ `JNI300a 1106 _ 63MOHS 11VIS 6 13AVa0 S 6V1 ON19Wflld ON N63OOW 31V1S _ )(NIS N3HJ11)( S30NIHS DOOM A6O1VAV1 S3I ONIHS 11VHd5V 13SOID 831VM O3HS 1Vld 1369WV°J I'm 61 W6 131101 06VSNVW 'X43 EI H1V9 j dIH 318VO 9NI9Wn1d 0L Joon 9 Good �I 3aO1OdaS ONItlIM 3WV63 NO 3NO1S .16NOSVW NO 3NO1S )(l9 a30N17 60 —I a0013 Y S61S JI11V 3WVad NO )(D1a8 kdNOSVW NO ?17169 II I 3WV6J NO O:)Jl11S NONlWOJ V3aV JI11V NIJ I '/a `/1 V36V .1.W.8 'N 13 r 11(13 V36V 1N3W3SV8 £ N13Nn 11VM AM 631SV1d I Sa31d �I3NI1 t— )(.19 3136JN0: EI Z I 8 r7-3138DNO: ., HSINIi tl01831N1 $ NOUVONf10d Z N0110f1U1SN00 _ S1N3W16Vd\ S3IJ30 AIIWVA mnv s160!S AlIWV3 31ONI! A0N Vd (1000 L H16V3 S319NIHS OOO.N 3130NOJ ONIQIS dOaO S17aV08dVD Stloold 6 S11VM 17 N3HJ11)( N63OOW II W008 OV31-1 V3aV JI11V NIJ I '/a `/1 V36V .1.W.8 'N 13 r 11(13 V36V 1N3W3SV8 £ N13Nn 11VM AM 631SV1d I Sa31d �I3NI1 t— )(.19 3136JN0: EI Z I 8 r7-3138DNO: ., HSINIi tl01831N1 $ NOUVONf10d Z N0110f1U1SN00 _ S1N3W16Vd\ S3IJ30 AIIWVA mnv s160!S AlIWV3 31ONI! A0N Vd (1000 L WOOD STOVE INSTALLAHON CHECKLIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove .� A. New Used 8. Typelrariiant Circulating C. Manufacturer % Lab. No. Name/ Model No. size Dimensionsi Height y Length o7 3 Width Chimney A. New P Existing B. Size (flue area)C. Other appliances attached to flue (Number and flue size) D. Prefab (Manufacturer—name and type) E. Masonry/Lined Flue liner Unlined woe 6 manWacturer) F. Height (refer to diagrams) cap CHIMNEY HEIGHT Hearth (non-combustible) A. Materials B. Sub -floor construction C. Minimum dimensions (refer to ciaaram) Clearances and Wall Protection (see stove installation c!earances chart) A. Type of wall protection provided B. Clearances (refer to diagrams) FIREPLACE ConNER HLAHIH WALL/CENTER. 13 INSTALLATION AND OPERATION INSTRUCTIONS for the MAJESTIC® R369 RC36 Zero Clearance Fireplace IMPORTANT: Read all instructions carefully before starting installation. Failure to follow these installation instructions may result in a possible fire hazard and will void the MAJESTIC warranty. Save this manual for future reference. MMESTIC Copyright Majestic Co. 1986 P 9 Accessory Chimney Band 0 I"ESiIC. SECTION 3 (3 Wall Chimney Components) Description I Model No. Used ONLY with 3 wall chimney to reduce air infiltration. TWC8A MAJESTIC Fireplaces are listed, certified, and/or accepted by leading national and local building codes and authorities including: Council of American L a�s Building Officials Underwriters' Laboratories, Inc. � ®'� Report No. NER181 THE MAJESTIC COMPANY, HUNTINGTON, INDIANA 46750 74-12-285 RII/587 mss. f�' {� �,.. �'ri'.�l'i�•a;: ., �....- - ... ., Location No. P2.f ? '� Date HORTM TOWN OF NORTH ANDOVER O�t��ao ,a,ti0 6 O O? • •� „ Certificate of Occupancy $ ,!Me -4 Q + ; + Building/Frame Permit Fee $� *� c►+usft - Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ S TOTAL ,, - • JJ��ty+� 9i3 Building Inspector �� 6211 Div. Public Works PER\ffT, NO. / Anlr :2 MAP KVO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 INSTRUCTIONS SEE BOTH SIDES - PAGE 1 FILL OUT SECTIONS 1 - 9 `t PAGE 2 FILL OUT SECTIONS 1 - 12 -� ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE ;FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR °" FEE rIA- V// `d PERMIT GRANT D 19 % ( 4 I9002 '} P OWNER TEL. # CONTR. TEL. # CONTR. LIC. 4 - 3 PROPERTY INFORMATION L)�-ND COST -:3u A EST. BLDG. COST EST. BLDG. COST PER SQ. