HomeMy WebLinkAboutMiscellaneous - Matthews Ln 31F�
Date.......................
827
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
SACHUS
This certifies that ..... L
has permission to perform ..........
.................
winng in the building of ... .. P., U
.............................
at.211 North Andover, Mass.
z/
Fec�/.&-.. Lic. No.21"Yq-7
,(./.7 ..........................................................
ELECTRICAL INSPECTOR
03/27/9713..36 3186( PA'�INIK: Treasurer
WHITE: Applicant CANARY: Building ep�.
014t Tows iawralt4 of MamOugettg
Ikpartiucttt Elf Vublic eafag
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only
Permit No.
Occupancy ,& Fee Checked
3/90 (leave blank) {f
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3 _ 2_G - % -7
City or Town of NORTH ANDOVER To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below.
Location (Street t
Owner or Tenant
Owner's Address __/ S 5 7C r� 1 n t O �� L' /U0 Y"F lit ✓J J C) V-0
RA
Is this permit in conjunction with e# building permit: Yes No ❑ (Check Appropriate Box)
Purpose of Building , IrJ G %ems �f (LI'✓.� _ Utility Authorization No. ;10 2 ;Z_ � J?
Existing Service Amps / Volts Overhead ❑ Undgrnd ❑ No. of Meters
New Service ZGy Amps 17—`� Z-c(y Volts Overhead ❑ Undgrnd a No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hol Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑ ❑
grnd. grnd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners u
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local Municipal ❑Other
❑
No. of Dryers
Heating Devices KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Com,,�p/leted Operations Coverage or its substantial equivalent. YES 4 NO ❑ 1
0 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 ap�p{ropriate box.
INSURANCE !Ji-' BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start 3 - 2-6 —97 Inspection Date Requested: Rough .4,.1 fC Ct.JC Final
Signed under the Penalties of perjury: qQ
FIRM NAME "r�� & LIC. NO.// / 7
Licensee 6friSf/SOlQr Z4POI'Al PQ� Signature LIC. NO.
Address �'71.�c&!aSleriz-9 _` ,/. �1�t0iIA Alt. Tel. No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
x-6565
691
0
4L
Date .......
......................
�A
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING,
cz 4
CL
ACHUS
This certifies that ........ I .....................................
has permission to perform ... ;-I� ....... "F,& ...................................
....................
wiring in the building of .. ...........
CU
a t L.. L . . ... Andover, Mas!6—;
Fee -Sb ... . ...... Lic. No./Z.f.�)V.1 .... Qg'�'
RICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Of TVIR111011wraltll of fflttoottclluung
iDepurttucttt of Vublic £hWU
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only /
Permit No. �� (� Z
Occupancy & Fee Checked -60
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
City or Town of NORTH ANDOVER
Date
To the Inspector of Wires:
The udersigned applies for a permit to perform the electrical work described below
Location (Street & Number) �� /!i(� Zd4 �rr- (f ,S Z
Owner or Tenant
Owner's Address
Is this permit in conjunction with et building permit
Purpose of Building
Existing Service Amps -J Volts
New Service 14_�o Amps mu/ Z� 6 -Volts
Number of Feeders and Ampacity
Location and Nature of Proposed I
Yes ❑ No ❑ (Check Appropriate Box)
Utility Authorization No. :7a6
Overhead ❑ Undgrnd ❑ No. of Meters
Overhead ❑ Undgrnd No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
Swimming Pool Above In-
❑ ❑
grnd. grnd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local Municipal ❑ Other
❑
No. of Dryers
Heating Devices KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Cor ted Operations Coverage or its substantial equivalent. YES NO ❑ 1
have submitted valid proof of same to the Office. YES O NO ❑ If you have checked YES, please indicate the typd of coverage by
checking the appropriate box.
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work $
Work to Start /"/0 -:Z-7 Inspection Date Requested: Rough Final
Signed under the Penalties of perjury:
FIRM NAME LIC. NO. '122 7A
Licensee �l�j.t ��0 14e 4 L 'Signaatjure�, /� LIC. NO.
�`�? p</Q,.' /J 3l'i x ,/� 11 w` 4t e . (�t Alt. Tel. No.
Address e�� -��
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one)
Telephone No. PERMIT FEE $
(Signature of Owner or Agent)
x-6565
Date. . :3. Y.�.71 7
3269
ORT -OF NORTH ANDOVER
+ TOWN
PERMIT FOR PLUMBING
$A U
This certifies that .................
has permission to perform .....................
plumbing in the -buildings of /)1! 1� . .........
at. ...... rtrth Ando Vass.
.........
Fee.3.1.5! Lic. No.10-3 ................
