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HomeMy WebLinkAboutMiscellaneous - 101 PRESCOTT STREET 4/30/2018o m .iL PA -d z O N �• CD CD �; sg `j • m ICD CO CD pO'� C) Q O v t♦ o I cQ -p v O � O 3 o m 3 O (7� m go c 0D z rt O�— W � N _3 N . - zT W O v > O C CO Q (D G `° T m m T m z < O =3 Q T /V 0 N QQ _ m o -I z 3 -1 O IR v C: O 70 X CD = 0 0 0 _ D c z Q 0 _ z v O C O 0 m N O O O N L Dtli D CD im -,4 N O O Location / dl tawrlej? No. Check # 30523 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Feed" f- i+� l� TOTAL f Commonwealth of Massachusetts Sheet Metal Permit Date Estimated Job Cost: 10 S'v O Plans Submitted: YES NO Business License # Business Information: Name: Street: U S 1J �tJ City/Town: M �� Telephone: f 5-4) U" 3(0 L 17 l�O Permit 0-1 / Z- Permit Fee: $__� 3 Plans Reviewed: YES NO Applicant License # Property Owner / Job Location Information: Name: _ ` s r� Street: ) O / f ��> Cr % S City/Town: Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES Building Type: NO Residential: 1-2 family Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: ,v/000 Renovation: HVAC '---- Metal Roofmg Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: 4-rnsi�►-t-� 41411" per. %del' civ c� INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A 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 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Progress Inspections Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master -Restricted City/Town ❑Journeyperson Signature of Licensee Permit ❑Journeyperson-Restricted License Number: Fee $ Check at www.mass.gov/dpi Inspector Signature of Permit Approval Sheet Metal Commercial Guidelines / Life Safety / Critical System_ s Jmspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of / mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license ✓ All sheetmetal work being performed with proper journ.eyperson-to-apprentice ratios tX hire dampers with access door properly installed and checked for operation ✓ Smoke and combination fire / smoke dampens with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) L// Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease /kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper clEd3`ances, fire rated enclosures and pressure testing required. uF se:.'?=: i�r .iur'flt� nsiall t ETl lE;i required b eq "* ent and diu.. Duct penetrations in fir'e'f atQ wall-, and floors sealed u/" Metal roofing systems installed watertight using proper materials and fasteners Flexible duct runs installed 6'-0" maximum length ✓ Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle / iron V Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining -� Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" FIexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections scaled substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) b Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" FIexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections scaled substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) The Commonwealth of Massgchusetts ' Department of Industrial.Accidents V - _ d 1 Congress Street, Visite 100 Boston, M.A. 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/bidividual): Address: 6: 3 S +0 D E (LS /,+Vt% City/State/Zip: ( c d e(( jc- c p -( Y5 ( Phone #: Are you an employer? Check tfi a appropriate box: 1.❑ l am aemployerwith employees (full and/orparitime).* 2. k�Km a sole proprietor or partnership and have no employees working for me. in any capacity. [No workers' comp, insurance required.] 3.FJ I am a homeowner doing all work myseI£ [No workers' comp -insurance required.] i 4. ❑ 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ Tam a general contractor and 1 have hired the sub -contractors listed on the attached sheet. These siib-contractors have employees and have workers' comp. insurance.t 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §i(4), and we have nq employees. [No workers' comp. insurance required.] Type of project ()required): 7. [] New construction 8. [] Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions l2. E] Plumbing repairs or additions 13. [1 Roof repairs 14.0J Other 'Any applicant that checks Box#1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who snbmif this affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new affidavit indicating such. ?Contractors that check this box must -attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -pori iaci&s have employees, they must provide their workers' comp. policy numbe}. .: fain an employer that is provid6ig workers' compensation insurance for my employees.' Below is the policy and yob site information. insurance Company Name: Policy # or Self -ins, Lic. #: Expiration Date:. Job Site Address: ' City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. p do hereby ce under the pains and penalties of peiyury that the information provided above is true and correct. Signature: Date: G620 Zd- Phone #: Civ - 7 2.1-(��'i 'y 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. Boar. of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Massachusetts General Laws cL x 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 contrdct of lure, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or' any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall_ enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill -out the workers' compensation affidavit completely, by checkingthe'boxes that apply to your situation and, if necessary, supply sub=contractors) name(s), address(es) and -phone, number(s) along with their certificate(s) of insurance. LimitedLiability 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. B e 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' compensatioii'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 perimitilicense 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 proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax ## 617-727-7749 Revised 02-23-15 www.mass.gov/dia T-1 ME'fAV WORK TO MR F LLOWNLI! L I CtNSE Rf AC' to A f�. 