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY N BOARD OF HEALTH PLANNING BOARD 41x � BOARD OF SELECTMEN 1 I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE ZONE SUB DIV. LOT NO. — LOCATION PURPOSE OF BUILDING OWNER'S NAME /A II�JS 1 �41 V l�� NO. OF STORIES y SIZE`T. v OWNER'S ADDRESS ` r� �1 I-IC� J I\ BASEMENT OR SLAB � ���, ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST pX (6 2ND ::;p,>< , O 3RD BUILDER'S NAME 6 ��' SPAN—cam DIMENSIONS ILLS ( \ v DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET a - POSTS DISTANCE FROM LOT LINES - SIDES (� REAR J,a G / GIRDERS �j v AREA OF LOTf n 1 �r� S FRONTAGE( 11 HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW p 0 SIZE OF FOOTING X IS BUILDING ADDITION . 1G MATERIAL OF CHIMNEY IS BUILDING ALTERATION G IS BUILDING ON SOLID OR FILED LAND Z (, WILL BUILDING CONFORM TO REQUIREMENTS OF COD1 IS BUILDING CONNECTED TO TOWN WATER 13 V BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IJQ IS BUILDING CONNECTED TO NATURAL GAS LINE isG INSTRUCTIONS SEE BOTH SIDES - PAGE 1 FILL OUT SECTIONS 1 - 9 `t PAGE 2 FILL OUT SECTIONS 1 - 12 -� ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE ;FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR °" FEE rIA- V// `d PERMIT GRANT D 19 % ( 4 I9002 '} P OWNER TEL. # CONTR. TEL. # CONTR. LIC. 4 - 3 PROPERTY INFORMATION L)�-ND COST -:3u A EST. BLDG. COST EST. BLDG. COST PER SQ. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY N BOARD OF HEALTH PLANNING BOARD 41x � BOARD OF SELECTMEN 1 I BUILDING RECORD 1 OCC ANCY 12 SINGLE FAMILY vs�oulEs THIS SECTION MUST SHOW EXACT. DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY QFFICES LOT LINES AND EXACT DIMENSIONS �OF'BUIL'DINGS.• WIYH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. J is ' n 1 L ;_ CONSTRUCTION 2 FOUNDATION CONCRETE CONCRETE BL K. ---III BRICK OR STONE PIERS _ 3 BASEMENT 8 INTERIOR FINISH PINE _ HARDw D— PLASTER DRY WALL _ UNFIN. AREA FULL V FIN. B'M'T' AREA '/. '/p % FIN. ATTIC AREA _ NO B M T FIRE PLACES HEAD ROOM MODERN KITCHEN i _ -(-' 4 WALLS g FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES - CONCRETE EARTH B 1 2 �_ 3 _ _ ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME _ _ HARDIV D COMMON ASPH. TILE BRICK N MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 OOF 10 PLUMBING GABLE GAMBREL HIP BATH (3 FIX.) MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY _ WOOD $HINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING A 11 HEATING WOOD JOIST FURNACE FORCESS FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GOAL B'M'T 2nd 13t 13rd ELECTRIC NO HEATING J is ' n 1 L ;_ 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 and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************A