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Miscellaneous - 106 PUTNAM ROAD 4/30/2018
106 PUTNAM ROAD J 210/045.A-0030-0000.0 i I Date �7-!.2 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform k7. . . . . . wirjng in the building of . . . . . . . at— ./P . Pc?Ty I . . . . . . . . . . . . . . . . . . . North Andover, Mays. F e e Lic. No. . . . . . . . . ELECTRICAL INSPECTOR Check Check# Zqol--? 11316 �'� 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the Provisions of M.G.L.c.143 3L V( permit application form to provide notice of installation of wiring shall be uniform throughout 5 \ on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166 § 32,the gh the Commonwealth,and applications shall be filed electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the P notification of completion of the work as required in M.G.L.c.143,§3L. § he Permits as deshalltermined limited as to the time of ongoing construction activity,and may be.deemed-by theTnspector_of Wires abandoned_and_iavalid_if he--. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work sly 1 be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or-the installing entity stated on the permit application. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections .74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension purpose by establishing an automatic four-year extension to certain permits and licenses concemin the use or development of real roe With p Act furthers this limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"duringthe qualifying property.m' q dying period beginning on August 15,2008 and extending'through August 15,2012. rPenniit Pormit/Date Closed: Note:Reapply for new permitxtension Act—Permit/Date Closed: Commonwealth of Massachusetts Official Use Only ` Department of Fire Services permit No. -t) � BOARD OF FIRE PREVENTION REGULATIONS (Please addzip codes &electrician's cell#• Occupancy and Fee Checked ' c®nfract# b/d p ml # [Rev. 1/07] (leaveblank) erI1Fa,�plicad�le. APPLICATION FOR PERMIT `lT O PERFORM ELECTRICAL WORK I All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINTININKORTYPLIO , LLl TOM01, N) Date: 1/�1 � f Z OIl 'or Town® ° ©� /°tt�; ! '2 j� To the Inspector of Wires: By this application the undersigned gives ni er intention to erform the electrical work described below. Location(Street&N ber) ©� hq, 1i1� D a p Owner orTenant J5'et-k 'o— Yi' V4 Tele ph ne �.?7& '5— Owner's Address trr c © dam✓ � '� ,' Is this permit in conjunction with a building permit? files ❑ No ❑ (Check Appropriate Box) ]Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead i - ❑ Undgrd ❑ No.of Meters um ea o Feeders and E rapacity Location and Nature of Proposed EIectrical Worlc: .�]S �`c��t C�ft J q l C'YVl i-.rR J e-v-t14- 2?� — ew Com�l tion of the,following table naay be tivaived by the Inspector of Wi s, No.of Recessed Luminaires No.of Ceil.•-Susp.(Paddle)]Fans N0' of Total Transformers IVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 7Above In- o.No.of Luminaires Swimming Poo o rner g e n c 3 ig in g rnd. ❑ rnd. ❑ Batter, Units No. of Rete tacIe Outlets p lets No.of Oil Burners s FIRE, ALARMS No.of Zones on s is No'.of Switches No.of Gas Burners No.of Detection and ' Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW_ No.of Self-Contained Totals: "' Detection, erl ing Devices No.of Dishwashers Space/Area Heating IOW LocalMunicipal ❑ ection El Other No.of Dryers Heating Appliances ICW curity Systems:' No,of Water No.of No of uivalent Heaters IOW Data Wiring: Si us Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No. of Motors Total HP 'Telecommunications Wiring: No.of Devices or E uivalent I OTHER: ���%C�,?7 i i i Attach additional detail if desired., oras required by the Inspector of I r 1M. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CI.lECK ONE: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured I certify,under the pains and penaltles of perjury,that the infq- FIRM NAME: ADT LLC DBA ADT Security ;....- rtraatior on this application is true and complete. . 4 LIC.NO.: C-172 Licensee: Thomas J.Leeignature :,/ ;�� LIC.NO.: C_172 (IfaPPIrcablv.ener• " pt"in the l' ense number line) ,�'' Address: C i�t v�' c '�J�. 1ti�, cr Bus.Tel.No.:�o 0� S c�Lt *Security System Conu-ac,lor License required for this work;if applicable,'enter the license number here:l.No.:,' 001779 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my.signature below,I hereby waive this requirement. I am the(check one)[]owner Owner/Agent ❑owner's agent. Signature Telephone No. PERM-ITFEE � tJ i �0�171r`oVk�`J�f rH As`� 3 0i ? °`?dy tai=tU S T 4o(A��(yjultllrol�flulrly ELECTRICIANS ::• .. - A,REGISTERED SYSTEM COIVTRACi`O ISSUES TRE ABOVE LICENSE TO: ° `'ADT*.L:LC DBA 'Ab .SECURITY.' \\_w ;"THOMAS J LEE.'. 41'0 :U`N.IVERSITY• 'AVE ` Vi E' , . MA 02090-�231�1 �•"� • 172 .0 0_7/31/13 __ �'201q.341': Fold,Then De12ch Aon9 All Perio¢?!lons Y, t Date.................. ......................... AN TOWN OF NORTH ANDOVER O � p PERMIT FOR GAS INSTALLATION .HU5� This certifies that 4� "'"` e-0Y\AAeAA4 .........................'......... ................................,... ...... ... .. ... has permission for gas installation 1..................................... -.....�„ ! 1 in the buildings of........�).!.......°'-.. ....... at...MD.........f..0 orth Andover Mass. �7Fee .�........ Lic. No. ......................... ................................................................ GG GAS INSPECTOR Check# 1 i21U a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTIItG WORK CITY I North Andover MA DATE 3/24/2014 PER IT# JOBSITE ADDRESSI 106 Putnam St OWNER'S NAME GOWNER ADDRESS I Same TEC FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL® RESIDENTIAL❑ PRINT CLEARLY NEW:F_] RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOQ APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 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 TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER -------- ctis� INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE 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 mpliance with all Pertinent provi ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. > PLUM BER-GASF ITTER NAME Joseph Marino LICENSE# 8736 SI NATUR MP� MGF® JP® JGF® LPG]® CORPORATION❑# 3285C PART SHIP®# LLC[J# COMPANY NAME:j RH White Construction Co ADDRESS 41 Central St CITY I Auburn STATE MA ZIP 01501 ]TEL (508)832-3295 FAX 508-926-4347 ]CELL 508-832-4614 EMAILJMarino@RHWhite.