HomeMy WebLinkAboutMiscellaneous - 247 Hillside Roadti
Charles Canty
6 87 - 03 a e Hillside did.
3
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installation W: t HS,al�ide Rd. _ __ � ::x.:1.1 ray ,c!�: t a�
system J.i^ c? :Co n'dWio t 1- A_ �I _ Cil ? !, S-�, ,".-C. `if (31. Via SJ Vl .a ari=. r.Ji C._L Jv`r
Massachusetts, Gond rc !L.i..iticns of too i:,oa:-ek of 1z,,,,a .th of t a ..
of North Andove_.
Further, ': will flim hcu,,-le of bell ;Z(
pipe, the minif"11111 diaia tc r° be:i. g r,. :..zjc:hes, :UC' vill maint-,L i.a
minimum grade of 1% -imtil 1C ._'aet preceding V,, sz[jt : zjvrk,
the grade shalt. not (:xcae;;L 2'4a I ; :.. install cDncr'ceZC.
tank of _j WWga? ;.� :�i�,� 4 �. 'r^..I1:tcb).c: (�;} e.:'�;s3. t.in E;a � " �� .z
ing removable caner (s) of iron or co,'.-
-ir
within 12 inches of the ,round slurafce:. i :r%:'.:#. pa ava.de :i
disposal field with olpLui -"ain sd be -.l and s i -Tot. A-.kron pi—B Lit
least -4 inches in diamet s r -1c' laid in a s, r*i,�s of tronches ;
bottom of which will provida a mini.rnu_ of ..., jg Lin ,
(square) feet ox"' effective"� OOOZ't9 t�iZ ar epi. rte pI peo .fµ.l.l
on a 6 inch layer of -nashed ;r.'avel or crashed stony r angirp, in
size from 314 to 1 1,l2 it c.he s (dia. ; and thse .pipes will be..
surrounded by similar materia' to a he iaht of 2 in,;hc:g obcv _ '.i n
crown of the pipe,, The ; cinLs cf" these pipes m-ili be p otac,, ,is -
from clogg=ng and bs'care fill-ing the trench, 2. inc).es of
or stone 1/8n to 1./411 w> ,'.? 1 be. p_"I.aced over t 1, 3 course
or stone. The disposal field -,ni:i l be installed. at; a „r cie -)J' '.
to 6 inches/100 feet. Nc Single tile, lire. z,i:{.� exc.ead 10C
in length and in any case, tic l.ine;> cif t,3_.'+.-: w -J.31 ':)a
A minimum of 6 feet will be ,aaintaincci botw,D- e:' the center I.LrU;= C
the disposal field tranches .and the r. irarags dapth of trench ,t:
not exceed 36 inches. Nc pa: -t of t::,e installation t ill be
than 100 feetf'row any pr i-va'. ; i:a.ter supply, 25 f s(A From a1n•r
stream, 20 feet, from any dwo? l ng oz- 1.0 f e: i-; .'rom iany
line. t�yI f(uyr�ihe�ry+�rvgr(�ee net to cover
a�7y �ao:�!�ica�i c�a _t�x�,ys+ i�/asa; � is
until G7l W�r�J Y V Y EI I pro
to=ncorpora a aslno * a�ic t3,r�}�w1a� r: ai e, ez :; ghat; ma.:t bo
the permit,. Plot Plans must be 3ubmit,ted !fjith a.ppli-cation.
DATE .�4
I hereby issue thT abova pez'm3; dor t.hE:: Board of Healthtai:
'gown of North Ani over, A�c3asa `:'iiL'ls r t t;
Date
I have inspected -the un.cozrcr :& indica.t,� d above, and
everything, dome as described.
Date
Percolation Test `
Garbage Grinder
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C,5r, 615 /„R ��P iEJi. LOT N 0--.-Tr-
F'I—X—
+ -Y Z_-
GPkRbAG-E GRI K'Df-
S' &HOW DfPflC.N-Sl0N5 OF 1400"F-
— / 1e,qf4T*-s
DISS-rANCE'S r /,)// I
1CCA-rioev Add 'SIZE or*
AN—A bs',rAJq&C .,PF 44M i-'kov) 'Se WCIV-16C
ae -7-1 ( C L: f -C,
()F S-ErVIC IrANK OR C.GSSj-,)>L f:i,,Dtn Mov-sc,
Le Reo-4 CAVO e'rrkl 1\1
May 12,1956
Miss Mary Sheridan R.N.
