Loading...
HomeMy WebLinkAboutMiscellaneous - 102 LOST POND LANE 4/30/2018 (4)I May 22, 2013 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 102 Lost Pond Ln, North Andover, Ma 01845 Policy Number: H3121861229540 Underwriting Company: Liberty Mutual Insurance Company Claim Number: 026646036-0001 Date of Loss: 1/9/2013 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws, Ch. 111, � 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 v C � o �• CA Cl) 'v O CD 0 z Cn CDo -0• r c c a �• CA 03 O CD v CD O CL CD CD O C6 CD C O y C= v y �• O CD I S W O CCDD 0O�' o CD C CD • G 0 m C O =rS y O CS y _ 0 E N CD O CD n N Cj O.0 � m CD �- y --i CD cT .. o. C n =rW = y "'4 C W y 0 O 0 m O CD D C -4 0 _ O tv O y� C7 CD: N '0a =: cc CD CD y CL CD O CO) CL = cr C W � C C : CO CD : CO) CoN m .0-► = CD O C'7 � v O : W O C42 cD o CD :J CD CDa� y oma: d D� _': CL 0 o CD : �? 6� cp cn O 7C' rr ry r aGv cn S. G Cr1 ., C OD w. G OG w O M ~ b O n• Qom.. p.�y y ,,...yy ��l z 0 CA 0 J4" C= y C d rF � H n CD Ca Z y O O 'v CL r. C') C � � C Q. �• CO) O a� -v �C2 C.) CD C.D o a M Cl) CD O CD C. CD y CD CLO CO) O I CO CD C C E� O N _ co) O Q N dc O_ C m C] m t -4 75 N ' Z =ry y -I = °«� c � a •• CL = m O -40 O N O O C m O n = O -0 CO) tG03 � p = O o o S. W =r _ 'a N ` 0 = p,�,.r• o�� C m O N �1 o 0 C ^\ ..r N N :( O wis H a :n Q O ib W - C (n _ N < - N .. :EC: N � m d CD �7 N f•f a _ CDUM ;0 1 0 0 0,0 CD C/) N Z 'D O CD C\ CD \ c " C/) n � Z .i N C/)CDo Z a_ CD O5. g, . O✓ cn C ~ h 77- ro = O C O rt IMF c t� I C� x M M N N O C C� t. Tow I A O ja J 0 I - m W A n m �o C= CA C � CA C-) CD C) Z CO) CD O 'v CL r 0 CoC O S C = a y �C O v CD CD o a� CD CD O CD c CD CD �O y O CD C c?�O m _ C �. ca r � FA- SO m-0 Cm amnm O H c Z - =r -O H o� Co °:m c17 „w m n M o m .w m y C y N o CD -jo .* _ o �mm; - n > > N O O .O+ CD W =r CL..-+: o `G /VJ m m Co m n cc P7 O H d. n C c `, Gm e��+ • c VJ y J O CD O l O CD 3 G H . m o ?. o m c o cn my j l 04 = rrCOD rz=oJ� c O !. , n: y; o = O✓ oil r" cn rD K Ct y 0 0 c Locafr'dn /0 77— No., 7— No., T. _ Date NORTH TOWN OF NORTH ANDOVER Of�t�ao ,1h F p Certificate of Occupancy $ • x p Building/Frame Permit Fee $ X o 4 i �►,b',^°''�t�' ss�CHU Foundation Permit Fee $ Other Permit Fee $ p , Sewer Connection Fee $ Water Connection Fee $ — ` TOTAL $ ��• "� � � Building Inspector ;- 9728 28 Div. Public Works -� PER31[IT�, NO.�- y APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KVO. LOT NO. AeT O I2, �S o 23'f'f 7,T 2 RECORD OF OWNERSHIP DATE PAGE ZONE �_ / SUB DIV. LOT NO. 6 I IN%��'O G �N - `f s (BOOK — Yz 7Z I 30 LOCATION /! O,! / ®ONO / 9NC f �/!�b• ! F- PURPOSE OF BUILDING `� M 7 I � SU J �c OWNER'S NAME /off zNL NO. OF STORIES IZE OWNER'S ADDRESS ,C 90 -5-3 - A,voovr f BASEMENT OR SLAB /QASc�.eNT �JIST ARCHITECT'S NAME A© ri`f,�� SIZE OF FLOOR TIMBERS -�X/o 2ND 3RD BUILDER'S NAME w G SPAN DISTANCE TO NEAREST BUILDING /JX� f.��T� // DIMENSIONS OF SILLS ��° 6 DISTANCE FROM STREET eI iS ,/ � � C.. --- POSTS 1.4 /%Olv""v S C% DISTANCE FROM LOT LINES - SIDES REAR /JI N AREA OF LOT /�X JS ,y FRONTAGEG G- " " GIRDERS 2 Z HEIGHT OF FOUNDATION J7 1 I /bt �� THICKNESS JQ IS BUILDING NEW L 5 SIZE OF FOOTING lo'k z (j �� X IS BUILDING ADDITION IN0 MATERIAL OF CHIMNEY ZC�C9 lraepN� IS BUILDING ALTERATION /V0 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ye IS BUILDING CONNECTED TO TOWN WATER yf S BOARD OF APPEALS ACTION, IF ANY eS IS BUILDING CONNECTED TO TOWN SEWER dl.) C7 a — IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3cl 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 SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE •,,Ift PERMIT GRANTED 7 19 3 PROPERTY INFORMATION LAND COST qzp- EST. BLDG. COST y EST. BLDG. COST PER SQ. FT. K EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSP[CTOR 08 OWNER TEL. # 1 CONTR. TEL. # CONTR. LIC. # H.I.C. k BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S ORIES 1 MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH 3 2 I3 PINE CONCRETE CONCRETE 81. K. BRICK OR STONE HARDW D N; i` PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M T' AREA _ 1/1 1/2 1/1 FIN. ATTIC AREA _ N_O B M T FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 \_ —{I J 3 _ DROP SIDING WOOD SHINGLES CONCRETE EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDW'D COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK.ON MASONRY ATTIC STRS. & FLOOR BRICK -ON FRAME CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR II POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) .� GAMBRELMANSARD I TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK P SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROIL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I ll HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 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 _ 10 13rd I ELECTRIC NO HEATING R/ 7 THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1 t, t G O �.11 11 O �. O ll a S.yoQ = O� p N I ?= i a O 5 cn m .O v! ?? .� 0 Nn>.O W n T v .�• Z m -o N -i y o� =r °:m N �1 r �amd rte" 5 d � N C4 W -O ? m' O = > c > O N m W CO) 10 0 CD Z CA O O 00 In. r c) wwC = C O. iy n� O 0 0 v CD dc 0 CD O CL CD CD o CD w w 9 O CD y �. CD o co CD 0 0 y .O 0 o CD 7 ... � ;;eta,' ��t+•; n m O O Z y C) C� I r) r- : O s c � = '� (A r n C•m �c U) m COto N c c. m CD CA U3 N y=: n Q �� N . 07 � C• CL d > ..« ca m N I �• �....r 1.1� N N� r� � �D d N c : = CD CO m o'�C o .� N \� ' O Z _ CD . �i'. ,�.� _ �•R ��+��a�i;i +P Ib�,7�'f?�``S•+�� .Om"-" C�rfi n0~ . ni c co oCQ G O �.11 11 O �. O ll a O o O� I ?= w Csf ?? EL b 0 r�rD rD r rte" 5 w b7 (3 L C xx� F: �, ro It x 7d t .. :jt. ..,k.rP�-�.nwk�,.> ��. .. .,r � 1 r--'_ �. t i,. x_�.tStSir. ,�L�; � • 9 gal �1 RECEIVE[ JOYCE BRADS HAWTOWn of North Andover TOWN CLERK OFFICE OF NQ NgMTY DEVELOPMENT AND SERVICES MAR 20 15 P 146 Main Street Worth Andover, Massachusetts 01845 This is to certify that twertry (20) days have elapsed from date of decision filed without6�n Bradshawof Co Joyce A. _ 'y Town Clerk BOARD OF APPEALS Notice of Decision Property: Lot 6 Lost Pond Lane 'eo ,A 7!rlle Cody ; .a s&6aa., TOWn Clerk The Board of Appeals held a regular meeting on Tuesday evening, February 13, 1996 which was continued until March 12, 1996 upon the petition of Thomas & Christine Tetrault requesting a Special Permit pursuant to Section 4, paragraph 4.121(17) so as to construct a family suite at property located at Lot 6 Lost Pond Lane, Zoning District R-1. The following members were present and voting: Robert Ford, Scott Karpinski, Ellen McIntyre, and in Joseph Faris. Ul The hearing was advertised in the North Andover Citizen on 1/24/96 and 1/31/96 and all abutters were notified by regular mail. Upon a motion by Scott Karpinski and seconded by Robert Ford the Board voted unanimously to #4,. -2Al1 Grant the Special Permit to construct a family suite 24' by � lfor a new house located at Lot 6 Lost Pond Lane. Voting in favor: Robert Ford, Scott Karpinski, Ellen McIntyre and Joseph Faris. Board of Appeals, William Sullivan, Chairman�— BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 CIO ocolema t R of-* lic. Location No: Date NORTk TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ J " # � Building/Frame Permit Fee $ /6� FoundationPermit 7j CMU-�St -0 Fee $ � Permit Fee $ -�- 5�.