p p l icant fills out this section******************* APPLICANT:C !7 ri 6_1 co�, %6 Phone b o� LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street l BR'Ti' S -T— St. Number e ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Approved Conservation Administrator Date Rejected Comments Town Planner Comments Food Inspector -Health Septic Inspector -Health Comments Public Works - sewer/water connections - driveway permit re Department Received by Building Inspector Date Approved Date Rejected Date Approved Date Rejected Date Approved Vr / Date Rejected Date f q-� 9\ 4 T4 11 ch EW t ... . ...... 7F4 sr TJO TIALZ 4 1, Le 3 ;gym CJ - i y 0 o N N m0 m Z M X W oo°n N m F_ D T� O >A D o C Dy O Z OI 0� cmc s 'o m c -A f W 6i�am y �.r D. N om" O O S m J m 1 N v, z W oo°n N F_ £mi � D s►: �: J OI cmc a=Om A 6i�am y �.r rr "g a 000 0%m VI co mm O ypT O x 00 9 M W n N Z Paz` m Z Comm `O > 04 C fA 3ET o m �O m to A o rn m Nr -+ Gm N r c I X-430. '0 Z ul = C Z ° z m m m s• �v z m0 m to >om t a � Z 0, om m o i -6-4 C O n 04 err c O 00 ►A Z to o /N� �/ O O < s o 06 a t/i 00 W N a � %A A < n m r A _ r 3NIl �NQI� OIOf N O Cf N �j m Z H m Z C, c z N 3 m m '4 Z a m o o '4-.. O N MG O T O D n m C) . _ �� � ZO S m mlip 'm M m�� m O � c r O m A a �L O'�4 Mme. D oo m o O M J 0 tS� �.s' m m Z Z (A �O �" = c� -4 O m Z m m m 00 m N � H Z N -n m -'1 mmj C { 37 m e TERMS C 1 PLEASE DETACH AND RETURN WITH YOUR REMITTANCE (D"q4 PAY LAST AMOUNT ROBERT LANGEVIN IN T"IS COLUMN PRODUCT 95-1 COI, I (:.. SAL Jones Boys Insulation Inc • M P.O. Box 266 Danvers, MA 01923 (508) 777-0629 I " faX (508) 7744694 /tel f. �4?' �r tiGe Mlrt"i�ip v. 95 Liberty Street April 23, �. AAdover a • ,• t. - a a n .hli:(171'1:J,.: ow, Dear Kr. Kip, We hereby subuit•,eetimates and specifications as follows; 8" A-30 Kraft faced batta in ceiling, 3V R-11 Unfaced batts in 2nd floor exterior walls. 31" R-11 Kraft faced batty in box in >3 ;,tnirwell (attic), common p<Jrc etween bedrootas and .bathroom partitions. Poly oa walls. proper vents where required. TOTAL STOCK AND. -LABOR $860.00 PLEASE SIGN AND RETURN ONE COPY. INDICATE APPROXIMATE DATE INSULATION WORK SHOULD COMMENCE. Thank you.... l WE PROPOSE to furnish labor and material —P complete in accordance with above specilicatior, corldrtions found on both sides Of this agreement, for the sum o1. , Eight Hundred Sixty Dollars no/cents dollars - Payment to be made as follows: ) '/3 To start, balance upon com letion. Work will not commence until receipt of si ned contract proposal and deposit. ---- - - - ---- - p-�-.�'os a(:,:1. %'rED. rh© above pncas. spur,trcv(on; and condinor;_ ,� ,,--�- ,IruJ :ur hereby aCCbpled. You dru uuthor,zed to do the ;vCrr, ;,5 ;r'� �.rro ,=,Etil-ulry 5Ub0W:";;. ._. ---- Il'.JY"lo'Nt will be made as ouninue auove, (Head to sloe/. . Date of AcceptanceBy j Py Hitch Turcott Nolochis proposal may be w,rhdr,ntn by us r,' nota .. ; jy - SUBJECT TO TERMS AND CONDITIONS OtJ da s BOTH SIDES OF THIS CONTRACT PROPOSAL OFFICE COPY i 150 Liberty Street NORTH ANDOVER, MA 0184.5 _ 0001026DATE: 2 l S/� / u 3 a 1. i % f✓ Z LLrH�Li%{' L/p�f��� s o • TERMS SALESMAN F.O.B. CUST. ORDER NO. DATE SHIPPED SHIPPED VIA OUR ORDER NO. -� DESCRIPTION QUANTITY - UNIT PRICE AMOUNT I I --V I , .. s Is s - -- - ,,��., A - D - ----- - _ _ --- - - ,-- , 4__ -- I — ` -'--:-7 -� ✓( is 0 = LTR - --� 7. I— — - --- a -- -...