Health Agent
board of Health
North Andover, Massachusetts
Dear Miss Sheridan:
An examination has been made relative to the
suitability of the soil for sub -surface disposal of
sewage on the proposed Hillside Road building site of
Mr. Charles Canty.
No percolation test could be made because of
ground water conditions. The soil in the area consisted
of a strata of sand and gravel, below which was sand.
It is recommended that a minimum of a foot and
one half of bank gravel be placed below the installation
of 6 inches of crushed stone. A 600 gallon septic tank
should be installed with 140 lineal feet of drain pipe.
Very truly yours,
Ernest F. Romano
Sanitarian
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1 f 17
Date A.,23.1 0............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that .... . P.u. �......) a AN O
.............................................................................
has permission to perform ......*Z... .
ffll........................................................
plumbing, in the buildings of....... �'a�'� 513^1
................................................................................
at ..... `.....'.`� . C!.� 5. ` ............................................ North Andover, Mass.
Fee:?,SA......... Lic. No. �. !.........
..................................................................................
PLUMBING INSPECTOR
Check # —!)I
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY 6, - MA DATE A/ 7,4—=h1ERMIT # __ M I g
JOBSITE ADDRESS fj �p i OWNER'S NAMEIrj%TffO
OWNER ADDRESS
TEL �l S 77% " AX
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El
NEW: RENOVATION: D,,II REPLACEMENT: 41
FIXTURES Z FLOOR—
BSM 1
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM_
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
E
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
;
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR /AREA DRAIN,
— P--- IF -- -
INTERCEPTOR (INTERIOR_
KITCHEN SINK
_
LAVATORY
s __
ROOF DRAIN-
SHOWER STALL
.. QF-'-
---
—=F
SERVICE
SERVICE I MOP SINK__
TOILET
URINAL
WASHING MACHINE CONNECTIONI,
WATER HEATER ALL TYPES
WATER PIPING
OTHER I
2 1 3 1 4 1 5 1 6 1 7
RESIDENTIAL E—.
PLANS SUBMITTED: YESE] NO,n
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES E] NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Ej 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
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER Ej AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a to of my krA
redge
and that all plumbing work and installations performed under the permit issued for this application will be in c ea all P n
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Steven J. Addado Jr.
LICENSE # 5-3ioi SIGNATURE
MPED JP LJ CORPORATION # 3102
�-1PARTNERSHIP(# LLC Lj#
COMPANY NAMEADDARIO'S INC ADDRESS 2 Gill Street Suite J
rn ]
CITY WobuSTATE MA ZIP j 01906 TEL
--, -- - 87 7.233.2746
FAX 3 .._._.. �..... �._.
39.883.3059 CELLEMAIL despatch@addanos com
)//c,? 7115- MI -4, I -W. ar) ' � V
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Date... 611.1
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .... e.J.¢'.'�.....�1
..Ct/1�t�1has permission for gas ' stallation �.!�:d.:� .!.. z..:.
in the buildings of ....... ..:P.��::50..�.......................................
at ........... oz.1,1k�,, �............................ North Andover, Mass.
........
Fee..... ...... ........ Lic. No.... 3 0.(,.0.........................................................................
GASINSPECTOR
Check #
M6-
S—N
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY //C��T.�1 %J �.a?./ __. w.. MA DATE ./s�2 //_ / S' PERMIT #
`
JOBSITE ADDRESS o"I, %!rj_ %IL�,S/1i- ,►f/,� OWNER'S/NAME PE,e�G'�E'SG1/J%` %/!!/
GOWNER
_
ADDRESS
TYPE OR
PRINT
OCCUPANCY TYPE COMMERCIAL . _' EDUCATIONAL I RESIDENTIAL,`
CLEARLY
NEW:. RENOVATION: ___ REPLACEMENT: , PLANS SUBMITTED: YES, :. NO/
APPLIANCES -1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ' i
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE _
FRYOLATOR _..
