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HomeMy WebLinkAboutMiscellaneous - 100 PHILLIPS COMMON 4/30/2018Date .....q ..... — /.... 0 7 ...... ..— ... .... 0 - TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... WA.Y.&F 44144-2*n ............. ................... has permission to perform ....... ""*.f .. . ............. wiring in the building of ......... Re.o ....... ........................ at .... A ......................................... North Andover, Mass. Fee Ar ......... Lic. No... ... LEN ................ jjELECTRICAL INSPECTOR 1 7 - Check # '0' 7233 - Commonwealth of Massachussetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATORS Occupancy and fire Checked [Rev:11/99-(leaue`Blank) ` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachussetts Electrical Code(MEC)527 CMR 12.06 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 12/26/2006 City or Town of North Andover 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) 100 Phillips Common Owner or Tenant Walter Radulski Telephone No. 978-689-0812 Owner's Address 100 Phillips Common Is this in conjuctions with a building permit? Yes ❑ No ❑ (Check Appropiate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Underground ❑ No. of Meters Y New Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampicity Locations and Nature of Proposed Electrical Work: Res. Burg System Completion of the followina may be waived by the insnector of wires No. of Recessed Fixtures No. of Ceiling Susp.(Paddles) Fans No. of Total Transformers KAV No. of Lighting Outlets No. of Hot Tubs Generators KAV No. of Lighting Fixtures. Swimming Pool Above In- ❑ ❑ No. of Emergency Lighting -i grnd. grnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones :witches' rt ,'. Lx `sof„S5t` j ' r.�...�u'"r"lx�f?' Noofy`Ga Burners �w,' k i"�A �s;.j:F�' z5�$�F:�"+6�'�"s��i No Fof Detectionand .pp F ,^' �.'.6�.. . 2t b,�„'r�a ��,pA:•'�'�S...g. 4 c�x..'• u. .�aht •�: 9IIa,A'c ,).�.wnS b?. f-„ Ae4 T - tr C.°'•k' "r:..^ z 2. S v� ,C G: 1' :�.i?+4� i h: No. of Ranges jl ° ,....' ,..r';f`A:`1t�+J.j {6� .y,t F r ^S. f A} !g, g No. of''Air Corid. � µ ,' � ..�eTotal � �E Tons No. of Waste Dispensors Heat Pump Number ITons I KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space Area Heating KW Local ❑ Municipal Other ❑ Connection No. of Dryers Heating Appliances KIN Security System: No. of Devices or Equivilant No. of Water No. of No. of Data Wiring: Heater KW Signs Ballasts No. of Devices or Equivilant No. of Hydromessage: Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivilant Attached additional detail if desired, or as requested by the inspector of wires INSURANCE COVERAGE Unless otherwised waived by the owner, no permit for the performance of electrical work may issue unless the /iscensee provides proof of liability insurance including "complete operations" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of the same to the permit issuing office. CHECK ONE INSURANCE ❑ BOND ❑ OTHER ❑ (Specify: Scottdale Inc. Co. 5/1/07 (Expirations date) Estimated Value of Electrical Work t (When rgquired by.,Municipal.policy) Work to Start: v ; x alnspections,to berequestedwin accordance with MBC Rule,10, upon -completion.,,,,,,, cern ,:under.. the pa and ` enal'ties:o`f, er u� ''thatthe information o' 'this application fs true anal;:complete`x fy P p p, J rY,: FIRM NAME:. Wayne Alarm Systems, Inc. LIC. No. C-1111 Licensee: Ralph W. Sevinor