PLUMB INSPECTOR
ck'*
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
I- &
. IkKicloW1% Mass. Date �3 /)I 5i 19
Building Location 3
1Ll�tUyel1Z1Q'
NevA/ Renovation ❑ Replacement ❑
Owner's
`
_Permit # 2- 4 7
Name Mik p `", 11" j r
Type of Occupancy SINGLE FAMILY
FIXTURES
Plans Submitted: Yes ❑ No ❑
Installing Company Name GALINSKY PLUMBING & HEATING INC.
Address P . O , BOX 1701
HAVERHILL, MA 01831
Business Telephone 508-374-1743.
Name of Licensed Plumber STEPHEN C. GALINSKY
Check one: Certificate
Corporation 1906 _
❑ Partnership
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes' No O
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policypl' Other type of indemnity ❑ Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does nol have the insurance coverage required by Chapter 142 of the Mass.
General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner O Agent O
t hereby certify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all plumbing Murk
and installations performed under the permit issued for this application will he in compl1 ce with al ninent provi{ions�'h lumbing Code and Chapter 142 of the
(;'neral laws,
By Signature of License Plu her
Title Type of License: Master Journeyman O
Cilvliown _ License Number --1034-8
4PPROVFD rOrTICF USE ONLY)
■■■■■■■■■■■■■■■■■■■■■■■■■
1111111; YLIM 1,11
nonnann■■■■■■■■■■■■■■■■■■
2nd FLO•• n■nn■■■■o■■■■■■■■■■■■■■■
r••, ■■E■■■■■■■■■■■■■■
■■....s
•• ■■
■
■■■■■■■■■■■■■■■■■■■■
Installing Company Name GALINSKY PLUMBING & HEATING INC.
Address P . O , BOX 1701
HAVERHILL, MA 01831
Business Telephone 508-374-1743.
Name of Licensed Plumber STEPHEN C. GALINSKY
Check one: Certificate
Corporation 1906 _
❑ Partnership
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes' No O
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policypl' Other type of indemnity ❑ Bond D
OWNER'S INSURANCE WAIVER: I am aware that the licensee does nol have the insurance coverage required by Chapter 142 of the Mass.
General Laws, and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner O Agent O
t hereby certify that all of the details and information I have submitted (or entered) in the above application are true and accurate to the best of my knowledge and that all plumbing Murk
and installations performed under the permit issued for this application will he in compl1 ce with al ninent provi{ions�'h lumbing Code and Chapter 142 of the
(;'neral laws,
By Signature of License Plu her
Title Type of License: Master Journeyman O
Cilvliown _ License Number --1034-8
4PPROVFD rOrTICF USE ONLY)
Date ..............
2490
TOWN OF NORTH ANDOVER -1
0 PERMIT FOR GAS INSTALLATIOtf-
11 'ISSACHU
'�SACHU -41
This ceriffies that. 1,15- ................. j
411"t
has permission for gas installation ...
r -r
in the buildings,of, . ..........
at 3 . . . . . . . . .. . . North Andover, Mass.
Fee.. Lic. No.../QA� ......... I .................
6k -4 3 k�o. GAS INSPECTOR
WHITE: Applicant -ZA—URY: Building Dept, PINK: Treasure.r GOLD: File
,. .. . .. r 1 • I I ' �; w•rnr. W�l�'INr1 t �
MASSACIIUSETTS UNIFORM APPLICAICION FOR PERMIT TO UO G�SEIJr71NG
il`'u - Mass. Date ^ 4 19' Permit 0 '1
f
' ="t Building Location Owner's Name---
`�isSINGLE GAMILY
Type of Occupancy
G
New ❑ Renovation ❑ Replacement ❑
FIXTURES
Flans Submitted: Yes U No IJ
Installing Company Name GALINSKY PLUMBING & HEA'T'ING INC.
Address P.O.BOX 1701
HAVERHILL, MA 01831
Business Telephone 508-374-1743
Name of Licensed Plumber or Gas Fitter STEPHEN C. GALINSKY
Check one: Certificate
ECJ Corporation 1906 _
❑ Partnership
❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which rneets the requirements of MGL Ch. 142.
Yes )t No U
If InU have checked res, please Indicate the type coverage by checking the appropriate box.
A li,110y Insurance policy Other type of indemnity O Bond U
OWNER'S INSURANCE WAIVER: I am aware that the licensee (foes not have the insurance coverage required by Chapter I42 of the Mass.
General I.aws, and that my signature on this permit applicalinn waives this requirement.