-- 5 Sewer Connection Fee $ w Water Connection Fee $ TOTAL $ uildj.rig Inspectof 9573 Div. Public Works Location_ i02 LOST No. s ODate �Z-Z9, �G 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ Sewer Connection\Fee` $ Water Connection'Fee $ TOTAL 9624 Div. PERMIT NO. 5–b— APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. I PAGE 1 MAP h40. LOT NO - to -PT oF IZ, /1/ a j t 175 2 RECORD OF OWNERSHIP IIDATTEE BOOK 'PAGE ZONE �- I I SUB DIV. LOT NO. lNTL�C LOCATIONJOZ ql' FcN o q Ne PURPOSE OF BUILDING OWNER'S NAME F)1 N T I D C t 1'V C//�� NO. OF STORIES SIZE G X 3 Z OWNER'S ADDRESS ,Q .gcOX' 131 N. gNO0V BASEMENT OR SLAB 9 `e ie v J 1� ARCHITECT'S NAME TQ DeS)' SIZE OF FLOOR TIMBERS IST 2xt0 2ND �X�d 3RD ,),y BUILDER'S NAME F INTCOC t /,V( SPAN / ^ DISTANCE TO NEAREST BUILDING aD6 o DIMENSIONS OF SILLS X DISTANCE FROM STREET ?60 POSTS ¢/l S � / �,�� DISTANCE FROM LOT LINES - SIDES62 ,/ REAR 81 0 " GIRDERS AREA OF LOT 6 400 sf j FRONTAGElI OD HEIGHT OF FOUNDATION '7 //0 !� THICKNESS /Q �! IS BUILDING NEW Ye 5 1 SIZE OF FOOTING !Q �� 6 �� X IS BUILDING ADDITION No MATER:AL OF CHIMNEY'�� IS BUILDING ALTERATION o IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ISP 5 Y IS BUILDING CONNECTED TO TOWN WATER yl -5- BOARD OF APPEALS ACTION. IF ANY O IS BUILDING CONNECTED TO TOWN SEWER /vo ,f IS BUILDING CONNECTED TO NATURAL GAS LINE 7V O INSTRUCTIONS SEE BOTH SIDES PAGE I 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 AP OVED6BY `C�B(U/UIILDING INSPECTOR DAT FIL D / 2 1,01? 1 ./ OF OWNER OR AUTHORIZED AGENT FEE PERMIT GRANTED q T _ ` 19 3 PROPERTY INFORMATION LAND COST ?0, Q Q O EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSP[CTOR 01NERTEL.0 CONTR. TEL. 0 CONTR. LIC. N H.I.C. # r, BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION INTERIOR FINISH CONCRETE PINE 3 1 2 13 CONCRETE 8L K. BRICK OR STONE HARDW D— PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA 1/1 1/2 1/1 FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS DROP SIDING B _ 1 22 f 3 I_ CONCRETE EARTH WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARDW D COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY . • BRICK ON FRAME ATTIC STIRS. 8 FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I -I POOR ADEQUATE ONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH Q 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 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 _ 10 13rd ELECTRIC 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. `A .