'it M T -tIM #1 - WOAKEMS COMPENSATIa4 AND EaPtOTrERS L[AalUTY LWS�JW4M Plmjr-y 10CMWON PACIIE S:90i--tl*tj,-d E-MOOYL%.ft lnxMMMCC.,r 54 Tlh" Aw emLw, fX41 h* 4 &xq r2A A wc� FE PA. ..�—TeO7 1 im I T1 ice'" Cc-pc---zn I - M --y C'-- --2,3 OL , -S 2215 r,,;i OC*219, 20 it JZ-ol - •t = 0 ft d—,*rcto mai'' r,-2 z6twa. A. Cc__` -n [7-- PM %Va" QrPMAL-rl L, -a um F-vc.') Z-3 L:,!- (-Zt--d n --n 3 A. 0 vc�' t" =rw Orr, C44 is t Fv -- --I SEC cw`-a cc—.-szv -7 " ; c ---t =Irrl VA7E C; -ASS :)7 CC 201 WO',,4NLR$ uiPFMSAnVNA" CVNOYERS l,IMWTY W��UAAKMCY (Wo-CAVATMN PAW PMICY NO 14 r", 2-41PA Pq= �hO J 1. w...✓ l �v�r/.. . iFITV '�. l v , n � r... _ .`j -_'- . .., �`"1 T�.� :� f"y �iw � y .'� ."'�i r: tGe`'�. -• C:�:,` :'..::. � �� +""'1 � �. C:"4 _ = -• :_ ._ .� �.:_� ,,`{�'_ ...E/�'' i_.. _ `.o.wi.��_i��� r .; •-_ -'� !'_._ice=""-l3:v.?.,i` , _''�e;� C 'ik� wVr�b��. ATS' .deai l' "{? • s�.R •... ',+rwc: L$ •`•fir": .,i" �t t sott• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK TM--')PeCTOWN POWNERADDRESS- TYPE OR PRINT CLEARLY ,. 1'1;r`)L)oei MA DATE SzrS/i6 PERMIT# �� t JOBSITE ADDRESS -JQ 1 Fre,; (—A cA OWNER'S NAME s ' IJc�� 10 t reSLO' St TEL 6C3- (-u-c/s 33 OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL Ll NEW d NEW WITHIN EXISTING BLDG ❑ RENOVATION ❑ REPLACEMENT ❑ PLANS SUBMITTED ID NO BSMJ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY a. ROOF DRAIN SHOWER STALL 1 SERVICE / MOP SINK TOILET g URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING J OTHER �. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 9NO ❑ IF YOU CHECKED YES, PLEASE INDICATETr TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. •� 1 PLUMBER'S NAME 1 ceorryfi\1 LICENSE �y TURE RTNERSHIP❑# /��{LLC�❑)# MP❑ JPL_7 CORffPORATION❑# I PAJ1j'e'141'AA COMPANY NAME (DCO \'C ro- S PJV I,—. j�Y ADDRESS �V 1 J (i S�V s CITY 1J �(1�,f✓�i STATE AA ZI Zl TEL -IV EMAIL I� 1� ec? i-ff0GIS a v� CELL The Commonwealth of Massachusetts Department of Industrial Accidents t I Congress Street, Suite 100 Boston, MA 02114-2017 r www massgov/dia Rockers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers- To BE FILED WITH THE PEPIMTTING AUTHORITY. Name(Busineesss/Organizatio'nandividual): 1�: (� Q T (r fV"— 1) V' V 1 ,p -\, Address: )-Oct City/State/Zip: 0 Are you an employer? Check the appropriate box: Phone #: -2WO S 1.Q 1 am a employer with employees (full and/or part-time).' 2.g1 am a sole proprietor or partnersbip and have.no employees working for me in any capacity. [No workers' comp. insurance requirtd-1 30 I am a homeowner doing all work myself (No workers' comp. ina»+^ce required.] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.a I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. ins rancc t 6.❑ We are a corporation and its officers have exercised their rigbt of exemption per MGL c. . 152, §1(4), and we have no employees. [No workers comp. insurance required.] Type of project (required): 7. ❑ New construction 8. E] Remodeling 9. 0 Demolition 10 [Building addition I LE] Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13.0 Roof repairs 14. ❑ Other .Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside connectors must submit a new affidavit indicating such. IContractors that check this box must attached an. additional sbect sbowing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. ' Insurance Company Policy # or Self -ins. Lie. #:. Expiration Date: Job. Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un peri a enalties of perjury that the information provided above is true and correct ' Date: - Signa Phone #- Ofj`icial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): I_ Board of Health 2. Building Department 3. City/Tovt'n Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone * COMMONWEALTH OF MASSACHl1SETTS TWH gamoll, Lo 'o s rim 111 log g PIN�@m BOAfi� OF PLUMBERSANb GASFITTERS ISSUES:TH...E FOLLOWING LICENSE;:. LIGEWEI3 i4S A JOURNEYMEN P,L%U Eft m a M ii - ixt a �1httpndfnae,handoverma.virwyointeloud.eom/#hteord;R0347 ,i%- C LjQ •Plumbing P<mnitit70341-...+ Town of North Andover, MA 20341 "Plumbing Permit- In Conjunction with a Bullding Permit (Commercial or Residential I 77MELINE ®submission received - - — - Your request is in progress May 16, 2016 at 1248pm We'll letyou know of any updates via email, feel free to check the status at any time by coming back to this page - 0 Plumbing Permit Review In Progress _ _ _ S__ Q' Permit Fee ` `1 '___-._ t -" a P im '1i$ Payme¢ pfCst^545 .. F �St oPermitissuance Of �2_uy.t� Monday, May 16, 2016 01:03 PM 4 ry�:7 N Applicant ! Location - kyle geoffroy 101 PRESCOTT STREET, NORTH ANDOVER MA 0— John bardett _. _. Attachments ... ... . ... ........ ..... No Files... Y /fir .k410 Date..�� ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .................................... ..i p ...... at ....... WA ........ I—I .. r .. ..C.... 7 C, ...... m ............. ................... . North Andover, Mass. Fee ...L®+..... Lic. No.OP45 ...... m 6- .................................................................... GASINSPECTOR Checko 2221 09904 This certifies that ... n, ......... M . ..................... 