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HomeMy WebLinkAboutMiscellaneous - 10 FOXWOOD DRIVE 4/30/2018c- 3 � N J O O �2 III O O O 9) v, 00 - o o m 0 Date ............. 75,P - a ..................... TH TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... bo�.�Zz) ...... e e, . .............................. has permission to perform ...... ....................... ........... wiring in the building of .......... P . ...................................... at ..... ..... ba ................... NLqvoLrtLjhLl Aundover, Mass. Li Y .... .. ..... Fee.. ......... c. No. D ....... i�S�ro ........ E -AI Check# 3 9'1 85 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, §, 3L, the permit application form to provide notice of instatlation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166, § 32, an f electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shalLbe limited as to the time of-ongoing construction activity, and maybe deemed by_the,Insp.ector_of_W3res abandoned.and_invalid,if_he._._.. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the. permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is tq promote job;growth and long-term economic recoveryand the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certaiwpermits and licenses contc-ning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was m effect or existence' during the qualifying period beginning on August 15, 2008.and extendingIbrough August 15, 2012. Rule 8 — Permit(Date Closed: 1 Note: Reapply for new permit ❑ Permit Extension Act — Permit /Date Closed: C'ommonweaR o f Madsackadetb Official Use Only 2cc77 Permit No. aParfinenf o/ }ira serviced BOARD OF FIRE PREVENTION REGULATIONS Occupancy v. IpOancy and Fee Checked leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: t-4/ , /0 City or Town of: IV ,Qdhoar- To the Inspector of Wires. - By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 10 oy i4,b Dr- Owner rOwner or Tenant E 1 n ; nip .fah k", Telephone No. ' Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I Kala 11 L. %ne V,, I -�cc P No. of Meters No, of Meters t'U N i✓l Com lesion o the otlowin table ma be waivedb rh / W No. of Recessed Luminaires No. of cell.-Susp. (Paddle) Fans e ns — or rres. No ofTotal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No, of Luminaires Swimming Pool Above ❑ n- ❑ rnd. grnd, o. oEmergency ig tng Battery Units No, of Receptacle Outlets No. of Oil Burners FIRE ALARMS [No, of Zones No, of Switches No. of Gas Burners o, 7o Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump Totals: .um,er ' ....,, "' ons """""""""""""""""" o, oSelf-contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Connection ❑ Other No. of Dryers No. OrAVa Heaters KW Heating Appliances KW o, o o. o Signs Ballasts ecurlty ystems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Euivalen( No. Hydromassage Bathtubs No. of Motors Total HP a ecornmunicahons trtng: No. of Devices or E uivalent OTHER: .Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on tl ' ap li tion is true and complete. FIRMNAME: 'DRgtD G'LfC-1rPlC4L �piTRgeTlraG �-L LIC.NO.: ig9to3a Licensee: 'D 4Vi 1D HA64AK Signature LIC. NO.: (If applicable, enter ",exempt" in the license number tine.1) Bus. Tel. No.: b v 2 Address: 8766LrxoNtSrORTN ApCOy�R &A 01Alt. Tel. No. 'Per M.G.L. c, 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER. I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ' . Date / ........... � TAORTN TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ; � ��has permission for gas installationin the buildings ofGAS INSPECTOFF ��O�� � �� � �� MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FM (Type or print) NORTH ANDOVER, MASSACHUSETTS Date- Building ate Building Locations Permit # z Amount $ s�� �-- G� � �'► `P S d� a ir. fyQ Owner's Name��--� New Renovation Replacement 1l1 Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name Corp. Address L2 l/WG1. ci-� ��' % ��'! ��/,1. !, J�� Panner... Business Telephone D-ftTfs/Co. Name of Licensed Plumber or -Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes t!