HomeMy WebLinkAboutBuilding Permit #943-2016 - 95 CANDLESTICK ROAD 3/7/2016I i�' L �
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BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: h
1APORTANT: ADDlicant must
all items on this
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
i4ne family
11 Addition
El Two or more family
11 Industrial
El Alteration
No. of units:
11 Commercial
iqAepair, replacement
11 Assessory Bldg
11 Others:
11 Demolition
11 Other
REPLACE 3 WINDOWS & 2 DOORS - NO STRUCTURAL CHANGE
Identification Please Type or Print Clearly)
OWNER: Name: SHARON MCCANN Phone: 978-655-1395
Address: 95 CANDLESTICK ROAD NORTH ANDOVER, MA 01845
ARCH ITECT/ENGI NEER Phone:
Address: Reg. NO.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER &F.
Total Project Cost: $ 17,419.00 FEE: $ ,?--4 1
Check No.:. �;-Iz— Receipt No.: r;-2� c),,) (SZ
NOTE: Persons contraciing with unregistered contractors do no_thzWe access to the guarantyfund
PermitNo#:
N -
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Date Issued: IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY VVNE
Print 100 Year Structure
PARCEL:— ZONING DISTRICT: Historic District
Machine Shop Villagp
MAP
TkORTH
-D 16.'6
0
, "Va"
yes no
yes no
yes no
TYPE OF IMPROVEMffN--T—
PROPOSED USE
Resi jential
Non- Residential
0 New Building
El Addition
El Alteration
El One family
0 Two or more family
No. of units:
0 Industrial
El Commercial
0 Repair, replacement
0 Demolition
P pp,
WL e:- a
El Assessory Bldg
El Other
-1 � 1 . �. Q��eNaEff
P.
0 Others:
@ NLaf_e�Fs_ftedjffJ§,t?1i
DESUKIP I IUN L)t- VVUMM I u t5r- rr-mrumivir-u-
Identification - Please Type or Print Clearly
OWNER: Name: Phone:
A AA
/-Xu U 1
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCH ITECT/ENGI NEER. Phone:
Address:
Reg. No.
FEE SCHEDULE, BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $
EE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
t
edLLocation
No. —ILI
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Perm,it.Fee
TOTAL $
Check #
3008.3
Building Inspector
-.-A ;;�" " . N�-x
Plans Submiff,'ed.Di Plans Waived F1 Certified Plot Plan F1 Stamped Plans F1
TYPE OF SEVVTRAGE DISPOSAL
Public Sewer
Taming/Massage/Body Art
Swimnling Pool,; 11
well El
Tobacco Sales
Food Packaging/Sales 11
Private (septic tank etc. El
Permanent Dumpster on Site,
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
I
PLANN9NG & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Reviewed On Signature*—
Reviewed on Si
qnature
Reviewed
Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionfteceipt submitted yes
I
Planning Board Decision: Comments
C064�servafion Decision:
Com
Water & Sewer Connection Driveway Permit
DPW Town Kagineer: Signa-ture:
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Renewal Agreement Document and Payment Terms
NA Menen,
Am Rcorwil b,-r,Am&mFt of B a Sharon and Andraw McfAm
IL Wit I P M2: i"m P1W. a I b V AA�l Wi LLIC t �" 1, kv it k H -it
RAP Aridamr. AAA 0 1 a4r.
W L MR.C. 310 F"Es No �-J Vkaq h b cro u U h. f*L MM55-1395
#W.: %&B21-2200 1 Farx: 1W61 %6-TW24
CuuormuulA Nau'le- ShOr*" �MCCa Min and Andrew MkCp nn WIM- 02MV-16
CtA161,1XV(s),% I uE Adxdtem: 95-Candil.astick Rd,. N orthAn dover, MA 01045
K13-111-ity'llelephuric Nur,26a:
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L;Wya(s) kreby joi ndy arid! smrvdkr aptri,ro purchax ihe products andlor servkes of Renewal by Andersen U.,Cd& In Renowd by
A
AsAttirn of,Bcwton(" Co:rinactorr.), in awordairux with the cernis :uW condidom dew9bedin Adli, 4ttv.ntma Docutneni asid llayrixmn
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CDMPJ=iP, 11, Ce"ff6te arter C-0-mim&.-air h;i.q ownphud 211 wati undar this Algrisimma-
ToW job.Atuatum: $1711,419 Bv agwernrnt', Yvl;;w6vwWgr dpit �i6 1311;wTv -our., aw, 4bvq t%Mqvqjt;
F.11 In4w ulim 61! Irl lAh 4 Mr -w -al 4(4i, DAMI -h Ctedit 00, e
014DOM71 Poo-tivi-A $5,1805
Dat: ST1,6 14 F-surnmied &ari�
$4 0 Weeks 1-2 days
Credit Wtscheddle insiallaiians Insedion dw,dav-of the 4ped conuaix and' wamlsdly� on
Vise4/18 the d2tr im Atich wu M=j�lvte thr lim6kaLimcastarain Ekirts. The inglAkIRLIUM dAtE t'h=
,,.,r av W"i Mg ar this amr is 0* an CWMalc, We utiff communicate 21.1 official daic
113 iomract SS805 ;and dMit at a 6L . er duxci Wuirt and ritte3ric weathev art qtw uawA Corunwn ClIML-s' for,
1 - 13 Start
1 $5807
113 COM Mitetiont S5507
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agw.s and undelfwanifi alat -dDh A ures the endyc un&m4Miw-- beiturcen the paritim, and ika-t Acre are,M), Wilbal
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pjthi� �jgpert nfIx.,ththig Bi
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thc sm-a attached Notion: of CmMIxfICIM., On Ithe darr first wrawn mIx-me and'2) wair omfir infurivied of Bu -mirk fighi go cancd Ais
Apimment. 0
NOT11C.1 10 OVN M- Do Ew.up-1 Lhweoticuct if 66- I-AL'You Al Cendtled C.0 I Ca
pv,of f he Oniltract At dit lismit vul. it.
YOU,11MEBUYER, IMAYCAN CELTHISTRANSACTION ATANITTIME PRIOR TO MIDNIGHT OFME
TMIUD RUSIMESS DAYAFTERTHE DATE 10F T -HIS TRANSAMHON. SEETHEX—rEACHED NOMICE OF
FOR AN IMPhIMATION OF THISRIGHT.
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Max lksta
I%izd 'N-unv tof Saks k-tsoft
Sharon, iMcCann
ptint �%fjlt
M
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Andrew McCan.-n
Print Nalut
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,Renewal Itemized Ordeir Receli
11Y�Aersenl pt
&Z Iltwrwaf 1by M&MM 'Of BQ$ftO Sbarom and Andrew McCann
tK-t tritn't.41P"I 119 ArOli(SEn tt( Vn Ul'ondke;i"t Rd
Wrilh. Andaver. MA 0 1041
�30 F�ol�n r-.,ozpJ Vgxthhtfough, ?AA oiz,,7?