'has permission for gas instal atio V .. ..... . ....... .... e,12- 1 inthebuildinp f ,o of............YJ.... ........... 7 ............................. .................................... ..i p ...... at ....... WA ........ I—I .. r .. ..C.... 7 C, ...... m ............. ................... . North Andover, Mass. Fee ...L®+..... Lic. No.OP45 ...... m 6- .................................................................... GASINSPECTOR Checko 2221 09904 G TYPE OR PRINT CT,EARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE 15 P MIT'# .,..,_� JOBSITE ADDRESS®�" /�Pe o OWNER'S NAME 2 OWNER ADDRESS TELE-_ �71FAX OCCUPANCY TYPE COMMERCIAL�]� EDUCATIONAL RESIDENTIAL Inw-p- RENOVATION: El ._ .. Z FLOORS-► sslv� 1 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER ­ LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/ SPACE HEATER . ROOF TOP UNIT TES -f'. UNI ; EATER UNWENTED ROOM HEATER WATER HEATER REPLACEMENT: 2 1 3 1 4 1 5 1 6 PLANS SUBMITTED: YES E -J NOR - 7 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Df0 El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ® BOND F OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER I AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurat o the best m n dge and that all plumbing work and installations performed under the permit issued for this application will be in complia i ertin As e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C/ PLUMBER-GASFITTER NAME cw�iJ �i (Pnc,c��£L� LICENSE# )6(.49 SI RE MP [3MGF El JP ® JGF D LPGI ® CORPORATIONqff3(�( PARTNERSHIP ®# LLC COMPANY NAME:ffje eacro�g[ SE2�J C e� T II ADDRESS CITY STATE' /� 7,6J ZIP2 f TEL )0 FAX CELL EMAIL Lee" ry 6r i e�fY�. o COMMONWEALTH OF MASSACHUSETTS'` 4 ' BOARD IG PLUMBERS'-'AJt� G15FiT�ERS f fi- 1'SSUES, THE FDLLOWIN�GLI'CENSEh r F R G1 S1 'RED ASA PLl1MBfIINC�ORPi D;AUI D 'W 'GARFlI ELD`'' t Lg C. E;:E�fNE'Y U T ER,'. `SERVICE, 2.1 W 11'1_ LOW ����� � �,..yk, °•> ` �� ' !x � a �Rt) CKfiON b MA 02301 i. 36fi9 A" 22141s3 FEENBRO.01 SMORAN .._-._..___._..... _...-_._CERTIFICA�,TE ®F LIABILITY INSURANCE DAT3012o1YYYY)-- 1 1 /301201 b THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In !leu of such endorsement(s). PRODUCER Rogers & Gray Insurance Agency, Inc. 434 Rle 134 South Dennis, MA 02660 CONTACT NAME: PHONE FAX (877) 816-2156 No Ext): Arc No -ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC @ 0210112015 INSURER A:Old Republic General Insurance Corp. 24139 EACH OCCURRENCE S 1,000,00 INSURED INSURER B INSURERC: Feeney Brothers Services LLC 103 Clayton St PO BOX 220601 INSURER D: INSURER E: Dorchester, MA 02122 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR TYPE OF INSURANCE DD SBR POLICY NUMBER d1 POLICY EFF MMlDP XP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR —R.E,PPR'ESSEE/NTAATIVIVEE /J A2CGO7501501 0210112015 02/0112016 EACH OCCURRENCE S 1,000,00 (JAMAUE TO RENTED PREMISES Ea occurrence S 300,00 MED EXP (Any one person) S 10,00 PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY1�1 FX I JECT LOC OTHER: GENERALAGGREGATE S 2,000,00 PRODUCTS -COMPIOPAGG S 2,000,00 $ AUTOMOBILE LIABILITY ANY AUTO ALLOANED SCHEDULED AUTOS AUTOS HIREDAUTOS AUTOSSA9VE0 COMBINED SINGLE LthSli $ Ea accident _ 8001 LY INJURY (Per person) $ ODIBLY INJURY(Per accident) $ Perraccide DAMAGE $ $ UMBRELLA LIABOCCUR EXCESS UAB CLAMIS•MAD£ EACH OCCURRENCE $ _ AGGREGATE _ $ DED RETENTION$ S A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY A14YPROPRIETORIPARTNER!EXECUTIVE YIN OFFICER&IFI.SBEREXCLUDEO? rfilNIA (Mandatory In NH) If yyes descnbe under DESGRIPTIONOFOPERATIONS bekry 2CW07501501 02/0112015 02101/2016 X AER OTH STATUi£ ER E,LEACH ACCIDENT $ 1,000,00 E-L.DISFASE - FA EMPLOYEE $ 1,000,00 E.LDISEASE- POLICYLIAIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION 1}. d% ©1988.2014 ACORD CORPORATION: All rights reserved. ACORD 25 (2014101) The'ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover And THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED —R.E,PPR'ESSEE/NTAATIVIVEE /J 1}. d% ©1988.2014 ACORD CORPORATION: All rights reserved. ACORD 25 (2014101) The'ACORD name and logo are registered marks of ACORD Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector TO 10902 Div. Public Works Location r No.- Date S G � ,.. ■ f NORT1y TOWN OF NORTH ANDOVE% w ?. �' �p $ « Certificate of Occupancy $ '95 p` + ; Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector TO 10902 Div. Public Works 11T NO.JL J U APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE/] /MAP4-40. -� OT NO. ooc:,-v 2 RECORD OF OWNERSHIP JDATE BOOK jPAG NE SUB DIV. LOT NO. ZOF —I Y II LOCATION V/ SC",Z� Ff Cf)eq-y�J4 PURPOSE OF BUILDING a a r oa OWNER'S NAME �/� ,� I i NO. OF STORIES SIZE It OWNER'S ADDRESS o �� Y✓�Y �O 6-_1 BASEMENT OR SLAB x �� ARCHITECT'S NAME�T_ j��� SIZE OF FLOOR TIMBERS IST 2ND 3RD 'fiUILDER'S NAME %� I 1/�q n SPAN DISTANCE TO NEAREST BUIIL/DIN �t•�� DIMENSIONS OF SILLS DISTANCE FROM STREET " POSTS DISTANCE FROM LOT LINES - SIDES/�/ REAR 41-5/ " GIRDERS AREA OF LOT FRONTAGE J HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND G 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 no, INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 9 PAGE 2 FILL OUT SECTIONS I - t2 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND A�PnPROV{1E/D�1 BY BUILDING INSPECTOR f1�TC CSI C/1 � � � �✓ ` 1 1 SIGNAT(JOE OF OWt4lkR OR A HORIZED AGENT FEE PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST /y/� ©D Do., EST. BLDG. COST PER SQ• FT. V "l EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY �- SUILDING INGFUCTOR p"OWNERTELJ -CONTR. TEL a / CONTR. LIC. # H.I.C. # I p'?lD-2— INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 9 PAGE 2 FILL OUT SECTIONS I - t2 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND A�PnPROV{1E/D�1 BY BUILDING INSPECTOR f1�TC CSI C/1 � � � �✓ ` 1 1 SIGNAT(JOE OF OWt4lkR OR A HORIZED AGENT FEE PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST /y/� ©D Do., EST. BLDG. COST PER SQ• FT. V "l EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY �- SUILDING INGFUCTOR p"OWNERTELJ -CONTR. TEL a / CONTR. LIC. # H.I.C. # I p'?lD-2— BUILDING RECORD 1 OCCUPANCY. 