---------- - --------------- J�7L - - i - - - ------------- I ,...__.._. I rr;;CDM h:iCilard Gacxoch ELECTRICIAN iv Erving Road Ivo, t. I h n0 -Over , ria . 0184 jc87-5o5� Bill TO: _L P- i r i i e n' . i , ;voice 11508) 687.6059 r II Richard M. Gacioch Electrician MA# E26468 NH# 8620 16 Irving Rd. • North Andover, MA 01845 Reference. Client Rep. Payment Terms= _., _. .,ow r ,t _at r Iters Description of Charges --------------------- Units Charges -- `, - r place r, oxt©wu- - 0 .0U 'Y TG'i" 1.1`({'�1 'i fllOt.OY .J F:1. "d Com; cviner . OUTLE 120 volt [: E FECTR11 iCIriiV 1� yrvi r: r oad Andover , Viiia . 0184-_5 Fill To: C118n� inv..lct Invoice Number Invoice Date= Client Number= t. 0. Refer en,ce L11 n - P- . Payment Terms' I down r .ut lute:. 2 - Bath, Combination Fan and Light, switched seperately. A Budget of 3s80.00 Payment is due on or before= 08,127,'93 Please remit payment to: Richard Gacioch Nontaxable Subtotal Taxable Subtotal Sales Tax Invoice, Total E-' a •� �_ �. 0.00 0.00 2150.00 ?1t�0.00 0.00 X150.00 for BOTH fans and Exaust Kits will be included. REC.CES5ED LT Reccessed Lights;- 120 volt, round 3 - Recces:,ed 'for Master I4 . ,,Fixtures, �, Bedroom. A 'Budget of $1;'20 for 1 O . .00 -` ALL Three Fixtures is included. n.1/ -' ' 1��^'lC7 SMOKE DETECT 1'20 volt, 3, wire, inter -connected 1.0 1 - Smoke Detector, located in Attic, connected to existing Detectors, ATTIC LIGHTS 120 volt, stand ard light sockets 1.0 �`- Attic Tights, controlled by a swith' -the bottom of stairs. P. TOTAL Total Estimated Cost of Job 1.0 Includes ALL parts and Labor unless otherwise noted. Light Fixtures, :witch and receptical plates are not included. These will be,: supplied by owner. ALL permits are included. Payment is due on or before= 08,127,'93 Please remit payment to: Richard Gacioch Nontaxable Subtotal Taxable Subtotal Sales Tax Invoice, Total E-' a •� �_ �. 0.00 0.00 2150.00 ?1t�0.00 0.00 X150.00 LICENSE#: 0222472471 GRANT BURNER SERVICE , COMPLETE BURNER SERVICE—INSTALLATIONS 28 Coolidge Street • Lawrence, MA 01.843 • Phone: (508) 851-4637 / (508) 681-8697 add yea 14'9 an 63�- Rr� &iseboa,� ��n�� ��✓h��e� Ua�u� 3 fl�O�rox. 16v,-C�aPI� l���in5 r� N,moun`�r �l,3ss� vhank'Y oR/ LK&A cn ;9 m m m m m DO M�l m C3 CO2 CO) CD 0 Z co Ic D 5• CO) >CO -0 O CD CD t7 =r c CD CD 0 CD mm a. CD co) CD O co) to CD CD O CD 0 CD I -ill O E -.q CD D2 O. N 0 cr Ndc C2 R co -0 rZ cm (a n CL C.) CD � = CO) �cp -- CL CL 0 m co . M CA CD CA -* CD :E ge . -0 C3 O D . C C,: cl RP C42 CD Ap Ca EL r- CD co CD C- Gn CD CD CD um C, O C3 C, Er a. CD C31 . . . O = C) r: CD 0 =O CA su 42 o 0 o c') z 0 m Cf) Cl) M 9 - r 0 z 't m 7j 0 i x Wo tp- n �o o r a C/) 0 T- CL cn 7Ct 0 0 0 C) C) 0 tT, M I it CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 257 (1993) THIS