The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #287-14 - 21 HEWITT AVENUE 9/27/2013 L— TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: /7 Date Received Date Issued:44PORTANT: Applicant must complete all items on this page LOCATION T _ � d Print PROPERTY OWNER 0 1 i Print 100 Year Old Structure ]es no MAP NO: ® O PARCELS ZONING DISTRICT: Historic District no Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial ❑Altqration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg 11 Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Pic (L- r-rz a v,..j vA 12 1- � I q c-E i i n t� �: c_1yq L i J �~h Identification PleType or Print Clearly) C� OWNER: Name: ��5. �V-q- ff $ y - - k% --,,JPhone: I 4 Address: ( w (( ►� L= - -. CONTRACTOR Name: Address: <' t c.� i '� � ✓ C Supervisor's Construction License: a S� Exp. Date: 3 '/ Home Improvement License: 3 g -3- Exp. Date: H ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 17 FEE: $ �� j Check No.: -11 0Z Receipt No.: Z-U -I� NOTE: Persons contracting with unregistered contractors do not have access toa guar ry fund t ��-�-�'- �Si�iiature of contract r Signatue of rAgent Owner _ 9 -f - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 1 -- i Plans Submitted ❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF`;SEWERAGE DiSP.OSAL Public Sewer ❑ ❑ Tanning/MassageBodyArt E] Swimmin.. g 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ` ❑ I i COMMENTS CONSERVATION Reviewed on Signature COMMENTS 1 i HEALTH Reviewed on Signature COMMENTS 1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes }Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW To`v;! Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMENT =Temp Dumpster on site yes. no Locafecl at;124,Main Street-{� Fire Did -ft signature/date"' r COMMENTS i 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 LI Notified for pickup - Date f Doe.Building Permit Revised 2010 Building Department The foli'owin is a list of the required forms to be filled out for the appropriate.permit to be obtained. 9 q 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 � p ❑ 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/Crossection/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;apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be;subm:+.ted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location No. —� ` Date10 1 • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ C—)— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ "�] r Check# 16 G LJ i 4. G Building Inspector �Town of NORTOy \Andover I` h ver Mass �13 COCNICKl WICK 0"7' 'ls.9s RAraD ►`Q�`,�,�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR AFoundation has permission to erect ........................ . buildings on ..zi ....... ..... .................. Rough to be occupied as ....ftPA ..... .. . .. .. ... .4............................................................. Chimney provided that the person ac epting this permit shall in every respect conform to the terms of the application 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STS Rough Service ............r... ...... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by-the Building Inspector.-- Burner- Street No. Smoke Det. SEE REVERSE SIDE U9/27^/2013 U9:UU FAX 781 942 2226 GILBERT 11001 / B DATE(MM/DDIffm ACORD1 CERTIFICATE OF LIABILITY INSURANCE i 4/10/2013 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject t0 the terms and conditiOhS of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME C Harbaz'a McDonough Gilbert Insurance Agency, Inc. PHONE (781)9d2-2225 F 1 (781)942-2226 WC,NA 137 Main Street DDRE ,bmedonough8gilberti>nsurance.coto! INSURERS AFFORDING COVERAGE I NAIC A Reading MA 01867-3922 INSURERA:NORFOLK & DEDHAM INSURANCE 23965 INSURED INsURERe-Travelers Ins. Co. 0031 Keen Construction Company INSURERC: 21 Hewitt Avenue INSURER D: INSURER E: North Andover MA 01945 INSURER