12 SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM I MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2FOUNDATION E1 INTERIOR FINISH CONCRETE 3 1 2 I3 CONCRETE BL'K. _ BRICK OR STONE HARDW D PIERS PLASTER _ _ _ DRY WAIL _ _ UNFIN. 3 BASEMENT AREA FULL IN. B'M'T' AREA _ 'G 1/1 % FIN. ATTIC AREA NO B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH HARD111'D COM/.ICN ASPH .TILE B 1 2 3 _ _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME I Y BRICK ON FRAME ATTIC STRS. 3 FLOOR I_ CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I_4 POOR _ 11 ADEQUATE NONE 10 PLUMBING 5 ROOF GABLEHIP RATH Q FIX )FIX) GAMBREL MANSARD TOILET RM. 12TOILET RM. 12 FIX) _ FLAT SHED- WATER CLOSET _ ASPHALT SHINGLES 'LAVATORY `' _ WOOD SHINGES KITCHEN SINK $LATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ 11 TILE GADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ .RADIANT H'T'G UNIT .HEATERS 7 NO. OF ROOMS GAS OIL B'M'i 2nd ELECTRIC _ 1st 13rd I NO HEATING A 0 r cn VI n O VJ 9 ?� O0 I _ a C N O Q' N cH C.) co) CD CL M m Z 'p ?lo H —I =r m w?0 = m CD ...I O m y p N OhIE m; m S > >'a 90) 00 co IG C3, 1p = -0 O ZsCO2CD O•=" Cn a a CO) COCL cc 0 = ?. CD O y CD C7'� C d ' t CT7 CA m T� = N Gd y! O' •' Ce. c CO) Oj 9 G .�► 3E CD N H :D m, N N : = O CIS OO O �3 U)o: Wim' cn = CD ;w HCD m =t m � m . n's C7 p CA C O 0 CD C/) 0- C/) 2 H w H w d o l� n � w a S d x 'O CA CM)O r z z CD C7 Z H �O 0 x CD O '0. n ? CL O y = O CD o p CDCL o Q� =r �O CD Sr CD O CD ca co C CD �. y CZ CDy �• O CD S CA v O CD C� Z Q O CCD 0� o N I CD A 0 r cn VI n O VJ 9 ?� O0 I _ a C N O Q' N cH C.) co) CD CL M m Z 'p ?lo H —I =r m w?0 = m CD ...I O m y p N OhIE m; m S > >'a 90) 00 co IG C3, 1p = -0 O ZsCO2CD O•=" Cn a a CO) COCL cc 0 = ?. CD O y CD C7'� C d ' t CT7 CA m T� = N Gd y! O' •' Ce. c CO) Oj 9 G .�► 3E CD N H :D m, N N : = O CIS OO O �3 U)o: Wim' cn = CD ;w HCD m =t m � m . n's C7 p CA C O 0 CD C/) 0- C/) 2 H w o oC: w o l� n � w a to Z O z� x o o a. o r z z c C/)7C n o n �O 0 x �O y 0 4 C J .. I r l� ?J.� N�Z -Z q3 -IPSO17.'�iG. I co, 1-1.:12. 0 _. P-IRIM7NO. Z APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 (r PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLA fj18 MUST BE FILED AND APPROVED BY BUILDING INSPECTOR /DAT V E FILED ') SIGNATUREOF OWNER OR A HORIZED AGENT FEE PERMIT GRANTED 4oL ` 19 ( �� MAY 1 4 1997 gqa 3 PROPERTY INFORMATION LAND COST —ST. BLDG. COST / 9 z) EST. BLDG. COST PER BQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY suILDIN IINiPECTOR OWNER TEL # CONTR. TEL # CONTR. LIC. # H.I.C. A 7 2 ; RECORD OF OWNERSHIP DATE BOOK 20NE SUB DIV—.—CO T Np. 'PAGE I LOCATION uRPO3E"OFM�S .,� NAME 47K XWNER'S M NO. OFSTORIES SIZE DOWNER'S ADDRESS i i(. SA, - � l `"r J(A{"( f�[ ff'nY.irP BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD � 'i/UILDER'S NAME �v ^ Y SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS - GIRDERS 1 DISTANCE FROM LOT LINES - SIDES -' REAR -7 C_•• AR OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY - IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY - IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE i INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 (r PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLA fj18 MUST BE FILED AND APPROVED BY BUILDING INSPECTOR /DAT V E FILED ') SIGNATUREOF OWNER OR A HORIZED AGENT FEE PERMIT GRANTED 4oL ` 19 ( �� MAY 1 4 1997 gqa 3 PROPERTY INFORMATION LAND COST —ST. BLDG. COST / 9 z) EST. BLDG. COST PER BQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY suILDIN IINiPECTOR OWNER TEL # CONTR. TEL # CONTR. LIC. # H.I.C. A 7 BUILDING RECORD 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: �l�t /_ ejyezt�, rc7 Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street SK St. Number 11z ************************Official Use Only************************ RECO TIONS OF TO AGENTS. p , Date Approved Conse a on Administ rator Date Rejected CommentsN U ids n SVw * Town Planner Comments Food Inspector -Health I i Septic Inspector -Health Comments l Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date Approved IN Date Rejected Date Approved Date Rejected Date Approved Date Rejected MAY 1 4 1997 Date Le, I 15LL16' MAY I A 1997 __ _4A ENT tiY "X" is outside the 500 yr. flood zone M THE ( Lawrence Savings Bank ) MORTGAGE INSPECTION PLAN AND ITS TITLE INSURERS. LOCA10 IN I CERTIFY THAT THE BUILDINGS SHOWN Do ( ) M SETBACK REQUIRE" N' O R T H A N D O V E R CQNF�n o ver r I.E. (FRONT, RU0 Nlt REM SETBACK ONLY) OF NO r t ❑ t� MASSACHUSMS TITLE VIII, Ct1RAP1ER 40A, SE011�P UMESS OTNERWISET FROM MOLATION N01 ENT ACTION UNDER MASS. C.l. S}IED FLOOD / I FURTHER CERTIFY THAT THIS PROPERTY IS " X" LOCATED IN THE ESTABIJ DEED 2267 HAZARD'OOMMUNITY PANEL NO.:250098 003C DATE: 5/2/93 BOOK THIS compANY IS NOT RESPONSIBLi FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED T DATE OF THE LATE3T DEED OF REOOR'v. pry' WHENEVER BUILDINGS ARE SIIOWN LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED CERT. NO. THAT A MORE PRECISE SURVEY BE MADE TO VERIFY THESE MEASUREMENTS. THIS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY M we HERS. AND DOES NOT PLAN BK. PAGEREP j�ESENT A PROPERTY SURVEY. VERmCATION OF SURVEY D . AS SHOWN. PLAN � 6�DATED MA f BE ACCOMPLISHED ONLY BY AN ACCURATE, INSTRUM THIS CERTIFICATION TO BE USED FOR M E PURPO �, _August --Z--. 