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HomeMy WebLinkAbout115 Dale Street Permits w/Plans - Permits - 115 DALE STREET 3/24/2021 TOWN OF NORTH ANDO V R BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING V sft fIr BUILDING PERMIT NUMBER: DATE ISSUED) 1 SIGNATURE: Buildin.g commissioner/Inspector of Buildingate SECTION I-SITE INFORMATION I �^ 1.1 Property Address: 1.2 Assessors Map and Parcel Number: RJ A Map Number Parcel umber 1.3 Zoning Informatioil: 1.4 Property Dimensions: Zonin IDistrici. Proposed Use Lot s) Fronta (ft 1,6 BUILDING SETBACKS 00 Front Yard Side Yard Rear"`Ward R aired Provide Eeg2±ed Provided Re aired Provided 1,7 Water S M'G.L.C.40. 54) 1.5. Flood Zone Infam�ut on: 1.9 Sewerago Disposal System: I.7 W W lic )4Private 0Zone Outside Flood Zane Municipal On Site Disposal System ❑ SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT J ,4t,l tc; U I.`.1.,lof: "(0- �sn M 2.1 CDwancr of Record ." ➢ " w _ . d Name(Print) Addres� "" s for Service: a Signature ITelephone 2.2 C1it+i�tar of Re rt➢: Name Print Address for Service: Si nature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3,1 Licensed Construction Supervisor: Not Applicable D W �� Licensed Construction Supervisor: ti _� 0. .. L, License Number n -� Address Expiration Date Signature Telephone J 3.2)2 istered➢-loam Improvement Contractor Not Applicable D 0 Company Name M Registration Number Address Now A Expiration DateSt nature Telephone 4ma�rrar�r Town of North, Andover Building Department 27 Charles Street ' Worth Andover„ MA. 01845 D. Robert Wicettal Building Commissioner (978) 688-9545 (978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. " DATE . r ^ � JOB LOCATION. v „� c ✓ n. Number Street Address Map/lot �� "HOMEOWNER Dame Phone Work Phone PRESENT MAILING ADDRESS d d, City Town State Zip Code The current exemption for"home6wners"was extended to include owner-occupied dwellings of two 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 108.3.5.1) DEFINITION OF H'OMEWWOI/WNER:. Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. 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 he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNAT'IJRE *.. ... APPROVAL OF BUILDING OFFICIAL The Commonwealth of Massachusetts t d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit [Name �` �"�, „�.,,m,��� .� e,.„�""� ,*��° , s,,M�,.,„_.,.�� Please Print -Location: Phone ." I arm 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: Address Ci Phone : Insurance Co. PQRGV# Company name: Address Ci : Phone : Insu ante Co. Poll Failure to secure coverage as required under Section 25A or MOL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'irnprisonment.as_well.as_civil.penaltiesinnfhelbrm ofa.S'TOP:tiW'.ORIf DRD R.anda fine of($10.0,00)_a-day against me. I understand that a copy of this statement may be forwarded to the office of Investigations of the ID A for coverage verification, /do hereby certify under the pains and penalties of pedwy that the information provided above is true and correct. / Date °� Signature Print name ' �� . " Official' use only do not write in this area to be completed by city or town official' City or"town Permit/Llcensin 0 Building Dept [IChk if immediate response is required ® Licensing Board ❑ Selectman's Office, Contact person:_ one# I] Health Department E' Other a i i fi jC II IFICATE OF USE & OCCUPANCY NORTHTOWN OF _N DOVER Building Permit Number 6z a Date. THIS CERTIFIES THAT THE BUILDING LOCATED ON � � �'�-J ,r MAYBE OCCUPIED AS f r,1 1/t, ACCORDAN WMTHE PROVISIONS OF THE MASSACHUSETTS STATE B� IlY CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. cERxcATE ISSUED TO: �) b M 0 R 4 Building Inspector AORTH ToVM of _, over No. lit Z - � dover, Mass. .�r >. ::✓ ��, ' �A �. �— COCHICHEwICK H BOARD OF HEALTH Food/Kitchen PERM/ I T T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....................91 .ff.. ..•...... .........:................... 