FURNACE �—
GENERATOR-
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
-OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UN(VENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES G, NO
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY .___1I BOND _
OWNER'S INSURANCE WAIVER: I 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: OWNER AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a ate tot b t of my kn ledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliant it IIP vision e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME I Steven J. Addario Jr. LICENSE # 13106 GNATURE
MP MGF JP ` JGF LPGI ...a� CORPORATION .,,.,'# 3102 _ r- PARTNERSHIP , _.`# ._ LLC,,,,,;# r
COMPANY NAME: ADDARIO'S INC. i ADDRESS 2 Gill Street Suite J
CITY Wobum STATE MA ZIP 01801 TEL 877.233.2"7"4'6
FAX 339.883.3059 ; CELL EMAIL dispatch@addarios.com
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organizationdndividual): ADDARIO'S PLB. INC
Address: 228 CENTRAL STREET, SUITE # 1
City/State/Zip: SAUGUS, MA 01906 Phone #: 877.233.2746
Are you an employer? Check the appropriate box:
1. V am a employer with 12 4. [:11 am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. [:11 am a sole proprietor or partner- listed on the attached sheet. I
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
- 3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9.0 Building addition
10.VElectrical repairs or additions
I I.S(Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: FEDERAL MUTUAL INSURANCE COMPANY
Policy # or Self -ins. Lic. #: 9306944
Expiration Date: DECEMBER 29, 2015
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under thgZns gllyft4Ues/bfperjury that the information provided above is true and correct.
Phone #: 877.233.2746
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Information and Instructions
al'l�I ssachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
exj ress or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1--877-MASSAFE
Fax # 617-727-7749
Revised 5 -26 -OS www.mass.gov/dia
P
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7661, Date... c ��. !... .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATI(
This certifies that . �'!� . ! �... f .! . � �'� . 7� . ...... .
has permission for gas installation ..est .' ... '.' . <
in the buildings of ...P.2�
at . {l.. ��i . (. .�: ....... cl .... , North Andover, Mass,
Fee. Lic. No..). /.`. �... C. ...: :. �..... .
r GAS INSPECTOR !
Check # G/ t p
G
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Mass. Date ( n 2010 Permit #
Building Location --I ' ' ` 1 S (�1� Owner's Name �Cif`.�
Owner's Tel # -pZ ^ 01).U07 Type of Occupency
New ❑ Renovation Replacement Ey" Plan Submitted: Yes No
Installing Company Name Addario Inc. Check one: Certificate
Address 20 Cooper Street x Corporation 3102
Lynn, MA. 01905 Partnership
Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Insurance Coverage:
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ex No M
If you have checked fes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑x Other type of indemnity ❑ Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner Agent
Signature of Owner or Owner's Agent
I hearby 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas
Code and Chapter 142 of the General Laws.
By Type of License:
Title
x Plumber
City/Town Gasfitter Signatbicensed Plumb Gas Fitter
Approved (OFFICE USE ONLY) x Master /D
11
Journeyman License Number 13106 D-
.
•
•
•
Installing Company Name Addario Inc. Check one: Certificate
Address 20 Cooper Street x Corporation 3102
Lynn, MA. 01905 Partnership
Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr.
Insurance Coverage:
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Ex No M
If you have checked fes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑x Other type of indemnity ❑ Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
General Laws, and that my signature on this permit application waives this requirement.
Check One:
Owner Agent
Signature of Owner or Owner's Agent
I hearby 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 installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas
Code and Chapter 142 of the General Laws.
By Type of License:
Title
x Plumber
City/Town Gasfitter Signatbicensed Plumb Gas Fitter
Approved (OFFICE USE ONLY) x Master /D
11
Journeyman License Number 13106 D-
.
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This plan is for the use of the Building Inspector
of the Town of No. Andover, for the purpose of
determination of zoning compliance. It is my
opinion that the location of the foundation
complies with the requirements of the Zoning 2.76' q'
Bylaws of the town for the RES.2 zone.
This plan is the result of an as—built construction survey
performed on 07/31/02 based upon plan #13088
Registry of Deeds North District Essex County.
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AS—BUILT
FOUNDATION LOCATION PLAN
ASSESSOR'S MAP 98B PARCEL 94
MILL ROAD, No. ANDOVER, MASSACHUSETTS
SCALE: 1"-60' N AUG. 5,2002
NEW ENGLAND ENGINEERING SERVICES, INC.