Signature SS CO# 000160 (If applicable enter"exempt" in the liscense number[ e.) Bus.Tel. No.:781-595-0000 Address: 424 Essex Street Lynn, Ma. 01902 Alt Tel No.: 781-596-0000 OWNERS INSURANCE WAIVER: I am aware that the /iscensee does not have liability insurance insurance coverage normally required by law. By signing below, I Nearby waive this requirement. I am the (check one) ❑ OWNER ❑ OWNER'S AGENT Owner/Agent PERMIT FEE: $ "�'�� , '�L��- Signature: Telephone No. CJI Proposal ID �oN 4145 Date ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.. fo tic -(,e4 — I rct d (,(— To (- - ................................................. has permission to perform ...... ....................................... wiring in the building of............... ............................................. at'.... orthAndve s. //P Fee.. c. N ...-7 Li ................. ...................... ELECTR'IC;Zf SPECTOR Check # The Commonwealth of Massachusetts Office Us Department of Public Safety Perm# No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 CK# ?. Occupancy & Fee Checked (leave blank) ,APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12�80i (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DATE October 17 2002 City or Town of N ANDOVER To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. No. of Transformers Location(Street & Number) 100 Pilips Common Owner or Tenant Walter Radulski BUILDING CONTRACTOR Mark Sullivan Owner's Address 100 Pihps Common CONTRACTORS ADDRESS 19 Tanglewood Drive N Andover, Ma 978-689-0812 Nashua NH 03060 603.759-8441 Is this permit in conjunction with a building permit Yes f_Xj No Building Permit no. Purpose of building Existing home Utility Authorization no. Existing Service 2 0 0 Amps 1209 / 240 Volts single PHASE Overhead No. Akeceptacle Outlets No. of Oil Burners Undgrd FXj No. of Meters O N E _ .Mast Service No. of Gas Burners Syphon Zones No. of Ranges New Service Amps Volts PHASE Overhead Heat total Undgrd No. of Pumps I No. of Meters- . . Mast Service Other No. of Dishwashers Syphon Number of Feeders and Ampacity Heating Devices KW ` No. of No. of Signs Ballast's Location and Nature of Proposed Electrical Work Wire for addition to existing home No. of Lighting Outlets No. of Hot Tubs No. of Transformers TOM KVA Above n- No. of,Lighting Fixtures Swimming Pool gmd gmd Generators f',KVA No. Akeceptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of No. of Detection and Inflating Devices. No. of Sounding Devices. Zones No. of Ranges Total No. of Air Conditioners ; tons Heat total No. of Disposals No. of Pumps I kW No. of Self Contained Detection/Sounding DevicesMunicipal Local � Connection Other No. of Dishwashers Space/Area Heating KW No. of Dryers rY Heating Devices KW No19 . of Water Heaters kW No. of No. of Signs Ballast's Low Voltage Wiring No. Hydro Massage Tubs No. of Motors Total HP O)IER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO F] I have submitted valid proof of same to this office. YES 0 NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE [0 BOND [:] OTHER n (Please Specify) Estimated Value of Electrical Work $ (Expiration Date) Work to Start October 17 2002 Inspection Date Requested: Rough: WILL CALL Final: Signed under the penalties of perjury: FIRM NAME Leonard Electric, Inc. Licensee Signature LIC -NO. A10638 _ LIC.NO. Address 154 Fletcher Street, Lowell, Ma. 01864 Bus Tel No (978)937-8620 Aft. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the licensee DOES NOT HAVE the insurance coverage or its substantial equivalentas required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner [D Agent (please check one) Telephone No. PERMIT FEE $ fjr (Signature of Owner or Agent) CUSTOMER 0 7 5 8 0 0 W 0# r1 3 0 0 9 s //E.E'EBY GE.CT/Fy TO TyE' T/TLE /NS&.eO.P ANO PG O T 14�14 .41t/ TO THE BAN.f' T.figT T//EOwEGGduG /S fOC,47L- OV T/�E GOT .qS S.SO/Y.V ANO T//,4T/T GOES CO,I/FO.PAe X iY/T// T.S/E TOu/N OF N, i4NpOPL-e ZO vl l-- PEGUGAT,O �/S , / . ' REGi4P0/NG .SETBAC.t'.S FEOW ST�PEETS f45:77- G/.uES. "' /l/O, �iVOO 1/E.e/ ASS, I Fli.�yEP CEPT/FY TilW7- T///S ON'EGL/N6 /S LVOT ��77 GnGgTEO /N T//E F EPAG FLO0O .S'.gZAPO APE4. _ . y,P•9i1//V FO.P SHarvN OA/ �t4fi��` ---``Ssgc"�®. 250098 c�cL'3S6 �i✓i�G/P,SG�oinma�vS ��✓6LoP/ylE.vT . EFFREY ��� P4re, 6/583 T///S PLAit/�� `F • AGE P//,PPOSES - �f/OT FO,P - Bovvo.Ps� EE•P.vG SE.P�/lES .oro-vrorE.S/ F,PO,N EX/ST/,f/C .PEfO.PpS, 6� Al.P,(� .ST.PEET A.t/ODYE.P, �IASS,4C,��/SETTS O/8/O i' o O � d O y °x y H W d K! O V H o y � H � ff N w d s C•] �=J lw n C .3•o fl. i Ma CL Po 20 eD mm I E! n C A A A c V A m to 110 IN m m z m Q IV �m CD ZZ m ��m� IOD c �O a° �_�O Fn } -st V m � m JIU IV �m CD ZZ U - _ _ .__ . i a • Y.. _i •'"jam :. z.....� .�. _... z . ...�., aiy,d i ' I Location /00/ ��/lU /t�S ( gym Inii J- L4 lR No. 2 ?ar Date 4%�-b 2— TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee $ �a d Pd 6 -1 6Q`� Foundation Permit Fee $ — >//74, SACMUSE�� Other Permit Fee $ Sewer Connection Fee $�'/JAZ 4- 12 0 Water Connection Fee $ RECEIVED PAYitMg7 $ JUN 24 1992 Building Inspector `// i✓E, — No: Andover Collector Div. Public Works Location !C 0 i g1,11, /P -S cop, M, © `- !) , No. 3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ -s Building/Frame Permit Fee $ Foundation Permit Fee $ CC) Other Permit Fee $ Sewer Connection Fee $ PAI v vection Fee $ `~ r5 CAL Building Inspector viv. ruunc vvV#ns rDCA Al / Location d� No. % _tea U Date NORT1� TOWN OF NORTH ANDOVER F ` p Certificate of Occupancy $ ' • ; Building/Frame Permit Fee $ �ss�►cw Foundation Permit Fee $ her Permi4 �e $ }; W (QNS r ection Fee $ j) -r",! L '/ZG� Water Connection Fee $ -/)Y,> bo. AL�tce¢ $ zd©n . 0 0 .., ,.. Budding Inspector ^ Div. Public Works �. z3 �pEg�ttT Nib APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER. MASS b r I A 1 —) a! I 1/I:R SAP KBO.LOT 7ANE '` NO. A. - I SUB DIV. LOT NO. I 2 RECORD ORD OF OWNERSHIP DATE BOOK 'PAGE — I I �— LOCATION - - OkY.NER'S NAME V� 1 /{ _ PURPOSE OF BUILDING NO. OF STORIES f' ! SIZE `•s Dw' rL2 TT OWNER'S ADDRESS - SEMENT O SLAB ARCHITECT'S NAME O BUILDER'S NAME ., s QC SIZE OF FLOOR TIMBERS IST2ND '7 SPAN I G•• 3RD DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET S�((- POSTS / `) DISTANCE FROM LOT LINESSIDES AREA OF LOT C��O'Z \7" REAR FRONTAGE loo GIRDERS HEIGHT OF FOUNDATION I THICKNESS)D IS BUILDING NEW vl C� SIZE OF FOOTING �'7 6_ X r .IS BUILDING ADDITION L j y1 MATER:AL OF CHIMNEY IS BUILDING ALTERATION N l'� - IS BUILDING O OLID R FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE eS IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY A �T IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 4I If INSTRUCTIONS SEE BOTH SIDES 1 t- IT FOR � PM Gay PAGE 1 FILL OUT SECTIONS 1 - 3 R�:W������yyUIM BY PAM 1143 PAGE 2 FILL OUT SECTIONS 1 - 12 �v a ELECTRIC METEPS MUST BE ON OUTSIDE.OF BUILDINGDATE 6/4, 7- PAID -A -P-0 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR i DATE FILED 6,4 -L SIGNATURE OF OWNER OR AUTHO GENT F E E f Z6 F PERMIT GR NTE 19192-- PERMIT 919Z___ PERMIT FOR FRAME/BUILDING DATE: �?! FEE PAID•1.