1 Fat: W51, 9W-;Q7Z I cum
1� lbo6-1 ROOT& OETAILS:
106 Den Patio, Dow: 200 Series Harroline, Gliding, 2 PanFl. 71 lMw x
82 3/8h, Aluminum SiO Support, Grey, Sill, Statimary I Active,
EXTERIOR Dark Bronze. INTEMOR Fine, Glass:,sash All:
Tempered High Perf. 9mrsiun Glass, flardwaTe! WbitmoreG,
Antique Brass, Auxilimy Foot Lock, Color Niatched. Sween.,
Gliding, iG dille Style! No finiles. Mlsc- None
105 Halbnay
Miisc.t Provia storm door. Piovia door deluxe #392 Rustir.
brave 36xr80
110 Den Wi-ndow.0 asernent - Triple, Casemen t,. '1:2: 1. 95w x 64 h, EJ
flame, at ickmould I IS(lute Name, Ven lied, EMKIOR Cocoa
geeii, INTE RIOR Wbite.GlIevs; Sash All: Piqti Pei foTmance
5m. ar [Sur# Glass, NO Pallem, Hardwatet ftitf�. screeq:
Aium inum, Gn.11e SW, e-. No Grilles, Misc- None
108 Del n Winftw.� Casenwnt - Double, Casement, 48wx 64h, EJ
frame, Brickimuld I Picture Frame, Ven iedll EXII'MOR Cocoe,
Bean, INTERIOR White. Glass,: Sash All: High Fe;forinante
SMartSua Glass, t4o, Fattem, Nar0oare: VVhI(e.,;5vme-n:
Aluminum, jGrflle,StyVI'e; No Grilles, Misc.- None
1109 Den WindawCaserrient- Double, Casement, 48wx6ft, U
frame, DrickmouI4 I Piavre franke, Vented. EXI ERIOR Cocoa
Bearn, INTERIOR W�4fte. Glass; Sash All'. High Pei' lormance
5M aftSuA,Glass, No Fifte,#Ift, Ma.r4wore; Wbite. S mr em
Aluminum, GfilleSty.fe: No Grilles, Misc, None
VANDOWS. 3 PATIO DOORS: I SPECIALTY!, 0 MISC:� I Tow S17,A1.9
UPDATED, 0211111161
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D... Renewal by Andersen Corporati on
m-enewal 30 117mbes Road - Narthbo.f.mid - 6!
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bYAn ders6h. Phone (5 N) 35 1 .1201) - Flix (5w�l, �9&6.7072 -
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NOA1 ONEY CM ANG E A NIE NDNI ENM TO, OR I GINAL C 0 NUACT. CH ANGINGFROA I D E IAJXlE STAME STO. RM, DOOR
FRON'll 9392 to #.194.36XBB COLORNI.ATCH PIANO HINC, FDARKHRONZE H INICE ONRIGHT FROM OUTSIME. .NO,CWH-
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Name RENEWAL BY ANDERSEN
AcldrftS: 30 FORBES ROAD
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JobSkeAd&eisl 95 CAN DLEST,ICK ROAD NORTH ANDOVER, MA 01845
Attach a copy atom workew compensetku polk-) deasm" pap (showingthe
Failure to kme cOvelfte U requirod unde'Section 25A tX %M, c, 15�1;, can W to the,
fac 0 to $L,-'00-0rj andior one-year w*prisoment, is well as C -M, I of criminal pwak&sof a
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of up ti) S250..00 � day. aphuA t&- viektor, & advWed that a oW of ft stumetit ma� be forwardad kv the Office of
Inve-st1gationi of the INA for insunwe mww vimifica6n,
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6. Other
ANDECOR-01 YADAVY0
CERTIFICATE OF LIABILITY INSURANCE
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.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THW--
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 18SUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: H Ow certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the torms and conditions of the policy, certain policies may require an endomemenL A statement on this certificate does not confer rights to the
ceMflcate holder In lieu of such endorsement(s).
PRODUCER
Wilile of Minnesota Inc.
c/o 26 Century IBWd
P.O. Box 305191
Nashville, TN 37230-5191
CONTACT
NAME: Willis Certificate Center
PHONE
IAICg go, E.M: (877) 945-7378 Z�Z�111111) 467-2378
E41WL : Cergneabn@WlllS.COM
AD
-- INSURER(S) AFFORDING COVERAGE NAIC 0
LIMITs
INSURER A - Old Republic Insurance Cam pany 24147
INSURED
INSURER B.,
INSURER C;
Renmal by Anderson LLC
30 Forbes Road
Noftborough, MA 01532
INSLIRERD:
INSURM E.
INSURER F:
MED EXP (AM one p" S 10,00
"�ft I rwi� I � Mi immww- M. --
THIS IS TO CERTIFY THAT THE POUCIES 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
LTR
TYPE OF INSURANCE
AUUL
INSO
SUOR
MR
POLICY NUMBER
POLICY EFF
IMWDMWM
LIMITs
A
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CLOMMS-MADE M OCCUR
MVWZY 305440
10/011M5
10MIM16
EACH OCCURIMC� S 1,000100111
WMIOETO RENTED
SES Me owurnerme) $ 500,000
MED EXP (AM one p" S 10,00
PERSONAL a ADV INJURY 5 1.0w.000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY Fli T - LOC
PIT, F—I
-GENERAL AGGREGATE $ 4,000,000
PRODUCTS - COMPIOP AGG S 4AM,00(
OTHER:
4
A
AUTOMOBILE
LIAMLITY
ANY AUTO
ALL OWNED P 110HEDULED
AUMS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
MWTS 30UN
110111111=5
1=11"16
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er� 6 5,000,00C
BODILY INJURY (Per pwm) $
FLY INJURY (Per awiderd) 5
(P OP 611GE
PR
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I
UMBRELLA LIAS
EXCESS U"
OCCUR
CLAM6-MADE
EACH OCCURRENCE $
AGGREGATE
DED RETENTION $
A
WORKERS COMPENSATION
AND EMPLOYEW LUMUTY YIN
ANY PROPRIETOWARTNER)EXECUTFVE r—U-1
OFFICERNAEMBER EXCLUDED?
NIA
MWC30W700
11IN01112015
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E.L. EACH ACCIDENT $ 1110NION
(MordOM In NH)
desmbe under
RIPTION OF OPERA77ONS bakw
EL DISEASE - EA EMPLOVE� $
E.L. DISEASE - POLICY LIMIT 1,000.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICI JACORD 101, AddtHOnW Renaft SdmduK may be aftached If MON SP&ve to reWhred)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 13EFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE VATH THE POUCY PROVIISIONS,
AUTNORMM REPRESENTATNE
w 1woo.".1% FL%OJKU UILIKIPUKATION. All rights r"arved.