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Caro FEE: $ PERMIT# PLAN REVIEW NOTES `= ::CC?NpiO'fViNEAL.TH OF MASS�LGt'$:tlTS I TI UNBERS ;AND GASFITT S"ED AS"A.W;TER P.L Uikif ='ISSUES TH `ABOVE LICENSE A_= D MARINO =..c.. IiJ[7fRGE`S I ER MA 0 a _�j ; 5 05/01/14 _.GQitiil1 ONWEAL.TH OF MASSA.CF#�JSEris ="< PLU]U("BERS AND GAS FI7TFITS :, L'f'Cr IVSE'D AS A JCIU.RNEYNF`1N-P-L fS$UES THE ABOVE LIC.ENSE RRI=NGTON ST. �UJDR ER I 04/03/2014 14:04 5088326751 RH WHITE CONSTRUCT PAGE 02/02 CERTIFICATE OF LIABILITY INSURANCE Page 1 of z OB/ /2013 THIS CERTIFICATE IS ISSUED ASA 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 poliey(ies)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 conferrig hts to the certificate holder in lieu of such endorsement(s), PRODUCER CONTACT willia of Massachusetts, Inc. MU I PHONE c/o 25 CQntuty Blvd. N0_FM)• 877-9457378 FAX'ND) 868-46_7-2378 R. 0. Box 305191 3 0.DRI,ss certificate Na�gk>ville, IN 37230-5191 �@w•i .H.G_OYtI INSURER(S)AFFORDING-COVERAGE NAICrt INSURED INSURERA: The Charter Oak Fire Inauranog Company 25615-001 R. H. White Construction Company, inc. INSURERS:TravolgXH Property Casualty cotgpany of Am 25674-003 41 Central Street 0. DQx P. 0. Bvx 257 INSURER 94 C:National Union Piro Insuranco Cvmpany o£ 7. 45-001 Auburn, MA 01501 INSURER O;TrOvgless Indomixa ty Company 25658-Dol INSURER F,; INSURER F; COVERAGES CERTIFICATE NUMBER:20287680 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 Is SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IJJJL NSRTYPE OF INSURANCE DD' SUB POLICY EFF POLICY EXP VUM POLICY NUMBER LIMITS A GENERALLIA9ILhY VTC2000 977R9948-13 9/1/2013 •9/1/2014 EACHOCGURRENCE �_ 2,000,000 X COMMERCIAL GENERAL LIABILITYTORENTF,p 3 0 ��� 5(Ea oceurancrl _ 0,00 0 CLAIMS-MADE OCCUR MED EXP(Any one anon F 101 000 PERSONAL&ADV INJURY $ 2 DUO,OOO GENERAL AGGREGATE $ 4,_000,000 GEN'LAGGREGATFLIRITOAPPLIESPER; PRODUCTS-COMPIOPAGO $ JQOO OOO POLICY LOG a AUTOMOBILE LIABILITY VTJCAP 977R9SSA-13 9/1/2013 9/1/2014 $ OMt31 ED 51NGLF.I,IMIT X acs�d $ 2,000,000 ANY AUTO ent BODILY I NJURY(Per Demon) $ AUTOg NED SCHEDULED BODILY INJURY(Peraccldent) $ X HIREDAUTOS X NON-OWNED AUTOS eME ,Rccl , $ X Co Ped 9 leX 0011 Ded C' UMB00 RELLA LIAR X OCCUR 886766140 /1/2013 9/1/2014 EACHOCCURRENCF. $ S_,000,000 X EXCESS LIAR CLAIMS-MADE AGGREGATE $__&000,000 DEC I $ IRETENTIONS 10,000 $ Ij WORKERS EMPLOY R$'LI ATION BILITY ZUB 820SAI85-13 9/1/2013 9/1/20 4 XX O AND EMPLOYERS'LIABILITY TJ7RY U D ANY PROPRIETORMARTNFRJEXECUTIVE N NIA VTC2XUB 8203A71A-13 9/1/2013 9/1/3014 E.L.EACH ACCIDENT F 1,000,000 OFFICER/MEMBEREXCLUDED? LTJ Ifred0ts batjN) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 U is 1iel-IriuN in U UNtdRATIONS below E,L,DIBEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Avach Acord 101,Additonpl Remarks Schedvla,If mora ep eco la rmqulrad) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Evidence of Inmurance AUTHORIZEDAePREaeNTAVVE Co3.1:4197604 Tp1:1E94012 Ce7:t::20287680 ®1988-2010ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are e registered marks of ACORD Date./. . NORTIy TOWN OF NORTH ANDOVER 0 149 PERMIT FOR PLUMBING 'I - SACHUS This certifies that ."'el . . . . . . . . . . . . . . . . . . . . . . . . . . -P, -t has permission to perform . . . . . "-, !�- . . . . . .j . .-. . . . . . . . . . . . . . . . plumbing in the buildings of ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Feek—�. . 7. L I C. N o. ... . . . . . . . . . . . . PLUMBING INSPECTOR Check # A 577 MASSACHUSETTS UNIFORM APPLICATION FOR'PERMIT TO DO GASFITTING (Print or Type) Mass. Date / ��v 3 Permit # Building Location_ Owner's Name M , J Type of Occupancy New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES CA yW Vf U Z OC V1 to cc to ewe 0 Z Z = o`v'a Z m H < C C 00 W a U V mZ < V ZZ 0° > ZW99 0W _ W WW V y 99 < 0 � ad0 '�' SUB-BSMT. l BASEMENT 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Crane's Plumbing & Heating Check one: Certificate Address 70 Douglas Street ❑ Corporation A Haverhill, MA 01830 El Partnership 1 Business Telephone 373-4001 r ❑ Firm/Co.. Name of Licensed Plumber or Gas Fitter Peter Crane INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes R No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 0 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application walves this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted for entered)in the above 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 provisions of the Massachusetts state Gas Code and Chapter 142 of the General Laws. By Type of License: ❑Plumber �) Tide ❑Gasfi[ter -� �__ ❑Master "Signature of Licensed Plumber or Gas Fitter City/Town ❑Journeyman O [ License Number APPROVED(OFFICE USE ONLY) FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE i NO. 1 APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED Date 19 Gas Merc. Final Insp. Gas Inspector Date/....1.. .......... N°RTM TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACNUS� zt This certifies that ........................ :...........,.::.............. .. ..... ................ i has permission to perform v'�-��.. G /..'.................................................................. wiring in the building of.... _ .... .;;... .................................................. at.... �....:............:�........ ................ ,North Andover,Mass. Fee..................... Lic.No..r... !7...\........,....... ...............................- �.:....:. ELECTRICAL INSPECTOR Check # 4771 TBE COMMOATR ALTHOFMASSACHUSETIS Office Use only DEPARTAfl 0FPUX1CSAFETY Permit No. _ 4177 7 BOARDOFFIREPREVENTIONREGUL' WONS527CNlltjV c Occupancy&Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date G Town of North Andover To the Inspector of WireE The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) J7-A1, Owner or Tenant Bordpji& -41- y �v Owner's Address ,.C4,7, Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building nLf Utility Authorization No. _ Existing Service AmpsVolts Overhead Underground r-1 No.of Meters New Service Amps / Volts Overhead Underground r--J No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work J C4-1.`i u . /ate! No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 1 OTHER• hMranoeCovaage Putstranttotheratlt mTiffZofMwmduseMatualLaws lbaveaamatLd)ikyba==FbhcylwkdTCon,pleepMMclnsCDwrdWorltsWjq=Wapvalat YES10 NO IbawabrroadvabdpoofofsmmtDdrOffice YES �Z BOND MER 0 IfyouhawdredodYES pleaseir dc*thetypeofcovetageby drddTthe INSURANCE [ ftasr*y) F ValueofDec�riical Wolk$ WorktoStart // DAY' Ir�spectionDateRegtle�d Roue F�lal Signed underTr Penalties ofperjury. FIRMNANIE /! �'I <,7 LMW No. d 9,S-/-7 Lk. lfonJ /"/pjY .f; SigiT' m _ Lkc=No BusinessTel No. 43 A`"P Alt Tel No. 603 o' lS.3 ct`y OWNER'S INSURANCE WAIVER;I am aware that the Lxxxw does not have the irlsar&=coverage or its substantial egtrivalent asw*red by Mw,chuscZ Genaal Laws and thatmysigmtuteon thispeanitapplication waives this wgmi em t. (Please check one) Owner F-1 Agent Telephone No. PERMIT FEE$ Signature ot_ wner or Agent z The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations w� Boston, Mass. 02919 5�1b Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone#: Insurance.Co. Policlr'# Company name: Address City Phone#: Insurance Co. Policy#____ Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment.as_weU_as_chni.penattiesinshelarn-faBTOP.W-ORK ORDFRAnd_afine-d..