� No If you have checked yes, please in e the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1-3 Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent - - --- -- .-.- —a auULlu«Cu kUF enterea) in above application are true and accurate to the best of my knowledge and that all plumbing work and installationserformed er ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G ode a$`,1nhapjer 142 o,Yhe General Laws. By: Title City/Town (OFFICE USE ONLY) Cl'v Signtore of Licensed Plumber Or Gas Fitter lumber � 3 � Gas Fitter lcense Numiner Master ourneyman w w a U c, d a F °� x z z H Wd W 0e; W 44 R w F WV H Z H d �" W a W W w > w z Q Q z c z c in x x o x w 3 0 a> a a 4 0 SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8_TH. FLOOR (Print or type) Check one: Certificate Installing Company Name Corp. Address L2 l/WG1. ci-� ��' % ��'! ��/,1. !, J�� Panner... Business Telephone D-ftTfs/Co. Name of Licensed Plumber or -Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes t!� No If you have checked yes, please in e the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity 1-3 Bond Owner's Insurance Waiver: I am aware that the.licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent - - --- -- .-.- —a auULlu«Cu kUF enterea) in above application are true and accurate to the best of my knowledge and that all plumbing work and installationserformed er ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State G ode a$`,1nhapjer 142 o,Yhe General Laws. By: Title City/Town (OFFICE USE ONLY) Cl'v Signtore of Licensed Plumber Or Gas Fitter lumber � 3 � Gas Fitter lcense Numiner Master ourneyman The Commonwealth of Massachusetts Department of Industrial Accidents 14 Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: /�� �,t¢ D /��l/ Phone #:— <; Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I erlb'yees (full and/or part-time).* have hired the sub -contractors 2. am a sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub=contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. fim ance 5• ❑ We are a corporation and its required.] 3. [1.1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees_ [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. [l Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.(] Elec 'cal repairs or additions 11. Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other ---- - - a,,. —L MU accuon Q "Av s^owmb their wOrken" compensation policy inform -lion. fi 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. l am an employer that is providing workers' compensatio information. n insurance for my employees Below is the policy and job site Insurance Company N Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: -_h9 /Gk14-Jn0d (S� City/State/Zip Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the 'ns ena and ltie ,P ti eriury that the information provided above is true and correct u, Dat ozJ one #: 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 S. Plumbing Inspector 6. Other Contact Person: Phone #: l 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 pe=rson 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, §25CM 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 of license is being requested, not the Deparmient. of Industrial Accidents. Should you have any questions regarding the law or if you are required to .obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a- space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. 3K 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 wwvu,.mass..gov/dia Date /,:2 0/`� ..... ...... . ... 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that W: . ...... ....................... has permission for gas installation— ........... in the buildings of .......... ................... at N ' orth Andover, Mass. Lic. 