� OWNER TEL. CONTR. TEL. #11— C (1— .. Z �. C0NTR. L1C. # 3 PROPERTY INFORMATION LAND COST v EST. BLDG. COST ©Wo r EST. BLDG. COST PER SQ. FT. !�/� ri EST. BLDG. COST PER ROOM ,7 SEPTIC PERMIT NO. i l 4 APPROVED. BY B= MMIT FEE $ /Z 6 F, c-0 = FICA FEE100,010 DUE FRAME PERMIT $.ZI6 K. 0v BOARD OF HEALTH PLANNING BOARD A BOARD OF SELECTMEN 1 SINGLE FAM MULTI. FAMI APARTMENTS OCCUPANCY r STORIES OFFICES l ILDI'N RECORD 12 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT,•AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH 'POR61ES. GA- RAGES, ETC. SUPERIMPOSED: THIS REPLAC E$ •PLOT PLAN. CONSTRUCTION ; `}'•;✓ _ �, r}gy� .1 cp@°� 903 � IL PI AN j M � ��[�} g g �,A STA,S,P�/€`..' A0 GO 331 -_ X7 4 • `' �j`� f _ d 2 FOUNDATION 8 INTERIOR PINE HARDW D PLASTER DRY WALL UNFIN. FINISH CONCRETEI CONCRETE EL'K. BRICK OR STONE PIERS � 3 BASEMENT AREA FULL '/, V2 �/ FIN. BMT AREA-_ FIN. ATTIC AREA NO SMT FIRE PLACES_�.. HEAD ROOM MODERN KITCHEN _ 4 WALLS I FLOORS CLAPBOARDS DROP SIDING WOOD SHINGLES -CONCFETE , EARTH HARDNJ'D COMMCN ASPH. TILE B 1 2 �— 3 _ _ ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY' ;1 STUCCO ON FRAME BRICK ON MASONRY ` BRICK ON FRAME',' -,I -AT.TIG.STRS. 8 FLOOR _ CONC. OR`GINDER BLK. WIRING STONE ON MASONRY ? STONE ON'FRAME'. '" ' i SUPERIORPOOR ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 8 COLS. STEAM STEEL BMS. & COLS. WOOD RAFTERS HOT W'T'R OR VAPOR AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS B'M'T 2nd 1st _ 13rd I GASB, ELECTRIC NO HEATING��� e 2 ' �. = �� t`./a ' ' i ' rE : •�vl.vo.v rio t/ Lac.a r/ooV X4=4 /44; JUN 1 51992 1 f 1 3o Lo r "/Q' 9 S 13,144Jol "J � Fo FrsT�NG 'vo.q pfd OC -s S flE.f'EBY CECT/FY TO TyE' T/TLE /.!/SUPO.P ANO /ZIZ O T R4 TO T//' 6,4,Vt' T.w,4TT,yEOwEGG/v / ,4.,v � s GOCATEO ON Tf/E LOT IfS S/rfOil'.V ANO T//.4T/T GOES CO,VFOPiyJ //V iY/Tf1 T.S/ETOwN OF N. 4aOp✓re zON/.vG .PEG!/GAT/O.�/S , / ' REIsA.PO/NG SETBApt'S FEO�'1 STPEETS f GoT L/✓ES. " /VO, /�it/Op (/�� I F!/.�7iYE.0 GEST/FY' r%�qs . T//qT Tip//S O/i'ELL/N6 /S LVOT ,S L/�LATE.O /N TiYE F E.PAL FCooO f,'AZA.PO A.PE.4. :.O.P�9it�iV " FO,P 6Hd#vN O/tV F M!/N/Ty P.4it/EG 10' ��t aSsyO v 250098 t1005-46 E �aeP ���. wt FnREY DATED 6/583. Igge J � u T///S PGAit/�� ^ ` `� GA6E PG/PPOSES ' LVOT FDP Bovvo,Py �iiov_ Bo�,voaes� itiFo.P.ri- �1E.P.P/ryl.9G� E'.VGi.�/EE,P/.liG SE !� AT/O-t/ TA.t�E.S/ F,POM E,(�/ST/.(/G ,PE-LO,POS. P /CES A.t/OOYE.P, /ylASS.4�////SETTS O/8/O %�5/y y (� OK � �� 09/08/2002 07:56 6036358441 MARK SULLIVAN PAGE 01 JKA BUILDERS LLC 19 TANGLEWOOD DR NASHUA, NH 03060 603-759-8441 9/9/02 To; Town of North ,Andover BuH Re.1 1 m Phips^Cozziaion"Addition: Ft I Ply find a copy of the certified foundation plan for the above motioned lot for your files. If you have any questions please call. L - Mum- 09/08/2002 07:56 6036358441 MARK SULLIVAN L-- -- — -I uw. 1w C om .J ow If MOM ON I= Sr Aff REM A= Wo Comm= Nm lWWWfAw#.jv.,60v&vfK =Nm jkrmufmw ,Nmdmmw loramm =w a I JIM amem a W Aafto WRAM is wr mf raw. opmost'. if off MUND -- 1�0 t p - I AM PAGE 02 �Q:ffiloo F?Lor PL4.tj ol 444120V Ott WAL:re 1,00 PW I F* 40-1 14z, 4e . 