1995 OFFSETS AS SHOWN ARE.; S9 T ; �' �! ' scALF: 1-- 20' USED FOR THE ESTABLISHMENT BRADFORD fl ...8 ENGINEERING CO� P.O. BOX 1241 ; HAVEWiILL MA. 01831 JAMES W. BOUGIOUKAS R.LS. 09529 TEL (508) 373-23" y d C � 'C7 O z H 06 O �� O CL = y O CD o v Q� O Q CD O CD ww C CDCD H� �O y CD CA y O 1CD z CDo 0 CD r� n . 6 C C? -10 0 -4O �• N O cr N d 0 m CO m �i'ao m es N � Z ?y N o ? n t a o -n m �0 an d C CO) N � O IE O O O N m C 0. p O o ZIN C = CD M: S c m o ate,.; e0 O ; �o mmH d 0 CDcCL CD m O d N N CLd X C S .\ N try s IE m N N Q O � 1 co, CD a CO S G =P CD o CC -0) � CDOS: m pb t CD .D CO) J CD -o ate. C-) w 0: 0 C m cp cn Z .z N- 0 pFp 7' :j ?�. '� n. 0 ro � ?�.OQ O Ix W ^ 1 J ro- O CL n m b. Cn O ro y� V A y 0 O C fD Location (7l (-A No. zo Date 1 q� NORTq TOWN OF NORTH ANDOVER > a Certificate of Occupancy $ Building/Frame Permit Fee $ J ! SACMUs Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �j S1t Building Inspector 10/20/95 16:03 75.00 PAID 1%-, 9274 Div. Public Works PER311T NO. 43 2,40 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP '.DATE BOOK '.PAGE ZONE SUB DIV. LOT NO. — OCATION �� URPOSE OF BUILDING r ,` OWNER'S NAME 'Q 6!,y., ,Ar---�.Q cam- i _-K.. NO. OF STORIES O c/ j,,, SIZE T\ PWNER'S ADDRESS < �1`G.- BASEMENT OR SLAB n i !- /. ARCHITECT'S NAME _ E OF FLOOR TIMBERS 1ST? S(/ 2ND 3RD ,BUILDER'S NAME AN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS oUMTANCE FROM STREET i �� POSTS JN8TANCE FROM LOT LINES — SIDES i� �T% REAR !� /C / v �✓ GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ,. ZE OF FOOTING L4 VS J J"UILDING ADDITION S MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND So ILL BUILDING CONFORM TO REQUIREMENTS OF CODE Yn C IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY S BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE~YpS INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED AB\Y\ BUILDING INSPECTOR rn SIGNATURE 1 OR AUTHORIZED FEE PERMIT GRANTED $ Lb 19 19 q %T t,8 [qr orn 1995 1 00 3 PROPERTY INFORMATION LAND COST ST. BLDG. COST t o b EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY YIUDING INBP[CTOR OWNERTEL.#00, CONTR. TEL. # CONTR. LIC. # H.I.C. # AFEA BUILDING RECORD 1 OCCUPANCY 12 = r SINGLE FAMILY S OulES MULTI, FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION _I 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE BL'K. BRICK OR STONE DW D _ PIERS _EA PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M'T AREA _ '/, 1/2 '/ FIN. ATTIC AREA N_O 8 M T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 _ _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING COMMCN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. &FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY _ STONE ON FRAME 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 & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR 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 _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd _ 10 13rd 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. C3 . C � O 10 o Cl)CD Z CO) CSD O 'O CL r �� C O ? C Q 5 y CD CCD O Q _ Q CD CD o CD C CD ra CD CZ O CO) CO 1. O CD � v CO) o 1 z CD o CD v CD 0 C CD CCP O O N O Q of GO Cm fl N m m� ® m • p v,maCc, �p �n►o o T ? o � caw Mn m H y CD o CD I ? _ oma" cz �o o C I OH"�' C y r hn a m R a,,,.. am CD? =' CD CD ►� C� 0 _ a m C) y 3 :� o m o � aQ .h : A L� o a H m o O EK C A I . :E m CD col)`C O io d � !- 3 O m ...r C7 io OO O (� Z m O � z y cm o m a3 C o ^' -► m: d' dw" z. c� CO)� moo: 0 O �m Mu m o 0 A 0n °7 PO � w �. o am a w o oma Cr�1 l c— n y c �. C z �^ N c a x r� d tTl o z x 9 a1 y 0 9 0 c Town of North Andover . OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES KENNETH R. MAHONY Director Please print. DATE JOB LOCATION } "HO111v1EOWN`ER" Number -)Q t' -A- 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 HC% EOW'NER LICENSE EXZDAPTION S 1 Street�alddress Section of town ' Name �� Home phone Work phone PRESENT' 'IMAILING ADDRESS S 3p \ Nn City/Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which heishe resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person woo constructs more than one home in a t,vo-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes. bv-la«rs. rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No, Andover Building Department minimum inspection procedures and requiremd that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICL-kL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. Robert Nicetta Michael Howard Sandra Start Kathlem Bradley Colwell TOWN of NORTH ANDOVER AFFIDAVIT Ebre bVmmant Crntractcr law Su *mm7it to Rm dt t%Hcaticn M3. c. 142 A regAres d -at the '�eoais�irtion, altwatirn rmmadm, repair, mAmf dm, owismion, imprmanmt, removal., dam3litim, or Mian of an a ditim m any pre- endstag aaier-ooaTned txrild- irg cantainfig at least cane bat not mxe ttm far dwelling units ... or to stxvcbxes 4dch are adjaoent to arh resit cr building" be doe by r% stered contractus, nwnth certain aceptioos, alk% path ot3-,Er , nts. Type of Work: L7Q i' yt,5,- Est. Cost Address of Work 6 s�=S«L St Owner Name: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Fcr office Use Only Work excluded by law Job under $1,000 Building not owner -occupied :V�O er pulling own permit Other Notice is herebv given that: Remit No. Date OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS ---- FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Si.gted under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I h y apply a permit as the own r of the above proy: G Date Owner Name r. i MORTGAGE INSPECTION PLAN NORTHERN ASSOCIATES, INC. 630 TURNPIKE STREET N. ANDOVER MA TEL. (506) 975-7117 FAX. (508) 688-6060 NGAT mom RQ9ERT A.