'sTP Foundation44 has permission to eaat.f . .. .. t.T .... building Rs ..... .L ... . .Ft a:... `: of ughff� .f . to be occupied as........ , 4 ��i S ' ey` G provided that the person accepting this permit shall in every respect conform to the terms of the applicati on file in Fig this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 7�� Buildings in the Town of North Andover. PLUMBING INS M VIOLATION of the Zoning or Building Regulations Voids this Permit. ou /-12 —es PERMIT' EXPIRES IN 6 MONTHS - �INSIPER UNLESS CONSTRUS�'AR S ELECTRICA Rough �............................ ..........�.5� 1►... _._ Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. DEPARTIVIENT�Burner � 1%7 � Street No. ' 7 SEE REVERSE SIDE SmokeDet. ..r 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. **'***************************APPLICAN�T FILLS OUT THIS SECTION*********************** APPLICANT PHONE (........ LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER USE RFG VMME OF T01_ AAVO ENTS: JZ CON&ERVATION-ADMINISTRATOW' DATE APPROVED DATE REJECTED COMMENTS raiuttj�C 1-haw aUW5,14 TON P_A�� 11 DATE APPROVED, DATE REJECTED W ,�I COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS Z'__6 DRIVEWAY PERMIT 491;1 FIRE DEPARTMENT,4// RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Im North Andover Building! Department Tel: 978-688-9545 DEBRIS DISPOSAL. FOR 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 IVIGL c11, S150A. The debris will be disposed of in: (Location of Facility) G Sa n ;cure f Permit Applicant Date ,f NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH Town of L Andover O � No. h ,Q = LA dover, Mass., Moo c>s t w tL-COCKICHEWICK y1. �7,4 A°Rar� Ae�\ Cl H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System •� THIS CERTIFIES THAT.....................��w.R�!y?...-..�.� %3 BUILDING INSPECTOR.............................----�-..............................-------� 4MI sr;� Foundation has permission to eeAt.A40t ctt'3� .... buildings�bn .....�1 B. �?.A-Lt......SMt��................... Rough to be occupied as.............r - ►...� L ....... ...0.f��/ Chimney provided that the person accepting this permit shall in every respect conforni to the terms of the applicati on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONST RUC STAR S ELECTRICAL INSPECTOR Rough ............. .......... ........... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises -- Do Not Remove RoFir Rouu No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - street No. `�� v -- SEE REVERSE SIDE Smoke Det. i Permit Number REScheek Compliance Certificate Checked By/Date 1995 MEC REScheekSollware Version 3.5 Release 1 Data filename: Untitled.rck TITLE: MORGAN RESIDENCE 1V'4- CITY: Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: Single Family DATE: 11/02/04 DATE OF PLANS: 10-22-04 PROJECT INFORMATION: MORGAN 115 DALE STREET N.ANDOVER,MA COMPLIANCE: Passes Maximum UA=375 Your Home UA=372 0.8%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perhiieter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1 105 30.0 0.0 39 Wall 1: Wood Frame, 16"o.c. 2420 13.0 0.0 174 Window 1: Vinyl Frame.-Double Pane with Low-E 256 0.360 92 Door 1: Solid 40 0.400 16 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 1095 19.0 0.0 51 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 1995 MEC requirements in RES checkVersion 3.5 Release 1 (formerly MECchec�and to comply with the mandatory requirements listed in the RES check Inspection Checklist. c.7 Builder/Design ��' Date REScheck Inspection Checklist 1995 MEC REScheckSoftware Version 3.5 Release I DATE: 11/02/04 TITLE: MORGAN RESIDENCE Bldg. Dept. Use f Ceilings: [ ] 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c.,R-13.0 cavity insulation Comments: Windows: [ ] 1. Window l: Vinyl Frame:Double Pane with Low-E,U-factor: 0.360 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ] Yes [ ]No 1 Comments: Doors: [ ] 1. Door 1: Solid,U-factor: 0.400 Comments: Floors: [ j 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space,R-19.0 cavity insulation Comments: Air Leakage: [ ] Joints,penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] Recessed lights must be 1)Type IC rated,or 2)installed inside an appropriate air-tight assembly with a 0.5"clearance from combustible materials. If non-IC rated,the fixture must be installed with a 3"clearance from insulation. Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R-values and glazing U-factors must be clearly marked on the building plans oi-specifications. Duct Insulation: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-6.5. Duct Construction: [ ] All ducts must be sealed with mastic and fibrous backing tape, Pressure-sensitive tape may be used for fibrous ducts. Duct tape is not permitted. [ ] The UVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] i Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the Treating and/or cooling input to each zone or floor shall be provided. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swinuning pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above I20 OF o€•chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Mininrnrn Insulation Thickness for Circulating Hot Water Pipes. « Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to P UR to 1,25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Kirurmmn hisulatlon Thickness for IIVACPipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range(F) 2"Runouts 1"and Less 1.25"to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2,0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0,5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) TOWN F NORTH ANDOVER BUILDING EPA `I` T APPLICATION TO CONSTRIJC'I"REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DNVELLING „ too Ul Iil 1 !d Cli3r BUILDING PERMIT NUMBER DATE ISSUED SIGNATURE: Building Cohir6issioner/Inspector of Buildin Dar SECTD[DN 1-SITE INFORMATION 1.1 Properly Address: L2 Assessors Map and Parcel.Number: ", " Z.69 6 0 r Map Number Par d�un,bcr P 1.3 Zoning ltrforatratiotn: ...... _ ^ Property Dt ue,usions: Zonin District Fr rased Use Lot Areas Frcnuta e li 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear'Yard Required Provide Required Provided Required Provided 1.5. Flood Zone lafomxatioa: 1.8 Sewverage Disposal System: 13 Waler Supply M-07L.C.40. 54) Public Private Cl Lan outside Flood 7.oao 0 Rluaicipal 0 On Site Disposal System SECTION 2 PROPERTY U'WNERSIUP/AUTIIURIZEPI AGENT 2.1 Owner of Record ka—x - Name(Print) Address for Service: Signatur 'D j Telephone v A 2.2 Owner of Record: Nar Pri Address for Service: �. H ature Te➢e hpCle SECTION 3-CONSTRUCTION SERVICES. 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor: ➢.,iceuse Number Address _....m_ Expiration Date mom Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Tel NORTH ToVM of : � _ _� Andover Nox�107414 I-K 11 dover, Mass., zG COCx1CME CK V �AaRATe Apt` •(� BOARD OF HEALTH /Kitchen PERMIT tic System • UILDING INSPECTO THIS CERTIFIES THAT................... p„ TaCr�4llIfW......�� ......................... Foun t'on has permission to on...t..L ..U•&4 .........".......... Rough s............................ to be occupied as........ �t�4 ..�� ... .. ,1 .. ..♦+��!.!�►-�. • •� Chimney, provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PL GINS ECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRIC SPECTOR Rough .............. .. .. ....................... .... Service BUILDING INSPECTOR Final G� INSPECT R Rough Display in a Conspicuous Place on the Premises -- Do Not Remove Final FIRE DEPARTMENT . _ Bu er lemon& SEE REVERSE SIDE moke Det. N®RTH ToVM of a �� �s Y y d_ G T O LAKE ower, Mass., g2a f �A COCMiC NE WIGS`� DRATE D ApR AC BOARD OF HEALTH /Kitchen PERMITSe tic System THIS CERTIFIES THAT................... TA • UILDING INSPECTO Foun tion has permission to on....l..1.5.310%4 .................... to be occupied as........ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,.Alteration and Construction ina Buildings in the Town of North Andover, PL GINS ECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS F irm ELECTRIC SPECTOR Rough .... ...... .. Service BUILDING INSPECTOR Final INSPE Display in a Conspicuous Place on the Premises -- Do Not Remove Rough Final FIRE DEPARTMENT Bu er S eet No. 7 SEE REVERSE SIDE moke Det. 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 A�llf/'_el �,- ��,� ;r "_`' T PHONE LOCATION: Assessor's Map Number �� PARCEL ->)/6 c%r)� 611 SUBDIVISION LOT (S) STREET, !aX ��� _ ST. NUMBER_ *****************************************OFFICIAL USE ONLY***"**************** ` R E A O TO ENTS: CON ERVATION ADMINISTRATO DATE APPROVED DATE REJECTED , COMMENTS S att D TOWN FLAhA9,Fk DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED C COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT %e l,7/, FIRE DEPARTMI=NT, _17$ RECEIVED BY BUILDING INSPECTOR DATE/ �&/ ,--- Revised 9197Im 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 Perm- it Number S. 2, ---is is that the debris resulting from this work shall be disposed of in a properly licensed solid waste, disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Fab' illty) S!666ture Qf Pe mit Applicant 110, Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector TRE COAMONWIEWH OF AASSi4CHUSEM, Office Use Only Permit No. L..• BO1AMUrr&EP , XdIVR.GULA.dTUNS52''1 CM12:00 Occupancy&Fees Checke 4k A. LICAALL WORK TIO CO PERFORMED I l EDP\ l O.[vEPFO t3INCE wrrH THE MASS 'CHUSSTS�E������Mxo"',- CPLEASE PRINT IN INK OR TYPE ALL INFORMATION) 7 ISateo � Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical lu/escribed below. Location(Street&Number) ° .. ` Owner or Tenant ' . ✓' 1„ Owner's Address Is this permit in conjunction with a building permit: Yeas No E (Check Appropriate Box) Purpose of Building Utility Authorization No. � n. ° Existing Service Amps / ®Volts Overhead Underground M No.of Meters New Service Amps / Volts Overhead ® Underground No. of Meters Number of Feeders and Ampacty Location and Nature of Proposed Electrical Work " _.w �"1"":2 No..of Lighting Outlets No.of Hot Tubs No.of Transformers 'total KVA No.of Lighting Fixtures Swimming Pool. Above 1p Below Generators KVA round ground No.of Receptacle.Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No,of Gas Flamers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones 'tons No.of Disposals No.of Heat Total Total No.of Detection and Pam s Tons IOW Initiating Devices ®®' No.oftDishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained DelectiordSounding Devices No.ofryers Heating Devices KW Local I Municipal Others Connections ED No.of Water Neuters KW No.of No.of Signs Bailasis No.Hydro Massage"rubs No..of Motors Total HP OTHER' manc Liabili Co Pw nrer=tsofM�sachusetlsC_"�ea : Laws I ty lteyr ludtngComplt%� rCamrageorits ecltlilart YES NO linwstrbnuttor V,Mproofuf etotheOfrw-YES F3uuha%,edn3wd YES,plt hk&thetypeofeoNmgcby INSURANCE� BOND C7lL1Ef� � �slaet=i6y) c g the ate EVimlion Date Est rtaated Valwofb ttkal lT c(k$ WotktoStatt hpoctionDaleRoquested Rough Baal Signed tnxxt�IeIWfiesofpcijuT. RRM NAME ��r c C' Licurse l's?o. 77 ' ! Sig ttute w.... .. t' Liut Na d r L t Atdclttc � r°. ✓d" c:.r t w-::, ,,�"' ' fM Alt Tell l' C (7` NFR'SINSURANCEWAlti1ER;Iama%mdalbeLicensedoesnothavetheinsatanaecoN oritssubstantial*valent as lucluiIedbyMassachilsettsGmalIam and that mysignawonkhispenut application WcU this wquiwmat (Please check one) Owner 1:3 Agent El 'Telephone No. PERMIT FEE$ Signature ot 177ner or 7gent Date. "�f, .s... d , 4 . ,;ORTH 3r°•'„' °: "a� TOWN OF NORTH ANDOVER .. PERMIT FOR WIRING i ,LOW " ""A US� This certifies that .. ` . ........... ......................... ... •...,.................... ....... has permission to perform V..... ..... �... . .: '.:: .................... wiring in the building of... :�� ... ... ........ . ..°.... ..,.,.......................... ,...,.... d at. .u..4 .. . ., . . .$tl ;.... .•... .. ..... .. ............... .North Andover,Mass. y ,........ .T ..;.