41_1 -s2 1 -1-,o?. ,Ifsnpjlfiw --- mawm " PAW 2i� ANBMJ% #4ff&ACWZrM- 01810 FORM U 2 TOWN OF NORTH ANDOVER LOT RELEASE FU1k1 SUBDIVISION ,1"..L ASSESSORS MAP SUBDIVISION LOTS) L ' 9 PERMANENT ADDRESS (ASSIGNED BY D.P.W. STREET] APPLICANT P%�+ ( l Yy� �J e} PHONE 6"6' %��i Z�S DATE OF APPLICATION 8' PLAN IJG B CONSE VATION 4 C0N'SERVATI BOARD OF HEALTH TUWN USE BELUW THIS LINE pISSION ill • l� l y � ' HEALTH SANITARIAN DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMIT SEWER/WATER CONNECTIONS �, FIRE DEPT. CA64L' �(`''. `4-1-111 v RECEIVED BY BUILDING INSPECTION DATE DATE APPROVED • DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED 4 /Q% DATE REJECTED Ce fvl50- &v-- 1. This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. Location /00 r � S CnWj0,41J No. 53 Date 40RTII TONIN OF NORTH ANDOVER M Certificate of Occupancy $ �� s'"'•°' E<�' ACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ 17/© TOTAL $ Check # C;�5 60 15757 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIJ RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: -3 SIGNATURE: �` BuildineCommissf©ner/i:� 'tot of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Addrr�s 1.2 Assessors Map and Parcel Number: IUO lilog b�^ J �o( Ci r Map Number Parcel Number 1.3 Zoninglniorrnatiori: "'` 1.4 Property Dimensions: S t DA1'fi/o1�( i3 (�llo I Sb Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard. Side Yard Rear Yard Required .' ` `, Provide', '° Required Provided R red Provided 1.7 Water Supply M.G.L.C.40. `54),, `\ a . 1.5. Flood Zone Information: \ Zone 1.8 S Overage Disposal System: Public Private ❑ Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record �1N�Lrc R-A+�uLS►c Name(Priv Address for Service Signature Telephone 2.2 Owner of Record: /1 pS-eyyiav U(GCd1V15+c1 IV U61+!1 �/�S �/�,G»i?'ln Ne Print1,Address for Service: XSignature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ (M 4rI L �O LLI VASIJ c Licensed Yonstruction Supervisor: Q Z D 1 1 p l 9 l�A KqL (,y d 00 DT* License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone a�. 1 0 0 t. , ` SECTION 4 - WORKERS COMPENSATION (M.G.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 ....... o.......❑ SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify d, Brief Description of Proposed Work: ZZ X?S� F,1�114t /Lv61.1 r/ 6-;n 1-,tgeAg Le q As v�VL t -ea( chi %meg SECTION 6 - ESTIMATED CONSTRUCTION COSTS ` Item Estimated Cost (Dollar) to be OFFICIAL USE ONLY Completed by permit applicant 1. Building(a) Building Permit Fee 3S_ 0 0 () Multi Tier 2 Electrical (b) Estimated Total Cost of 3 06 Construction 3 Plumbing 'no V Building Permit fee (a) X (b) 4 Mechanical HVAC Z0 06 % D 5 Fire Protection r o 0 6 Total 1+2+3+4+5 -5--oo Check Number SECTION 7a OWNER AUTHORIZA ION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, WALl C iL kAl) U LS 14Y as Own /Authorized Agent of subject property Hereby authorize I Aelc 5t) L L 1 UAd to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, aslOwner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief MpkiC SU LL:JvATJ Pr" e L 0 � Si ature of Owner/ erit Date v'WE WN77 'i�, - •,a,- '' :fir c_ . a NO. RIES SIZE SEMER SLAB SIZE OF FLOOR TMERS IST 2X 10 2ND 3 RD SPAN 1 y DM ENSIONS OF SILLS DIMENSIONS OF POSTS L �c DIMENSIONS OF GIRDERS 1 O HEIGHT OF FOUNDATION k D" THICKNESS 0" SIZE OF FOOTING '' X MATERIAL OFC Y v IS BUILDING Olt SOLID CJR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 � D►J6U..y I C c1•q �.,f 0I j I MUBY CilBmy ro rm No. ^tjoeh/gU N-OPaSep FST PLA1 J B D6, D�Pl' Inr In dk.tV a I8 LOCi M OR Im rHa Lar A8 BHOI►N AND reser Ir DoSS CORFM W= I=IPW f4 OR N D • AN06VM 90=0 Anca lrloXR I�lorzTtil Atil �01� BIZ, I-�I�c�✓, RaWWG SITBAW JPAW SMUra & LOr UJV�B.