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HomeMy WebLinkAboutMiscellaneous - 980 WINTER STREET 4/30/2018 (2)/' iI'l ' ._/"� � ,.� Date. f . �. ... o �'..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . .. ! . G'.../�. fir. y.�? .:....... . has permission for gas installation in the buildings of !!............................... at ...... North Andover, Mass. Fee. ? . .... Lic. No...f...! .f... .. I:.. `.... ...... . GAS INSPECTOR Check # y i 3115 -� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING tv (Print or Type) ;.lit- MA Date a-3 2CIQ;1- Receipt# Permit# Building Location �°j�'�e �� OwneesName ��`�ils�1 /b�/i/s�rred I� JF' -a3 Map • Lot: Zone: Type of O=pancy C A New Ude Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ Fee: � Y ¢ W N V1 C (n O W W ¢ O U — N Z Q } m Z � Z Q W Q ¢ O m cn W �- Q w ¢ w a 2 O a O W r En Crc7 Lu Q W _ z �- — N O ~ > w W LU (n cn J = H Q Z 2 W S W CW7 S O W 7W W F U -1 N H ¢ W F Z O 2 W = O W - Q W > O O W — O W ` a 0 x> c n. f- o SUB-BSMT. BASEMENT 1ST FLOOR I U S 2ND FLOOR I r' 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name EASTERN PROPANE & OIL, INC. Address 131 WATER ST DANVERS SLA 01923 Estimate Value of Work: Business Telephone 800-322-6628 Name of Licensed Plumber or Gas Fitter Checkone: Certificate XCorporation ❑ Partnership ❑ Firm / Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of,MGL:Ch. 142. Yes ®---- No ❑ If you have checked Yes, 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 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. Checkone: Owner , .. Agent❑ Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowiedge and that all plumbing work and installations ,performed underthe permitissued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the I aws,,.. By Type of License: Plumber Signature of Licensed Plumber or Gas Fitter Title Gasfitter a Master License Number City /Town I L -I Journeyman APPROVED (OFFICE USE ONLY) b Reused 05117= N O T m m T z r Z m n O z cn m n m U) .D O G1 m cn cn H a m n O z 3553 Date..Z—. ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 1. Thiscertifies that ................................... . .................................................. has permission to perform ..... .............. . ............................................... wiring in the building of... Z- ............................................................................... ................... . Norah Andover, Mass. ................ Fee -..-.--',N7) ........... Lic. No::.. . ... ............ ......... .............. .......... ---ELEcrRICAL INSP,R Check # 12 Official Use Only Permit No. Occupancy & Fee Check f BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 C Rg1 00 (Please Print in ink or type all information) Date )ot 6) j? To the Ins ctor of Wires: Town of North Andover The undersigned applies for a permit to perform /the electrical work described below. Location (Street & Number ___ -_-2 �0 6( /N 7 Owner or Tenant 7-r ku z_ f miAl-r Owner's Address 1 Qq I1J2 Nib/5 11 - Is this permit in conjunction with a building permit Yes 9 No ❑ (Check Appropriate Box) Purpose of Building S. /✓ C2G£ Ml L `/ �, (,6/f t L f V G Utility Authorization No. Existing Service Amps� Voits New Service A Amps_/z_ Overhead ❑ Overhead ❑ Undgmd ❑ Undgmd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work S tV,I-r14-i 1 1A A / I Al Jf m b"i _i�- I�?� CL iZ 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 = 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) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties FIRM NAME LIC. NO. LIC. NO. U , / Bus. Tel No. 1 Address IAJ O b t (J7 -;r h U� � � Alt Tel. No. —7 3-11J �?4—� 6 J2 2 NS • OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not hav_ e.the insurance covera9substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requge or iirement. Owner Agent (Please Check one) Oma+ No. PERMIT°FEE (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ gmd ❑ Generators KVA No. of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers Spa rea Heatin KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Total