Check one:
Owner O Agent C
ci{!nattne of ()%vncr or Owner's ARpnl
I ht"I tr,lift that all of lhr t1oad, and W"f aiinn I ha,r snh,ninrd In, entered- In thr at-vt applicalinn art true and accurate, In the hest of my knn. lydi?e and that all plumbinil eat,
a„d en.•s'lalinnt pr,fmmr.f under thr prrn,lt ip urtt In, IN% applic aline will M In tomphanre with at! txrtinenl pm, isions Otho Massachusetts State Gas Code and Chapttr 142 d 0,e Gr„enl I a+•
ttrr nl lit lint( ��
-
ti,i,. k1we, S-gnatu,e of 11CAH Mumbrr rn Gat finer
_..__ l' Intpnryma”
N
min
NN
NNNNNNIN
aeee6iiie��°cE°�6�MN
.�'
Installing Company Name GALINSKY PLUMBING & HEA'T'ING INC.
Address P.O.BOX 1701
HAVERHILL, MA 01831
Business Telephone 508-374-1743
Name of Licensed Plumber or Gas Fitter STEPHEN C. GALINSKY
Check one: Certificate
ECJ Corporation 1906 _
❑ Partnership
❑ Firm/Co.
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which rneets the requirements of MGL Ch. 142.
Yes )t No U
If InU have checked res, please Indicate the type coverage by checking the appropriate box.
A li,110y Insurance policy Other type of indemnity O Bond U
OWNER'S INSURANCE WAIVER: I am aware that the licensee (foes not have the insurance coverage required by Chapter I42 of the Mass.
General I.aws, and that my signature on this permit applicalinn waives this requirement.
Check one:
Owner O Agent C
ci{!nattne of ()%vncr or Owner's ARpnl
I ht"I tr,lift that all of lhr t1oad, and W"f aiinn I ha,r snh,ninrd In, entered- In thr at-vt applicalinn art true and accurate, In the hest of my knn. lydi?e and that all plumbinil eat,
a„d en.•s'lalinnt pr,fmmr.f under thr prrn,lt ip urtt In, IN% applic aline will M In tomphanre with at! txrtinenl pm, isions Otho Massachusetts State Gas Code and Chapttr 142 d 0,e Gr„enl I a+•
ttrr nl lit lint( ��
-
ti,i,. k1we, S-gnatu,e of 11CAH Mumbrr rn Gat finer
_..__ l' Intpnryma”
7--..;;; ,
Location
No. 63 3' Date
0 Pf
d
TOWN OF NORTH ANDOVER
a,, - 0
04. -
A6m9dk S
- -womw .
Certificate of Occupancy
$
Building/Frame Permit Fee
$
S A MU
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
k4
tBuilding
Inspe6tor
I �2' 10 6.64
/91 14-.23 11282.00 PRO
Div.
Public Works
Locatipn
No. Date //1 -619,2
/ I -G,62
0
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ — 5-0
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
TOTAL
N
Buildin In
1W
01/31/97 13:50 150.00 9 Ij:tor
Div. Public Works
Location- zn
No. Date 1-27-q7
TOWN OF NORTH ANDOVER
Certificate of Occupancy :$
Building/Frame Permit Fee $
rs Foundation Permit Fee $
IMU
Other Permit Fee $
Sewer Connection Fee $ /000
33 7.
water Connection Fee s ZoA
TOTAL $
ild',
19000.00 PAI
I F404
PER '.% rr NO. 35 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
✓ PAGE 1
MAP h40.
I LOT NO.
2 RECORD OF OWNERSHIP iDATE
BOOK 'PAGE
ZONE tee
SUB DIV. LOT NO.
LOCATIONPURPOSE
3/ a T7'4Qi,,,s
Com �—
OF BUILDING
�� a
e,/ z°s
OWNER'S NAME t I) "P w o ow JQ'
v co r �
NO. OF STORIES � SIZE
OWNER'S ADDRESS 173 3 Tu }
ARCHITECT'S NAME // ail
G✓
121`ke C j
J
BASEMENT OR SLAB 8,9s -p L� y f
SIZE OF FLOOR TIMBERS IST 1 2ND
�oi�D
�jtl`(� 3RD
BUILDER'S NAME 1 _e IJ_i 0 -/
Vi t'r, „/�
r
SPAN
DISTANCE TO NEAREST BUILDING c)
I
DIMENSIONSOFSILLS u x 6
POSTS 3
DISTANCE FROM STREET /
r
DISTANCE FROM LOT LINES - SIDES
7
, REAR oU %
GIRDERS
V /lCy
AREA OF LOT Lr 1
FRONTAGE tZJ� 1
HEIGHT OF FOUNDATION / THICKNESS
oq
IS BUILDING NEW /P7 S'
y
SIZE OF FOOTING X
U
IS BUILDING ADDITION iS J 0
MATERIAL OF CHIMNEY d7 r
IS BUILDING ALTERATION /u
IS BUILDING ON SOLID OR FILLED LAND
jl /
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
/
IS BUILDING CONNECTED TO TOWN WATER
Ye s
BOARD OF APPEALS ACTION. IF ANY
,✓ zi
IS BUILDING CONNECTED TO TOWN SEWER
)j -e s
(
IS BUILDING CONNECTED TO NATURAL GAS LINE
YY s
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
i ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED / /� '� /9
PERMIT GRANTED /
r 19
mmpu=m f�a.