F. COVERAGES CERTIFICATE NUMBER:CL1341800232 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. ILTR TYPE OF INSURANCE A POLICYNUM ER MMIDDYEFF POLICYYJ(P LIMITS GENERAL LIABILITY PCCURRENCE S 1,000,000 E TO RENTED X COMMERCIAL GENERAL LIABILITY E nce i 100,000 A CLAIM6�tADEOCCUR -P-010076/000 /13/2013 /13/2014 P(Myona arson I S 5,000 PERSONAL&ADV INJURY S 1,000"000 OEtlEML AGGREGATE I S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO S 2,000,000 X POLICY F1 PRO• LOC S AUTOMOBILE LIABIUTY COMBINED 61NOLE L MIT ccldent ANY AUTO BODILY INJURY(Per peMonl; I ALL OWNED SCHEDULED BODILY INJURY(Par xcidenq S AlJT03 AUTOS NON-OWNED PROPERTY DAMAGE S HIRED AUTOS P AUTOS (Paracridamil I s UMBRELLA UAaOCCUR EACH OCCURRENCE $ EXCESS LU1B HCLAIMS-MADE AGGREGATE I S DED RETENTION SI S B WORKERS COMPENSATION VVC 5TATU- OTU- ANo EMPLOYERS'UAINLrTY ANY PROPRIETOR/PARTNER&XIECUTIVE YIN E.L.EACH ACCIDENT i f 100,000 OFFICERIMEMBER EXCLUDED NIA 61DIH-SH0726-A-13 /3/2013 /3/2014 (Mandatory 1s NN) E.L.DISEASE•EA EMPL04E S 100,000 it yes descrbe under DESaRIPTION OF OPERATIONS W19- E.L.DISEASE•POLICY LIMr 9 500 000 DESCRIPTKMO OF OPERATIONS/LOCATIONS(VEHICLES(Alach ACORD 101,A040mal Remarks Schedule,It mon space Is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BEICANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.. Evidence of Coverage AUTHORRED REPRESENTATIVE M Gilbert, CIC/RAPEAR i ACORD 25(2010105) 0 19382010 ACORD.CORPORATION! All rights reserved. INS025 pntom)m The ACORD name and logo are registered marks of ACORD 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/Organization/Individual): �) Address: W i 7T jd 1/C_ City/State/Zip: oq,N �Q Phone#: Q'''7 �� •. 'v2� Are you an employer?Check the appropriate box: Type of project(required): 1.[UI am a er emp to with 4. ❑ I am a general contractor and I y —�-- 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL . 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.[<ther comp.insurance required.] *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: -ra Oq V L [4,Vu Policy#or Self-ins.Lic.#: („ I U (D F-7,2 ' Yq Expiration Date: Job Site Address: ► R vCity/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$1,560.00 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 the pai s and penalties of perjury that the information provided above is true and correct I Signature: rz,. r Date:Ck 9 7-1 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): 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 Massachusetts 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, express 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 peimit/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 Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor , License: CS-076691 ROBERT A KEEN;-- 12 EEN-12 E WATER STol' North Andover MA Ol: � 'A )I IS` Expiration Commissioner 08/16!2015 1 ,.. Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058245 KENNETH B 19EN 21HEWITTAVE, U184�0, s N ANDOVER MAL, ; a v-' ► �� " J,•G••� �sf►4 Expiration Commissioner 03/24/2014 ,r ~�4 �,e ipo�rrumo�u�ret��o�Cacriecoelld I Office of Consumer Affairs&Busi ess,Regulatiom l OME IMPROVEMENT CONTRACTOR egistration:• .1x8383 Type: a xpiration 8/18I2D14 DBA KEEN CONSTRUCTIONZa Kenneth Keen 21 Hewitt Ave Y No.Andover,MA 01845 Undersecretary I Locations / No. 6 6a- Date �oRTM TOWN OF NORTH ANDOVER P * ; : Certificate of Occupancy $ �' b'•••°''<� Building/Frame Permit Fee $ /3a. �sscHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 12o Check # yL� i 5 5 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Se+Gboln fp>p "" 9C{�8� ;'71 BUILDING PERMIT NUMBER: DATE ISSUED: X ic SIGNATURE: C —1 Building Commissiorter/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required " Provide Required Provided Rapired Provided 1.7 Water Supgly M.G.L.C.40. 