• I FMMM URMY Mr !7113 d w 6L.. IB 1V0r LOCAIND JN �MR FLOOD MAZW AMU AS DRAWN POR SHORN ON ;? PAMM ! 7.6oa98 erq a E M� RY �� I. � � WA ��'>ri2 Ravi �.' loo ro I L Ll N cr��-i pry D41S to MAY `15 ZooZ MMMACK XXCIXBRRlXC SRR17CRS BB PARK SrRBar AXDOVBR. YASSACHUSMS 01810 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT VV�'� IC.f�/LS% PHONE LOCATION: Assessor's Map Number L� PARCEL-- SUBDIVISION h rl loCaw 0 0 yl LOT (S) _ STREET 109 61010 l()W\00 ST. NUMBER 100 ************************************OFFICIAL USE ONLY*********************************** I RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINIS ATOR DATE APPROVED DATE REJECTED COMMENTS Cc�QI l�ndS u)/fir. �f)� TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMME PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm a � + j ✓�Q �at�rrnzon�tXr+, j1lz o�.�n�;slrcf � BOARD OF BUILDING f License: CONSTRUCTION SUPERVISOR ISOR - = Number. CS 02011$ + Birthdate. .()8/30/1957 ` Explres: 08130/2003 I Restricted: 00 Tr- no: 4660 { MARK J SULLIVAN + 3 MOUNTAINVIEW RD PELHAM. NH 03076 j Administrator �c�J The Commonwealth of Massachusetts Department of Industrial Accidents Office or Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit city _ /U. An A o P-9 ki— /L1 A. S S am a homeowner performing all work myself. 6o5, 7S ®1 am a.sole proprietor and have no on6 working in any capacity am an employer providing workers' compensation for my employees working on this job. .Company name: Address city: Phone #- 9a!-rm if mm -e: Ad -dress City: Phone-*. Failure hone# Failure to Securo coverage as required under Section 25A or WL 152 cm lead to the ar►d/or one years' imprisonment aS'wHl as of crirnir►a1 penalties of a fine up. to $1,500.00 penalties in "form of a STOP WORK t and a fine of ($10D.00') a day against me. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for caverage verification. I do herby certify�u/n�der the p ins end penaAties of pedes y Uw the k*nnatim provided above is tnre aril-co►reet Sionature ( "i I ak 6 -L Print name HAQIc, 5't1L t l VA f / Phone* tr - `iS�j a Official use only do not write in this area to be completed by city or town official' Building Dept j O.Check if immediate response is required Building Dept(] Ucensing Board Q selectr»an's tmc6 Contact person Phone # 0 Health Department Cl other ?A4 WORKMAN'S COMpff'NSATIOM w x O O a A. CA cn CL C w o—cdoczo W WV) ° L cn ui N � o ♦•oma o ' a.� o m Q cc oG3 L m . N�J COD. : d C, _ .� o »� b► JG5 E E L L cm o zy = 01Om M :m�Wy c � p y � C w� �ymm cm c o m CS y o L m '� Z 0. o cm � a c a Hmc . = m o,wc o N COD Im w oc ��z •• W E 0.0 Q .y C O O m V) d m '0 0:70 2 cyv o�h'= C ►— r s aZm > z 0 W w a I -1 O O 6:-:� O D y .E L CLO O O V rrm EL y 0 .v CO) 0 V 3� O G O L L C. O a ca cc 'o O co Z coCLCOD C 0 U) LLJ U) w W Irw LLJ U) O z r L.L.. a. z W LU CC 1 c 0 C u 61 r 4. O y E a r O w c 0 u a a+ c a r y a. a W ao A a u u C CL w r V cc t �o AL Z O U 0 W W U- I' q V v N " S V tv R .a W% C G .m m LAJ Orj. CL cu 66 Z Z —1\\ V ru m W OC cc mc kS L we H. L Y `tel O L C, ¢ v u O ¢ j W o C CC CO U. oq ¢ O N O z r L.L.. a. z W LU CC 1 c 0 C u 61 r 4. O y E a r O w c 0 u a a+ c a r y a. a W ao A a u u C CL w r V cc t �o AL Z O U 0 W W U- I' q V v N " S V tv R .a W% C G .m m Date../`./...G..?..... . o= ` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... !'