CERTIFIES THAT Date JUNE 16, 1994 THE BUILDING LOCATED ON 95 LIBERTY STREET MAY BE OCCUPIED AS FINISH SECOND FLOOR IN DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. o, ,AORTW , CERTIFICATE ISSUED TO Agatha Giglio 3: •:N "% 95 Liberty S t . �± ADDRESSNo MA Building Inspector Location (?S /1JpO/7' S'` No. J9 Date -C/ Check # )03 TOWN OF NORTH ANDOVER Certificate of Occupancy $ BuildinglFrame Permit Fee $ D Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i 6439 /to( -� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DE�MrOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER:, DATE ISSUED: 3! ' SIGNATURE: Building Commissioner4ps Zctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rapired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: a Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Re\r�i, N (Prin Address for Service S Sig re Telephone 2.2 Owner of Rec d: Name Print Address for Service: Signature Tele hone 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 Telephone Ma M 0 v m 0 Z M 90 O r v M r _r z 0 Y 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 ❑. Existjng Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: d 3 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OMCIA) VSE ON'Ll 1. Building Bp (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee Via) 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 11 d� I, n 2f_� c (-�' , as Owner/Authorized Agent of subject property Her autho e i C L GrM S fr'l, L/�yt_; to act on M belt lf; i 11 matters rclae to work authorized by this building permit application. i na e of Owner Date `Z SE ON 7b OWNE THORIZED 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 a Signature of Owner/A ent Date NO. OF STORIES SIZE a BASEMENT OR SLAB SIZE OF FLOOR TINMERS I ST 2ND 3RD SPAN DM ENSIONS OF SILLS DM4ENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS S17 -E OF FOOTING X MATERIAL OF CIUVINEY 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 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION ( �PPLICANT PHONE_ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) p STREET__ Lt ST. NUMBER **********************************OFFICIAL USE ONLY******************************* AI RECO NDAT19,NS F WN AGENTS: , r CONSERVATION ADMINIST OR DATE APPROVED 8 DATE REJECTED e� 1 COMMENTS No kkilA_S 4"„ TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMME DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9197 im DATE 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: J l- C� G�'►l5 true W- Address Z o v`- Y4 4afi ,1 17%Veelf City:i � Vir / 0 2.476, Phone #: 7 E i LI PSS Insurance Co. t1Yi CIL 6~6AN Policv # -5-W-2 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 and/or one years' imprisonment.as_weU_as_cimi penaltiesinihelnrm-&A STOP WORK_ORDER..and_a.fine_cf_(.$100-00)-aidM against.me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensina. Building Dept ❑Check if immediate response is required E] Licensing Board p Selectman's Office Contact person: Phone #. E] Heath Department ❑ Other . 