($1110.00)-atlay.against-cne I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. r Signature Date Print name P_hone.# Official use only do not write in this area to be completed by city or town officiar City or Town Permit/Licensing ® Building Dept Check if immediate response is required [] Licensing Board p Selectman's Office Contact person: Phone#: ❑ Health Departmen I] Other Location No. Date NaRTM TOWN OF NORTH ANDOVER l0?o•,t`•o I•,�OOR 9 Certificate of Occupancy $ ENuS t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Ale) Check # i 764 Building Inspecto�/ TOWN OF NORTH.ANDOVER BUILDING DEPARTMENT APPLICATION TOCONSTRUCTREP RENW T OR D9MOUSH AONE ORTWOFAMILY DWELLING Wo o M SIGNATURE- IPA � -4 Building Commisgioner r of Buildings Date Z SECTION I SITE INFORMATION IA Propaty Address; 1.2 Asswors Asap and Parol Number: 0 io(n- Pu 4(s' A 30 ?viae Number Parcel Number 1.3 Zoning Worrnation: 1.4 Property Dimensions: %60 14,41,11 zoningDidrid Ptoposed Use _ Lot Arra t ft 1.6 BURRING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ESEired Provided Required Provided l.7 warar S Vpky MQLC.40. $l) I.S. Flood Zaao baa: t 8" Sowesago UiipasaS Sysiem >' Nbho Px►vate C! 2aaa oasi nooaz«m 9 htanicy+l oosi+eUispasal Sy"M 0 -4 SECTION 2-PROPERTY OWNERSHIPJAUTHORIZED AGENT M 2, Owner of Record e rzOlAi ) s (. A /ivy► Nanta( ) Address for Service: 9/10V Signature Telephone 2.2 Owner of Record: Nampprint0-Address for Service: 'a &P3 -6 ?"'0' w)O,sad-6 111 Si ature U Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed construction Supayisor: 0 L;icanseNumber on Address Expiration Date Signature Telephone r 3.2 Registered Home.lmpruvoment Contract( ,-t� A07 orr� 'a Not Applicable Ci fWt_Af4*1A1Cj POOL companyName _ //Fs / 1 1 s�. (r] Ragisttfi°"Number r 3r 12212,005r Z si stare Telephone 1+arp6torr safe 4/ SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Wodfers 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,..;..n 140.......0 SECTION S Description oCPm"used Work tautoplable New Construction Existing Building 0 Repair(s) 0 Altmtions(s) 0 Addition 'G AccessoryBldg; 0 Demolition 0 Other 11 Specify Brief Description of proposed Work; Pao SECTION 6-ESTIMATED CONSTRUCTION COSTS item Estimated Cost(Dollar)to bep Completed by pertnit a icant t. Building (a) Building Permit Fee Multi lien 2 Electrical (b) Estimated Total c4m of / 31 I Construction (P 3 Plurnbing Building Pernat fee 4 Mecbanical(HVAC)' , 11 5 Fire Protection 6 Total 1+2+344+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPUTED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT J, as Owner/Authorized Agent of subject proput Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application' Si Lure of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/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 Print Name SignattireofOwner/ ent Date NO.OF STORIES Sly BASEMENT OIL SLAB SIZE OF FLOOR TIMBERS Iff 2 3RD SPAN DNIENSIONS OF•SILLS DIIviI~NSIONS OF POSTS D14ENSIONS OF GIRDERS HEIGHT OF FOUNDATION TMCKMSS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUII,DING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a cr . 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 OUT THIS SECTION* * * * APPLICAN �SiLvA (FL,4be-ttH Jly,4 &1I PHONE 6U-iMbe! tvokK i�5:26��7/l LOCATION: Assessor's Map Number_ 45-A PARCEL_`3 SUBDIVISION_ LOT(S) STREET 1 U �ln *11-b ST. NUMBER f0� ************************************OFFICIAL USE ONLY*********************************** RECONMENDATIONS OF TOWN AGENTS: 10 CO SERVATION ADMINIST TOR DATE APPROVED /f/ DATE REJECTED COMMENTS__ _ TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT_ FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR — DATE Revised 9197 jm CERTIFIED aOT A A N PREPA RED FOR.' BERNARD B ELIZABETH S/LVA AT 106 PUTNAM STREET NORTH ANDOVER, MA. NORTH ESSEX REGISTRY OF DEEDS.'8K. 4479 PG. /39 ASSESSOR'S MAP 45A, PARCEL 30 ZONING.' R-4 D SCALE: /" 30DATE.' MARCH 31, 1998 z z o . 0 /00.00' 14.4' IS ^ Lor 2 Q ►� 9660 SFS `\\6" 1l K 29.1 �-►- rl \EX/S TING QDWELL,.AlGa M .JNO06_ \ \' � 29.4 Q 29.3'\ . 21.6' . -9748' JQHN AIs N0.35773 � . .e9 S1G�Av 4 su PREPARED BY. JOHN ABAGIS B ASSOCIATES, PROFESSIONAL LAND SURVEYORS 137 CHANDLER ROAD, ANDOVER, MA. (508)- 688-4899 NO. 3446 SWIMMING POOL CENTER, INC. 670 South Union Street Lawrence, MA 01843 (978)682-6916 NameFgeA4rIA�7� Home# Address /©G PVTjhq*j N/ Work# 0—.�26 47/1 - IXTSY City/Town N®, A/,rLza State ZipYXY _ u INGROUND POOL SALES CONTRACT We agree to sell one / }AOR e Inground swimming pool for the sum of$ !3 coo 100 Liner choice IMAI-TAGe- 7��/ql E 04 O iQ v�r,&l LS Circle one: Diving pool on-diving pool Deepest pool depth feet Circle stair location: En Side (show diagram) Show Swimout location,if applicable All inground pools come standard with: Complete filtration system,Self-cleaning system,Stair unit, Ladder,Skimmer,Main drain,Hard bottom,Concrete collar,Print liner,Receptor coping,Foamed walls& shallow end,Manual vacuum cleaner,Maintenance package. Optional Accessories Stair upgrade $ Swim-out Jets $ g Diving board-6 ft. $ Base pool price $ 7 60a,00 Diving board-8 ft. $ Slide $ Nicheless Light -SAAt t t(TMT Total extras $ Fibre Optic Light System Fibre Optic Light Perimeter $ 5%MA sales tax$ Heater-Propan atura Heater-Electric eat Pump $ Total price $ ��,�SQ�QO Automatic vacuum StLfft6fW $ — • Solar cover&reel $ Pavment schedule Winter cover pkg. $ -Safety cover 166Ptoe $ _j',nitL Deposit $ .Do Pool Alarm $ Other $ Balance due upon Other $ Delivery of pool $�00 The Buyer ackn wledges that they have read and accepted all conditions of this contract and agree to honor the Contract act dingly. Seller ate / -924_03Buyer ' / ADate (/.3 Date / 1R Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 118519 Type: Private Corporation Expiration: 3/29/2005 SWIMMING POOL CENTER INC ROY CHARLAND - -- 670 S UNION ST --- LAWRENCE, MA 01843 Update Address and return card.Mark reason for change. Address ❑ Renewal F� Employment ❑ Lost Card at.