.�? .. /. ! �/. P; :...?,� r? ...... has permission for gas installation in the buildings of ...� c ( . .............................. at ...%.U.. ,��./....��� =:.`r..-... North Andover, Mass. Fee.. .. Lic. No,'�� 1 ?... .... CAS INSPECTOR Check # )- C 4287 `31P 3C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) zv4 n �oy-4--t. , Mass. Date 1 -a_>-010 Permit# Building Location 100 Pt + l C, .n -c ' Lu+ c K Owner's Name 7 Type of Occupancy New ❑ Renovation 19' Replacement ❑ Plans Submitted Yes ❑ No ❑ Installing Company Name Address CDS 40, �C Check one: Certificate ❑ Corporation ❑ Partnership Business Telephone 7p� ^ Y S - (, C[ N`` ll ❑ Firm/Co. _ Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes QP No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy M I Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bestgf my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with .all pertinent provisions of the Massachusetts State Plumbing ode and Chapter 14 of the General Laws. By Tape of License � Plumber Title ❑ Gasfitter Signat f Licensed Plumber or Gas tter Master i/� -2233 22 .3 . City/Town Journeyman License Number APPROVED OFFI E USE NLY) ■■■■■■■■■■■■■■■■■■■■■■■■■■■ Installing Company Name Address CDS 40, �C Check one: Certificate ❑ Corporation ❑ Partnership Business Telephone 7p� ^ Y S - (, C[ N`` ll ❑ Firm/Co. _ Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes QP No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy M I Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the bestgf my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with .all pertinent provisions of the Massachusetts State Plumbing ode and Chapter 14 of the General Laws. By Tape of License � Plumber Title ❑ Gasfitter Signat f Licensed Plumber or Gas tter Master i/� -2233 22 .3 . City/Town Journeyman License Number APPROVED OFFI E USE NLY) Date. ,<..—V � : . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s o •' a This certifies that .... ........ has permission to perform .... ................ . plumbing in the buildings of ...... . .�... .. ................. . at ..., 1 ..�?�< .l j�, .� , North Andover, Mass. c Fee.. .... Lic. No....._.t....: y.,.. _... . 1 1 PLUMBING INSPECTOR Check # `�� C � 5508 o?s � %�� LU ,��C> MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT.TO.DO PLUMBING o (Print or Type) a l�✓(,�J , Mass. Date _Permit# Building Location JI Pk t , d>'uolo- Owner's Name �1-cam New ❑ Renovation LR' Replacement FEATURES --r`Type of Occupancy Plans Submitted Yes ❑ No ❑ Installing Company Name 4 � Pi"t7 7_ i, Check one: Certificate Address _gin ! (� Corporation 4f�.1 ❑ Partnership Business Telephone �� irI CIA i% ❑ Firm/Co. Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes N No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy `®' Other type of indemnity ❑ Bond ❑ OWNERS 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: Blonature of Owner nr Ownar's Owner El Agent ElAncnf '' 1VFVUy cerury inai all of the aetails and information I have submitted (or entered) in above application are true and accurate to thbest of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massac usetts State Plum ing Code and Chapter 142 of the General Laws. By igna ure onse umoer 44 r Title Type of License: Master Journeyman ❑ City/Town License Number !2-73—? APPROVED OFFICE USE ONLY)