ACORD 25 (2014101) The ACORD name and logo.are registered marks of ACORD
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Nptrbvwd of PWWic sMbiy
Vasid of Ruikfing Reg4kftw ww
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APO
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of Conmer Afain & Budnew Replation
ME IMPROVEMENT CONTRACTOR
Typw-
Supplement Card
Explra"
RENEWAL BY AN
JAIME MORIN
30 FORBES RD
NORTHBOROLIGH, Underftereftry
a
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
TURE: Yes No
WGL Chapter 166 Section 21 A —F and G min.$100-$l 000 fine
NOTES and DATA — (For department use)
13 Notified for pickup - Date
Doc.Building Permit Revised 20 10
Building Department
The foliowing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofipg, Siding, Interior Rehabilitation Permits
Li Building Permit Application
u Workers Comp Affidavit
Ei Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Ei 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
L3 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)
u Mass check Energy Compliance Report (If Applicable)
L3 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
ci Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Ei 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 subm'.,tted with the building application
Doc: Doc.Building Permft Revised 2012
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 rnin.sloo-si000 fine
Doc -Building Permit Revised 2014
r --
ZT
1 �41
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
-4� 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
10TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
�6 Copy of Contract
;6 Floor/Cross Section/Elevation Plan of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (if Applicable)
,;6 Mass check Energy Compliance Report (if Applicable)
Engineering Affidavits for Engineered pro uc s
10TE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: Ali 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
Doe: Building Permit Revised 2014
-1
Location 70
No. C'7 Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
M.
Building/Frame Permit Fee $
MU
Foundation Permit Fee $
Other Permit Fee $
TOTAL s
Check #
19545
7 --T�wWing in—spect6/
No.: e��
Date
cl-
%ORTH
6 0
-TOWN-OF NORTHANDOVER
-A
BUILDING- DEPA'RTMIENT
Ar.D
13bilding/Frame Permit Fee s -
CH
F Oundation Permit Fee
Other Permit Feefi
Building Inspector
TOWN OF NORTH ANDOVER
1600 OSGOOD ST
NORTH ANDOVER MA 01845 rNSPECTOR'S NAME
OFFICE OF THE INSPECTOR OF BUILDINGS BRIAN LEATHE
INSPECTION REPORT FORM
A/ - .6 J::�
CLASSIFICATION k*\, PASSES INSPECTION yes 7__ no DATED (9 ;?-)
OWNER–
BUILDING NAME OR NO.
STREET LOCATION
TYPE OF OCCUPANCY - Day Care Center X Aud. Ell Restaurant L'j Cam C,
School 0 Common Victualer's 11 Liquor [I Placeof Assembly 0
Other
OCCUPANCY NUMBER (include stories # and occut)ancy Per floor - use reverse sid
EXIST SIGN
LIGHTED EXIT SIGNS operable
VENTILATION
UTILITY ROOM - CLOSETS I�Z
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS 115C)
NUMBER OF
STAIRWAYS ACCESSIBLE PER
FIRE DEPARTMENT
Gym 10 Apt. I'l -
E X I S T I N
yes/
no
yes Li no
16
EMERGENCY LIGHTING SYSTE M operable 0 dry cell 0 wet cell 0
SPRINKLER SYSTEM operable 0 gage pressure yes 0 no 0
SMOKE DETECTOR operable 0 yes no
FIRE ALARM SYSTEM NIP— expiration date y e s Oj no 0
ANSUL SYSTEM
FIRE ALARM SYSTEM operable 0 municipal 0
yes no
yes no
ELECTRIC EQUIPMENT PROPERLY PROTECTED yes no
EGRESSES LAWFULLY DESIGNATE unobstructed 11 yes no i.j
STAIRS PROPERLY RAILED yes
HALLS AND STAIRWAYS LIGHTED yes
RADIATOR GUARDS yes no
COMPLIES HANDICAPP SONS LAWS yes no
FIRE RESISTANT CURTAINS OR DRAPERIES
HOW HEATED NO. FIREPLACES yes no
BOILER ROOM CONDITIO
�Zwr)p.q
1ST FLOOR SEATS
HANDICAP ELEVATOR yes
f'�T FLOOR BAR SEAT OTHER LEVELS
no ci
w
CO,4fAfONTMLTH OFAL4SSACHUSETTS
TOWN OFNORTHANDOI'-ER
1600 OSGOOD ST
A PPLICA 77ON FOR CER TINCA TE OF 17VSPEC77ON
Date Fee Required (Ainount)-z ------
) No Fee Required
Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby apply J -or Certificate c
Inspection for the beloivravied premises located tit the following address:
Street and
Number—
Name of
Premises
qS- corlelb (77L4
(,C)
Purpose for which Premises is 6)
Used, t --e-- r ...............................................
Licenses (s) or Permit (s) Required for the Premises by Other Governmental Agencies:
License or Permit
Certificate to be issued to
Address
A
4eno
Telephone ----------------
Oumer of Record of Building
Address -z--
--------------------- -------------------------------------------
Name of Present Holder of Certificate -----------------------------------------------------------
Nameof Agency, if any ----------------------------------------------------------------------
SIGNATURE OF PERSONS TO WHOM CERTIFICATE TITLE
IS ISSUED OR HIS AUTHOIRIZED AGENT ------
DATE
1�" 'TRUC77ONS.-
I
Make check payable to: Town of North Andover
------------------------------------
2) Return this application with your check to, BuildinA, Dert.
2 7 Charles Street, North AndoverIL4 01845
PL,E4SE NOTE
Application form q.(;ith �iccoi7),I)tin-,-ing_LEErrii,tst be submitted for cach building or structure or Part thereof to be certified.
3) Application and fee must be received before the cei-tificate will be issued.
4) The but'Lling officials sfuzLt be notified uithin ten (10) days of any change in the above infornuttion.