� ✓fie -Varrtirr�.o�zuraczcGfi a�✓U�czc�iuee�6 Board of Building Regulations and Standards h � License or registration valid for individul use only � HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:�-�-= /•-a Registration: 118519 Board of Building Regulations and Standards Expiration: 3/29/2005 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Private Corporation SWIMMING POOL CENTER INC ROY CHARLAND 1 670 S UNION ST GG-� ✓ (�r /� �—, LAWRENCE, MA 01843 Administrator Not valid without signature - .coRv CERTIFICATE OF LIABILITY INSURANCI;w op DATE(MMIDDIYY) i C 04/01/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONI„Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE Landmark Insurance Agency, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 198 MaRaachu.setts Aven-ue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845-4190 INSURERS AFFORDING COVERAGE Phone: 978-688-8829 Fax: 978-975-3987 INSURED – INSUREIRA: Proferred Mutual Insurance Co. INSIIRER D: Safety Insurance Co. Swimming Centr�r INSUKE:R C: Guard InsuranceGx ou RoyCh�.xlaz�nd d ---------'�....._..,.............,,,.,...:._._._......�:..__......... 67D So_ Union St. PNSURrROtLawrence MA 01843URER E: COVERAGES TIME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO'rO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITH$TANQING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR O'rHER DOCUMEN'I Wi(H RESPCCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN.THE INSURANCE AFFORDED SY11-It!POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,ACGREGATE LIMITS SHOWN MAY HAVE SEEN RFDIW.F.D BY PAID CLAIMS. L TYPE OF INSURANCE POLICY NUMBER DOITC`Y CFCY PIRATION LIMITS LTR I DATE MMIDDlYY DAFECTIVE TE MMIDD/YY GENERAL LIABILITY i CACH OCCI,IRRENQ2 $ 1000000 A X COMMERCIAL GENERAL LIABILITY CPP0120552265 03/01/03 03/01/04 FIREDAMAGE(Any one fire) $)EXCjUCjeC1 1 CLAIMS MADE l X]OCCUR I MED F,XP(Any ons parson) S Excluded PERSONAL B ADV INJURY 51000000 GENERAL AGGREGATE s2000000 L;F..N'I,AC;GRFGATF LIMIT APPLIES PER: PRODUCTS.COMP/OPAGG $2000000 POI,IGY PHOCT LOC JG AUTOMOBILE LIABILITY .... .. COMBINED SINGLE LIMIT B ANYAUTO 1022438 I 03/22/03 03/22/04 (E"G^`on') 's1000000 ALL OWNED AUTOS j BODILY INjIJRY X SCHEDULED AUTOS (Per person) S X HIRED AUTOS .__ BODILY INJURY S X 110WOWNE11 AUTO (PCr aGbdCnq –_—._................. PROPERTY DAMAGE (Por 4I=I lj) $ GARAGE LIABILITY AUTO ONLY-CA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ • AUTO ONLY: AGG S EACE55-LIABILITY_ EACH OCCURRENCE S 1000QQQ A I OCCUR CLAIMS MADE UC0130540211 03/01,/03 03/01/04 AGGREGATE .51000()00 S DEDUCTIBLE S - - I 3G RETENTION S 10000AIU S WORKERS COMPENSATION AND TORY LIM11 S ER EMPLOYERS'LIABILITY SWC405588 02/28/03 02/29/04 E.I-.EACH ACCIDENT SSQQOQQ i j E.L.DISEASE-CAEMPLOYEE $ 500000 E.L.DISEASE•POLICY LIMIT $ 500000 OTHER I I I DESCRIPTION OF OPERATIONSILOCATIONSNF;HIGI,ESIF,XCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION XXXXXXI SHOUI.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL]ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 30 SHALL For BiddiAg Purposes Only IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. gUTFlO REPR]E$ENTA ACORD 25-S(7197) ¢.iACORD CORPORATION 1988 AORTH ®wof over p 1— I A � � � h � IO—�,►- 003 No. 0741) o� �o� LA � dover, Mass., oRATED pPGt�� BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT I& r� Z 10•� S/*ova ................................ ................................................................................................. Foundation has permission to erect.. �. a .... buildings on .....� �! �1. ! .�......Rd............... Rough ....... to-be occupied as.......140 iii x Y y.0.......poo 1. . . oN !A� Chimney .. . .R . .. ...........fA. .... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to th Inspection, Alteration and Construction of � Buildings in the Town of North Andover. A15,91310 R^yo m PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR w Rough ................................ .. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE L No Date........ .... ... ... .. ... .. NORTH t` °ft"`°:• '"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING . ° i�e"IVED PAYMENI 'ss�cHusf� This certifies that ............... .. ... . ........... .... ......... .. COLLE b�R 1-6 has permission to perform ............................... .... . .,�....... . .....................CTOR wiring in the building of.... ... .. r..................................... at.....fd t-:�. .............................. .North Andover,Mass. Fee-, �Lic.No. .... ............. ............................................................... ELECTRICAL INSPECTOR WHITE:Applicant , CANARY: Building Dept. PINK:Treasurer u4E LDIAII1Qnwailth Qf !flzBu4jlEztSua. Pttrtnit Na M0, n ErparmIrm of Public E6t:fcig O=pwwti A Fae Ciacmd BOARD OF FIRE PREVENTION REGULATIONS 521 CJS 12.00 3*0 Own biamo APPLICATION All work 10 be performed n accordance W PERMIT TO PERFORM ELECTRICAL WORK e Massachusetts Electrical Code, 527 CaAA 12;'00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date T/sem i1 rY Q* or Town of NORTH AN DYER To the Inspector of vVlna; The udersigned applies for a permit to perform the electrical work described below. Location (Street b Number) 106 Putnam Road, North Andover Owner or Tenant Bernard & Elizabeth Silva Owner's Address 106 Putnam Road 13 this permit in conjunction with a building permit: Yes .v No [ (Check Appropriate Box) Purpose of Budding ___AL4,f iiP_ a<x �, / Utility Authorization No. Existing Service 19�4 Amps //�'J 2 ,20 Volts Overhead •;' undgrnd [I No. of Melefs New Service Amps _�-%/Oils Overnead 77 _ Una rna ' 6 C No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical 'Norx No. of Lignting OutletsI No. cf yet '_cs I No. of Transformers Total KVA No. of Lignting Fixtures i A cve Swimming 12-:01 �:n. r— grra gr^a — I Generators KVA No. al Emergency Ligng No. of Reeeotacte Ouwu I No. of Oil corners Battery Unita ttu No. of Swuen Outlets I No. of Gas :ewers FIRE ALARMS No. 01 Zones No. of Ranges I No. cl A-r Ccr.c. '01di No. of 001SCtlan and Cns Initialing Devices NO. of Oiaooaala I No.of Heat -0:at ;bias suns -Ons INKY NO. Of Sounding OeVtCaa No. of Sett Containea No. of Oianwasners SoacerArea meat ro sc.v OeteetiorvSounaing Devteas No. at Oryers I Heating Cev,ces Kw Lrocai - Municiou �.Othen Connection NO. 01 .`U Ji Low Voilage i No. of water Heaters KW Signs 3a,las:s Wiring No. Hyaro Massage Twos I No. of Motcrz bias mP OTHER: INSURANCE COVERAGE. Pursuant :o the reouirements .;t ;enerat Laws 1 haw a current Liaoiiav Insurance Policy snctucing C;.mo stet Ccerauons coverage at its suostanllal souivuent. yl[S = NO 1 have suamteteo Vaud proof of same to trio 0111ee. YES = 140 = if you nave eneexea YES. please indicate line type of Coverage uy crieciting the acorvoriate lion. INSURANCE ✓8CNO = OTHER = (Please S=ec.