'No., ASINSP OR Check # 7081 i MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations I VA- W 000f Y&LAJfjCja1W fCja2 Owner's Name New ❑ Renovation ❑ Replacement 0 Date-- �1�/09 Permit # / U Amount $ , Plans Submitte _ f 111 • � w � U' OU" x `� a vi a F w F w x v, da a z y p F 0 ] o F O O a W W F w Cw7 H z H d x w F" w U O w Z O w z U x O x .G d W d ? v� °a A° x x o x 3 c 0 J U > H o SUB -BASEMENT BASEMENT ► 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8.TH. FLOOR (Print or type) Name Address Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. r ty - ❑ Partner. .n 'r _ Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No If you have checked Les, please indicate the type coverage by checking the appropriate bo Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent ..may .,.,. L..y uiaL all U1 Lug UUMIlb aiiu u„Viznauon 1 nave Suomiuea kor enterea) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber A 7 9Z 3 Gas Fitter LicefiseNumber- B Master Journeyman I r. 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): r CI %C Address: ` V V City/State/Zip: Phone #: i JF ox:L❑Are you an employer? Check the appropriate box- LEII am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp.',insurance. [No workers' comp, insurance 5. We. are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' �.._ttV A11nEiron4 ki.ntr ..l. a,.L.. L_-. y comp. insurance required.] Type of project (required): 6. ❑ New construction 7. (Remodeling 8. %❑ Demolition 9. ❑ Building addition 10.❑. Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13.0 Other. . — vo:.� u:c J vpOn QerQY.� SnQR2^.0 f.^glr wort e;s' comp�,...sat:en p^�L`c}' 2nfOZ-.1at1Qn. 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: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the I�A for insonce covgrage verification. I do hereby cert¢y,fjinder thellins and , aloes of perjury that the iWrmadon provided above is true and correct — Com- / / — Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. PIumbing Inspector 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.emplpYs pdisbns to do mmain�exiance; construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall enot because hof such employment be deemed,i o 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 constrict°buildings in''the coinmonwealth 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 permitilicense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture (i.e. a dog license or permit to bum 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 -addresi, telephone and fax number: p The .Cominonwealth of Massachusetts ' Department of Industrial Accidents Office of Invesiiasions 600 Washington Street Boston, MA 021.11 Tel. # 617-727-4900 ext 4406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 wwvv.mass.gov/ilia A Location_2�� - -, r ad a 2 -4�. all No. Date V40RT �TOWN OF NORTH ANDOVER 0, -VCertificate of Occupancy $ Building/Frame Permit Fee $ n awn er C-14USs' d t' -P mit Fee $ ermit e $ Sewer Connection Fee Water Connection Fee TOTAL jft�!,Idlng Inspector MAT IMM 20. 00 PAID Div. Public Works 'to at i A) / Jl- c on N o. 6) 9�� Date AORT TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee. $ /6/2,f Foundation Permit Fee Acs4u Other Permit Fee ------ J r, Sewer Connection Fee Water Connection Fee --2�v TOTAL . . . . . . Building Inspector 7 2- 21, Div. Public Works Locatio �No. Date "ORTF, TOWN OF NORTH ANDOVER 0 ClAhL 0 Certificate of Occupancy 4L Building/Frame Permit Fee $ Foundation, Permit Fee $ Other Permit Fee Sewer Connection Fee Water Connection Fee TOTAL $ Building'Inspector 150- 00 PAID Div. Public Works Location -7— No.- Date "ORTh TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee,---4— Other Permit Fee $ C5 $ -Sewer Connection Fee water Connection Fee $ TOTAL $ J1 04/13/94 08:44 6945 Building Inspector "W '44 Id 4000.00 PAID —qlh'/Publl� Works APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER MASS. PAGE 1 MAP 4-40. T NO. I 2 RECORD OF OWNERSHIP (DATE BOOK !PAGE ZONE � -Z SUB DIV. LOT NO. f LOCA ION 0r` ! PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDRESS r BASEMENT OR SLAB v 7S /�� L / ARCHITECT'S NAME .SLI SIZE OF FLOOR TIMBERS IST 2ND Y3RD ,rlo BUILDER'S NAME S} ceI SPAN ���ro i DISTANCE TO NEAREST BUILDING Q i _ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS y �X DISTANCE FROM LOT LINES - SIDES + ,� T REAR GIRDERSAo ! // AREA OF LOT YZ ./_ _ C FRONTAGE HEIGHT OF FOUNDATION ��/ O THICKNESS �� 4 IS BUILDING NEW .