34) 1•S. Flood lune Infomntion: _ / 1.8 Sew Disposal System: Public 8/ Private ❑ Zone Outside Flood lune LY Municipal On Site Disposal System ❑ _J SECTION 2-PROPERTY OWNERSHW/AUTHORIZED AGENT "M 2.1 Owner of Record (ot I fjn,=4 K�-Pjortk t�j MEW Name(Print) Address for Service Signature Telephone 2.2 Owner ot Record: [J O Name Print Address for Service: O Z rn Signature Tele one go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: S ��,�� O ff vG License Number M Address Expiration Date S a Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Namern Registration Number r L/t Address C6ar" . Expiration Date ^ " t natur Tele hone v/ SECTION 4-WORKERS COMPENSATION(KG.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.......❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: OuwolcL i xs►,s�,`ns /4; fd,;!e tv /G x y Ty )2loVn of SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee C7 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC /3 D i 5 Fire Protection 6 Total 1+2+3+4+5 Check Dumber SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUELDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on - My behalf,in all matters relative to work authorized by this building permit application. Si nature of Owner Date SECTION 7b OWN AUTHORIZED AGENT DECLARATION I, ,as Owner/Authorized Agent of subject prop Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge ' and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE 16 )1111 BASEMENT OR SLAB 'E✓L SIZE OF FLOOR TIMBERS 1 2 3 SPAN / -31 641 DIMENSIONS OF SILLS Z 6 DM-NSIONS OF POSTS THICKNESS SIZE OF FOOTING X IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE I 1 21 Hewitt venue North Andover, Massachusetts { Scale: lu 301 Date: March 17, 1978 1 89,3 S,3 i r _ . y 1 1 S' Iti N I D�'y ELS` I hereby certify that the building on this. property is located as shown ' on plan and complies with the Building � .:". and Zoning Laws of the Town of North v ys Andover. Refer to zoning by-laws of r 4 1943, article TV, Section 2(C). CHARLES E. CYR CIVIL ENGINEER LAWRENCE, MASS. N.B. Do not use offsets for establishing lot lines for the erection of fences, walls, hedges, etc.. FORM U - LOT RELEASE FORM N�8Z (� INSTRUCTIONS: This form is used to verify that all necessa rov o� rY a pp als/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with p an applicable Y pp e or requirements. ************"""APPLICANT FILLS OUT THIS SECTION APPLICANT K'� PHONE_C`� Co —_ LOCATION: Assessor's Map Number PARCEL_ SUBDIVISION LOT(S) STREET ST. NUMBER a *****************************************OFFICIAL USE ONLY*********************************** RECO MEND TIONS OF TOWN AGENTS: CO SERVATION ADMINISTRAT DATE APPROVED 0 DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED- COMMENTS— PUBLIC EJECTEDCOMMENTSPUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE__ Revised 9197 jm Town of North Andover No RTh 1 q t".! 16 /� ? gt,,� *6 0 Building Department 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 COC MIC .WKK Building Demolition Affidavit SSACHUs��y DATE S -2- OWNERS OWNERS NAME &ADDRESS PROPERTY LOCATION W i T u C DESCRIPTION 2f- O U 6- C L�c a 60 ��i,�. SW r rr1 ire �OOL - n'I S CONTRACTORS NAME &ADDRESS IT Aj 6- DEPARTMENT SIGN-OFFS D.P. WATER SEWER S ELECTRIC TE PHONE C LE TAXES PO L 4CE FhRE EXTERMINATOR DUMPSTER-ON/OFF STREET DIG SAFE NUMBER BLDG. INSPECTOR DATE RECD 07/e�omvnw�uUea/C! BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR f Number: CS 058245 Birthdate: 03/24/1943 , ?a Expires:03/24/2004 Tr.no: 20021 Restricted: 00 KENNETH B KEEN _ 21 HEWITT AVE III N ANDOVER,.MA 01845 Administrator. HONE ItIPROVEMENT CONTRACTOR i 1 � Re9istration� 108383 'o n� 8118/02 ExPirati , T�Pe; DBA KEEN CONSTRUCTION CO. `i Kenneth Keen ta/ 21 Hewitt Aye 5 L0184 R doyef 11A ADMOSTRATO NQ, An r ' I • C Y�\ The Commonwealth of Massachusetts Department of Industrial Accidents - �:_� O//iceo//nyesligations 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit ;.17, 1 ase Ri nx 0 1 ..V11*11r: A licant•tn orf'°'"rnat in.