`.,I Eatunatea valve of E!ecsncal work S tExolrauon Oates . wont to Start y-�`�- �/ - Insoecaon Oats �acwas:ec: iiougn Final �•���y� Signed unser the Penalties of peryury: FIRM NAME iC, UC. NO. Licensee EZ Gid r'r/ S.gra:_re UC. No. �h,�,, / y Bus. Tel. No. Address ,P '6144r_ All. Til. ya. � r��s OWNER'S INSURANCE WAIVER: I am aware tnat ms t..censee ^cos nrn nava ins insurance coverage an its suostanuel eQtu'vabent as r♦ dutred Uy Masawnusens General Laws. ana trial my signature on nix _emit aopocauon wolves this reauuentem. Ownw Agent (plea" cried ones• issonons No. PERMIT FEE S 3 . - (S.gnature 08 Owner or Agenn 17 N2 (/ ...5 .... / .... A t NOR7M 1 i3?;.t�`` "�a� TOWN OF NORTH ANDOVER = p PERMIT FOR WIRING ,SSAcHUSE� n This certifies that .....!yJ.�`..:�... � ....G-2.�.......` ............... has permission to perform f ........ wiring in the building of.......��..1.. ..J�.j ...................................................... At......� ?... �...... tl�t11.... Q�` ,North end ;Mass. Fed / .... Lic.N �.fl ..... � 7 �. ....1.... ........... ELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer tx 0lle (golnlnonweatth of Massadjusetts Office Use Only Departmerit of Public Safety Permit No. �-7 YJ BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy & Fee Checked 3/90 (leave blank) 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 City or Town of /14R-rfi To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) f�b I[JTi✓fl/t7 >7 Owner or Tenant c�i 1 V h Owner's Address 0a�me �� ✓� Is this permit in conjunction with a building permit: Yes No Y--J (Check Appropriate Box) Purpose of Building reS! r Utility Authorization No. Existing Service _Amps J_ Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters '*"Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work eJoy TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA Above In- No. of Lighting Fixtures SwimmingPool rnd. ❑ rnd. 1:1 Generators KVA No. of Emergency Lighting No.of Receptacle Outlets No.of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Tot I No. of Ranges No. of Air Conditioners ons No. of Detection and Heat Tota Tota Initiating Devices No. of Sounding Devices. No. of Disposals No. of Pumps Tons KW No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Neof Dryers Heating Devices KW Local❑. Connection ❑Other No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES 0 NO❑I have submitted valid proof of same to this office. YES 13 NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE � BOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Work $ (Expiration Date) Work to Start d oC©d� Inspection Date Requested: Rough Final Signed under the penalties of perjury: / e FIRM NAME LIC. NO. .Licensee D13ERT T_ tiJA r-,41,& ti T Signature LIC. NO. Address /YJ 9/1 STr/y Sr L�cvi2e�t/er,, �� , Bus. Tel. No. Alt.Tel. No. .OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantia)equivalent as required by sachusetts .General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) d (Signature of Owner or Agent) Telephone No. PERMIT FEE $ 355 �� Date.�.. . ..... . NpRTM TOWN OF NORTH ANDOVER now Fr - pp PERMIT FOR GAS INSTALLATION SSACHUSEt This certifies that . . ��/. f`� f.'. .�f., . . . . . . . . . . . . has permission for gas installation . . . . .... ). . . . . . . . . . . . . . . . . . . in the buildings of . . .- . .l.t:. !!. . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . ./11,��,�North Andover, Mass. Fee. f: .'. . . Lic. No.. .F . ... . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING =- (Print or Type) L , Mass. Date �- . o�ODd Permit # J^ ' Building Location_, M n ,( A 6 Owner's NameJ _ 1 Zy J Type of Occupancy New ❑ Renovation ❑ Replacement X Plans Submitted: Yes❑ No ❑ N m Y WCr N N N V Z 2 N m N ¢ 0 N = x W W cc o a m H s z p W F' Q � _ Z 0 Y w Q m N F- a Cr o 0 r✓ 6 W W m t- a0 � W N > 4 WCr W ta cc ' WJ z tl0 Wz Q W a M z W i ' < yo0 0: o 0 � U. =j 0 j 0 c c nx F- o SUB—BSMT. SASEMEHT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR S 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone -68,7-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy X( Other type of indemnity❑ Bon ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and aocu�te to the best of my knowledge and that all plumbing work and installations performed under the permit)ssu f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s.------------- T of Ucense: 6 LTidtle umber Signature oflicensed Plumber or Gas Gasfitter Master Ucense Number 8697 (OFFICE SE ONLY Journeyman 1, BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS tNSPECTION FEE N0. APPLICATION FOR PERMITTO,DO GASFITTING r � c NAME TYPE OF BUILDING 5 LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE —19 GAS INSPECTOR � t Location �! Flo. Date +� �oRTM TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ A i Building/Frame Permit Fee $ sus',^°•''c�' Foundation Permit Fee $ _ s�cMust Other Permit Fee $ Sewer Connection Fee $ 1 Water Connection Fee $ m TOTAL $ C Building Inspector y 2273 Div. Public Works :R)tIT NO.�_`-"' , APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 f/v1AP 1JiBt �� y1 r LOT NO. 2 RECORD OF'OWNERSHIP (DATE 13� BOOK iPAGE — ZONE (� SUB DIV. LOT NO. '� (p1_ I 1,L/. LOCATION 106 Pitt nJ'*�1 Road i) ✓1 �� PURPOSE OF BUILDING putting in above lriground pool 14 LOCATION and wooden deck OWNER'S NAME Bernard and Elizabeth Silva �`'l NO. OF STORIES 1 SIZE OWNER'S ADDRESS 106 Putnam Road, No. Andover BASEMENT OR SLAB � �r,/V-r ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME gpA DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET / POSTS i DISTANCE FROM LOT LINES — SIDES REAR "' "' GIRDERS AREA OF LOT Q (I) FR NTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ➢V,n o SIZE OF FOOTING X 19 BUILDING ADDITION MATERIAL OF CHIMNEY Brick IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER yes BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER yes IS BUILDING CONNECTED TO NATURAL GAS LINE yes INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. 'PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM ECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO.4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED \ NUI NO INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT U ' F E E OWNER TEL.Al 978 685-6998 APR ,PERMIT GRANTED .3 iooQ CONTR.TEL X t CONTR.LIC.A' H.I.C.AI I OORT aTown of Andover No. /ate Z dover, Mass., 19 -COC XICM WICK A- AT - �S ORA T E p �G BOARD OF HEALTH PERMIT T- Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......................................................3�10.4................................................................................................................... Foundation . . has permission to erect...&I... ....p E�l�.. IM+IdiRge on ....../.�(o...............�.� �!v..41P. �....... .D.:....... Rough o be occupied as _ It °vil . '... .. ............. .......................