C- E R 7 71,7CA TE # 4
FORMSBCC-3-74 REVISED 3.2006jmc
Location
No. Date
TOWN OF NORTH, ANDOVER
41
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other PermjiFee C-4 s
;71
TOTAL
Check #
7755
Building Insp
Date
i I I
COMIONWEALTH OFAWSACHUSETTS
TOWN OFNORTHANDOVER
27 CHARLES ST
APPLICA TIONFOR -CERTIFICATE OF INSPECTION
F
Fee Required (Amount)
No Fee Required
Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby applyfoi
Certificate of InTact4on fior -the below-namedpremises Jocated-at 4he following-adWess:
Street and
Number 7-5 Cd1146kVi1_-L L -2d_
Name of
Premises cooi-r&
Purpose for whi�h Premises is
Used 0 t -
L icenses (s) or Permit �s) Requ iredfor -the Premises hy-OMer -GovernweVal AgRwcies:
Liceme or Permit Age
Certificate to be issued to
A ddr, ess gs & ldl&&" 0_4 I&L 0jrg Telephone 177,r 6 f, _2 S,�
Owner of Record of Building M
AdIrtess 15 e,, a die, s AZj, &tizt�ev AA41 6144S
Name of Present Holder of Certfzcate___QVL_CAu.,,j�!,f p zat-tt G En rz-k- 4A J4- el
Name of Agency, if
I
(A i P1 id mias-t-e— Wd-;C-j - L -4 1'K
SIGNATURE OF PERSONS TO WHOM CERTIFICATE TITLE
IS ISSUED OR fflS AUTHOIRIZED AGENT f (3 S/6
DATE- /
INSTRUCTIONS:
1) Make checkpayable to: Town of North Andover
2) Return this a
pplication with your check to: BuUdhv DWL
27 Charles Street, North Andover M4 01845
PLF,4SE NOTE:
Application form with accompanyingfEE must be submittedfor each building or structure or part thereof to be cen
3) Application andjee-mustbe receivedbefore -the -cer-tif4cate will be issued.
4) The building officials shall be notified within ten (10) days of any change in the above information.
CER TIFICA TE # EXPIRATIONDATE.-
FORMSBCC-3-74 UVISED2199jmc
TOWN OF NORTH ANDOVER KJSPEC�FOR'S NAME
OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE
INSPECT40N-REPORTfORM
CLASSIFICATION PASSES INSPECTION yes no 0 DATED -Lo C/
OWNER
BUILDING NAME OR -NO.
STREETLOCA
�� -D / F S 1�1 (f
TYPE OF OCCUPANCY -- -Day 'Gam-C� 4Wd. .0
School 0 Common Victualer's 0 Liquor 0
-Ca* -0 -G" fl -Apt. .0
Placeof Assembly 0
Other
OCCUPANCY NUMRER 4Yvh;We-A--4-- -# -jWI-0- 'de
-C440aj-WW i3w - wap -se .41
-41ew *ew
EXIST SIGN
LIGHTED EXIT SIGNS
EMERGENCY LIGHTING SYSTE M
SPRINKLER SYSTEM
SMOKE DETECTOR
FIRE ALARM SYSTEM
opereb!
operabl
operable
operable
I
-eorafien-date�__
dry cell 0 wet cell 0
. gage pressure
ANSUL SYSTEM
FIRE ALARM SYSTEM operable lg----" municipal. 0
ELECTRIC EQUIPMENT PROPERLY PROTECTED
EGRESSES LAWFULLY -DESIGNATE unobstructed 0
EXISTINGS
yes 0 no 0
.Jes -0 -no �
yes 0 no 0
yes 0 no
-yes - D
yes 0
yes 0
14
no -41 ---
no, 0
jes�--no
STAIRS PROPERLY RAILED yesL-,B-' no 0
HALLS AND STAIRWAYS LIGHTED yes 0 no 0
RADIATOR GUARDS yes 0 no 0
COMPLIES HANDICAPPED PERSONS LAWS -yes -11 -no �
FIRE RESISTANT CURTAINS OR DRAPERIES
HOW HEATED NO. FIREPLACES yes 0
BOILER ROOM CONDITION
VENTILA
UTILITYROOM - CLOSETS
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS
N1 IMRFP OF.RFPARATE STAIRWAYS ACCESSIBLE PER STORY
SHOPS
no
FOR INSPECTOR USE ONLY Revised 2/99 imc
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Y
OUT COUNTRY PRESCHOOL
GEORGE MITCHELL, DIRECTOR 95 CANDLESTICK ROAD
NORTH ANDOVER, MA 0 1845
TELEPHONE (508) 683-2820
'-B L' " � a i 'ri � Ty) SfeGA-c�— :
Ea aA o u4 C�-- o "� "I '. s k I C'-4".Jkcale_ &CAi�
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Location.
No. Date Z/
TOWI$�OF NORTH AN Ii ER
41
'S Certificate of Occupanc $
Building/Frame Permit Fee
S s
Foundation Permit Fee $
Other Permit Feee-:�� s
TOTAL s 7-Y
Check # 413 �lb
14 3
Building Inspe or
WAgwNim
TOWN OFNORTHAADOVER
. 27CHARLESST
PLICA TION FOR -CER TIFICA TE OF INSPECTION
Fee Required (Amount)
No Fee Required
-7.5-0--2)
Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby applyfoi
Certificate of Ins
,pection for -the below-namedpremises Jocatedat-the foUowingaddress:
Street and
Number q5 C-Als)ou-sucs t3D*
Name of
Premises o- CY-1 C C) tzN/ zc- 5r L
Purposefor which Premises is
Used TIP -Esc �+o 0
Licenses (s) or Permit �s) P-equiredfor Me Premisesby-Other -Governmena AgRpcies:
License or Permit
AY—e
C— S
Certificate to be . issued to Telephone (y93-,j9,jL
Address q5 (�-A M Dt esa I C -K, V'a
Owner of Record of Building
Address CIS
Name of Present Holder of Certificate
N.ame of Agency, if any_
SIGNATURE OF PERSONS TO WHOM CERTIFICATE TlTLE
IS ISSUED OR JVS A-UTHOIRIZED AGENT
INSTRUCTIONS:
DATE 11
1) Make checkpayable to: Town of North Andover
2) Return this application with your check to: Buffifim Dept,
27 Charles Street, North Andover AL4 01845
'�PLF,4SE NOTE.
Application form with accompanying FEE must be submittedfor each building or structure orpart thereof to be cert
Application andfiee,=W-be receivedbefor-eAe-cer-tif4catewW-be4ssued.
4) The building officials shall be notified within ten (10) days of any change in the above information.
FORMSBCC-3-74 REWSED
I - TOWN OF NORTH ANDOVER I I 'NSPECTOR'S NAME
OFFICE OF THE INSPECTOR OF BUILDINGS N41��42 MCGUIRE
INSPECT4ONREPORTFORM
CLASSIFICATION PASSES INSPECTION yesono 0
OWNER
BUILDING NAME OR -NO.—,
STREET LOCATION
DATED
TYPE OF OCCUPANCY .- -Day �C�4er D Aud. .0 -CaM B -Gym fl Apt. 0
School 0 Common Victualer's 0 Liquor 0 Placeof Assembly 0
Other
OCCUPANCY NUMBER and-eccu� imllm - use -few -se side
E X I S T I N G S
EXIST SIGN
yes 0
no
0
LIGHTED EXIT SIGNS -eperab4e -0
-yes
-ne
EMERGENCY LIGHTING SYSTE M operable 0 dry cell wet cell
SPRINKLER SYSTEM operable 0. gage pressure
yes 0
no
SMOKE DETECTOR operable 0
yes 0
no
FIRE ALARM SYSTEM aoraWn-date_
-yes..