HP 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 = 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) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penalties FIRM NAME LIC. NO. LIC. NO. U , / Bus. Tel No. 1 Address IAJ O b t (J7 -;r h U� � � Alt Tel. No. —7 3-11J �?4—� 6 J2 2 NS • OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not hav_ e.the insurance covera9substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this requge or iirement. Owner Agent (Please Check one) Oma+ No. PERMIT°FEE (Signature of Owner or Agent) NORTH 0 A i ( _ • • i 'Y1617�_$' ,SSACHUS� This certifies that .. i. Date. / ?. 3.. `.'. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING has permission to perform ... /A.r `r..`.'..`` ............... plumbing in the buildings of ... �................... at .... .�L^.... �. ........ , North Andover, Mass. r Fee.2. ?. ? ..`.. Lic. No.. / (-J ..... ...... ,.. }� ........ . /PLUMBING INSPECTOR Check # i `d? 5116 A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO`DO PLUMBING (Type or print) j NORTH ANDOVER, MASSACHUSETTS Date�— Building Location CNO W tt� Owners Name \24Src7 ' — Permit # of Occupancy New [! Renovation M Replacement FIXTURES Amount � 2-0: Plans Submitted Yes [] No F1 (Print or type) Check one: Certificate Installing Company Namei A C c�/ Corp. 6 Address �-®- �%® Partner. Business Telephone7 e� 7 yj Firm/Co. Name ofLicensed Plumber: L mac, Z,44,4 Insurance Coverage: Indicate th e o insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations7PIuZbiCcoA�der P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State d apter 142 of the General Laws. By:igna Ot Licen um er /,re of�lu bing License Title (`� City/Town rcense um eTi r� Master Journeyman APPROVED (OFFICE USE ONLY ❑ Date..!...!. ..� . ? .... . o= ` °•° TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ......... k �� has permission for gas installation .. �. L'... ..� .:..:........ . in the buildings of ..... .:.................................... at ... `.. ......`.....�.. !............... , North Andover, Mass. Fee. .�.a..... Lic. No...1�.?: .. �.: ', ....... . GASINSPECTOR Check # S > > % 3911 MASSACHUSETTS UNI MRM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date�- NORTH ANDOVER, MASSACHUSETTS C Building Locations 6 � )01-47) Permit # 3 l Amount $ 7 j Owner's Name B STr tez -- New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type)(//rye+ one: Certificate Installing Company Corp. 1 Address �� . 19 y c O ❑ Partner. Business Telephone �' - �(- 1) c j ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter � 64"4f--.1Axy49 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indi to the type coverage by checking the appropriate box. Liability insurance policy 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 ofthe 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 nereny cerary that an or me aetaiis and mtormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State,$as Cede a_QjIapt9e142 of the General Laws. VED (OFFICE USE ONLY) _Shpature of Licensed Pl b Or Gas Fitter Plumber V as Fitter TICense NuMber Master ❑ Journeyman I (Print or type)(//rye+ one: Certificate Installing Company Corp. 1 Address �� . 19 y c O ❑ Partner. Business Telephone �' - �(- 1) c j ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter � 64"4f--.1Axy49 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes, please indi to the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I nereny cerary that an or me aetaiis and mtormation 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State,$as Cede a_QjIapt9e142 of the General Laws. VED (OFFICE USE ONLY) _Shpature of Licensed Pl b Or Gas Fitter Plumber V as Fitter TICense NuMber Master ❑ Journeyman N I Town of North Andover�NORTN ' qti O taw , Building Department 3+ , 61, OO 27 Charles Street o -= North Andover, Massachusetts 01845 41 (978) 688-9545 Fax (978) 688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCY / INSPECTION ADDRESS LOT NUMBER SUBDIVISION ! DATE REQUEST FILED yh 91 D ,a I j DATE READY FOR INSPECTION i ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION FEE OF TWENTY-FIVE ($25.) DOLLARS WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLIC? BLE CODES. SIGNATURE OFFICIAL USE ONLY ROUTING ! CONSERVA PLANNING DATE DATE G/ — / 6) — �--� D.P.W. — WATE METER 1 X01 &,9 3h' )oZ DATE y-/7-bz D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. i SIGNATURE / DPW AUTHORIZATION i Z CL C V 00Z O� 08 � W 0 c LL 0 Z a� v W C) � f , N :I W A _ .,, V I/ ID M co O CD GC Z O y co .E O L CD C O 03 V CO) 0 0 �O. CO2 C V m 0 is GD C. CO) c CD CM c o c p 'D CID m H = 3� O Q o a. C. ca � C ' ev '0 O O Z CD CL. CO) C 0 W Ir W k 'Ile C H V ; ; o oj ° N m W C A ° Q w° w ° cn w 0 cn cn = o ® m� .,, V I/ ID M co O CD GC Z O y co .E O L CD C O 03 V CO) 0 0 �O. CO2 C V m 0 is GD C. CO) c CD CM c o c p 'D CID m H = 3� O Q o a. C. ca � C ' ev '0 O O Z CD CL. CO) C 0 W Ir W C O C H V ; ; o = ~0 C HCf* N m W C A � V c oc CA E vN z o = o ® m� _ t= o Cos L -_C= O CD o'. _ �► •. m r N E c CD rn 2: CD L m 3 VN V cm� m� H i CA O vl �C o Q : N Qmo ,. m V N Z C . .,, V I/ ID M co O CD GC Z O y co .E O L CD C O 03 V CO) 0 0 �O. CO2 C V m 0 is GD C. CO) c CD CM c o c p 'D CID m H = 3� O Q o a. C. ca � C ' ev '0 O O Z CD CL. CO) C 0 W Ir W C O C H r.+ `^. C. ® Y N 0�3 = ~0 m N 0.2 N m W C . r = _ � r.+ r oc CA E vN z o oo a o y m� _ t= o Cos L -_C= O .,, V I/ ID M co O CD GC Z O y co .E O L CD C O 03 V CO) 0 0 �O. CO2 C V m 0 is GD C. CO) c CD CM c o c p 'D CID m H = 3� O Q o a. C. ca � C ' ev '0 O O Z CD CL. CO) C 0 W Ir W Location (� No. Date�— NORTH TOWN OF NORTH ANDOVER t �: Certificate of Occupancy $ 5CU ;�a '••a° E<�' s�cMus Building/Frame Permit Fee $ a � Foundation Permit Fee $ Other Permit Fee $ % 5 TOTAL $ Check # 33 `S 1 5 1 5 0 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION. TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY .DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/1ctor of Buildings Date sr,'U 1!Ur4 I- SIL I X IN YORIVIATIOIN 1.1 Property Address: ar,%, l lq-Plv 2 - rKUFEJK 1 Y V WINERSIUVAUTHORIZED AGENT 1.2 Assessors Map and Parcel Map Number Number: Parcel Number Name (Print) Address for Service: 1.3 (Zoning Information: 1 � Zoning District Proposed Lge v/.��,,� r- l Imo' ' 2.2 Owner of Record: 1.4 Property /Diimeensions: r � b" J 4l _+ Lot Areas 7 i AV / Frontage ft 1.6_BUILDING SETBACKS ft N e Print Address for Service: L — 2- — � Front Yard i na re , Tele hone Side Yard Rear Yard Required Provide Required Provided Required Provided Licensed Constructio Supervisor: OJT Z2.�/ License Number 1.7 Water Supply M.G.LC.4o. 54) 7 Public Y Private ❑ L5. Flood Tone Information: 1.8 Zone 15—b� 3 Outside Flood Zone ❑ Municipal Sewerage Disposal System: ❑ On Site Disposal System ar,%, l lq-Plv 2 - rKUFEJK 1 Y V WINERSIUVAUTHORIZED AGENT 2.1 Owner of Record k Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: CyLym, as L �r `�i4�s Ue�L d �9 ➢`?Ji^i✓/J/ I� 'nor N e Print Address for Service: L — 2- — � i na re , Tele hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constructio Supervisor: OJT Z2.�/ License Number Address G Z ' Z �� 0/10 _z_ Expiration Date ignature.. Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ ' Company Name Registration Number Address -Signature Expiration Date Telephone E-1 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 ...... IC No,......❑ . SECTION Descriptio -In o ProosedWorkcheckaila Hcable.. New Construction '�; Existing Building ❑ Repair(s) ❑ Alterations(s).. .❑ Addition ❑ Accessory Bldg. ❑ Demolition -.� ,'�!+ Other ❑ Specify Brief Description off Proposed Work: I SFC TIrON 6 - FCTTMATF.n r 0NCTR1Tf TTnN VncTc I Item Estimated Cost (Dollar) to be Completed by permit applicant . . . . . . BASEMENT OR SLAB 1. Building(A) SIZE OF FLOOR MMERS Building Permit Fee Multiplier / f .50 0!' 2 Electrical 0 -(b) Estimated Total Cost of Construction yX L 3 Plumbing_ K L Building Permit fee (a) x (e) r7 C/� 4 Mechanical,(HVAC) 5 Fire Protection 6 Total 1+2+3+4+5 / Check'Niimbei 40 X SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPL)S.ES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION / -// . Y 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 /th Tlate NO. OF STORIES 2,- Z SIZE Z BASEMENT OR SLAB Gl79 Q SIZE OF FLOOR MMERS Ax P" a X 2 No?