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final MS office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS - Rough E .................................... Service LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CERT/F/ED PLOT PL AN PREPA RED FOR.' BERNARD B ELIZABETH SILVA AT 106 PUTNAM STREET NORTH ANDOVER, MA. NORTH ESSEX REGISTRY OF DEEDS.'8K. 4479 PG. 139 ASSESSOR'S MAP 45A, PARCEL 30 ZONING.' R-4 D SCALE: l"=30' DATE.' MARCH 3/, 1998 z z o . 0 100.00' . /4.d ' Q- LOT 2 \23 5.0' 2/' - 9660 SF-* \ " � h a 615 DIAP.' 105 POOL \\ 3 :PROPOSEDED \EXISTING WOOD DECK o DWELLING a ►° \ \' 29.4' Q , 29.5'\ 34.8' 9748' HN A, . 3IS NO. 5773 coq �v sua � PREPARED BY. JOHN ABAGIS B ASSOCIATES, PROFESSIONAL LAND SURVEYORS 137 CHANDLER ROAD, ANDOVER, MA. (508)- 688-4899 N0. 3446 'r i Qi �a�'d Moil-H Q,N'no� c� --AIL o/ �� 0 dpwul ?q .im FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and ^-partments 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 SECTIONIM APPLICANT `� .A�,� f �[ Luff l PHONE _l n Ode- M59 LOCATION: Assessors Map Number Q4�) NOC /LY4, PARCEL_ l SUBDIVISION /� LOT(S) STREET /� 44 ' ST. NUMBER i© IUSE ONLY ` t RECO ENDATIONS OF TOWN AGENTS: CONS RVATION ADMINISTRATOR DATE APPROVED S U DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED ! SEPTIC INSPECTOR-HEALTH GATE APPROVED DATE REJECTED i COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR GATE_ 1 MASSAt iUSt_II 15 UNIFUHM APPLICATION FOR PERMIT TO DO GASFITTING / (Print or Type) /(/ ���o�✓ . Mass. Date —1992-- Permit# '2-214/ Building Location_,�Z�� 4 � 722 � Owner's Name Type of Occupan ),0&1U New ❑ Renovation ❑ Replacements Plans Submitted: Yes[] Nob N OC X W N N a N x p yul = �U„ Z O f✓ w m N h W O O a. H N a W 2 U W x N Z < Lx U' Q W W UJ 07 -� a = � a C7 a W ~ W ~ Z H a z Q W Q �. H V O > u. z W J fa W m z o z tf) aac 'i 'o d � �,, 3 a tl v a y n a `r o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR 1d] JHH I I A Installing Company Name. BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET �❑ Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone 508-68,7=1105 ❑ FIrm/Co Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: 1 have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No 0 If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy J( Other type of Indemnity❑ Bond ❑ OWNER'S.INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent❑ hereby certify that all of the details and information I have submitted(or entered)in knowledge and that all plumbing work and installations performed under the permit 1ss f risceb�are true and accur to to the best of my pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene application wil U n� mpliance with all Type of License: Title Plumber Signature o cense um r or Gas Gasritter City/Town Master License Number 8697 �r•r O G p J i BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION i FEE APPLICATION FOR PERMIT TO bO GASFITTING <:. NAMES TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. > PERMIT GRANTED i DATE X19 i GAsINSPECTOR f 1 Office Use Onl _ 01 4e (fQmmIInwr# 1f :ffiagsar4usEfts Permit No. 3epartment Df public: _* frtq Occupancy& Fee Checked_± �4 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) 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 ^ (Xor Town of NORTHANDOVER To the Ins ecto of Wires: The udersigned applies for a permit to perfor he electrical work Obscribed below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunctio with a building permit: Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 1� Amps Volts Overhead Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacityv Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- grnd. Elgrnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total No. of Detection and tons Initiating Devices No. of Disposals No.of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices No. of Dryers Heating Devices KW Local MunicipalOther Connection ❑ 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 _ NO -_ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ` OTHER (Please Specify) (Expiration Dale) Estimated Value of Elec al Wok s Y� Work to StartInspection Date Requested: Rough Final oK/ C Signed under the enaltie of perjury- FIRM FIRM NAME a.., L �� LIC. NO. Licensee n SignatureLIC. NO.�., �/ G 1 s.8 Tel. No.(-'rd r 2 is, Address 19 _0":e77 Alt. Tel. No. � 4960 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 j gen (Please check one) + _ Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-5565 t Date.. :. ....e'Z.S.. ....... NORTH "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4 i # � '"'444"` �`��• �,SSACMU�� Thiscertifies that /,........................................... .:.....g.................................... as permission to p dorm ..... :t k --'..- . �rf*s-- . .:..................... Cf wiring in the-building of ......... at - '.................................... .North Andover,Mass. ELECTRICALINSOCTO Check # le_-4 -1) 5 s r_ 0 itmh,tJLYlLmunYILSHL.!nur/YltfJ�Y�l,L1v.Ls1iu --••• ��-�•�, DEP14M30VTOFPUB ICSOM Permit No. ✓�� / BOARDOFFMPREVEMONRBGUTA1 OMM7tg12Ba J Occupancy&Fees Checked APPLICA77ONFOR PERNIlTTO PERF RMELECMC,A.L WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSAC STS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datg el,;2 12)&Y __. � Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical rk de 'bed below. Location(Street&Number) QR)/„ "” Owner or Tenant V Owner's Address 2 Is this permit in conjunction with a building permi Yes[n No (Check Appropriate Box) s,��i . Utility Authorization No Purpose of Building 4 Existing Service .J.iL 0 Amps 120 /2ANolts Overhead Underground 1:3 No.of Meters New Service ..ice Amps 120volt- Overhead Underground Q No.of Meters Number of Feeders and Ampacity 2VIDL1J, � Location and Nature of Proposed Electrical Work 1i e nC A2,<__A�— No.of Lighting Outlets No.of Hot Tuba IKof Transformers Total KVA No.of lighting Fixtures Swimming Pool Above Below Generators KVA and and No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tom No.of Disposal No.of Heat Total Total No.of Detection and Puma Tom KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained { Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No. No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tuba No.of Motors Total HP OTHER, 1ww=Com•W Aaaiattibthett�c}nar �C�ett®lIaws IhmaanentlidxT1y1wwxeFbkiduftCamp' aksmegttivalat YES tj NO °Ih=,%brAwdVAd , tfsarrelod>e01�M ffyouhned�ed®dYFS. sricaledretypeefanetageby decd. ft box. ff���777 IIIA RZURANCE BOND [3 (PleaseSpt*) U l A f�,(J—// i Daft • S Estirrr*dvatieof�Wak C� WddcbStatt Rec}reslBd Rough FkW underPEsnaltiesofl r F tMNAME LjmveNa L icerwe e^�S C N w SO —�_A Siglaw Lioa>lgeNO X1_ l 9 "TdNa Addnm -� W G llX 12SALTri.Na OWNER'SMRANMWAMa;Iama