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HomeMy WebLinkAboutBuilding Permit #242-15 - 18 HERRICK ROAD 9/18/2014 14ORTFI BUILDING PERMIT OF�t,eo ,bq'�'O TOWN OF NORTH ANDOVER o� '° /APPLICATION FOR PLAN EXAMINATION *?o e« w 1 Permit No#: Date Received 1TED �SSACHUS�� Date Issued: I ORTANT:Applicant must complete all items on this page LOCATION' PROP RTY OWNER—,oV1*, G-1k— n Prit 100 Year Structure yes no MAP PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alte tion No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIP N O WO OBE PERFO ED: Idntifi ion- ase Type or Pr' Clearly OWNER: Name: A7, Phone: Address: 112, Contractor Name: hone: J Address: , Supervisor's Construction Licensec`�1 Exp. Date: Home Improvement License: _- Exp. Date:__ _ ARCHITECT/ENGINEER Phone: s Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ h?�� ,` FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ss t Signature of Agent/Owner T Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments b Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street FireDepartment signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location aA � I � No. v 1w N4 �( Date IV . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee q7& v Foundation Permit Fee $ Other-Permit Fee $ TOTAL $ Check# Building Inspector T 11 DAYLILY DR NASHUA, AIH 03062 PHONE: 603-204-2334 www.AJCROOFING.com GAl~License#ME17843 MA CSL#96194 M4 HIC#153131 Roofing Contract Snh�idia of AJC Pro rtitti L� To: Home Phone: Date: r .� 4 e Ify Street: Cell Phone: By: City,state Zimp -Job Address.Same We propose to furnish material and labor complete in accordance with specifications outlined below: EXISTING ROOF consists of -#Comp layers: 4 Wood Layers: Metal Layers: ROOFING SYSTEM to INSTALL:Manufacturer d Tyles. �� � Color. E�Teat Off Comp: Woodshake: Metal ❑'Apply Decking: i 2^CDX 112"OSB fl Other B't',tak Barrier. 9.90otmGuard ❑Weadte-Match Q Other _(3 Feet wide along rakes Feet wide along eaves [.}'Starter Strip Shingles: [ start Q WeatherBlocker QOther e-ftp Edge: ®Color: 'St 00t* -- 0 Valleys: [}Closed Cut Weave []Leak Barrior StormGuard ❑Leak Barrior Weather Watch 91(0of Deck Protection: i[deck Armor 0 ShingleMate ❑915 Felt n 036 Felt Q Other ( fn3tall Pipe Boot(s): 1"_3" [ 3^_4^ e•Flash chimneys)5 anrl'mail abutments)S [ rtgle Fasteners: Nd"Nails (,]Other Nails per shingle: 17 (©/Attic Ventilation: [3-Mra Snow Country Cobra Exhaust Ridge Vent �}Other [��Ridge Caps:. 0 Tirabertex ( gal-A-Ridge (]Other ®Magnetically sweep yard for nails/Clean up yard anti haul away rooting debris For the slim of:` liars: � " ,includes labor/material/dumpster,excluding options. instructions: (N •, °(u' '� ��� F ftgtlfig 4t 01`Removal:No etlarr b"been made far rcmpving additional layers otmofing,unless specificany stated above.if additional tayersis)ofrooting axe fount{derririg n tnovat otexictirrg r otthet cxc d i(ager.the customs shall pay an mwitionat amp of Intl per too sgit for each riddhionel layer of rooting minoved.Additional charge is due upon Uuripk:ian of work. Deteriorated or Rotten Wood:No charge has been mak for replacing UvA.unless specifically stated above.tfioned wood is distxrveied allerreihoving the "istingmnfing system.standard CW plywood steed is$65.00 and will be applied each shat.56.00 pet nnem A up 1a 1-s6,..110.00 per 1`1rteat R above t"A" for dimnsional wood ivm1 ei and 1l4 per frim itfor-IX composite materiel. Payment Terms:1/3 due at dire of eontract.•z;gning Contract balance due upon completion of#otic Stan Date. weather permitting V End Date: weather permitting Estimate is valid uretic: Financing Options War FF Manufacturer Warranty ���� *See brochure C hoofing Labor Warranty 2 years} . Acceptance-of Contract:The above prices,s ccifications,and conditions are satisfactory artd are herby accepted.1/We agree to the contract provisi o the back side of the coflmact.AJC Roofing is authorized to do the work as specified.Payment will be made per P then s above: Dr f 1 Own roneer: Date, AJC Roo ing: Date: j7 F10 M0lif Mild y., a�ty p r 1 ® DATE(MMMD/YYYY) ACORN CERTIFICATE OF LIABILITY INSURANCE 6,18,2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Iieu of such endorsement(s). PRODUCER NAME: Eaton&Berube Insurance Agency, Inc. PHAI ONE FAX No 11 Concord St E-MAIL Nashua NH 03064 11 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 8 INSURER A INSURED AJCPR INSURER B Arch InSUran;e AJC Properties LLC INSURER C:MMG Insurance Co dba AJC Roofing