� 3PD SPAN / Z ' DMIENSIONS OF SILLS yX L D11v1ENSIONS OF POSTS K L DIMENSIONS OF GIRDERS - Z Y / Z HEIGHT OF FOUNDATION M ' THICKNESS < '' SIZE OF FOOTING 40 X X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND v IS BUILDING CONNECTED TO NATURAL GAS, LINE A0 In Location / /2 No. C�,-? Date Id -11-01 �_NORTy, TOWN OF NORTH ANDOVER Check # C! r 15210 —d Building Inspector Certificate of Occupancy $ ��s''�•°'tt�' sA2NU5 Building/Frame Permit Fee $ Foundation Permit Fee $ s. Other Permit Fee $ r, TOTAL $ Check # C! r 15210 —d Building Inspector 'j 9 20 l j i t'l -rnz fAri,6CL-A (49.61 s&-) 14-7, t I x=Br CaRmy ro in 1Jo„o µ ODvv�a 6L&, vcpr; rmr mr F nru, to wca n Ox r Lor A8 =VN AM raAr rr nose Com7roRI[ MM r=-U►WQOIr n/o, ^Nowff"0 Ix0 BaOOLtrloxS Ra o Mnwm iPmw mcirs & Lor inme • r nmrmm cun” raur rms Fvtsr, m LOCAl9f;D 8 !' MnM AM LB Imo f 250098 aV70 t7sE?'EI'J G -2q 3 PL* "!�rrv-E ET PLOT PLAN IN DRAWN FOR W 1"IAA -1 �AafOTT S 1 0- 11401 UBRRIYACK RMCINBRRRING SRRVICRS BB PARK SrBaar ANDOYRA YASSACIIUSMS 01610 cr 401 'j 9 20 l j i t'l -rnz fAri,6CL-A (49.61 s&-) 14-7, t I x=Br CaRmy ro in 1Jo„o µ ODvv�a 6L&, vcpr; rmr mr F nru, to wca n Ox r Lor A8 =VN AM raAr rr nose Com7roRI[ MM r=-U►WQOIr n/o, ^Nowff"0 Ix0 BaOOLtrloxS Ra o Mnwm iPmw mcirs & Lor inme • r nmrmm cun” raur rms Fvtsr, m LOCAl9f;D 8 !' MnM AM LB Imo f 250098 aV70 t7sE?'EI'J G -2q 3 PL* "!�rrv-E ET PLOT PLAN IN DRAWN FOR W 1"IAA -1 �AafOTT S 1 0- 11401 UBRRIYACK RMCINBRRRING SRRVICRS BB PARK SrBaar ANDOYRA YASSACIIUSMS 01610 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*********************** APPLICANT %/ �' LD��/d�v 0,4 LAG"'" PHO - �L- Jq 3 2f 6 _. LOCATION: Assessor's Map Number l�J,/, p PARCEL SUBDIVISION LOT (S) STREET � ST. NUMBER ****** *********************************OFFICIAL USE f 11 ONLY*********************************** �,'lirr[TI� COMMENTS W TOWN AGENTS: ISTRATOR DATE APPROVED _ DATE REJECTED C °dam ;I. Neuf `I " MVS U TOWN PLANNER - DATE APPROVED O 3 O+L'_ DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED % f DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS ,dL` DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECT R DATE Revised 9\97 jm Buildinq Value Calculation - for Property at..... LOT# Room Length Width Sq.Ft. Cost per Sq.Ft. Total Cost Kitchen - 65 $ - Brkfstnook - 65 $ - Dining Room - 65 $ - Family Room - 65 $ - study/office - 65 $ - Living room 32 24 768.00 65 $ 49,920.00 Garage - 35 $ - Entry - 65 $ - 2nd floor foyer/sitting 36 24 Sunroom 864.00 65 $ 56,160.00 - 65 $ - mudroom - 65 $ - Walkin closet - 65 $ - Basement Finished 65 $ - Balcony - 65 $ - Screened Porch - 35 $ - laundry - 65 $ - Bedroom 1 - 65 $ - Bedroom 2 - 65 $ - Bedroom 3 - 65 $ - Bedroom 4 - 65 $ - Lav / Bar - 65 $ - Bathroom - 65 $ - 1/2 Bath - 65 $ - Bathroom 2 - 65 $ - Bathroom - 65 $ - Balcony - 65 $ - GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVER BUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. L11101;1 fe.- /ay13 3 Permit Applicant Property address Map / Parcel Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 ofthe Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further 1 understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for building permit for the enlargement, restoration or reconstruction of a dwelling in existence as the effective date of this bylaw, provided that no additional residential unit is created. The lot(s) was / were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals, where all of the conditions of 8.7.6are met and or represents dwelling units for senior residents, where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land For purposes of this section "senior" shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40 % permanent reduction in density (buildable lots) below the density permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit ( all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that year. One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY, WHETHER DONE TO MY KNOWLEDGE OR NOT IKJROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE DA' ' THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 10-26-2001 DATE OF PLANS: 10/10/01 TITLE: 980 Winter St COMPANY INFORMATION: William Barrett Homes COMPLIANCE: PASSES Required UA = 665 Your Home = 558 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA CEILINGS 864 30.0 0.0 30 WALLS: Wood Frame, 16" O.C. 3944 11.0 3.0 303 GLAZING: Windows or Doors 253 0.500 127 DOORS 58 0.500 29 FLOORS: Over Unconditioned Space 768 19.0 36 BSMT: 8.0' ht/6.0' bg/2.0' insul. 