-no
ANSUL SYSTEM
yes
no
0
FIRE ALARM SYSTEM operable 0 municipal 0
yes
no
0
ELECTRIC EQUIPMENT PROPERLY PROTECTED
yes 0
no
0
EGRESSES LAWFULLY -DESIGNATE unobstructed 0
jes
0
STAIRS PROPERLY RAILED
yes 0
no
0
HALLS AND STAIRWAYS LIGHTED
yes 0
no
0
RADIATOR GUARDS
yes 0
no
0
COMPLIES HANDICAPPED PERSONS LAWS
-YeS D
.-no
-0
FIRE RESISTANT CURTAINS OR DRAPERIES
HOW HEATE NO. FIREPLACES_Yes
0
no
BOILER ROOM CONDITION
VENTILATION
UTILITY ROOM - CLOSETS
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS
NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY
SHOPS
FOR INSPECTOR USE ONLY Revised 2J99 JIVIC
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07/14/99 10:26 FAX 9789750858 SCHL GEOGRAPHICS
OUT COUNTRY PRESCHOOL
GEORGIE MITCHELL, DIRECTOR
mr. Wec-&4o
Rol
95 CANDLESTICK ROAD
NORTH ANDOVER. MA01 845
TELEPHONE (508) 683-2820
JW
S"e -6 *.ccbv-msj,4
tan^.
0""" 44%&
U.. IN9 oce S.
Di rec6r-
r �
07/14/99 10:28 FAX 9789750858 SCHL GEOGRAPHICS (601
ROW41 60"
609 W/" "'194iVe, Amite -jov
ARGEO PAUL CELLUCCI TELEPHONE
GOVFANOR (617) 727-SRS3
WILUAM 0. O'LEARY (617) 727-4137
SECIFIFTARY (978) 524-0012
ARDITH WIEWORKA (978) 524 -OM
COMMISSIONER FAX; (617) 727-25M
6.15.99
Ms. Georgina Mitchell
c/o Out Country Preschool
95 Candlestick Road
North Andover, Mass. 01845
Dear Georgina Mitchell,
On 5.18.99 a licensing visit was conducted at the above mentioned
Day Care Center. Enclosed is a list of non -compliances we
discussed during that visit.
In the attached Statement of Non -Compliances, there is a blank
section entitled "Plan for Correction". You need to complete
this section with specific information as to how you will correct
each non-compliance listed. You must also list the date each
correction is to be completed and sign the cover page of your
Plan for Correction.
One copy of the Plan for Correction must be returned to this
Office within ten (10) days of your initial receipt of this
letter. Upon receipt of your Plan, an assessment relative to the
licensing status of your Program will be made.
Thank you for your cooperation.
Sincerely,
M. J. Byrntes.
Group Day C e Licensor
C, f ile
a
07/14/99 10:32 FAX 9789750858 SCHL GEOGRAPHICS
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ARGEO PAUL GELLUCCI TELEPHONE
GOVERNOR (617) 727-N53
WILLIAM 0. O'LEARY (617) 727-4137
SECRETARY (978) 524-0012
ARDITH WIEWORKA (978) S24,0040
COMMISSIONER FAX: (617) 727-2533
18 May 1999
Ms. Georgina Mitchell
Out country Preschool
95 Candlestick Road
North Andover, Mass. 01845
Dear Ms. Mitchell and Parties Concerned,
Please be advised that thg information listed below reflects the examination of the
currently called "Coat Room', as I determined it today during che program's licensing
study.
I measured the room to be 19, On in length and sos,, in width. Multiplying those
measurements, a total of 159.904 square feet is available "activity space" as defined
by the Office of Child Care Services (OCCS) Group Day Care Regulations. When divided
by the regulatory 35, square feet regulatory requirement for each child, the "Coat
Room" has a licensed activity space capacity for 5 additional children to the program.
Adding the "coat Room, sn licensed activity space to the previously determined activity
space of 4251.7511 square feet, the program's total activity space is determined to be
585.654 square feet. Dividing that total by the required 35.0 square feet per child,
the total liqensable capacity would be that of 17 children.
I hope you find this information both helpful and useful. And, please feel free to
contact me at extension 332, should I be of further assistance.
sincerely,
M.J. Byrnes
Group Day Care Licensor
C! file
V
Date
COMMONWEALTH OFMASSACHUSETTS
TOWN OFNORTHANDOVER
A PPLICA TION FOR CER TIFICA TE OF INSPECTION
nm�jffl��
Fee Required (Amount)
No Fee Required
Accordance with the provisions of the Massachusetts State Building code, Section 108,15, 1 hereby apply for
Certificate of Inspection for the below -named premises located at the following address:
Street and
Number
Name of
Premises OLa C-ouw7kv 'PRESU-Ont—
Purpose for which Premises is I
Used jgja�q-m'OL
Licenses (s) or Permit (s) Required for the Premises by Other Governmental Agencies:
License or Pennit
C
Agency
Certificate to be issued to
Address 95 ('-a nd&�Lk AJ Telephone (a 0,3 -,,�2 9;2b
Owner of Record of Building G ", -n' P - M ""e-il
Address q,5 (�a ndleA!Ck Ad
Name of Present Holder of Certificate oLrr coo A_7LZV kto GL_ =QjC1
Name of Agency, if any _/ j
SIGNATURE OF PERSONS TO W90M CERTIFICATE TITLE
IS ISSUED OR 14IS AUT1401RIZED AGENT (twig
DATE
INSTRUCTIONS:
1) Make check payable to: Town of North Andover
2) Return this application with your check to: Building Dept., Town Office Building
120 Main Street, North Andover MA 01845
PLEASE NOTE
Application form with accompanying_EEE must be submitted for each building or structure or Part thereof to be certified.
3) Application and fee must be received before the certificate will be issued.
4) The building officials shall be notified within ten (10) days of any change in the above information.
cER TmicA TE # 03
EXPIRA TION DA TE //
FORM SBCC-3-74
TOWN OF NORTH ANDOVER INSPECTOR'S NAME
OFFICE OF THE INSPECTOR OF BUILDINGS JAMES MCGUIRE
INSPECTION REPORT FORM
CLASSIFICATION PASSES INSPECTION yes El 0 11 DATED lll(-3 b
,�IeOP (Ald M1 -
OWNER r , �21V 1 /
BUILDING NAME OR NO.
STREET LOCATION
00 . -� covv-�o Y 7)pto,�S(:� 400
/ 6 11( )(:�C� I
TYPE OF OCCUPANCY - Day Care Center Aud. 11 CA 11 Gym [I Apt.
