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Miscellaneous - 1070 SALEM STREET 4/30/2018
1070 SALEM STREET 210/106.A-0046-0000.0 Date.. ............ r NORT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING ��SSACHU n This certifies that ..:`::f..-r:...............:/..�:-<�.. ��:."....�..................................... has permission to perform . ............................................... wiring in the building of.......:,.,.:......................... ......................................... at � �' al� -�- .......... ... .. .North Andover, ass. Fee: ...`✓....... Lie.Nofi.t/..�,/ � ? ` ELECTRICALINSPECTO v �. Check #/fes . 930 Commonwealth ofassachusetts MOfficial Use Only Department of Fire Services Pemut No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked_.�S' .... [Rev. 1/071 Qeave blank V APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W AW OR TYPE ALL INFO&"TJO City or Town of: NORTH ANDOVER Date: t4— _ By this application the undersigned gives notice of his or her intention to perform tTo the'he elc electrical wector �l�ies described below. Location (Street&Number) S Owner or Tenant Owner's Address a ephone No. 1 Is this permit in conjunction with a building permit? Yes Purpose of Building NO ❑ (Check Appropriate Box) Utility Authorization No. 71/A Existing Service ?60 Amps d /y Volts -t Gverhead E Undgrd❑ No.of Meters New Service Amps ____/_Volts' \ Overhead Q Undgrd ❑ � No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No.of Recessed LuminCom letion o the ollowin table may be waived b the T——tor of Wires. aires No.of CeiL_Sus No.of p.(Paddle)Fans Transformers Total No.of Luminaire Outlets No.of Hot Tubs KVA Generators KVA No.of Luminaires Swimming Pool Above ❑ In_ o.o mergency d• d• ❑ Bo Units g No.of Receptacle Outlets No,of Oil Bun-Hers . FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o..of Detection and No.of RangesTotal NImiaatm Devices No.of Air Cond. No.of Alerting Devices No.of Waste Disposers eat p Number Tons ICS' Totals; -- o, of elf-Contained No,of DishwashersDetection/Ale Devices Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KWSecurity Syeterns: No.of Water No.of No.of Devices or E uivalent Heaters M Si No.of Data Wiring: s Ballasts. No.Hydromas sa a Bathtubs No.of Devices or E uivalent g No.of Motors Tom Hp Telecommunications Wiring: OTHER; No.of Devices or E uivalent Estimated Value of Electrical Work: 1? .4aach additional detail if desired,or as required by the Inspector of Wires. Work to Start � (When required by municipal policy.) 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 undersigned certifies that such coverage is in force,and a The has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BONDE3OTHER Icertify � El (Specify.) G4'1 M. �� ". under the pains and penalties o perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: //� r (If applicable, a er "exempt"in the Cense n er line. LIC.NO.: Address: Q p d 3 9'�7�l-8'cF'j'-66'!,3 *Per M.G. Bus.Tel.No.:_L c. 147,s.57-61,security work req es Department of Public Safety"S"License: Alt Tel.No.: 't :kT o 9'x'6 OWNER'S INSURANCE WAIVER: I am aware that the Licensee doliability Lic.No. re es no wired b law t have the Iia ' ' q y . By my signature below,I hereby waive this requirement I am the(check one) E]owner normally Owner/Agent E-1 owner's agent Signature Telephone No. (9 Av o Poe oP l � i The Commonwealth of Massachusetts kf Department of Industrial Accidents i, Office of Investigations 600 Washington Street Boston, MA 02111 t ' WKW-Muss govldia . Workers' Compensation Insurance A.fiFdavit: gudders/Co>atractors/Eiectriciaas�piumbers A iicant Information Please Print LeQibl Name(3usincss/oWiration/individual)- r Address:, D Q City/State/Z.;ip: Phone#. . Are you an employer?Clmecktbe appropriate box:' 1•[SG I am a empioyer w 4 1 Type of Project ith t(requiref: emPloYees(foil andlor�— ❑ am a general contractor and I G. part-time).* have hired the sub-contractors ❑New construction 2.❑ I am.a.sole proprietor or partner- listed io ees °n tae attached sheet i 7. [ZRerrtodeling ship and have no em . P Y These soli-contractors have working for me.in any capacity, workers'.comp.insurance. g' Q Demolition [No workers'comp.insurance 5. ❑ Weare a corporation and its 9' ❑Building addition Id] Officers have exercised their 10.0 Electricalairs or ad 3.0 I am a homeowner 7eP dations doing all work right of exesn '� MGL myself, [No-workers' Pu P� 11.�]Plumbing[N rkers comp. g repairs or additions P c, 152, §1(4),'and we have no insurance required. .t 12. Roof ] I ❑ repairs em ees. P oY [No workers comp. insurance-inquired.] 13.0 Other w�Y appiicattt that checks ba l must also fill out the section below showing their workers'co 1 homeowners who submit this affidavit indicating they are doing all mpeaudion policy information. 