& MARY K. DASCOLI LOCATIGAt 101 PRE"9COTT irmiT CITY. STAT," NORM AAADOVER NA DATA 5/89/94 DEED REF'. 997 / 90.1 PLAN REF. ASSESSORS SCALE. 1— SIO e ✓OB * 94/ 02200 PREBCOTT BTAEET MTIFZM Ta LAMRENCE SAVIN" 94J1i@1C This mortgage inspection was prepared in accordance with the Technical Standards for Mortgages Loan Inspections as adopted by the Massachusetts Board < NOTE: This mortgage inspection was prepared Registration of Professional Engineers and Land Surveyors 250 CHR 605.I specifically for mortgage purposes only and further state that in my professional opinion tht is not to be relied upon ase land or property �µ OF -- griq the structures shown conform with line survey. Building location and offsets determination �a� C yG� the local zoning horizontal dimensional setback shown or specifically for zoning O� JAMES J. requirements nt the time of construction or are only and not to be used to establish property d> c ABEIY '' exempt under provisions of N.C.L. CH. 10-A See. 7. lines. The land shown hereon is based on referenced information noted end May ba avhjant to further to..ings and easements. Northern r, Z 52 H 1.Property/House is not in a Flood Hazard, 2.Proporty/Hou8e is in a flood Haserd Area. 1j.Intormation Acaociatee, inc— ner.epts no responsibility for is insufficient to determine damages reeultinq from said reliance by anyone (< \ Plara Hazard. -)ther then the said mortgages and its asei�ns floe,.' namard determinod f m late id :cnnoction with its proposed mortgage fl with insurance Reto Nap Panel to ■aid mortgagor. - -- _. Data �� - n5. 2 J. 94 cis : 1 0 PM Fol KENNETH R MAHONY Director Town of North Andover HORT" OFFICE OF 3?0,'`�•� ��c� COMMUNITY DEVELOPMENT AND SERVICES f s i ♦ 0 146 Main Street :/ North Andover, Massachusetts 01845 9SSncuUSEt (508) 688-9533 October 16, 1995 Mr. Robert Dascoli 101 Prescott Street North Andover, MA Re. Prorosed 14' x 15" = Rccm Addition Dear Mr. Dascoli: Please be advised that a Certi-_"ied Plot Plan must be submitted for subject project. The Mortgage Survey Plan previously submitted is not adequate and your Building Permit Application will be held until we receive a Certified Plct clan. Thank you for your prompt attention to this matter. _o "s truly, RichaU_rdoA. l 1 Local Building Ins ector RAC: crb HANb b -to I 1+tc(2� e,4 � �ee V, to I e, �z &�Iez CrN cam- AaA BOARD OF APPEALS 688-9541 BULL.DING 688-9545 CONSERVATION 688-9530 HEALTH 688.9540 P 688-9535 Julie Patrino D. Robert Nioeua Wchad Howard Sandra Starr Kathleen ey Colwell e � Town of North Andover HORT" OFFICE OF 3?0,'`�•� ��c� COMMUNITY DEVELOPMENT AND SERVICES f s i ♦ 0 146 Main Street :/ North Andover, Massachusetts 01845 9SSncuUSEt (508) 688-9533 October 16, 1995 Mr. Robert Dascoli 101 Prescott Street North Andover, MA Re. Prorosed 14' x 15" = Rccm Addition Dear Mr. Dascoli: Please be advised that a Certi-_"ied Plot Plan must be submitted for subject project. The Mortgage Survey Plan previously submitted is not adequate and your Building Permit Application will be held until we receive a Certified Plct clan. Thank you for your prompt attention to this matter. _o "s truly, RichaU_rdoA. l 1 Local Building Ins ector RAC: crb HANb b -to I 1+tc(2� e,4 � �ee V, to I e, �z &�Iez CrN cam- AaA BOARD OF APPEALS 688-9541 BULL.DING 688-9545 CONSERVATION 688-9530 HEALTH 688.9540 P 688-9535 Julie Patrino D. Robert Nioeua Wchad Howard Sandra Starr Kathleen ey Colwell p^. .. ....�_ ..ry...,. �.:.., t ..� Y ate......, ,_...a -- ------ A --- rn, D_E.S.TZ ICT.^ - :55ES,5.0.ZG RF -r- = MAP 82-lo.T2.�� � 00 I r i 4 co w/ aw Io - 13' ' MT 1 8 ZS' N M� r; iia f r pro'-_. ria� Ns �- 2 C E u GT +� tee Zorni'r� - r�ov . .L � . �� rj Vit\!. �, 4c."r. ��— .�.• _ ,'. bra �,? t ., „f f _._ --- SCC) C- F- PL= r- mAp 6 2- Lo -r2 5K- 4053— P, -1,14 t 0 ASI>w-V (�UYd2 �P �V l,, -.� 48*A Lo,=10 ,n ce�aAcze- y,va- 7 x 1� x 40 I op`O 06-) _ PLCQ . 40x O= 6-Z#'/Ar- Y,, b� = 3 t; -a -V I 1& 0 &.)nA-rue. =►Tsr- = 3goo az Z S� --I X -6.s, 2rl'- �OA-b CK-) 006-QZ f -M -,aAb-t- SAX* �t oo¢.. -1, 3 .- K Sb = lzZC QA;&% ZX AMC, ,Z++ns Isf-- 09/27/95 08:04 FAX 603 425 2747 CARLSON TRAVEL oo; 1 1.7 A A Al .1 AA —ILL I T -il �i Ali I I i 1 i i i I((� ' �- i- li I i :� I i -7 k Ile Al I Ir 16 I CONTINUE FROM PREVIOUS PAGE 001 4s Thursday, October 12, 1995 North Andover Building Inspector Mr. Robert Nicetta 120 Main Street North Andover, MA. 01845 Dear: Mr. Nicetta: A It My name is Robert Dascoli and I live at 101 Prescott Street in North Andover. I am writing this letter out of frustration. I am currently building a room off the back of my house. I am doing the construction myself, therefore I was unaware of the need to pull a permit on a job of this size. On September 25, 1995 I was notified via a door tag that an inspection and permit was necessary for this work. I immediately stopped working on the addition. I then spoke to your assistant Richard on the telephone. (I apologize, I'm not familiar with his last name.) He informed me of the documentation needed for the permit and to bring it to your office. On September 27, 1995 I met Richard at your office and gave him the documentation. Since that meeting ,I have made numerous -phone calls to your office getting no return calls or results. On October 3, 1995 I finally spoke with Mr. Jim Capolla.