• came: 1�EGw (-ONS f/t�l e.'�'iorl lGG NN C `i ,;EEnI 1 location: Z/ •yow r• 71- A16- city /Ecity A/A • f "d l zl l n 44. phone# 0 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity _:wry C'tstaitw r.. %i3':�..`.s;..,:... `f .1. •'. [j I am an employer providing workers' compensation for my employees working on this job. comnany name, - address: phone# i insurance co Policy:# - „-'T...,-.-....•r.. x,.:.r.s «,....,....:......r�.,.T...�^'' `�:. .�. i�ivJA''AT... '^ iinflt?"� n- T .;:.kms I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers'.compensation polices: company name• address: sin'' phone# . _. insurance co. 0=1Q # ........,.:'.........�,�?r,.!�.::s�.:. L' .:n:atiie'ei�Y,e'tif�Y�d� company name: address: : r city, phone;# s .: insurance co pY Atfac ncfditi"maI'sheeEil�e'cessar � �' `" �+ " ",els:•�,�`�'-....�^ Failure to secure coverage as required under Section 25A of MGL lag can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a . copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the ins and penalties of perjury that lite information provided above is true and correct. Signature Date S y Z `D Z Print name K EAV Aj E fA G • it tr Ekj _ . ..... . . . .. _. ._. Phone# �jofficiilusc only do not write in this area to be completed by city or town official,..1.... .. __... city or town: permit/license# nBuilding Department O Licensing Board" ' e �check if immediate response is required Q S electmen s ORc - " []Health Department contact person: phone#; nOther (revised IMS PIA) Town of North Andover Q� t14RT11 Building Department �°. s = 27 Charles Street * North Andover Massachusetts 01845 i y" �► (978) 688-9545 Fax (978) 688-9542 s940 ,rtW WK �,�y SACHUSS II� DEBRIS DISPOSAL FORM II In accordance with the provisions of MGL c 40 s 54, and a condition of. Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: cl/z 5�e X 6-,L, "20 L Facility location Sig ature App scant A; Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I i NORTH o 4 over 0 Town _ No. & o = o dover, Mass., I� COCMICMEWICK A�RA7E1) F` �C� S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............v .. ".. ! �../..4 `�ti .... ................................................ .. Foundation �/ ,/ '_• has permission to erect...I.:1....x .............. buildings on ..�.�.......................` ' ................... .t ........... ..................... Rough to be occupied as...�L!V h'1.. Lj old,,tjdN 9--Rce a1 a J,&- .....L�i.....G�l.1D.il/.................................. 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- ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6 0 ,S/S' � PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS 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 Final No Lathing or Dry Wall To Be Done - FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Lgcation No. 3 Date of 'AOR, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ie ,ssAGMUSE�� Fou datio jPermit Fe $ therermit Fee $ �0 Sewer Connection Fee $ Water Connection Fee $ TOTAL $ U /.7 Building Inspector �, 8:�4 32.50 PAID 3 A �' ei`f 3 Div. Public Works RL PERAHT NO.. 3 ! APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. �I LOCATION r PURPOSE OF BUILDING OWNER'S NAME •J NO. OF STORIES I SIZE OWNER'S ADDRESS � BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD F BUILDER'S NAME ; SPAN DISTANCE TO NEAREST BUILDING 1 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 LAND COST SEE BOTH SIDES EST. BLDG. COST 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. a 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 DATE FILED BOARD OF HEALTH SIG URE OF 41NN R AUT �RI ED AGENT i FEE OWNER TEL.# ' 417 PLANNING BOARD ` PERMIT GRANTED CONTR.TEL it 19 l CONTR.LIC.