INSURER D: c/o Mark&Shirley Freeman 11 Daylily Drive- INSURER E Nashua NH 03062 INSURER.F COVERAGES CERTIFICATE NUMBER:1663964287 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEtADDLISU I POLICY EFF POLICY EXP LIMITS LTR 'I IN WVD I POLICY NUMBER MMIDDIYYVY MMIDD/YYYY B GENERAL LIABILITY I GL001113600 /1312014 /13/2015 EACH OCCURRENCE $1,000,000 I DAMAGE X COMMERCIAL GENERAL LIABILITY PREMIS $100,000 _ CLAIMS-MADE �OCCUR MED EXP(Any oneperson) $10,000 X 500 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 i GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $2,000,00 X POLICYF7JECT PRO I LOC I $ C SINGLE LIMIT AUTOMOBILE LIABILITY KA0113773 /24/2014 /24/2015 $1,000,000 � ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED BODILY INJURY(Per a=dent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE 1 AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 0288300204706 /27!2014 /27/2015 X VJC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100,000 OFFICERIMEMBER EXCLUDED? YY NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $100,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 j I I I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) - I I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. c/o AJC Properties LLC 11 Daylily Drive AUTHORIZED REPRESENTATIVE Nashua NH 03062 i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD :. The Commonwealth of Massachusetts o Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 771-1 Name Business/Or anization/Individual v i ( g ) i Address: U City/State/Zip: Phone#: q X6 L A A�V&� IT i Are you an employer?Check the appropriate bo Type of project(required): 1. ❑ I am an employer with 4. am a general contractor and I 6. ❑New construction i employees(full and/or part time).* have hired the sub-contractors 7 p Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building'addition [No workers'comp.insurance comp.insurance.$ required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their Il. ❑2of ing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12. repairs employees.[no worker;' 13. ❑Other comp.insurance required.] *Any applicant that checks box#1 must also rill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box most attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing work s'compensation insura f r y employe Below is the policy and job site information. Insurance Company Name: Policy#or Selfins.Lic.#: Expir ti Dat • 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 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 I $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for covers a verification. I I do herby oe 'y under a psi and [ties of perjury th the information provided abo e is e and correct. Si natur Dale: ';7 1 Print Name: P, Phone#: 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): I.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other' Contact person: Phone#: _leersc CS-096199 4 MARK FREEMAN I I DAYLILY DRIVE Nashua NH 03061 07/1412016 or Oflice of Ci;r, - -- -__ t.mcr.A-,cir;d HJsines�fievulatin�n HONE IMPROVEMEKIT C,iUTRACTCR �_='_ . Registration: 1�3�3, - Type: Expirztion: 1^130314 2 x = _id LiabrHi,y Cr,,,r AJC:RCS�==RTIES DR. MARK FR=EV..AN 11.DAYLILY DR. NASHU.A,NH 33062 ¢�` -- ' t.+�dersrcretorn i NORTH Town Of . t E ��' . YAndover O - 0 No. 0142 --- 145 01" �o h ver, Mass, COCL,11,146"IC"CWICK �1' ADRATED P4p,`'(5 S U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System THIS CERTIFIES THAT ...... .... �.��......let,cco—A-1BUILDING INSPECTOR . has permission to erect .......................... buildings on .... ............. Foundation Rough to be occupied as ................ . ... .... ............�� I�t\ .. ......................... ........... Chimney provided that the person accepting this b�rnit shall in eve res ect co rm to the terms of thea lication p p p 9 p every p pp Final on file in 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 MO HS ELECTRICAL INSPECTOR • UNLESS CONSTRUCTIONrJ 4&w0000 Rough Service ....................... . .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Wall Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Location No. A47- — Date S 40MT TOWN OF NORTH ANDOVER 0 „ Certificate of Occupancy $ Building/Frame Permit Fee $ cMFoundation Permit Fee $ � s� uS s Other Permit Fees,Ot $ Sewer Connection Fee Q $ Water Connection Fee $ �co TOTAL $ 0— Building Inspector 09/07/95 12:43 52.00 PAID 8783 Div. Public Works PERMIT NO. 44-2— APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZOtJE I SUB DIV. LOT NO. I d LOCATION Q� �/>' -S77 PURPOSE OF BUILDING IAI l- �/ib 9 OWNER'S NAME v/ O� 7-1 CJ ✓ NO. OF STORIES SIZE -'{ • C— OWNER'S ADDRESS /Cl } �A/n S'T` BASEMENT OR SLAB - • ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME , Lj-1-10A3 el SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES -SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER .� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION C LAND COST SEE BOTH SIDES � � � �\��`i�46 EST. BLDG. COST �'Uo. �j CJ' V s PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR D E FIL _ _ „ nvftbtfqb INSP[CTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT FE E ^Z� o OWNER TEL.# PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# ©� �!&..;7777 I H.I.C.# a85-�3 � 9��3 BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D — PIERS PLASTER ' _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 1/1 1/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDV✓'D ASBESTOS SIDING COMMON — 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 STONE ON FRAME SUPERIOR I I POOR ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE 11 HIP BATH 13 FIX.) GAMBREL 1_1MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & 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. & 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 _ ELECTRIC 1st 13rd 11 NO HEATING 1 NORTFy Town o Andover 0 No. 442 't- LA dower, Mass., COCHICHEWIT I- Odc?ATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System .V*4.k..vkfzt�.... W. BUILDING INSPECTOR THIS CERTIFIES THAT.... !! .ISA..... .. i.&............................................................................................... Foundation has permission to erect.A-0711%z. .............. buildings on .....US.......4ee.ekCW............................................ Rough to be occurred as +e�.p....kkynx...90041a...-...Q. Q. Chimney . (Z�.................... provided that the person accepting this permit shall in ever �reasplect-c_o_�n- Aiok..tothe teras 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXP MONTHS Final UNLESS CON TR C ELECTRICAL INSPECTOR Rough ------- BUILDING..DING... .... Service INSPECTOR Final 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 DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT _ COMMONWEALTH FPnEPARTMENT Of FUBLIC SAFETY � OF ONE ASHBORTON PLACE Paliat0 s MASSACHUSETTS BOSTON,ISA 02108 - tlassaoAasatrr Ststo Q�lp j; Codo Is caaaa lot rov*0tt L I CE N S E Ofthla ifocravo- EXPIRATION DATE CONSTR. SUPERVISOR CAUTION 05/29/1997 EFFECTIVE DATE UC-N0. FOR PROTECTION AGAINST RESTRICTIONS THEFT, PUT RIGHT THUMB NONE 9 -, C!bI30/ 1C4 .0516_t- � PRINT IN APPROPRIATE- > ThOMAS i SAYERS E' z 116 WASHINGTON ST SS * 020-26-7402 z GROV€LAND NA Olf34 TINGO m MUS E PH PHOTO(BLASTING OPR ONLY) F �,•il4V w a �.�. 0 C■ 00 NOT VALID UNTA S`GN&D By LICENSEE.AND OFFPCIA—Ly V{ 1394 r HEIGHT: STAMPED•DQ-&GNATURE of THE CM04ISS DNEQ a DOB: rf-05/29/193. •�aa�� . THIS DOCUMENT MUST 8- 4t/,7.t, ti CARRIEOON THE PERSON O LICENSEE 'N NAME IN FULL ABOVE SIGNATURE UNE / �i4 _='J•� THE HOLDER WHEN EK I OTHERS•RIGW l)gUMB PRINT GAGED IN THIS OCCUPATION x>:, ER {� 4SkaJ�iir..T�r.Y r a Tr- ac2isttati0o 108503 Type: PRIVATE CORPV TMj F t. IE>13►iration OR/p;#$ r' CT f X11='t w P. RZ 00 St. . u � I d,wwrN � e OFFICES OF: fir',,,.`-" TOWIl Of 120 Main Street ` APPEALSNORTH ANDOVER North Andover, BUILDING �,;a .• Massachusetts O 1845 CONSERVATION DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR In accordance V-1hr the provisions of NIGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of to a properly licensed solid waste disposal facility as defined by MGL c III, S 150A. The debris will be disposed of in: (i.ocation of Facility) Signature of Permit App/an Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Office Use Only The Commonwealth of Massachusetts 19 Permit No. Department of Public Safety .