wdmttheLmwdDonothmdr nuaroet�aver orilsmrb�arrialt�gtrivala�tasa3gatedbyN�d GareralLavus andthatmys mkwcntrispwnkappkaimwaivesdigte#mnt (Please check one) Owner ED Agent Telephone No. PERMIT FEES V�- Signature Owner JIM l.tJIMMU[v rrr"n Ur j,3 �•••--�--�•-, DE PAR'IMWOMBUCSAMY Permit No. S�2o BUARDOFFfitEMVFN7MRWUlAMM517C11�12. Occupancy 481,Fees Checked APPUCA77ON FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Da 12)& S Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. . Location(Street&Number) 0 U�^,A,,L Ro Owner or Tenant ; Owner's Address Is this permit in conjunction with a building penmi• Yes M No [Z) (Check Appropriate Box) Purpose of Building 4 �aJ �V Utility Authorization No. w Existing Service 100 Amps ?U /2ANolts Overhead Underground No.of Meters New Service 2Amps12G�Volts Overhead Underground No.of Meters Number of Feeders and Ampacity 14 L , �� I Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs .of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Oeneratar KVA ground 11 ground No.of Receptacle Outlets No.of Oil Burner No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Toru No.of Disposals No.of Had Total Total No.of Detection and Pumps Toru KW Initiating Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryars Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Sims Bailesis No.Hydro Massage Tubs No.of Motor Total HP YrHER- hmeacurt=Lid*kszaxeFbL-ji Nes st-die dvaid cfSMIDde016x YM ffpwhatedrad edYHS, = drtypedoowsargeby INM BOND 0 TA���+� 6(071z 5 Estirn*dValie0fl~7e"Wtk$s 12m•c'o akbSWt Regre�iad >klal PW ( N � r S t- LioaneNa 1`3 �' / 9 S Lim �F i 9 9- Bui=TdNa 7 rC -77s-0Ya E w t Le"", A L � �ilX ��SAkTdNa 'S INSURANMWA1VEIt;IamawaedutdreLxemedomMihartdrinarneco►al�ariaa�b�rrialt�gtivalait�lagtiedbl'Me�adru9ettsGalaalLawa PdviaWigridwonfisparrikappicalianwmadlismWI anal (Please check one) Owner Agent Telephone No. p FEE r m The Commonwealth of Massachusetts b Department of Industrial Accidents Mice of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: U- WA,- City L27 �"1 J�� Cbte— A/�4— Phone—* U 7 -7S aI am a homeowner performing all work myself. I art a sole proprietor and have no one working in any capacity F] I am an employer providing workers'compensation for my employees working on this job. Company name: Address City Phone Insurance Co. Policy# Company name: Address City: Phone# Insurance Co. Policv# Faiture to secure coverage as requlrgd under SedcnA or MGL 152 can lead-to—the imposition of criminal penaitles of,a fine up to$1,500.00 and/or one years'imprisonment_as dvfl. in d-a-ST.OP.MRK_ORDER..and..a fine of.($140.00)-aAi against-me. I understand that a copy of this s may and the roe of Investigations of the DIA for coverage verificalion. ti I do hereby certify under th i Ifies of% erju the information provided above is true and correct. Signature Date Z��S Print name `-� '4 0,_ Phone0Y0 / Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensi [-]Check if immediate response is required ❑ Building Dept ❑ Licensing Board ❑ Contact person: Phone#. Selectman's Office❑ Health Department ❑ Other 5�� !.:N.�,,,,:.w.a.,;T Via'-�•:1,. ....._ _ - � +• _.. +- 4 "s T3 6 Date... . .� .d'U. ..�?.. . . - 12 Q „oRrM 1 TOWN OF NORTH ANDOVER to PERMIT FOR�T NSTALLATIOM si � a � S SS'q USES t v This certifies that . . r . . . . . . . has permission forrr'!i mint Dation fle-. �. in the buildings-o . . .Q-'. . . . �- If . . . . . at . ./.l�. . .�u !jtlN?? North Andover, MA's. Fee. .fv Lic. N44!.?. �. . 6i INSPECTOR WHITE:Applicant"" ZANARY: Building Dept. PINK:Treasurer GOLD: File U 1 Date. �'A`.. ...... I f -� a�,•No o'"1ti TOWN OF NORTH ANDOVER o p PERMIT FOR GAS INSTALLATION,v y �9SSACMU`'Et m � r, /� to This certifies that `. . has permission for gas installation . . . . . . . . . . . . . . . . . . . - in the buildings of . .4.�. .Z. l. .` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . .. North Andover, Mass. Fee. .?. '. .'. Lic. No..,)-. .S. . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer L r i Office Use Only r(� ���-�,� Permit No- s U�e lYI3Yjjjjjjlnwra10 � 'J11it adpw Occupancy&Fee Checked l IlepaTtaitn2 ,nf-publte Y5 f tv 3/90 (leave blank) BOARD OF ARE PREVENTION REGULATIONS 527 CMR 12:00 ward lug Area n A 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 AL INFORMATION nate o City or Town of ►1 � t/ To the Inspector of Wires: m n The undersigned applies for a permit to perform the electrical work described below: O Location Street 8. Number) . �t � Owner or i©Want CIJd�/Jf f It"_4 4eCrh /NUQ Owner's Address z x Is this permit in conjunction with a building permit_ Yes ❑ No ❑ (Check Appropriate Box) i 7 Purpose of Building _ Utility Authorization No. rn Existing Service Amps I Volts Overhead ❑ Undgrnd ❑ No- of Meters O New Service Amps J Volts Overhead ❑ Undgrnd ❑ No. of Meters n Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work I n s t a 11 A t i on O f a l a rm s y s t e m Total S No_ of Lighting Outlets No. of Hol Tubs No_ of Transformers KVA m m 1 No.of Lighting Fixtures In xtures Swimming Fool gmd. Elgm-d- ❑ Generators KVA o No.of Emergency Lighting O JNo-of Receptacle Outlets No-of Oil Burners Battery Units n O 'o No- of Switch Outlets No-of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Gond_ tons Initiating Devices O Heat Total Total — No. of Disposals I ''^�o' ofPumos Tons KW No. of Sounoing Devices O _ I No. of Sell Contained Z No. of Dishwashers Space/Area Heating KW Detection/Soundin Devices N m No. of Dryers I Heating Devices KW Local Connection �� O DD r:o. Of No. of Low Voltage ` n No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. Of motors Total HP C7 OTHER: y m m z I IINSURANCE COVERAGE Pursuant to the requkements of Massachusetts General Laws 1 have a current liability Insurance Policy induct- rm— ing Completed Operations Coverage or its substantial equivalent_YES O NO O t have submitted valid proof of same to the Office. n YES O NO O if you have checked YES.please indicate the type of coverage by checking the appropriate box_ � INSURANCE)CR BOND O OTHER O/ (Please Specify) n Estimated Value of lectr cal Work S "?, `co (/Expiration Date) Work to Start a Ins /a 4� (D pection Date Requested: Rough Final 11 i(i O -o Signed under the Penalties of Perjury_ FIRM NAME y ry LIC. t,10. 12 31 C Licensee Signature l ri• LIC. NO_ Bus- Tel-No-617-431-5800 J Address 60 William St./Wellesley. MA 02181 AiLTeLNo.6T7-4-' 1 -5837 OWNER'S INSURANCE WAtVEFc 1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- %'=,l-quked by Massacxrsetts General laws.and ilial my signature on this permit application waives oris requirement.Owner [ Agent a�t',.,.i,'r.'-a2'' Ct►¢ckone) TeteDhone No_ PEf7MrC FEE S 2638 Date.. . . ... 