# ll BOARD OF SELECTMEN ALa&LIZ�_leez-2-33 )BUILDING INSPECTOR i E I AP 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 3 I 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PIASTER ---{I DRY WALL I _ UNFIN 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/ 1/1 1/ FIN. ATTIC AREA _ N_O 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 HARD"J D _ ASBESTOS SIDING _ COMMCN 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� POOR ADEQUATE NONE i 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 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 II 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 B7M'T2nd _ ELECTRIC 1st 13rd 11 NO HEATING r"i• 1 ., ,. o,,., .t �`n is,.- i�It\`. .a {.`tL�"ti.ti lk Z• /t �.��}; k� .r11 Zj�t-a R L '� �t5t 'L , 1�rk-itaur-tt+��''91.fa'l.t "l.l�"^St�i��Y�t Castricone Roofing & Siding REPAIRS . FR v EE ESTIMATES b ` Telephone: (508) 682-4266 MARIO CASTRICONE 61 Water Street, No. Andover, Massachusetts 01845 I/we, the owners) of the premises mentioned below hereby co all necessarymaterials, contract rials, labor and workmanship,to install, construct and lace with and authorize you as contractor, to furnish specifications, terms and conditio s on_premises place the improvements according dIn to the below described: g following Owner's Name /du.cc..,s-.;.A=--cl..,1�1/ ........ ....... Job Address .... ..f. , , .... . . . .. .............. City State �GL-' .. .. SPECIFICATIONS ... ........................................... . C.. ...... ... ......... . ................................... C. �...... < .................. ...,, .. .................. ................... ..................................................................................... .................................................................................. .................................................................................... ............................................................................................................. ................ , ~..... ......................... ............................................................. ....... Materials and labor to cost `�^ ........... r $... .: ............................. Payable ........................ on ... G........ ...... and balance in ................ n-:onthly installments of $ .................... each, payable on ........................ day of each and every month thereafter until paid it,full (............% charge per year is to be added to above cost of labor and materials and.is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accord- ance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs,attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed.that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title I hereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any sub- sequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no reresentation in contained shall be binding upon the parties and that all of the agreements and.understandings ofrsaid partieseement t tained herein. Owner or Owners are not responsible for Property Damage or Liability while 'Job is in o mat' �+f' IN WITNESS WHEREOF, the parties have hereunto signed their names Accepted: this ,..1! L!� �ff l day of . C.. ...i...., 19.,/...� _ (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed ....7`.::..........�' " �Cti �9Gc�� Owner / Signed ... Owner.......................:............................. .�,� r i dr NORTH �. I Town of Gc 6 iJ Andover I 0 It No. 23i ' or1.i over, Mass. 19 I COCHICHEWICK V ADRAT[D BOARD OF HEALTH j PERMIT T D Food/Kitchen f Septic System i . BUILDING INSPECTOR BU - THIS CERTIFIES THAT.......... ..�.�.� ..... ... ....�i/�� ... ..................................... � } Foundation has permission to erect. 006.... buildings on ..1 �.. {y. Rough 1. , to be occupied as..�r491-e� ��JX..O ...exzw- . .... .... 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ! ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ] .R� Rough ...... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR RouDisplay in a Conspicuous Place on the Premises — Do Not Remove Fal n a No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. i Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT OFFit-=ur: Nonn Andover. APPEALS .�; ... NORTH ANDOVER Massachusetts o t 84S BUILDING (617)6854-715 CNSERVATIONHE. DIVISION OF' \NN-i PU PLANNING & COMMUNITY DEVELOPMENT PL�NNWG i KAREN H.P. NELSON,DIRECTOR In accordant,, with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the dcbris resulting from this work shall be disposed of in a prcperiv licc:ucd solid waste disposal facility as dcfincd by MGL. c 111, S 156A. The debris will be disposed of in: (Location of Fa .lity) i I r Signature of c,—mIt Appiic.nt IDJAc Oemoiition oer=it from the To*«n of Vortn Andover oust be obtaire this Dro ect through the Of:ice of the Building Inspector. Location 1 Nod Date Go Sao TOWN OF NORTH ANDOVER C?O: . ' 'ti'O R Certificate of Occupancy $ * Permit/Frame Buildin P o , � g e Fee $ CH Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �a Building Inspector I° °' ��'44 65.00 PAID Div. Public Works .a Location Nol ` Date NpRTM TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee f CMUs<� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 1 Building Inspector E5.CO Div. Public Works PNor RM�T' NO. APPLICATION FOR RMIT TO BUILD********NORTII ANDOVER, MA /•1►P NO. LOi.NU. 2. RECORDOFOWNERS)nP DATE BOOK PAGE ZONE SIIB 111►'. I.OT NO. G 1.0( A I ION PURPOSE OF IM1I DING I n Ex �19R E 1 OWNER'S NAME0 � E N NO.OF STORIES SIZE OWNER'S ADDRESS Z �w L A e BASEMENT OR SLAB T ND RD AR(1111 EC1'S NAME SIZE OF FLOOR IlMHERS 1 2 3 BUILDER'S N.AJ IE C 00 osite G HQ.+� SPAN DIS'l ANC F 10 NEAREST BUILDING DIMENSIONS Of SILT-S DI S i'ANCE FROM STREET DIMENSIONS(1F POS S DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA Of LOT FRONTAGE IIEIGIEFI>f FOUNDAII(NJ THICKNESS IS BUILDING NEW SIZE OF FOCYIING X IS BUILDING ADDITION MATERIAL OF CIIIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLIDO R FILLED LAND WILT.BUILDING CONFORM TO RE"AREMEN TS OF CODE IS BUILDING CONJNECIED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CCNdNEC1 ED'T01OWN SEWER IS BUILDING CONNECT ED TO NAFURAL GAS LINE INSTIICTIONS 3. PROPERTYINFORMATION LAND COST y EST. BLDG.COST C7 — PACE I FII.I.OIJF SECi10NS 1-3 EST. BLDG.COST PER SO. FT. EST.BLDG. COST PEiR ROOM ELES FRIC METERS MUST BE ON OUTSIDE OF BUILDING SE19IC PERMFF NO. AI'1 ACI IED GARAGES MUST CONFORM STATE FIRE REGULATIONS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR 13111 . ING INS ECTOR DA I E FII.ED �j. "/ rV 9 OWNERS TEI.# G?(6 3 772 - C(WI R.IEI.# (p!l 1—2V CONTR.I.IC'# S� Z SION.A Lftf OF OWNER OK All'll IORIZED AGENT PERMIT GRAtiml) 19 syn-rES kER�E T( A jC- -3 -3 772 w C6 cei L x. c5 � ' '� �/ �✓ IDC '•� 1 L J�"� C i �� t CI"'`�. _- ��_/� � NoRry Town of over * z - dover, Mass., 19 S LAKE COC" ICHEWICK E S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .:........... ..................................................................... Foundation ........................................... j buildin s on Z ! ......... i .. ..�.... ... ............ .v. ....... Rough has permission to&reet..... �..P�-L. - 9 to be occupied as................. G-OF................................... ........................................ 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T S 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 _ Final - - No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 30/40 S Date.. .../... �...... c NORTH t ;•'"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUS� This certifies that .............:.. .............. . �. �.` ........................................... has permission to perform ..., 'P ... .............. .......................................................... 4 wiring in the building of......•,a..G.. .....^^e......................................................... ,at.......... ........... V:,2........ .,North Andove s. Ll Fee..,J.Q... .. Lic.No...?7/.... .....ZELECTRICAL .,. ?^ '..,1 .......�... I PECTOR Check # _� umcial use only /1 Permit No. aeAwewmt Occupancy&Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 rr / (Please Print in ink or type all information) Date / J v To the Inspector 4 WireV Town of North Andover The undersigned applies for a permit to perform the electrical work described below. � { Location(Street&Number ( 1 1 iw%T1 4U-& Owner or Tenant s i g_ _{lam Owner's Address Is this permit in conjunction with a building permit Yes l.1/ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Z-06 Amps Z` � Voits Overhead [D./ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location,and Nature of Proposed Electrical Work T1.2m S.L, i fen40 Ti A,bm 401 Total No.of 0hting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators INA No.of Emergency Lighting No.of Receptacles Outlets 2 Q No.of Oil Burners Battery Units No.of Switch Outlets /. No of Gas Burners / FIRE ALARMS No.of Zone Total No.of Detection and No.of Ran es No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area HeatingKW Detection/Sounding Devices I ❑ Municipal ❑ Other No.11 D rs Heating Devices KW Local Connection No.of No.of Low Voltage No:of ater Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: . INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER =.(Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start inspec"on Dat Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME UC.NO. LicenseeSignature LIC.NO. � Bus.Tel No. Address Aft Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.An hat my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No" .. 0 %233ERMITfEE6 `� " (Signature of Ow r,Agent) 3S4 'i Date...715 I ... .y f pORTI{1 ° <<``°:•�"� TOWN OF NORTH ANDOVER � 3? �•,r ... ._,• of t PERMIT FOR WIRING CHU This certifies that ..........G `!.�(..... ....� :............... z........................ c' has permission to perform ......... .......... `' ............... wiring in the building of.......f. '' 1........ at...............1...... ...ca/a.. .f...... J...... . ... ,North dov ass. �, xG�t ELECTRICAL INSPECTOR Check # ML umcial use�unly / Permit No. 6 / VCA4V1 ,4 4;`A`Shy Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date U To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number ,t a k t l t 4(� 1/ Owner or Tenant1..N 0 S.�h, Svt (Z�� ft1'�i s tj Owner's Address V7 f ttLQ� 41 y 6 " Is this permit in conjunction with a building permit Yes Er' No ❑ (Check Appropriate Box) Utility Authorization No. ® Q � Purpose of Building �' E-;,ting Service D 0 Amps l Z 2 I a Volts Overhead (9� Undgrnd ❑ No.of Meters ,{ P U 0 and New Service ?i t5� Amsf 2 2 y 0 Volts Overhead 19— �9 ❑ No.of Meters Number of Feeders and Ampacity 3 — 3 36 Location and Nature of Primed Electrical Work 2 A 4 -10p A fJ L Total No.of Light nOutlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners / FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diosal No. Pumps Tons KW No.of Sounding Devices rNo./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dr-Ail Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No..Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy incl0epe, plated Operations Coverage or its substantial equivalent of NO = hav valid proof of same to the OffiNO = ff you have checked YES plea a indicate the "' coverage by checking the appropriate box SURANCE BOND = OTHER =.(Pliry) L E9 r 0� SNS , 0 �! �6 _ (Expiration Date) Estimated Value of Electrical Work$ ........ Work to Start Inspection Date Resquested RoughFinalSigned Q FIRM NAMEerthe P naR�es of perj ry: LIC.NO. io 3J r O Lkensee 'ItaZ Signature p h LIC.NO. 3� E Bus.Tel No. / -Ti Ft 19 Address 'E t _ AIF " `— OWNER'S INSURANCE WAIV : I am aware that the Licenses does not have the insurance coverage or its substantial 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. PERMITTEE�7d (Signature of Owner or Agent)