+� ✓ft6 (idIIL7Yl07LClJP,QGGfI- CtL ��, ``CI;i.:CLC�(GiC�,i DEPARTMENT OF PUBLIC SAFETY y CONSTRUCTION SUPERVISOR LICENSE ~? Nuaber: Expires: Birthdate: CS 005693 01/13/1998 01/13/1954 Restricted To: 00 OAVIO A KINDRED 40 MARBLERIDGE RO POBOX531 N ANDOVER, MA 01845 Restricted To: 00 17650 00 - None 1A - Masonry only 16 - 1 & 2 Faoilr Hoes Failure to possess a current edition of the Massachusetts State Buiilding Code is cause for revocation of this license. PRECAUTIONS Nota: These 6repiace systems are not difficult to install. However, in the interest of safety, itis recommended that the instalierbe a qualified or certified "tradesman -familiar with commonly accepted fireplace installation and safely tech- niques as well as prevailing iocal codes. The most important areas of concern dealing with the instailatlon of factory -built fireplaces are clearances to combustible materials. proper assembly of component parts, height of the chimney system, the proper use -of accessory equipment supplied by Superior and the tech- niques employed in utilizing finishing materiais applied to the wall surrounding the fireplace, hearth extensions and wall shields. Each of these topics will be covered in tnorougb detail throughout this.manuai. Please give each your special attention as you progress with your installation. WARNING: WHEN INSTALLINGTHIS FIRE- PLACE IN CANADA, THE CHIMNEY AIR KIT MUST BE INSTALLED PER WARNOCK HERSEY INC. LISTING. TYPICAL INSTALLATION - INTRODUCTION General Information The CST -38 and CPF-38 Series are radiant- heat, adiantheat, two-sided and three -sided fireplaces with standard glass doors. A steel grate is also included with the. CST -38 and CPF-38 to prop- erty position the fire. An outside Combustion Air Kit is available as optional equipment. Note_ Illustrations shown reflect '"/pical' in- s-.11ations with nominal dimensions and are for design and framing reference only. Actual in- staflat(ons may vary due to individual design preferences. However.. always mountain mini- mum clearances to combustible materials and do not violate any specific installation require- ments. The CST and CPF fireplaces have been tested and listed by Warnock Hersey Inc. (ieport.No. 0503-762) to the UL 127 standard for U.S. installafions and to the ULC $610 standard for Canadian insWlations. This system is intended to be installed In residential homes and build- ings of conventional construction, not in mo- bile homes. This fireDlace system is intended for installa- tion in accordance with the National Fire Pro- tection Standard -for chimneys, fireplaces and solid fusi burning appliances; NFPA 211 and in accordance Mtti:codes such as the BOCA Ba- sic/Nationai Cudes. the Standard Mechanical Code, Uniform Building Codes and/or the Cana- dian NatfonatCodes.- FAiLURE70 USEPARTS MANUFACTURED BY SUPERIOR RREFLACE COMPANY OR VARIA- TIONS IN.TECtlN10f3ES AND CONSTRUCTION MATERIALS DESCRIBED iN THIS MANUAL MAY CREATE. X FIRE HAZARD AND VOID SUPERion LUYIi7ED WARRANTY. The CST. and CPF systems consists of four "subsysteri►m 1. The Fireplace and Door Assemblies 2. The Chimney. -arid Termination 3. The Opiicipaf Combustion Air Kit d. T be .Chimney Ail Kit (Canada Only) CLEARANCES AND HEIGHT REQUIREWNTS: - The CST and CPF Series may be placed on or near normal construction materials:' The com- bustion aif kit: firestop spacer and roof flash- ings (not chase•flashings) may be placed di- reczfy on or against normalconstruction mate- rial': The.. chiraney requires' a minimum 2' (51 mm) air spaceto combustibles. A combus- able mar>tEr may be installed 12' (305 mm) above tate fwepiace. bperr q as per NEPA 211, Section 7-313. In Canada the minimum is 18' (45.7.mm):abm.tfle opening (Refer to Figure S� on page 17).. The fireplace arrT chimney must be enclosed when in=tled in or passing through a iNing area wnem combustibles or people may come in contact wilti it This is i,� cortarrt to prevent pos-ible persoAal injury or fire nazard.. For questions.: please c2R your distributor or Superior RrepAce Comparry. Special restric- tons apply Wthe front and facing of the fire- place and nearby -alis (See pages 17 and 18). 