60 BEECHWOOD DRIVE
NORTH ANDOVER, MASSACHUSETTS
(978) 686-1768
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AS—BUILT
FOUNDATION LOCATION PLAN
ASSESSOR'S MAP 98B PARCEL 94
MILL ROAD, No. ANDOVER, MASSACHUSETTS
SCALE: 1"-60' N AUG. 5,2002
NEW ENGLAND ENGINEERING SERVICES, INC.
60 BEECHWOOD DRIVE
NORTH ANDOVER, MASSACHUSETTS
(978) 686-1768
Location Ado -4 y �� �� Fd
No. la 13 Date
�oRTN
TOWN OF NORTH ANDOVER
Of �„c ,,h•G
1 _ A
i y
Certificate Occupancy $
of
CMUs
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ _
a
TOTAL $
Check # % S0
`i5767
Building Inspector
Let I
Location Z1 '�" � � �510� �cj
No. Z� Date S 3i
N°"T" TOWN OF NORTH ANDOVEF?
jsiiiiiiili�p Certificate of Occupancy $
83� —
Building/Frame Permit Fee $
�' s •��' E Foundation Permit Fee $
s�cMus <
M
Other Permit Fee $
Sewer Connection Fee $
`t Water Connection Fee $
TOTAL $83(P
t !• l (L f " C��.. Building Inspector
Div. Public Works
Location 77e f�+ (�S �' �'�
/o¢ 7
a Z30
' 1
date
r
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\ A
H
TOWN OF NORTH ANDOVE4p
Certificate of Occupancy $
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Building/Frame Permit Fee $
� 8 s�CMUS ACH Eta
Foundation Permit Fee $
gCg
Other Permit Fee $
Ma ��
Sewer Connection Fee $
do
" A/a.v%
Water Connection Fee $
lo77. `
TOTAL $
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Ins for
8355
Div. / bli Works
214
Location
No. 2Ao Date
S a t 9 b"
TOWN OF NORTH ANDOVER
A
O�t..•o .x,'40
3? : • o`
p
Certificate of Occupancy $
Building/Frame Permit Fee $
"CH Eta
�cMus
Foundation Permit Fee $
Other Permit Fee $!
Sewer Connection Fee $
—�r-
Water Connection Fee $
`
TOTAL $
Q464 n U V Building Inspector
T 7 3207
Div. Public Works
PER31IT NO. 230
a
•
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP i-40.
I LOT NO.
3 PROPERTY INFORMATION
2 RECORD OF OWNERSHIP DATE
BOOK ;PAGE -
ZONE ,�
SUB DIV. LOT NO.
REGULATED BY PARA. 114.8-S. B.C.EST.
(J
UnD)
BLDG. COST
-
PAGE 1 FILL OUT SECTIONS 1 3
LOCATI Nr//
EST. BLDG. COST PER SQ. FT.
7
PURPOSE OF BUILDING5911
1
OWNER'S NAME fY y -a
G) C
r O
NO. OF STORIES IZE
5. fm
�W NER'S ADDRESS
4ef
`Su
BASEMENT OR SLAB
ATTACHED GARAGES MUST CONFORM TO STATE FIRE
ARCHITECT'S NAME ` Z
SIZE OF FLOOR TIMBERS IST `' 10 2ND
�.A/! 3RD
✓✓ll
BUILDER'S NAME I
DATE FILED �/ ��/p
FFF---
If
SPAN :C
DIMENSIONS OF SILLS (�x�
POSTS
DISTANCE TO NEAREST BUILDING
DISTANCE FROM STREET
DISTANCE FROM LOT LINES — SIDES REAR
/
GIRDERS 5
AREA OF LOT <2= FRONTAGE s
`
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW `! s S
r SCA
F E E �
SIZE OF FOOTING V A X
OWNER TEL. #
IS BUILDING ADDITION , O
PERMIT FOR FRAME/BUILDING
MATERIAL OF CHIMNEY
PERMIT GRANTED
IS BUILDING ALTERATION
CONTR. TEL. s �0/—
IS BUILDING ON SOLID OR FILLIED LAND
4%`<
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
es
IS BUILDING CONNECTED TO TOWN WATER
H.I.C. #OU
BOARD OF APPEALS ACTION. IF ANY
/%
IS BUILDING CONNECTED TO TOWN SEWER
r y�
m MA
S—
IS BUILDING CONNECTED TO NATURAL GAS LINE
E
INSTRUCTIONS
3 PROPERTY INFORMATION
PERMIT FOR FOUNDATION ONLY
LAND COST ri.(J� 1S
�
SEE BOTH SIDES
REGULATED BY PARA. 114.8-S. B.C.EST.