(please excuse the spelling of his name if wrong.) After explaining my situation to Jim, he told me to keep building the addition and that he would speak with you. Mr. Capolla reiterated this to my wife on the telephone when she called on October 4,1995 looking for the price of the permit. On October 11, 1995 I spoke with Richard on the telephone. He was unaware of what Jim said to me and that he would have to get back to me. This, in a nut shell ,is were we stand. Mr. Nicetta, I am willing to pay the cost of a permit. I am willing to have the inspections done and to follow the rules. I am willing to do whatever is necessary to complete the job. But, I need some cooperation and direction from your office. OCT 1 6 Thank you in advance for your time -and attention in regards to this matter. Sincerely, Robert Dascoli Thursday, October 12, 1995 COMMUNICATION ACTIVITY WITH BUILDING INSPECTORS OFFICE 9-25-95 I received notice that a permit was needed. 9-26-95 Spoke with your assistant Richard, informed of paperwork necessary. 9-27-95 Met Richard at your office with paperwork. Richard had questions for you. He would get back to me. 9-28-95 Called your office, no return call. 9-29-95 Called your office, no return call 10-2-95 Called your office, no return call 10-3-95 Called your office, Mr. Capolla returned call 10-4-95 Called your office, Mr. Capolla returned call 10-10-95 Called your office, no return call 10-11-95 Spoke with Richard, he was unaware of what Mr. Capolla told me. He would have to speak with you. 00T 1 6 Location /G'/ No. Z Date f � N°RTN TOWN OF NORTH ANDOVER oft,,•° ,•,41 „ Certificate of Occupancy y $ ,rf u Building/Frame Permit Fee $ ', ,SSACMUSEt Foundation Permit Fee $ eOther Permit Fee � $ ` Sewer Connection Fee $ 1N / Connection Fee $ 4�y ter. o Q TOTA[ 199' $ 4,71yo�'c� I �A y� Building Inspector Vz cezot Div. Public Works PER311T Vi O. 2-33 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. / PAGE 1 MAP KJO. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK -'PAGE ZONE SUB DIV. LOT NO.I LOCATION PURPOSE OF BUILDING 'PCC /SCI /IIWEIV7'r flela VN/'�� OWNER'S NAME jl�y_•J� NO. OF STORIES SIZE OWNER'S ADDRESS �O/ S�- BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD --� BUILDER'S NAME i 11y_ l�A/ SPAN DISTANCE TO NEAREST BUILDINGf% 0" DIMENSIONS OF SILLS POSTS X/ L/✓ DISTANCE FROM STREET DISTANCE FROM LOT LINES -SIDES �1��" REAR ,j��� f-� aa77 GIRDERS �T�/��X��'/� /1e-�I-7FlJ vc,v�L/� AREA OF LOT FRONTAGEv-v HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION t/4jE�5 MATERIAL OF CHIMNEY IS BUILDING ALTERATION/ IS BUILDING ON SOLID OR FILLED LAND z> WILL BUILDING CONFORM TO REQUIREMENTS OF CODE i/�s / IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY Vo IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ¢/91 SIONAJURE OF OW R OP AUTA RI ED AGENT Ft)Z" gi, PERMIT GRANTED 19 CONTR. TEL. k CONTR. LIC. H 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST !2n:'iO EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING INSPECTOR e BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE.FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA - APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. isi CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE 3 1 2 13 _ _ CONCRETE BL K. BRICK OR STONE HARDW D PIERS PLASTER DRY WALL UNFIN. _ 3 BASEMENT AREA FULL FIN. B'M'TAREA '/. '/r '/. FIN. ATTIC AREA _ NO BMT HEAD ROOM FIRE PLACES MODERN KITCHEN _ _ 4 WALLS 71 9 FLOORS CLAPBOARDS CONCRETE EARTH HARDW'D COMMON ASPH. TILE B _ 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIORI� POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLE GAMBRELMANSARD I HIP BATH (3 FIX.) TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR _ TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS, ' 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ 3r d NO HEATING isi z O L z r m V) V , r 5 zzJ m M (n CU -n m tl (n Poo T m T o m Vel 3 O T v �• C w > � 0 eD j O Z m n O ® :7O Ci W O O �. eD O .Q Q• 0 O � C ewi P O CL eD pp7qq Ma 00 R O y qp CL L z r m V) V , r 5 zzJ m M (n CU -n m tl (n m T m T o m 3 T v j C z M 0 > m 0 y m T O X j O Z m n O 3 :7O Z n O O v O T a- V4 z w ca Cj) rn T" CU Pu { lel _ � I •.� . ICi,�e ���� I`�-'--- -a ► �,�.� ; I� .mow- _ f �!� �;����� Office Use O,nly�1 ul�e Tnmuwriw>.nI oftt l3wu>Ei#s Permit No. 30eartutesti of Public Eafetq Occupancy & Fee checked% _ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 iso peeve bjankj APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 12:00 _ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date % 1 —q (M* 5 (M* or Town of NORTH ANDOVER To the Inspe or of Wires: The udersigned applies for a permit to pe ,rrn/the electrical work described below. Location (Street & Number) 71 #00 0C/L Lme, Owner or Tenant Pari 60 Fouhy Owner's Address Is this permit in conjunction with a building permit: Purpose of Building Yes ❑ No T' (Check Appropriate Box) Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Uro lar )arm INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws it/NO have a current Liability Insurance Policy including Comoieted Operations Coverage or its substantial equivalent. YES it NO = I have submitted valid proof of same to the Office. YES ❑ NO ice' If you have checked YES. please