�/��(�/` SIZE OF FOOTING Q K x CEJ IS BUILDING ADDITION O MATERIAL OF CHIMNEY IS -BUILDING ALTERATION d IS BUILDING ON SOLID OR FILLED LAND u r 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 SEE BOTH SIDES RK POW W S 0PAGE 1 FILL OUT SECTIONS 1 - 3 LEn EDA FEE—c�; PAGE 2 FILL OUT SECTIONS 1 - 12 DUE FRAME PERMIT $ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS s PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAT ILED I ATURE OF dWNER OR AUTHORIZED AGENT FEE a i/z G PERMIT GRANTED `(/ OWNER TEL, N G CONTR. TEL. - Z 19 CONTR. LIC,it i � �. � ice► 3 PROPE TY INFORMATION LAND COST -o 0-27zJ EST. BL rMl 4'&0 � EST. B PE SQ. FT. m EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH 1, PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 - l ; SINGLE FAMILY STORIES MULTI. FAMILY Of.FICES APARTMENTS " _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 2 I3 PINE CONCRETE "3 CONCRETE BL K. BRICK OR STONE HARDW D _ PIERS PLASTER DRY VJAII _ UNFIN. 3 BASEMENT AREA FULL y4 '/r °/, FIN. B'M'TAREA _ FIN. ATTIC AREA _ NO B M T FIRE PLACES I HEAD ROOM MODERN%KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 �_ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING CONCRETE EARTH HARDIrJ'D COM/,ACN VERT. SIDING _ 01-1. TILE STUCCO ON MASONRY _ _ STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME CONC. OR CINDER BLK. ATTIC STRS. & FLOOR _ WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) Z GAMBREL M ANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR Hi TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. / STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS 7 AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd -� ,,r 1-3,d NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF'LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS .OF BUILDINGS. WITH PORCHES. GA- RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1 s A a t s ' 1 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section****************** APPLICANT: af' / / Phone LOCATION: Assessor's Map Number Parcel �- Subdivision -1 w�i.�rrr���i9 , Lot(s) C6 4 Street wvX w©9W St. Number_ ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation Administrator Comments Town Planner Comments Food Inspector -Health r Septic Inspector -Health Comments Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected j Date Approved -/ Date Rejected Public Works - sewer/water connections - driveway permit .Fire Department Received by Building Inspector �i - «t - ` Date kt �. f, AIS - 7 1994 1 J C*eA7-,'.-Y 727 7314- 777,�E 1A1X41WCAA1,O OWC,0-4-Vle 7-'147 rW*,AOKeZ41AW IS ZCe,41-d-oO OW ZVrAf JrAV-*A"A&,O ;A'I47'1r,04CS eaAlla;�Iehf .)Ylrll r11 -C, r-oz.,,v * etom/wa 'dE6"'144rV11-f SrfCerT / 407'ZIM-C.S. " XW7- 7;Vl-f OA-Lnuelwa IX,,va7- r,,y4' ,V4Z4.eO 4 -e -c;4. * %.Wd#VAt OAI A-eow,4 AeAleZ '* 'A -47W .47-161,V MAY MeNG DEPARTfOENT RL or Rz.4� /IV ,,- Vv.. ,VO7- AeW ra, e, Z, -V. vo va I 41t:S:•NIbR(]'3itdSitltL:Sti4_i:bn..::Wl ll�a'�;l�f'u •1F Viy�- •su'tg-yy '41?.7fF�'SaayA I ---- - - -- - - - v m • • C• V� C Q N = a: CCD C502 :CL m p m Cl) O CA CCD =r-o a, � G Q o 01 go P -o CD H D ..w =r p CD -► m p rn =r y w - l o �' $ -1 > > rn W H p fli tC a 3 p O v o o, �± • C O G N• C -3T "® Q r. `� W ac CD D n Z y vZ c'C-L aye p" O DZ acog CD ®' ilk CD m CL y n ..y� C C7 CL CCD CL CCL y O d Q' ^ v RDCDo �-rCD O CD Q co O Q • oEr �► 'i y, N M ►►-��++ a o):VN.4 � mCf)C CD y v^ CA 0 < cn CD -q 0CD ^s. D n m D mm m — CQ 0 co m2t CD , R - Cl)CD2j � O /�/D � � � 1'x"1.' co z a` ay D cocl fDo 0 rD 0 y y w O a- r" W 00 wO a- �'•' CTS W � co �� p o C drD ,� p a x r x y� -:'09 'log ocation Zz ba't6 No. 40R TOWN OF NORTH ANDOVER AhL Certificate of Occupancy $ Building/Frame Permit Fee $ CMU FoundatiOnpermit Fee $ 0 her P4 VMY�Fee c t 2 Sewer Connection Fee Water Connection Fee $ TOTAL �,2 S - 0 D Building Inspector /94 13:40. 25. 00 PAID AN 7 394 Div. Public Works iC�ll`J.�IN(, ex)NJUIVATION y ., 1'.I.ANNIN( ATE )CATION LINER 1 S NAME: 1ILDERIS NAME:— SON AME: ' ' " .SON IS NAME: . kSONIS ADDRESS: ' LSONIS TELEPHONE: u.:'PI T"":(.\ � "a. �.�r •;A �'i �!1'�'lll?��i'%Xt -"4c �;"� i a' ' , � {I I'�r�illll�t i'1'I + (i�4�`,#�!� ...�� . �5x���: --i �' J :i, •x, >�- r x ,... s aro ^ .-.4. l..y • 5 ' `.'