(J
UnD)
BLDG. COST
-
PAGE 1 FILL OUT SECTIONS 1 3
EST. BLDG. COST PER SQ. FT.
7
PAGE 2 FILL OUT SECTIONS 1 - 12
DATE FEE PAID °^^�''
EST. BLDG. COST PER ROOM
y v
ELECTRIC
_
IC PERMIT NO.
METEPS MUST BE ON OUTSIDE OF BUILDING
`Su
4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE
REGULATIONS
PLANS MUST BE FILED/AND APPROVED BY BUILDING
INSPECTOR
DATE FILED �/ ��/p
FFF---
BUILDING INSPECTOR
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E �
OWNER TEL. #
-
w
PERMIT FOR FRAME/BUILDING
PERMIT GRANTED
CONTR. TEL. s �0/—
19
DATE: �Q� FEE PAID-
CONTR. LIC. # d
H.I.C. #OU
zfiz�
3 noS
m MA
S—
E
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY sroRlEs THIS SECTION MUST SHOW EXACT. DIM ENSIONSOF LOT AND DISTANCE FROM
MULTI, FAMILY OFFICES 'LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- ,
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT {°LAN.'
CONSTRUCTION
2 FOUNDATION �I 8 INTERIOR FINISH '
CONCRETE 3 1 2_I,_ •
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER �
_ ORY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B MJ AREA -
'/ 1/2 '/, FIN. ATTIC AREA
NO B M FIRE PLACES �•�,
HEAD ROOM _ MODERN KITCHEN
4 WALLS I 9 FLOORS '-
CLAPBOARDS 8 1 22 f 3
DROP SIDING CONCRETE I_
WOOD SHINGLES EARTH
ASPHALT SIDING HARD"✓ D —
ASBESTOS SIDING COMMGN
VERT. SIDING ASPH. TILE _ • -
STUCCO ON MASONRY.
STUCCO ON FRAME,
BRICK ON MASONRY - ATTIC STRS. & FLOOR _
BRICK ON FRAME, '
CONC. OR_CINDER BLK.
STONE ON MASONRY WIRING Y
STONE ON FRAME -�. s .. t •' .
SUPERIOR POOR _
11 ADEQUATE I A NONE
5 ROOF 11 10 PLUMBING
GABIE
GAMBREL
FLAT
HIP
BATH (3 FIX.)
MANSARD
TOILET RM. )2 FIX.)
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SL•4TE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING II
11 HEATING
WOOD JOIST
APIPELESS
FURNACE
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
GAS
OIL
B'MII
1,t 3rd
ELECTRIC
11 NO HEATING
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FORM U - IAT R13ZPME 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.
****************Applicant fills out this section*****************
APPLICANT: / 115 61'e e -e a /Tc, C6
Phone
LOCATION: Assessor's Map Number
Parcel
Subdivision PY a do W oa C -V _
Lot (s )
Street A/ l�S/N� �fL�
St. Nuru;er 2 7d(
************************Official Use
Only*******************x****
RECOMMENDAT ONq OF T WN ""`Ts:
_
Date Approved
Cons ar-: ation Ad::inistratcr
Date Re; ected
cc= er. -_
Date Approved
Town Planner
Date Rejec=ed
Coru:;e: zs
F c o d =^spec-.,,_- eal th
Septic Inspect.._-siea_t�'
CJ'. S :5
Date approved
Date Re -i ec zed
Date Approved:
Date Rej ec :ed
Pu_1_c Wcr::s - sewer/water connections _ 1`� 5'4 `q5
- drive*aay pe: -mit
Fire De=ar -:-.nen,: L
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Location
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TOTAL
E) 215.1
7855
(9 1
Building Inspector
Div. Public Works
EE
NORTH
TOWN OF NORTH
ANDOVERy
p
Certificate of Occupancy
$
>
Building/Frame Permit Fee
$
s�cMus
04
Foundation Permit Fee
$
Other Permit Fe O
$
�—
i' o
.
Sewer Connection Fee
$
M
Water Connection Fee
$
TOTAL
E) 215.1
7855
(9 1
Building Inspector
Div. Public Works
PER\tIT NO. �� J
J
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1
MAP 4-40.