224 19.0 33 HVAC EFFICIENCY: Furnace, 86.0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1255 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer -�J� 6-a�R Date 10 a,d / _ t� � ',�_ ' ,�� .M ;,� - l , ... .. T� .... q ' .Y- -1 ' � � � r '` � ., . .. _ � P .' :.. T l�.} to , 1 �._ „r ' - r.4 s.':. . . 1 �. .. r.. �, _ � r r� . �..� r �? i r .� r � 1� t _j r .- .T _rMr« t .. j. t � � - . .. 4 [.. i I REQUIREMENTS FOR BULDING PERMIT SIGNOFFS BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Building Permit application 1. What is the proposed project? Deck pool addition new house ` other 2. Are plans attached? Yes No (For additions and new houses on septic systems, complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is municipal sewer available at this location? Yes (RD 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes No 5. Is the location served by private well? i Yes No 6. If this project is an addition and the house is served by a septic system, has there been a Title 5 inspection done recently on the septic system? Yes No 7. If, yes, is the inspection report on file at the BOH? Yes No 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 Facility) 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 Name Name: Location: The .Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print City Phone_ _# F7 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. Companv name: G ,n,nT if,.I 10,Qe Ce,r4 40re4 — Will /am Ao/-feff' N�i»cS Address 1042 Qi'✓z City Q L'2 a n cioy e/' Phone #• L 4 a- a 3 a O Insurance Co M I w ia.nc!L C.a.Sda [Li CQQ4aA v POlicv # W(:,* 3 76 970 3 Com anv name: Address Citv. 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 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine cf (5100.00) a day against me. I 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 (fit ��/cam �Gt�r� _Phone # (n�a Official use only do not write in this area to be completed by city or town cm"cial' City or Town P=rmit/Licensina ❑ Building Dept ❑Check d immediate response is required ❑ licensing Board ❑ Selectman's Office Contact person: Phone: ❑ Health Department 171 Other ✓ice ��„"„�„«u�u �` :� 1�:,�:/rrwr!!s __ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 052241 Birthdate: 10/10/1952 Expires: 10/10/2001 Tr. no: 7876 Restricted To: 00 WILLIAM K BARRETT. 1049 TURNPIKE ST (.,� -e, N ANDOVER, MA 01845 Administrator J.VVILLIAM HMURCIAK, P.E. DIRECTOR TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 DRIVEWAY PERMIT Telephone (978) 685-0950 Fax (978) 6W9573 DATE _ 3p LOCATION BUILDER phone OWNER R. hone 2 - 2 3 Zo THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET. CALL THE SUPERINTENDENTS OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. X 0 A Pr L, L CA 1J- S/ n/A-r ✓Z E 1113 APPLICATION FOR WATER SERVICE CONNECTION oeol North Andover, Mass. oef� Application by the undersigned is hereby made to connect with the town water main in 0)1 Street, subject to the rules and regulations of the Division of Public Works. (% I The premises are known as No. or subdivision lot no. ,f A, I/C Owner Contractor Street Address Ad'Ps UfV Applicant's Signatur PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to /tet/ J -GC , kN� &ece � «� to make a connection with the water main at U);k? eT Street subject to the rules and regulations of the Division of Public Works. 