School 0 Common Victualer's El Liquor 11 Placeof Assembly D
Other
OCCUPANCY NUMBER (include stories # and occupancy per floor - use reverse side
1\0W-er- OJI-t-
EXIST SIGN
LIGHTED EXIT SIGNS
EMERGENCY LIGHTING SYSTE M
SPRINKLER SYSTEM
SMOKE DETECTOR
FIRE ALARM SYSTEM
ANSUL SYSTEM
operable
operable
operable
EIA�
operable
expiration date
dry cell 0 wet cell 11
gage pressure
FIRE ALARM SYSTEM operable El municipal 0
ELECTRIC EQUIPMENT PROPERLY PROTECTED
EGRESSES LAWFULLY DESIGNATE unobstructed
STAIRS PROPERLY RAILED
HALLS AND STAIRWAYS LIGHTED
EXISTINGS
yes no El
yes no El
yes no 0
yes no
yes no
yes no
yes no
yes L�� no 11
yes R` no El
yes no
yes no
RADIATOR GUARDS yes no 0
COMPLIES HANDICAPPED PERSONS LAWS yes 0 no 0
FIRE RESISTANT CURTAINS OR DRAPERIES
'F �wd
HOW HEATED NO. FIREPLACES _yes El no
BOILER ROOM CONDITION
VENTILATION
UTILITY ROOM - CLOSETS
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS
NLJMRF:R OFqFPARATP qTAIRWAYS ArrPRRIRI F: PP:P qTnRY
SHOPS 'NA -
FOR INSPECTOR USE ONLY ReAsed 3/98 JMc
Use reverse for comments
Ito
A
I
r2
Pr
C )4
P4
At
0 C^
0
rn
'Q4
..........
..........
0 C^
0
rn
'Q4
0 C^
0
rn
Town of North Andover
OMCE OF 6"
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
North Andover, Massachusetts 0 1845
WILLIAM J. SCOTT
Director C US
November 25, 1996
Ms. Georgina Mitchell
95 Candlestick Road
North Andover, MA
Re: Out Country Pre -School, lnc.�
Dear Ms. Mitchell:
It was a pleasure meeting with you today. Please accept this letter as a follow-up of my
inspection at Out Country Pre -School.
The following violations must be corrected within 45 da rom date of this letter:
ys f
1. A second means of egress must be made to comply with the Massachusetts
State Building Code, Sec. 633.5.2.
2. The Day Care Center must be protected from the Boller Room area in
accordance with Section 633.9 of the Mass. State Building Code.
Copies of referenced sections of State Building Code are enclosed.
I will be happy, to work with you in order to alleviate this matter. Please contact
me as
soon as possible.
Yours t5r�gy,
K�nnetil S'urette,
_�Idcal Building Inspector
S/g
Enclosure (2)
�ARD OF APPEALS 689-9541
BUILDING 688-9545 , CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
AV
V
A 2
NO. j - -- !� e
75
TOWN OF NORTH ANDOVE�.
n
Certificate of Occupancy
*Building/Frame Permit.Fee S
0 d ti P it Fee $
n a
4a Wi�, r m
CH
-er i Fee
er 4 F
Sewer. Connection Fee
Water Connection Fee
—/Y
TOTAL $
Building inspector
Div. Public Works
Date /0 '-,3 / - f6
COMMONWEALTH OF MASSACHUSETTS
TOWN OF North Andover
APPLICATION FOR CERTIFICATE OF INSPECTION
Fee RequiAed (Amount,
No Fee RequjAed
In accotdance with the puvizionz o4 the Massachusetts State Buitding Code, Sectio . n
108,15, 1 heAeby appty 4m a CeAti4icate o4 In/spection 4m the betow-named ptemisez Zocated
at the 6ottowing addAers:
StAeet and NumbeA
Name o6 P)cem,,�6ez
PuApo,se 6ot Which-
Licenze(,$) o,% PeAmit(.6)
Requi�ed 6ot—t-he PAmisu by OtheA GoveAnmERXE Agencces:
. . License ok PMmit
. Aq ency
Cexti6icate to be issued to
Ad&Le,s/s q5 C�r%) LAr"flor
Ownelt o� Recotd o4 Buitding
Addke,s/s
Name o6 Ptuent HotdeA o6 CeAti6ieate
6-% PR-ZS0t00L- a&-61-,4-:1Akf hJZC&-U
Name o6 Agent, ij any
.�;4UNAJURE OF PERSON 1U WHOM UXTIPICA7—
IS ISSUED OR HIS AUTHORTZED AGENT
71fEBS09 -1
1 11LL
............
VATV '
INSTRUCTIONS:
1) Make check payabte to': Town of North Andover
2) RetuAn thiz apptication with youA check to' Town of North Andover**Bui:ldi' Dept.�
ng
146 Main Street - Town Hall Annex
North Andover, MA 01845
PLEASE NOTE:
1) Apptication 6oAm with accompanying 6ee must be submitted 6ot each buitding oA stAuctuAe
o,% paAt theAeo6 to be ceAti6ied.
2) Apptication and 6ee must be teceived be4oAe the cekti6icate witt be i.6,sued.
3) The buitding o661(-'ciat 6haU be noti6ied within ten (10) days o6 any change in the above
in6o�Lmation.
CERTIFICATE #3 -
EXPIRATION DATE:
NOV - 5 IRZ FORM SBCC-3-74
16dation 4tc(Ir:M&I44,11�1
No. -�e
LO Ur OPOV 07U/ Date
&OR'rh
0 -'n
TOWN OF NORTH ANDOVER
"'s I...+
10
Certificate of Occupancy $
Building/Frame Permit Fee $
VACHUSV.
I-ourlopmon R I �IF
1, - $
-ermit 'e
$
Sewer, Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
41
7630
75-00 PAILD
Div. Public Works
CUi'4tUt4WLALI H L& t-.iASSAL.hu.-)Li IS
TOWN OF NORTH ANDOVER
I APPLICATION FOR CERTIFICATE OF INSPECTION
Date Id -,31- �,-/
Fee RequiiLed (Amount), gle�l
L
No Fee Requited
in accoAdance with the puvizion,6 o6 the Ma/ssachuzetts State Buitding Code, Section
108.915p I heAeby appty 6o,% a CeAti6icate o6 Impection 6ot the betow-named pAemi,6e/s Zocated
at the 6ottowing addAus:
Stue,t and NumbeA I
Name o6 PAemizes
PuApose 6ot Which777teiFu
Liceme(s) ot PeAmit(s)
Requi.ked 6oA—th-e
Licmse ok Pekmit
0 u I C -7 ill&4 S HC6 L-
e7L Go�anmMtYE 'A�enccu:
Agency
0 Fn- 14,, ; Fog- UltWo--ag)
Cett,Z6 cate to be izzued to
Add,te,sz
RL2
OwneA o6 RecoAd o6 bui-f-ding GF-0�?C�IAJM
Add,te,6,6
Name o6 Ptaent Hof-deA o6 Cexti6icate 0 j c,),) ry -7p �2zE fye cL :Tfj(�
Name o6 Agent, ij any'
....... ........