16 11XIq MORTGAGE INSPEC77ON PLAN N0. ' 95 LIBERTY STREET IN 7 NORTH ANDO VER, MASS. MIDDLESEX SURVEY INC. LAND SURVEYORS 131 PARK STREET NORTH READING, MA. 01864 SCALE'`' l "= 80' DATE.• OCT. 5, 2000 CER77nED TO. MORT. NETWORK, INC. r r NOTE: CORNER 0 OVER PROPERTY C1R. LyOo rv. .w LIBERTY STREET J_ CtL ZZ. - NOTES: Nc 1. OFFSETS ARE NOT TO BE USED TO ESTABLISH PROPERTY LINES.2. LOT LINES ARE COMPILED INFORMATION. "°S 9 REGISTRY OF DEEDS ( ESSEX ) DEED BOOK 4076, PAGE 52 1 HEREBY.CERTIFY BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF THAT THE STRUCTURES ON THIS PLAN ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND CONFORMS WITH THE TOWN OF NORTH ANDOVER ZONING SETBACK REQUIREMENTS AT THE TIME OF CONSTRUCTION AND THE PARCEL IS NOT IN A FLOOD HAZARD AREA AS SHOWN ON F.E.M.A. MAP. COMMUNITY NO. 250098C ZONE: X EFFECTIVE DATE: 6/2/93 P11080 Jul Z0 00 12:26p Daly ~"9 '94 15:59 CRE NORTH ANDOVER a LOT 6A 978-685-1667 Well LOT 3 381.60' � 48.0' nor � 43,899 S.F. 005TWG TANK /� EMSMNG FNDN. TF / -219.44 E70S11NG 0-9OX o� aya, EASuT::h- a '193.SOr -tel LOT 1 Well a ELEVATION TO TOP OF PIPE DWELLING: -- TANK IN.- 218.45 TANK. OUT: 216.2D D— Box IN: 216.05 D -BOX OUT. A 215.80 B 215.80 C 215.80 D 215.80 END OF DISTRIBtrripN LII A 215.46 B 215.50 C 215. Sq D 215.54. P.1/7 ~THIS IS TO CERTIFY THAT i HAVE INSPECTED THE CONSTRUCTION OF THE SAID DISPQSAL SYSTEM LOCATED AT IAT 25LIBEr ST" NORTH ANDOV�, MA THE S ARE AS SPEQ n XN THE PLANSICATIONS DATED 7/20/88 BY TI. AS BUILT SEWAGE DI- SPOSAL SYSTEM PLAN IN NORTH ANDOVER, MA. AS PREPARED FOR MARK CONSERVA SCALE 1"=80' DATE APRIL 1969 MARCHIONDA & ASSOC., INC ENGIWERWC AND PLU MNG CONSULTANTS 80 MAPLE STPFM R. F. D. 18 ( 17MPL434 MASS. ) 6121 02180 1LANCRESTM NH 03103 (803) 434-8725 p.4 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: WeS &:U -, i%/tee (Location of Facility) x Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Tel: 978-688-9545 ttOR71y q O sieo e �O Town of North Andover Building Department0.�9goq ''yr 27 Charles Street 9SSAC14USES( North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. DATE k Z { JOB LOCATION X_ C,W- Number c�Str-e7et Address U J_2Y-1, G Section /of Town "HOMEOWNER l / Y'(S�S ` / 2 _2Q1, Ild2- 6 Vt10 f Number Home Phone Work Phone PRESENT MAILING ADDR City Town State The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less 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 109.1.1) Zip Code DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of larld on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory 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 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that Building Department minimum inspe on r, comply with said procedures and r quire i HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFICI understands the Town of No. Andover s and Muirements 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. C/) 71 m m U) m 0 m v V1 'v C as O CO V! C') co n zy CD O -o _ = O CZ 5 y o p CD CD o Cr CD CD o C CD yCD. O y CD S v y O 'O z CD CD 0 C CD m o.. 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