LOT NO.
I
2 RECORD OF OWNERSHIP :DATE
BOOK :PAGE
ZONE
SUB DIV. LOT,NO.
LOCATION
G
PURPOSE OF BUILDING I._O
\�t
OWNER'S NAME
NO. OF STORIES`ISIZE
` :3
OWNER'S ADDRESS V ^
BASEMEN OR SLAB
ARCHITECT'S NAME •
SIZE OF FLOOR TIMBERS IST 2ND
3RD
BUILDER'S NAME ` .�` �4,{, `,
C- Wr V
SPAN --
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM STREET
<-
DISTANCE FROM LOT LINES SIDES L I� REAR Z
"" GIRDERS
AREA OF LOT LG_ �7 FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW (\
V
SIZE OF FOOTING X
IS BUILDING ADDITION
-
MATERIAL OF CHIMN YNb
IS BUILDING ALTERATION
IS BUILDING O SOLID FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE -
IS BUILDING CONNECTED TO TOWN WATER
\ /�
v
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
DATk tI,�D \� '
SIGNATURE OF OWNER OR AUTHORIZED AGENT
. F E E
PERMIT GRANTED
1 3 ,9_
3 PROPERTY INFORMATION
LAND COST it
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
NO
OWNER TEL I
CONTR. TEL. #
CONTR. LIC. #� \ 1 7s
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY I
lArORIES
MULTI. FAMILY KI
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
_
8 INTERIOR FINISH
CONCRETE
PINE
HARDW D
3
2 13
CONCRETE BL K.
BRICK OR STONE
PIERS
PLASTER
_
_
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
'/ 1/1 1/.
FIN. ATTIC AREA
_
NO B M T
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
_
4 WALLS I
9 FLOORS
CLAPBOARDS
B
1
_
2 3
�_
_
_
DROP SIDING
CONCRETE
WOOD SHINGLES
EARTH
ASPHALT SIDING
ASBESTOS SIDING
HARD"J-D
COMIAON
VERT. SIDING
_
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STIRS. 8 FIOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
_
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR POOR
ADEQUATE NONE
ADEQUATE
5 ROOF
10 PLUMBING
GABLEHIP
GAMBREL
BATH 13 FIX.)
MANSARD
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
_
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR 8 GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
_
TILE DADO
6 FRAMING I
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. 8 COLS.
_
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 2nd _
10 1 3rd
ELECTRIC
NO HEATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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KAREN H.P. NELSON
Director
BUILDING
CONSERVATION
HEALTH
PLANNING
�9 Town of 120 Main Street, 01845
`� NORTH ANDOVER (508) 682-6483
e@�°" 9�4 DIVISION OF
PLANNING & COMMUNITY DEVELOPMENT
DEMOLITION OF BUILDING AFFIDAVIT
DATE
,
3 Tui o ofk-e ST- L^ !9h d ny Pr 0/ e Y �—
LOCATION OF PROPERTY TO DEMOLISH ? //S'/ 644 le
DEPARTMENT SIGN- FFS
✓D i t
DEPT. OF PUBLIC WORKS -{WATER.
VGAS � .fie � fTO 4' h d S'
J
I/
I
C
EXTERMINATOR
DUMPSTER - ON/OFF STREET o r t
DIG SAFE NUMBER C?
DATE RECD BLDG. INSPECTOR
.02
DEC -29-94 THU 13:42 BAY STATE CAS LAWRENCE FAX N0, 5086881875
Bay State Gas Company
December 29, 1994
TO WHOM IT MAY CONCRRN:
This is to inform you Chat the service indicated below has
been cut On the date(s)indicat=ed, and the building may be
demolished.
Address
274 Hillside Rd., N. Andover
Date Service Cut
No Gas at this location
Very truly yours,
BAY STATE GAS COMPANY -LAWRENCE DTV,
William J. W�ite
Supervisor Distribution
Post -It'" brand fax transmittal
memo 70-71
a of pages 0.
T�1 r- � �
From
� �•�
Co; G
Dept.
PhOnC M��
/fit
—!
Fax N wFait
i
5.5 Visator• Sheat ?o. Sox 869 !_atn_i�gg NA GiE:•9t 2372 SOg.S37-1165 rax: 50t4-683-1$75 I
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