SIONATURE OF PERSUN JU WHUM CLXIlFlCA7Y—
IS ISSUED OR HIS AUTHORIZED AGENT
INSTRUCTIONS:
1) Make check payabf-e to: TOWN OF NORTH ANDOVER*
?Ao /*
I I I Lt
'VATE
2) RetuAn this apptication with youA check to: ' Building Dept'. , To . w . n BldZ.
120 Main St., North Andover, MA 01845
PLEASE NOTE:
1) Apptication 4o)un with accompanying 4ee mu6t be zubmitted 6oA each buitding o.�L stAuctute
OA paitt theAeo6 to be ceAti4ied.
2) Apptication and 6ee mu,6t be teceived k6ote the ceAti4icate wiit be issued.
3) The buil-ding o66iciaE shaU be noti6ied within ten (70) days o4 any change in the above
injo,tmation.
5-1) ... I .. .... ...
CERTIFICATE # EXPIRATION DATE:
CK-� -.G� FOR�i SBCC-3-74
a -
Z4,
w
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..........
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0.- iQ 9 CALL
NOTES
CLASSIFICATION
OWNER
TOWN OF NURT11 hf�DOVER INSPECTOR'S NAME
OFFICE OF THE I14SPECTOR OF BUILDINGS
INSPECTION REPORT FORM (PA,/) A- r -T\
PASSES INSPECTION yeszz�/
no =
DATED jq4-
BUILDING NAME OR
STREET LOCATION
TYPE OF OCCUPANCY - Day Care Center Aud. L7 Cafe Gym E7 Apt. 4:7
School = Common Victualer's 1::7 Liquor = Place of Assembly =
other
OCCUPANCY NUMBER (includp stories i�� and occuPancy pp floor - ti, -:;p rpyersp
EXIT SIGN
LIGHTED EXIT SIGNS operable
E X I S T I N G
yes Z2�� no =
yes =' noyz---
EMERGENCY LIGHTING SYSTEM operable
dry cell ar/1"
wet
cell
ZZ7
SPRINKLER SYSTEM operable z=
gage pressure
yes
no
L-1
SMOKE DETECTORS operable Z--7
yes
ZL?--",
no
Z77
FIRF EXTINGUISHERS f-
expiraticn da min
yes
ZZ71
no�
ANSUL SYSTEM
FIRE ALARM SYSTEM —'�kAkf-2b-perable z=
municipal
yes
IL7
110
yes
n o
ELECTRIC EQUIPMENT PROPERLY PROTECTzD
y e s
LIP-<
no
EGRESSES LAWFULLY DESIGNATED
unobstructed
y e s
ZVI'
no
1---7
STAIRS PROPERLY RAILED
yes
no
HALLS AND STAIRWAYS LIGHTED
yes
no
RADIATOR GUARDS
yes
no
COMPLIES HANDICAPPED PERSONS LAWS
yes
1'�:7
no
Z1---7
FIRE RESISTANT CURTAINS OR DRAPERIES
yes
no
HOW HEATED NO. FIREPLACES �tavtfi— yes no ZL7
BOILER ROOM CONDITICN
VENTILATION
UTILITY ROOM - CLOSETS
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS
NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY
SHOPS
use reverse for contments
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E X I S T I N
yes no
y e s n o
EMERGENCY LIGHTING
SYSTEM operable ZYK dry cell L7
wet cell 4F,4�
SPRINKLER SYSTEM
operable = gage pressure -z,�
TOWN OF NURT11 AUDOVER
= no
INSPECTORS NAME
SMOKE DETECTORS
OFFICE OF TILE INSPECTOR OF BUILDINGS
yes
z��no
INSPECTION REPORT FORM
FIRE EXTINGUISHERS
expiraticn date //
yes
0
ANSUL SYSTEM
FIRE ALARM SYSTEM
CLASSIFICATION
PASSES INSPECTION yesztK no
DATED
OWNER
yes
o
BUILDING NAME OR
NO. cpnl) 11Q
PROPERLY PROTECTZD
yeq
STREET LOCATION
EGRESSES LAWFULLY DESIGNATED unobstructed
yes
TYPE OF OCCUPANCY - Day Care Center Aud.
Cafe
Gym )L7 Apt.
School ZE�
Common Victualer's ,C7 Liquor
Place
of Assembly
other 4Qi:L-
OCCUPANCY NUMBER
EXIT SIGN'
LIGHTED EXIT SIGNS operable z=
E X I S T I N
yes no
y e s n o
EMERGENCY LIGHTING
SYSTEM operable ZYK dry cell L7
wet cell 4F,4�
SPRINKLER SYSTEM
operable = gage pressure -z,�
yes
= no
L-��—
SMOKE DETECTORS
operable zz��
yes
z��no
FIRE EXTINGUISHERS
expiraticn date //
yes
0
ANSUL SYSTEM
FIRE ALARM SYSTEM
operable municipal
yes
10
I
yes
o
ELECTRIC EQUIPMENT
PROPERLY PROTECTZD
yeq
11 o
EGRESSES LAWFULLY DESIGNATED unobstructed
yes
110
STAIRS PROPERLY RAILED
HALLS AND STAIRWAYS LIGHTED
RADIATOR GUARDS -
COMPLIES HANDICAPPED PERSONS LAWS
FIRE RESISTANT CURTAINS OR DRAPERIES
yes �74-7--'no Z'7
yes no =,
y 0 s Z�2 10
yes 26�ljo
y e s t i o
HOW HEATED .... NO. FIREPLACES,
,4L , yes
BOILER ROOM CONDITICN
VENTILATION
UTILITY ROOM - CLOSETS' /
NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS
I
i NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY
SHOPS
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COMMONWEALTH OF MASSACHUSETTS
XXKTX/TOWN OF NORTH ANDOVER
APPLICATION FOR CERTIFICATE OF INSPECTION
Date 2" rlo� e1v
(X) Fee Required (Amount) 16
No Fee Required
In accordance with the provisions of the Massachusetts State Building
Code, Section 108,15, 1 hereby apply for a Certificate of Inspection for'
the below -named premises located at the following address:
/Street and Number 96 0-A-AAQLC6Tjz_K_
/Name of Premises __,10-r 0 -hi) - kooL -Xive
-/Purpose for,Which Premises is Use 00 1 TAVCAu=1
License(s) or Permit(s) Required for e Premises by Other Governmental
Agencies:
License or Permit
Azf —nC.-y-
0 -YOE
Pr FO R Ed
T 7e , /z)CfiH_
_n 6k
Certificate to be Issued to 7- PkES040,0L.