'Cons#rra�oti AdeteriatS fiarnmamwisis .. •paneling • parnrde beard .: • dry wall mill`boa :: • flooring • pl3aod;i.: `::: • etc. 1 1 r FORM U LOT" REL ASE' FORM INSTRUCTIONS'r. 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 localor state law, regulations or requirements. *****************Applicant fills out this section****************** APPLICANT • car lint TL o f( z fie. Phone � 8 g r 6 5 S S LOCATION: Assessor's -Map Number Parcel 14 Subdivision zo.57- P6,V Q Lot(s) b Street ` � 657- L ASE co St. Number `O Z ************************Official. Ue.Only *************** ******* RECO AT IO OF WN ENTS: ,1 0000ork Date Amoroved. V Conservation Administrator Date Rejected Comments • ��lc Date Approved town Planner -'Date Rejected Comments Food / Inspector -Health ,ell i� Septic Inspector -Health Comments Date. Approved Date Rejected % Date Approved Date Rejected Public Works sewer/water connections - driveway per ' t r Fire. Department Received by Building•Inspector Date v. 'v CA Cl) CD Z CA co o CL r �. C o. HTT O CU 0 t9 v Q*MC O Q 1 CD CD O CCD w ca a. C O y CD CLO CA O ' to CD � v t'A O $ CD Z CDo 0 CD O rli C rC n 3 C ' O m 2 .CA O Q' (A d O CD m C7 N m n C �� m O CA m T m aim �_ m CD N O N O S Ca = CD G cl) O Z�. 0 O H n ; O CD CA n � CLCW: CD m W: Q Camom, C1 CA : O? C a W � d CD C CC7 co CA N O CD ca •�_•~ CD CD O CD o N Ca . Or = a: .m: CD n� :+N C 9 w o m dd: a'o G* O Com! O O = - O Ca P 9 � ZCD � r .. `Zi 0 � n � n � C C _ 1 n � On R C W v T x p7 z z ►�Gn y z d y N 7 0 0 c .«� Tow �M� h l J as �99 �f►i m c� l J � z c � r �p d cry z C/1 ►.0 � b� coo C CEJ y \ x Gd � d ~� Z � C� n ,p O d d � �99 �f►i m c� CA 1 CD C F z CD O CL r d � O CD O � CL c aI =i�U CD O .. .. v L -j n CD O CD -0 •D y� CD CA O O co 0 co 12 0 Z O CD O C cc L. a co CD II C N C 0 C. � N V fM co��_��_ �. y O C r N CCD 10 CA C- O Cl) n �c)r.L 3 m CD .O-► CD N T =r CL m O O N O O ? m CD n CD C� ; CD 7 -0 0 . Cl) O Z<,C09 O N C2 LA. ; a.� CD m H �.O O CD C. -4 N. Da N =rCr . C, C W CL CD : tC O N N ,� O 1 CD go�CD CD �'► C•i MVV/ O O 11 w CD O N CD C: CD : J D� CCD N O CD : �n3: C7 n 0 90 O r .2in 'O Cn o C O CL C/) ?C 70* cn C C, d o 0 � O O r .2in 'O Cn o C O CL C/) ?C cn Office Use Only 0i 4r �':0MMUnlUl:# Of 49a95a `4U9tft Permit No. — i[lepurtmettt of Public ttfetq Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) 3 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 (M* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) ! ,Zos -r & J Owner or Tenant //VC, Owner's Address 0 Uo Y �`3I Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building ZLi /\% Utility Authorization No. 7 Existing Service Amps _ _ _J Volts Overhead ❑ Undgrnd❑v No. of Meters New Service _-�p0 Amps 1ay / 6 Volts Overhead ❑ Undgrnd ISI No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: 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 .