� Occupancy& Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 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 INFO OR TYPE I ORMATION) Date 1 2 City or Town of 6 f- To the Inspector of Wires: f The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) L Owner or Tenant 1k v Owner's Address_ Is this permit in conjunction with a building permit: Yes ElNo ❑ (Check Appropriate Box) Purpose of Building /� j G'J. l«4, l it 1/ Utility Authorization NO. Existing Service /04) -Amps_� ?G'/ // r Volts Overhead,,Undgrd❑ No. of Meters New Service Amps /`►�—Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 4e f 42G G t e*-S" Total No. of Lighting Outlets No. of Hot Tubs No. of Transformers XVA KVA No. of Lighting Fixtures Above In- No. Swimming Pool grnd. ❑ grnd. ❑ Generators INA No. of Receptacle Outlets No. of Oil Burners No. of'Emergency LightingBattery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and 8 No. of Air Cond. tons Initiating Devices No. of Disposals No. of pumps Total Total No. of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection No. of Water Heaters KW No, of No. o Low Voltage 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 Completed Operations Coverageor its substantial equivalent. YES❑ NO ❑ I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ Expiration Date Work to Start Z ` Inspection Date Requested: Rough Final 6 Signed under the penalties of perjury: FIRM NAMEStO eC LIC. NO. Licensee L Si natureL C. NO.-IJ Bus. Te . Q Address BlN 7 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this pet application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ i ' Signature of Owner or Agent i i ELECTRICAL APPLICATION PERMIT #� y' DATE: ELECTRICIAN LOCATION DATE COMPLETED nttice Use Only : The Commonwealth of Massachusetts Department of Public Safety relief[ �: Occupancy L Fee Chocked L3 BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 (leave blank) � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Work to be performed In accordance With the Massachusetts Oectrical Code.527 CMR 12:00 (PLEASE PRINT IN IHR OR TYPE ALL INFOMMON) Date City or Town of a To the Inspector of W res: The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) `vim Owner or Ienant Owner's Address Is this permit in conjunction_with a building permit: Yes& No ❑ (Check Appropriate Box) Purpose of Building " Utility Authorization NO. Existing ServiceAmps / Volts Overhead ❑ Undgrd❑ No. of Meters Nev Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and A_=pacity Location and Nature of Proposed Electrical Work i r-- lfe--e v No. of Li htin Outlets Total 8 8 NoSwimming Pool. of Hot Subs No. of Transformers KVA \` No. of Lighting Fixtures Above In- grnd.❑ grnd. ❑ Generators KVA No. of Receptacle OutletsNo. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Ranges No. of Air Cond. No. of Ran - tons Total No. of Detection and 8 Initiating Devices Pumps Tons No. of Disposals INo. of Heat Total Total No. of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of DryersHeating Devices KW Local❑ Municipal ❑Other Connection No. of Water Heaters KW INo, of No. ot: Low Voltage signs Ballasts Wirin 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 Completed Operations Coverage or its substantial equivalent. YES& NO C] I have submitted valid proof of same to this office. YES® NO If You have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE � BOND ❑ OTHER'J (Please Specify) (Expirartioi;Date) Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under thef�7&nalties of perjury:FIRM HA:O: // 'r /G(FC'T C Cr/f LIC. NO.44,03 3 Licensee S• ir'I 7a-1; o, Signature LI NO. 59 3 3 Address Z /L� 5'/ �' 7 g#eu Tel. No. SGk CO Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature.on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S /S 4� (Signature of Owner or Agent y 2519 Date....... . ....4......... Nor+rM , 4, TOWN TOWN OF NORTH ANDOVER PERMIT FOR WIRING via- ,SSACMUSE� This certifies that ......... ... ..... .......��.. lr::: •.. !^ :• ..... ........... ....... has permission to perf rm .... .. .. . ,�...��� ....... . .. . . . wiring in the building of. ..... .. .............................. at... �� ,...� .. ..,............... ... . .North An er ss. Fee....' 174..... Lic. ............. .......................... ` ELECTRICAL INSPECTOR 1 /.�.� 15.00 PAID WRITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Date..a. .�...�! 1� •3 12 661 NORTI{ 1.. ;,e "�� TOWN OF NORTH ANDOVER q FO •sisim 9 _ y PERMIT FOR WIRING SSACMUS� l ��/� This certifies that ........... e„ct ?.F. .......................G.. ..?... .... W7 has permission to perform ... ..!?.s!.::.. ............... wiringin the building of....... -�..0 �.1', t�, 8 ................................m F 4c.ti �.....: ,North Andover,Mass.” at.....1.. ...... 1..,. ,.tt.�..... ............................ Fee...... ....L). .... Lic.N40 ............................................................... ELECTRICAL INSPECTOR i WHITE: Applicant CANARY: Building Dept. PINK:Treasurer