MlE FRAME PERMIT 9 /Z$7—,
3 PROPERTY INFORMATION
LAND COST /
EST. BLDG. COST �,{Q
� KJ
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM �/�
[7 )
SEPTIC PERMIT NO. J
4 APPROVED BY
BUILDING INSPRCTOR
OWNER TEL. # � 611- 3(a > 7'
CONTR. TEL. # _6 16 V- 76 24"
CONTR. LIC. # /6 ` D
H.I.C. #
I I OCCUPANCY
?I-NGLEFAMIL) PRIES
CONSTRUCTION
,-: � , ' - ,
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE
8 1 2 3
CONCRETE BL'K. NE
2-1
BRICK OR STONE HARDW D
PIERS T -ASTER
V I -AL L
7N-F7N-
3 BASEMENT
AREA FULL
FIN. 8 M'T* AREA
FIN. ATTIC AREA
t!O 8 M T FIRE PLACES
HEAD ROOM 'VODERN KITCHEN
, 71 1
4 WALLS 9 FLOORS
CLAPBOARDS
DROP SIDING
WOOD SHINGLES
B
1
2
3
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
HARDW D
COMMON
-��SPH -TILE
STUCCO ON MASONRY'
STUCCO ON FRAME
BRICK ON -MAS
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONC. OR CMFER -BLK.
WIRING
STONE ON MASONRY
STONE'ON'FRAME
_LUPERIOR POOR
ADEQUAiE NONE
5 ROOF
10 PLUMBING
GA �EW
HIP
BATH (3 FIX.)
GAMBREL]
MANSARD
TOILET RM. 12 FIX.1
FLAT
I
SHED
WATER CLOSET
ASPHALT SHINGIFS
X
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
BUILDING RECORD-,
12
THIS SECTION MUST SHOW EXACT- DIMENS'10-NS OF, LOT AND DISTANCE FROM
�'�.LOT LINES AND EXACT DIMENSIONS-OFJBU!LDINGS", WITH, PORCHES. GA-
RAGES ETC SUPERIMPOSED.- THIS REPLACES PLOT PLAN -:- �
6 FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS. STEAM
STEEL BMS. & COLS. HOT W*T'R OR VAPOR rim mug
WOOD RAFTERS AIR CONDITIONING_
RADIANT H'T'G
UNIT HEATERS
GAS T M 9 3 1 31MAl 3 3 11
7 NO. OF ROOMS OIL
iM'T C> 2 d ELECTRIC
2n
3rd NO HEATING
' iL.VJ JUOGG»041! tutKUKtEN MAVAUEMENI PAGE bl
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dd
~� YG✓a.� yA4AD
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iN
13
�t1E.�.!y�IGC E,vci.�EE.P.ui6 j1e147
646
i
'i
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verifyjthat 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: /h Phone 6 L (_/ - 3d 7 y
LOCATION: Assessor's Map Number. Parcel
Subdivision �jy1 P[�)dr�0% Lot(s)
Street -F/ y,57 LAA/ St. Number 2
7fficial Use Only************************
RECO MM�N ATION OF O AGENTS:
Date Approvedf Y7
Conservat' n Administrator Date Rejected
Comments
14
Date ApprovedA2ZJ
own Planner Date Rejected
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Date Approved
Date Rejected
Date Approved
Date Rejected
Public Works - sewer/water connections ` J Lt) 1-27-7 7
driveway permit —J a� l Z7- '? 7
Fire De amentz
t�L� L
Rce ed by Bui ng Inspetor
i
Date
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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 exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
N e of Applicant on uilding Permit (below) Address of Property for Permit (below)
�4 if • C Or :�� // 01 Tn 'e_
Map and Parcel: Purpose of Application (check below)
P o e,NuJe �f pplicant: 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 of the North Andover 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 I 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 a building permit for the enlargement, restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
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This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons 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 a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density, (buildable lots), below the density, (buildable lots), 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 and/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 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 building permits,(i.e. 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
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination
that your application is allowed 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 and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowl dge or not, is grounds for re usal by the Building Department to issue a Building Permit.
n ture f Owner or Authorized Agent who signed the Attached Building Permit ate
This form must be attached to the Building Permit upon application for such permit.
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