Address 9_0� Ro -77-
.Owner of Record of Building (!t2AIC, At -10 GFIOR6, - 1AM A� MITC14
Address
Name of Present Holder of Certificate— Oul: pe�f Cnae-
Name of Agent, i.f any A� 1A �/ " i
Alva
SIGNATURE OF PERSON TO WHOM TITLE
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT
INSTRUCTIONS: DATE
1) Make check payable to: TOWN OF NORTH ANDOVER
2 Return this . application with your check to: Building Dept. I Town Bldg.
North Anddver_��IA. U-LS45
PLEAS2' NOTE:
1) Application form with accompanying fee must be submitted for tach build-
.ing or:stru�cture or part thereof to be certified.
2) Application and fee must be received before the certificate will be issued.
3) The -building official shall be,notified�iwi thin t . e'n (10) days of any change
in the above info�mation.
CERTIFICATE# 3
EXPIRATION'�ATE:
t //- go .3— 9?_
FORM SBCC-3-74
No.:
_n
By cHECK
6TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
coil, iecv
01"lluilding/Frame Permit Fee $
Foundation Permit Fee $
-I 0'r 00
Other Permit Fee $
atlk
Building Inspector
COMMONWEALTH OF MASSACHUSETTS
X=/TOWN OF NORTH ANDOVER
APPLICATION FOR CERTIFICATE OF INSPECTION
'.Ld3a omamne
UAOGF,�V HPIHOON
agAl LID L
Date Sept. 8, 1988 (X Fee Required (Amount) $75. (biennal)
No Fee Required
In accordance with the provisions of the Massachusetts State Building
Code, Section 108,15, 1 hereby apply for a Certificate of Inspection for
the below -named premises located at the following address:
/'S,treet and Number_ 95 C-P'Nr>U�ST/ck
/1-ame of Premises
60-r ftOAJTP-y iffatill-� D/4V ej�&e.. _-TWC,
V��Purpose for Which -Premises is Uded
L icense(s) or Permit(s) Required for the Premises by Other Governmental
Agencies:
License or Permit
__e_!Qe7JP/,-ATE fiF
CaRTIFfea-fidt) Qr LfaP ZMA7146 INSPIFL-Udbl
Agency
6FEICE FOR 041LOgej
/Certificate to be Issued to— CQUO Lk _D19,1 CnRF . =NC,
Address _T
ArarT�t Ambo(Ic-7N-,
V/Owner of Record of Building C 9 q LG ArOn r14FQRC'1A-JR A, Hirr"Eu-
Address
Name of Present Holder of Certificate- GeOR&LOR 1-117-CAOLC
vo-'Name of Agent, if any___ JAg W/"/S
�WHOM
EeEslcglyr Ago -7,gaosujeep
SIGNATU E 0 P'ERSONTO
TITLE
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT
se-pTelvec-p_ 9, 1986
DATE
INSTRUCTIONS:
1) Make check payable to: TO1v1N OF NORTH
PJTDOVER
2) Ret.ygn this application with your check to: Building Dept., Town Bldg.,
Nor h Andoverp MA. Ui8457
PLEASE NOTE:
1) Application form with accompanying fee
must be submitted for 0--ach build-
ing or stri�cture or part thereof to
be certified.
2) Application and fee must be received
before the certificate will be issued.
3) The building official shall be notified
within ten (10) days of any change
in the above information.
CERTIFICATE # 3-93B
EXPIRATION DATE: 10/15/90
love
FORM SBCC-3-74
Location //
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occup $
'A
Building/Frame Permib.R, OA
Fee V3�0
Foundation Permit Fee
ACH
Other Permit F0, 0. $
Over$C,
Sewer Connection Fee tl I -
Water Connection Fee $
TOTAL
$
Buildi6g Inspect
Div. Public Works
Date 10/20/92
LUi%fikiUNWLAL I H U� t,.iASSAL) lu.�L i IS
i a
TOWN OF NORTH ANDOVER
APPLICATION FOR CERTIFICATE OF INSPECTION
$75.00.
X) Fee RequiAed (Amount) Biennially
No Fee ReqtaAed
In accoAdance with the ptovL6ionz o6 the Mmzachuzett,6 State Buitding Code, Section
108.1151, 1 heAeby appZy 6ot a Cetti6icate o6 Impection 6m the betow-named ptemiza tocated
at the 6ottowing addAezz:
StAeet and NumbeA 95 -Candlestick Road
Name o6 Rkemi,5e,6 OUT COUNTRY PRE-SCHOOL INC.
PuApo,se 6ot Which-P)Lemiza i/s Uzed SAME
Licenze(z) ot PeAmit(-6) Requi)Led 6oiL the Ptemizez b -,g OtheA GoveAnm5T� A_9,enr�n:
Licms e oA PeAnlit
Cexti6 cate to be izzued to __Oo
AddAnz
OwneA o6 RecotT76 Bux-td-Eng
AddAms
Name o6 PA
Name o6 Agent, 1*6 any'
SIUNATURb U� PUKSUN W WHUM CbK1 IV
IS ISSUED OR His AUTHORIZEV AGENT
INSTRUCT70NS:
. Agency
1) Make check payabf-e to: TOWN OF NORTH -ANDOVER*
� . I . 1 2 A,,o*j44,1=
I I I Lt
bcto*beZ:. .27, 1992
VAI L
2) RetuAn thi/s appUcation with youA check to- * Buildi*ng Dep*t. , Town Bldg.
120 Main St., North Andover, MA 01845
PLEASE NOTE:
I ) Appf-ication 6otun with accompanying 6ee mu.6t be zubmitted 6o,% each buitding ot .6tAuctuAe
0)1 PwLt theAeo6 to be cexti6ied.
2) Apptication and 6ee mu,6t be teceived be6oke the ceAti6icate witt be i56ued.
3) The buitding o66iciat shaU be noti6ied within ten (10) day.6 o6 any change in tile above
in6mnation.
CERTIFICATE EXPIRATION DATE:
p,� , eo�-r� . 5V FOU SBCC-3-74
CRAIG MITCHELL
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31WIL-DING DEPARTMENTI Dirac-c-n'z
Defense Systems
201 Lowell Street, Wilmington, Massachusetts 01887, Tel. (508) 657-1053
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DATE OF PLUTWPIN �Z-5/64--�-QUANTITYPUWEI) 50 0
CESSPOOL NO YIES
:SEPTIC TANK NO
YES
NATM OF SE'RVICE; RQV-TINE
EMERGENCY
OBSERVATIONS:
GOOD CONI)j�j
ON, FULL TO COVER
4AVY GREASE BAFFLES IN LACE
ROOTS LEACHFIELD RUNBACK
EXCESAWE SOLIDS 'FLOODED
SOLIDPARRYOVER. OTHEREXPLAIN
SYSTEM PLTMPtD BY Roil)