�:r�.,�� �°e.»°.�v...., p..�..:. �h, ELECTRICAL 1NSPEcr0R Check 1! 4 l„ i Date.. . tApRTM TOWN OF NORTH ANC V R q'�< as ,�'�•�� PERM IT FOR PLUMBING ���p�CtlNUS+E�' l This, certifies that . . . . . . . has permission to perform plumbing in the buildings of at. .Vu �. : . . . . , ': . . . , North Andover,. Mass, Fee y.a ����° Lic. o.-: '. . :u' . . ' .. . . . . . . . . . . . . . . r �_. ° . PLUM 1�,� INSPECTOR Check # — Location f No. �,����+� date r ,dRT TOWN OF NORTH ANDOVER Certificate of Occupancy Buildin �/Frame P'ermiit Fee $ cr+ust Foundation Permit Fee $ Other Permit Fey" TOTAL $ Check # Billiding Insp�ecpor Location l , - L No. -119P Date fi HdRTM TOWN OF NORTH A N OV E 1 y q,M 41 rm`sstiia 's�d d t� t &; Certificate of Occupancy Buildin /Framie 'Permit. FeeCHU Foundation Permit Fee $ Other Permit Fee $ u TOTAL r Check # u Building Inspector t a. date..... , . TOWN OF NORTH ANDOVER 4 PERMIT FOR WIRING QY "nar�o1w'm«y Kh ITSACHUS^f This certifies that .-.... ... . ...�����..,, .� ....................... has permission to perform .......... .c: c ��t 'e.............. wiring in the building of . '.Iz , ...1.. ;f `" `. ..... at .. °... ` ...... .:.. ........ Nor h Andover,Ma ss. ass. i~ee..: Lic.No. ...yr�.. .. ...... W .. ELECTRICAL INSPECTOR Check H date tj0RTaa TOWN OF NORTH ANDOVER ° ' PERMIT FOR WIRING L �ShCHU9k� " p "his certifies that ....A, �: k r has permission to perform .. . .,...,. ° � . ,. . 'u.� .,. � wiring in the building of ......,. ....... ..°,..... ° R d°s ° ,North Andover,Mass. at. w..,.. d a �x ELECTRICAL INSPECTOR, Check # o(-1'11 r f SECTION 4-WORNITRS COMPENSATION(NVLG.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.......C SECTION 5 Descri tion olProposed Work checiralf applicable New Construction © E cistutg Building Repair(s) 0Alterations(s) ddition Accessory Bldg. 0 Demolition 0 Other U Specify Brief Description of Proposed Work. M � d .� �'RpP ro.r'.%un,.�l' ' a �✓ ..,tt� „�w^""�r„K,+ Ap ,,...,,, SECTION 6 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b permit applicant I. Building — (a) Building Permit Fee 00 Multi lien 2 Electrical (b) Estimated Total Cost of Construction t , 4 . Mechbanical. I3VaC ;„ing "` Building Permit fee t.}x (b) t - , can S Fine Protection ' � A - 6 Total 1+2+3+4+5 Check Number .. SECTION 7a OWNER AUTHORTZ A TION TO Ift,C MPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as OwnerfAtithorized Agent of subject property Hereby authorize to act on My behalf,in tall matters relative to work authorized by this building permit application. Signature ot'Owner -- Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that die statements and information on the foregoing application are trade and accurate,to the best of my knowledge -aid belief Pritit Name Si tatttrc of OsvntrfA ent Date NO. OF STORIES SIZE BASEMENT OR SL,A13 SIZE OF FLOOR TRVIDERS 1s ?` 3 SPAN DIIvfENSIOiAIS OF SILLS DEVIENSIONS OF POSTS DM ENSIGNS OF GHtDERS HEIGHT OF FOUNDATION ----� -- - THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEYIS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NASAL GAS LINES �' FPONf UVAION M01?6AN M51PFNCF -------- ------------ 115nA-�5Tl:��f N0PTH ANPOM,MA __-------_----__- __ -------------- ------------------------------------------------- ----------------------------------------------------------- ----------------------------------------------------------- ------------------------------------- -------------------------------------------- --gum ----- - --_-- NI�121J9 i6P -------------- ------------ ---------- --------------------------- -------------------------- El 0 Ifl ❑F-I F-I❑ 1-1F-I0❑ NIIsrr�ai ® ® IEU! ❑EI❑❑ ❑❑❑❑ - a000 oc oo 1 1 i � 1 __ ____ __ ____ ___ ___ Ps1TI5 FL° MOV6AN PF51MNCF ................. ii5 PA,� NOF,TH ANt2OVrp,MA 5M6:/I.,,1'4" PAIL,10122101 Wf UNION ................................................................................ il------ - C�anp,�r1 _ �EYoN� - fth�lSfLY. 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