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Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: ning District Proposed se V r 1.4 Property Dimensions: �J. • �Q+Y,V r �'I / f Lot Area Frontage ft i BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided Water Supply M.G 1-C.40. §S4) lic ❑ Private (}/ 1.5. Flood Zone Info Zone d q Outside Flood Zone 0 1.8 Sewerage Disposal System: / Municipal ❑ On Site Disposal System ;CTION 2 - PROPERTY OWNERSHMAUTHORIZED AGENT Owner of Record me (Print) Address for Service nature Telephone Owner of Record: Cn( do io'A i ame Print 16, -g- oeo. . �78'-� Cir )ot-(9 —rul'n ai tec St. Ab. PrnAavc� Address for Service: S� a3aQ fy i �(ics„� �t ire tf-' iature Telephone CTION 3 - CONSTRUCTION SERVICES Licensed Conjtruction Supervisor: Not Applicable ❑ :nsed Constr4;ion Supervisor: _110 Q 4-rufn.Pi U e Si- NO fel n &wee- License Number ress Expiration Date ature Telephone tegistered Home Improvement Contractor Not Applicable ❑ pany Name Registration Number 'ess Expiration Date tture SECTION 4 - WORKERS COMPENSATION (MG.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 buil 'ng permit. Si ned affidavit Attached Yes ....... W No ....... ❑ SECTION 5 Description of Proposed Work check all applicable New Construction 0 Existing Building ❑ Repair(s) 0 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 b permit a licant -- W01 1. Building O (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction cs Q Q C ^_ 3 Plumbing Building Permit fee (a) x (b) �J 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 as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date L SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION G tr ,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 —Wi1iccrn 3arre° I Print Name of Owner/ Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 NO 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DRvIENSIONS 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 i Town'of North Andover Building Department . 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 DEBRIS DISPOSAL FORM ti NORTH O Y` Q O 2% o F .... 'pq <Otw.tM wt■ r 9SSACHUS�� In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, s 150a. The debris will be disposed of in /at: Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. �� EF 1C, ! he .Commonwealth or Massachusetts Department of Industrial Accidents Cr;ioe of Investigations Boston, Mass. 02111 I1111orcers' Compensation Insurance Amdavit Name P!ease Print ! Name: Location: CIN Phone I am a homeowner performing all work myself. I I I am a sole prcpreter and have no one working in any capacity E911", I am an employer providina wcrkers' compensation for my employees working on this job. r1. Comcanv nar e: CSI^rt- li 1 % t' 1l)[y4P 10etJ COC4 Q je4 — Gy/1llaim AArrc 11 N�McS Address 10 >a 4 TW n D i t Sf City: jR ( ddU e r' Phone #' (-a!? a - a 3 a O Insurance Co Mg.r'v ia,nt� t)^,o 2.j v Policv # WC, 9S 8' 3 7G 97a � Comoanv name: Address Citv: Phone #: insurance Co. Police # Failure to secure coverage as recuired under Section 25A or MGL 152 can lead to the imposition of criminal penaities of a fine up to S1,900.00 and/or one years' imcnscnment as weil as civil penalties in the form cf a STOP WORK ORDER and a fine C (5100.00) a day against me. I understand that a copy ct this statement may be forwarded to the Office cf Investigations cf t`e CIA or coverace verificaden. I do hereby csrTfftl u eiins and ^ aities of pe7ury that the information provided above is true and ccrrec:. 9Si nature �ipate 10136101 Print name Gtr i l Ilam �G;�Y�'"— Phone Officiai use only do nct write in this area to be completed by city ortown criciaf City or Town Permit/Licensinc C1 Building Dept 71 Check d immediate response is required (] licensing Board Selectman's Office Contact person: Phone #: ❑ Health Department ❑ Other Town of North Andover Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 Building Demolition Affidavit DATE A0fe. i' r/ 0 s (/I PROPERTY LOCATION i CONTRACTORS NAME & ADDRESS 16 Lig I-Urn1-7;k c St ©- !qn da •e A DEPARTMENT SIGN -OFFS - D.P.W./WATER SEWER/AW GAS ELECTRIC TELEPHONE 11 PLO I CABLE N TAXES U U DIG SAFE NUMBER Sk 00 ( H 00 (0 3 9 BLDG. 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