± NO I have submitted valid proof of same to the Office. YES 3�-`NO :: If you have checked YES, please indicate the type of coverage by checking the appropRate box. INSURANCE - BOND ` OTHER -_ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S _ Work to Start -c`' t? Inspection Date Requested Rough fitWl"L Cl't1— Final G`Z4-1- CA4� Signed under the Penalties of perjury. LIC. NO. /4V33/ff FIRM NAME Licensee /� a /-• �i�lSe� Signatur UC. NO. /y�3 ���i17 S�_ /fl �. Bus. Tel. No. SC�� ys� -//G7 Address 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- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) ? t) � Telephone No. PERMIT FEES �i (Signature of Owner or Agent) x•6565 Total No. of Lighting Outlets /Dy No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Above Swimming Pool grnd ❑ In - grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets / D I No. of Oil Burners / / I Battery Units No. of Switch Outlets 36 No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and. Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained No. of Disposals Dis P No.of Heat Total Total Pumps Tons KW No. of Dishwashers :::,2 I Space/Area Heating KW Detection/Sounding Devices Municipal ❑ Other Local ❑ Connection l No. of Dryers Heating Devices KW No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs I No. of Motors Total HP OTHER: 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 .± NO I have submitted valid proof of same to the Office. YES 3�-`NO :: If you have checked YES, please indicate the type of coverage by checking the appropRate box. INSURANCE - BOND ` OTHER -_ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S _ Work to Start -c`' t? Inspection Date Requested Rough fitWl"L Cl't1— Final G`Z4-1- CA4� Signed under the Penalties of perjury. LIC. NO. /4V33/ff FIRM NAME Licensee /� a /-• �i�lSe� Signatur UC. NO. /y�3 ���i17 S�_ /fl �. Bus. Tel. No. SC�� ys� -//G7 Address 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- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) ? t) � Telephone No. PERMIT FEES �i (Signature of Owner or Agent) x•6565 The Comnwnwealth of Massachusetts Deparanent of Indumial Accidents /1ffC'd stArrestviffew 600 Washing on Street Boston, .Mass 03111 Workers' Compensation Insurance Affidavit location- j = 0 _ sd x J%jVU L �IP 1&,4 © / J763 one, S Od' C 1 am a homeowner performing all wort: mvseLL 1 am a sole proeriemr and have no one worms in anv c'rac:^J Failure to secure coverage as required under Section _:i, of MGL 15: nn lead b the imposition of criminal penalties of a tine up to SI.300.00 and/or one years' imprisonment as well as civil penalties in the form of a S T OP WORK ORDER and a tine of SI00.00 a day_ against me. I understand that a Copy of this statement may be forwarded to the Office of Investigations of :be DEA for coverage verificacon. 1 do herebv cerr0!rUnd)r tffe pains and pendities of�pQ,:try :ham the iniormauoes provided above is aue and correm Print name ii nG� /L P� �'0_Phone # . �� t/S ��� Official use oniv do not write in this area to be Compieard b7 atr ar on" GJMCW cin or town: "Building Department [Licensing Board [t check if immediate response is required CSelettmen's OlTice CHealth Department Contact person- pboee.l: ^Other (M"dd3M PIA) Date ....... 11111117 ... 2959 o TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 41 , 6 S CHUS This certifies. that ........ V..C;J ... ........./5. `/`-`-.( . .............................. has permission to perform ..... .x'..4'.1...... P— wiring in the building of....... ............... I ............................... at .... /01 ...... Lo I ....YO.Ij ...... ��................ . North I Andover, Mass.4 .......... .......................................... . - Fee..Lic. No. ELECTRICALINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File