45. .f. i I NOR," TOWN OF NORTH ANDOVER 020, PERMIT FOR INSTALLATION t • o �♦ H i 'rf9SS4CcMUSEt 9 t O This certifies that . �. . . . . J. e S ; has permission for installation . . .A I ck g.t*l in the buildings of . . . . . , , , . , , 4 ! at . .�.�. .�P. . . . AN �1 V . . . . . .M. . . . . . . .. North Andover, M I Fee.3�.'�O. . Lic. No./.off 3!�. . . . . . . . . . . . . . . . . . . . . . . . . .A . C '- 4 -5— , INSPECTOR 8 i WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File i BUILDING PERMIT NORTF� O��•tq+O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ 70 f/ X04 eb Permit No#: , Date Received � AOR,,,.E, �SSACHUSSC Date Issued: IMPORTANT:Applicant must complete all items on this page �"" 1 LOCATION,' 06 �t l /1/ & I I PROPERTY OWNERbe)'Ir th�Q `-5/.��A Print Et(' ( cSr�L�1� a r �-�, Print 100 Year structure, yes no MAP:- © S PARCEL:M,3D ZONING,DISTRICT: —Historic District yes . -o (- Machine Shop Village . yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑Addition 0 Two or more family ❑ Industrial N/Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _❑ Other _ _ p�Sepcp l/Ue�l — ❑ Floo�dplarn; ❑Wetlantls°��n= � �❑ VVatershed�D� trrict. a. fir, d', .. ✓'.'r t ,,, �, 7Water/;Suer ., __ __ � � __:��._._:�•�� . ' � � _ - . , �:. X DESCRIPTION OF WORK TO BE PERFORMED: � bu.,((do's A 2dtf-cz '0�0" oF-F 9rottl-LcS_d-. a- fg-P, /tn/I'cAe-d —� `2, Identification- Please Type or Print Clearly OWNER: Name: m1a 15,U./1" Ebr`zip-f-f'Z�f S,—4 Phone: Add ress:/0(p Ptj(; 44" 1 /IOQ /�✓ 2'P OWS 'Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date:: _ Home Improvement License: . Exp: Date: ARCHITECT/ENGINEER Phone: Address:_ Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ !f 000 FEE: $ 16''D Check No.: Receipt No.:- NOTE: Persons contr ting fir g e>"ed contractors do not have access to the guaranty fund �r ._ .. ti I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ �, TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ ❑ Permanent Dumpster on Site � THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si natur d (C-"oL COMMENTS l v 0 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street " F �DEPi4R+TMENIT 'Temp ®wrnp,star on' s'ife; dye"s - trio Lo t at 1�24MamStreet¢ Fire De : a e .. °si:g . a We%d ted Dimension i Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name = ..._.......... __.�____-_ Doc.Buildinb Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract � Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit 46 Photo Copy of H.I.C. And C.S.L. Licenses 4. Copy Of Contract 6 Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit-Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location No. Date • i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee $ f i TOTAL $ Check 30 Building Inspector NORTf� own_ of E 1/, ndover In No. * _ ,� _ � Z y 3 is h ver, Mass / o L > > COC NI CNl WICK s u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..../,57 BUILDING INSPECTOR .... .............................. ........................ ......................... fi��6.,p? Foundation has permission to erect .......................... buildings on ..., Q16 . .......................f.............................. Rough tobe occupied as .......... .... .1?................... ....rC .�.............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR > Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ARTS Rough ''�� ... .......... Service ............. ...... G� '2 "/ a''�.................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. TOWN OF NORM AND OVEP, ��a ►�J 4a° OSCE OF - • ' Hca :':1600 D,9kODd%rOOtBuff ft 20 -Suite 236 �iu5� NoithAndo-vox,Massachusetts 41845 , Gerald A.Brown - Telephone(9 78)68$9 45 hnspeetorofBuildzugs _ Fax (978)689-9542 . HOME4W:NER ICENSE PMRPTION ' pleaseprin-E - DATE: , �0B LOCATIOz -, DC Number StreetAddress l�ap/Zot . ' I�OAMOWNER AenqN - Name• Home Phone W orlt 'hone -PRESENT 4IL1N"GADDRESS d �; y11'�-i� •:• ' r wo � � _ Tnwn � �f . qtr• . 41 zip Cod; The current exempfion far"homeowners"was extended to iaQhide owner occupied dwellings to two units•or;$s5 and tos as s such hompo„rets to engage au.iudivadnal•forhire-rho does notpossess a License,provided that the owner acts as supervisor). Is ate3uilding (Code Section 108,3.5.7) DEF.IMTION OFHoMEOVMR I?erson(s)who awns apareel of land on which he/she resides or intends to reside,an wXzich there is,or is intended to M1 he,a one ortwo fauaily structures. Apersonwho constacts more t7iat onehome in atwoyearperzod shall not bp, considered ahomeoviner, , The nndersigned”homeowner"assumesresponsibilityforrempliances with the StateBuilding Codeand other Applicable codes,by lays,xWes and-regOations. The undersigned"homeowner"cert,Res that he/she lnders dsTown ofljorthAndoyerBuzldingDe�artment minimum inspection procedures and requiraments and /sh co requirements, / Y with;said procedures and HOAMOWNMS SIGNATURE _: / • , ATRO'S1AL OE 33UMD)NO QFFICJAL Revised 7.2009 �ozna$omeownersl=ix�nption - i3OARD OF'APPEAT.9 688-9541 CONSER.VAUON 688-9534 � _ 13EAL�.3'6$8-954U PLANNING 689-9555 35 i The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 '< Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legribl Name (Business/Organization/Individual): f h A l Address: 16 WL- P City/State/Zip: In Jd V&r Phone#: /5— Are 5Are you an employer?Check the appropriate box: Type of project()required): 1.❑I am.a.employer with employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself[No workers'comp.insurance required.]i 1 ❑Demolition ❑ P q l 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions 7 proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.hisurance.$ 6.❑We are a corporation and its offs cers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and We have no*employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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-coritrac`tors have'employees,they,must provide their workers'comp.policy number. Y am an employer that is providi�eg workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: 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. X do hereby cer ' under 1 bin and nalties ofperlury that the information provided above is true and correct. Si nature: Date: 4//2 Phone#: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Information and Instructions ; Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, 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 commonNyealtlifor any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall" enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out the workers' compensation affidavit completely,by checking the*boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)-and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 C' ffiUS� da" 0. �r F v ' 'J CNY A cl 1 7,