indicate the type of coverage by checking the app prate box. INSURANCE BOND 0 OTHER D (Please Specify) VVV r / /� (Expiration Date) Estimated Value of Electrical Work S 4001 d® s— Final Work to Start g'� Insoecnon Cate Recuested: Rough _ _. Signed under the Pe/ities of per ury: L FIRM NAME iR h Ke �i l/Y) 1 y .SyS}�iYl s LIC. NO. 2- -- Licensee �Y(/C�i e% Signature .G� LIC. NO. Q��b /44 -p Bus. Tel. No. 4l7—�2 qs F96,? Address 6 �" '� �' ' ` ' ' A �! a �a All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit_ application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Teleohone No. PERMIT FEE S x-6565 Total No. of Lighting Outlets i No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures I Above—. In - Swimming Pool grnd. _ arnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets I No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Total No. of Ranges 9 I No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals I No.of Heat Total Tota! Pumps Tons KW No. of Dishwashers I Space/Area heating KW Detection/Sounding Devices Municipal Local ❑ Connection ❑Other No. of Dryers I Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wirina vl No. Hydro Massage Tubs I No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws it/NO have a current Liability Insurance Policy including Comoieted Operations Coverage or its substantial equivalent. YES it NO = I have submitted valid proof of same to the Office. YES ❑ NO ice' If you have checked YES. please indicate the type of coverage by checking the app prate box. INSURANCE BOND 0 OTHER D (Please Specify) VVV r / /� (Expiration Date) Estimated Value of Electrical Work S 4001 d® s— Final Work to Start g'� Insoecnon Cate Recuested: Rough _ _. Signed under the Pe/ities of per ury: L FIRM NAME iR h Ke �i l/Y) 1 y .SyS}�iYl s LIC. NO. 2- -- Licensee �Y(/C�i e% Signature .G� LIC. NO. Q��b /44 -p Bus. Tel. No. 4l7—�2 qs F96,? Address 6 �" '� �' ' ` ' ' A �! a �a All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit_ application waives this requirement. Owner Agent (Please check one) (Signature of Owner or Agent) Teleohone No. PERMIT FEE S x-6565 :.�—.t�^v.7^..mn,<eH°" *sar•-�-^�".,s.�"''+w"t.�r.,�y.-k"t.+«Y,'^ta+-°ws.'�"'F.-..-�..r.»p;�--'--- r Date ... :.... !. .... ,T 2699 4 HOR7M Oftt�eo .•1ti TOWN OF NORTH ANDOVER PERMIT FOR WIRING o"••`� ,SSACHUS� This certi has permi n Y�J wiring in the building ,.otf......l.j.GC..WI!i.....�!.i�J.-- ................at ...7.1...� o�...X.G.. �..1�. Qq n.:.:.............. . North ndover, Mass. �'~• 1//t, Fee .3�... `._'.... Lic. N66>'J.7.0......:..............................:........................... ELECTRICAL INSPECTOR 0� -- 4614/95.11:24 _ 35.00 RAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Office Use Only 01 4c Ciommonm ealth of Mtts£carhusett Permit No. i9eparimtnt of pub it —AafttU Occupancy & Fee Checked _7, % 3190 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /0— �� (XiQ or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the elec ricai work described below. Location (Street & Number) b/ 9-e S Owner Tenant wner's Address Is this permit in conjunctionyvat a f�l�ilding permit: Yes Eta No r' (Check Appropriate Box) Purpose of Building 1 `t ti tr Utility Authorization No. Existing Service Amps _J D Volts Overhead Undgrnd a No. of Meters New Service Amps _J �� Volts Overhead r Undgrnd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No. of Hot Tubs No. of Lighting Outlets I I No. of Transformers KVA Abover-, In - No. of Lighting Fixtures Z I Swimming Pcoi , grna. grnc. I Generators KVA No. of Emergency Lighting No. of Receptacle OutletsI No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Surrters FIRE ALARMS No. of Zones Ranges No. of Air Cond. Total No. of Detection and No. of Ran 9 tons Initiating Devices No. of DisposalsNo_of `feat Pumps Total Tons Total KW I No. of Sounding Devices ��II No. of Salf Contained No. of Dishwashers Space/Area -!eating KW Oetac:lon/Sounding Devices of Dryers I Heating Devices KW Local , .. Local - Municipal F-1OtherNo. No. of No. of Low Voltage No. of Water Heaters KW I Signs Bailasts Wirinc No. Hvdro Massaqe Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements or %lassacnusetts general Laws I have a current Liability Insurance Policy including Comp.eteo Operations Coverage or its substantial equivaient. YES = NO = I have suomitted valid proof of same to the Office. YES = NO = If you have checked YES. please indicate the type of coverage by checking the appropriate box. INSURANCE -- BOND = OTHER = (Please Spec;fy) (Expiration Date) Estimated Value of Electrical Work S Work to Start Signed under the Penalties of perjury: FIRM NAME Insoect:on Date Recuestec: Rough Final LIC. NO. Licensee �� ' Signature LIC. NO. ��� C� d-45Sus. :el. No. Address /0 � � J � Alt. Tel. No. �%�� OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- gwrea b assachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please ecx one) 1&145100/ 00 ^ r`) Teieonone No. PERMIT FEES • v (Si re of Owner or 4ent1 x-5565 Date.. 2636 1611 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SACHUS This certifies that ..... W.CA ..0.y........ 0. (..% ..................................... has permission to perform ........ W ......... ........ wiring in the building of ............C.. &14.1. 1C ... .... WW.rf.e...) at .... &.1 ........... V � ......G t .............. . North Andover, Mass. Fee..!X�AO Lic. No—Iff"o .. ................................................................ ELECTRICAL INSPECTOR C 16-04 3.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File