�� ,3,, �. • '�. \0 �}�� �§' s:..a `Y �� -:t;- fi,�''at-�. \+ A .�� + .� i1,�'-s 41\lilti`il/ I111':1'�� lyi.�$�1!' ifrio �yG ��'`� F �,,r 4 I/1�1 i111N111 �A-;�•; � °� =`llil i)tili!i l i'i', ��'��r:'• hABEN 11.1'. NJ: I »tit V. 1)11 tl a : I ()I t CHIMNEY APPLICAI*IOIJ ANU 1'ERAII f p >v � 3 UTv� U 4 -a®3 -1y I�Llzrli I'. # JERIAL OF CHIMNEY: IrERIOR CHIMNEY: ExI LRIOIZ CHIMNEY: IMBER AND SIZE OF FLUES:— oey IICKNESS OF HEARTH: ; U cUbiney oa 6i4epCace con(anm o .the kequ.61temeii.t.s uO the code and have, :ucl'e.3 (Md :gutati.ojo been ucebect: .TE: .. GNATURE OF MASON: :Rl{IT GRANTED:X —a 3 1'LE 2 j— , rJ 'BERT NICL-TTA ILDING INSPECTOR SPECTEU: :MARKS: �112 10 SOLID BLOCK HQUIRLU ~ THIS PERMIT MUST GE UISPLAYLU 014 ME VU1,IISLS: 1 1 1 ' y' 6. � S f [S l g r � 3 ik i� � t � � . }�y Y �►}��yy7 6 1F ,� C� t , � S - s d. •i r TO "k - J:1► u' W� c a.�.i�.3 W ^. CF 5 3 r .7.y fn` � Y � ow iF r M'1 ll; 11 F r r P rT M� x y j.3 kc, a �*a.r 4i a s - (N T a �� 1_ � ,. `I \� y1 /A� _ f � N .,., � r �.,i• t � ►y/��=VyyF �e � � � � 7 '. In } .u. �) S ���,. .' �, .`•.�� $, n- ) .,- rf1 - � .. iii s. :7 ,. ._ ... �..[. '• G t`n6Y t 4 { 'u S1 Y �.S rF' i vS+ f 7 � 8 , 51 • 1 a, ' i f } y�..4{, F 7 Fn.,.. iY � ?4 Y ) F y G t`n6Y t 4 { 'u S1 Y �.S rF' i vS+ • 5' ��o`V z.� W� o. p 0— `f 3 O m r y Y iq f r {� y Y L A er ♦ M � r kto � a r xa fi t _ L Ca : Q fi r. ^ I� %5 ' to } • ■■■■■■■■■■■■■■■■■■■■■■■■■ `41th FLOOR: FLOOR■■■■■■■■i■■■■■■■■■■■■■■■■ z `Installing Company Name GALINSKY PLUMBING & HEATING INC. Check one: Certificate 4. Address =' P -0 -BOX 1701) Corporation 1906 HAVERHILL, MA 01831 0 Partnership Business Telephone 508-374-1743 p Firm/Co. Name of Licensed Plumber or Gas Fitter STEPHEN C. GALINSKY INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes)e No i if you haveilchecked yes, please indicate the type coverage by checking the appropriate box. y; A liability insurance policOther type of indemnity 0 Bond O OWNER'S INSURANCE WAIVER. I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this per -:it application,,valves this requirement. Signature of Owner or Owner's Agent Check one: Owner L Agent .I hetet,, certify tha: all of the details and information 1 has,sub-`red for entered i, -the ab,,'e applicatio are it,, and accurate to the best of my knoM�..o. 2ge and that at' pVrnbinF 'r; and insta'iations periormed under the permit issued for this applicatin- wi11 be in compliance with al: pertinent pro,isiom of the haassachuser, State Gas Code an:: Chapter 142 of tv General La,.s. 1 5 t� . t t is • ■■■■■■■■■■■■■■■■■■■■■■■■■ `41th FLOOR: FLOOR■■■■■■■■i■■■■■■■■■■■■■■■■ z `Installing Company Name GALINSKY PLUMBING & HEATING INC. Check one: Certificate 4. Address =' P -0 -BOX 1701) Corporation 1906 HAVERHILL, MA 01831 0 Partnership Business Telephone 508-374-1743 p Firm/Co. Name of Licensed Plumber or Gas Fitter STEPHEN C. GALINSKY INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes)e No i if you haveilchecked yes, please indicate the type coverage by checking the appropriate box. y; A liability insurance policOther type of indemnity 0 Bond O OWNER'S INSURANCE WAIVER. I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this per -:it application,,valves this requirement. Signature of Owner or Owner's Agent Check one: Owner L Agent .I hetet,, certify tha: all of the details and information 1 has,sub-`red for entered i, -the ab,,'e applicatio are it,, and accurate to the best of my knoM�..o. 2ge and that at' pVrnbinF 'r; and insta'iations periormed under the permit issued for this applicatin- wi11 be in compliance with al: pertinent pro,isiom of the haassachuser, State Gas Code an:: Chapter 142 of tv General La,.s. R O w T n Y °31 h "z 'O n R O w T "z • , r z N '9 _1 O Z N Date. ........ .. T"To 2006 40RTH TOWN OF, NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION —41 SACHU This certifies that (74 ............ s has permis'ion for gas installation A ..... ��'n in the buildings of ................................... at ...... North Ando' ver, Mass. &Lic. No. ��A .............. 5/95 1401 70. 00 PAID GAS IN-SPECTOR. WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOL6. File