4C nintctors that check this box must g ° and then him outside contractors must submtt a new affidavit i an additional sheet showigg the ng 6f the sub.. ndica*such. tea'—.rs' �' . - wn: . I ant ane _ F p6u�y mi6miaiion. employer that is , y !r!14 ft workers compensation insurance or inforrnafion. f employees: below is the Policy mid job site . Insurance Company Name: Policy 4 or Self-ins.Lie.P Expiration Date:_ Job Site Address:_— Attach a copy of the wor rs Com City/State/Zip; pensation policy declaration page(showing the policy number and expiration Failure to secure coverage as required under Section 25A Of MGL c. 152 can lead to the imposition.ercriminal fine up to $1;500.00 and/or one-year imprisonment, Of up to$250.00 a da a y advised a well tis civil penalties in the form of a STOP WORK ORDER and a fine Y gainst the violator. BeEe advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I !do hereby cert fy under the pains and penalties nfPerjwy *at the infnrmatfonP vtro ' da above is true and corm Sierrature: ' Date: Phone#: Of, vial ase only. Do not write in this area,to be cmn 1 eM or town o rcia( �' fi' ` City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2_ Building 6.Other Department 3.City/3'owu Clerk 4. Electrical inspector S.Plumbing Inspector Contact Person: Phone#: Date.. . . . . . ..... .. '40RTH OF 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9SSACNUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation in the buildings of . . MAY176-747 . . . . . . . . . . . . . . . . . . . . . . . . . . : at J.0. . . . ... . . . . . .S',-4. . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. . . Lic. No..":� . . . . . . . . . . . . . . . . . . . . . . A.". GAS INSPECTOR Check# Ti 79 r MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date- NORTH ANDOVER,MASSACHUSETTS Building Locations J(10,90 f 4 s-7-- I Permit# Owner's Name Amount$ New❑ Renovation � Replacement Plans Submitted ❑ .wa w c U x x C', �' v� F W O .�z D O z F U W x z H a c a > W a x x F x zz w w w a W > W C � Q >+ z O z O x x o x w > SUB -BA SEM ENT BASEMENT , 1ST. FLO O R 2ND . FLOOR fes, 3RD . FLOOR A ��- 4TH . FLOOR 5TH . FLOOR R`- 6TH . FLOOR 7 T H . F L O O R STH . YLOOR (Print or type) Check one: Certificate Installin Com an Name _J �UlL6 FSC Lrt" S 7/ +• • g P Y El Corp. Address `11�rj' �c.��/P,✓1 GL G 1 "T��-CC'�/j 41 &- Partner. usmess a ep one 9 -2j, Name of Licensed Plumber or Gas Fitter .��� ht 6 _r g 4,9,&. INSURANCE COVERAGE Check one: ' I have a current liability Insurance policy or it's substantial equivalent. Yes E3 No M If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ©� Other.type of indemnity Bond Owner's Insurance Waiver: I am aware that the-licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:3 Agent 0 1 hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in By: Signature of Licensed Plumber Or Gas Fitter Title [0--Plumber City/Town El Gas Fitter License umber !.' Master APPROVED(OFFICE USE ONLY) Journeyman W The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ..600 Kashington Street Boston., MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organiza6on/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1.❑ I am a em to er with 4, Type.of project(required): p y ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub=contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp.insurance 5. 9. ❑Building addition p ❑ We area corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no insurance required.]t 12.❑Roof repairs Q ] employees. [No workers' comp.insurance required.] 13.7 Other *Any applicant that checks box 41 must also fill out the section beiF '^ snol'icb heir wok compensation policy infozmatian. f Homeowners who submit this'a'ffi' davit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub contractors and their worker comp policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the poliQ7 and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: ' City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).,' Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date.: 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#: r Information an d 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, anP or express implied,oral or written." P An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coxnpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter.into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented.to the contracting authority.,, Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,:are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the peramt or license is being requestedI,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 i town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business.or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. Tlie Commonwealth of Massachusetts Department of Industrial Accidents Office of Investicafioas 600 Washington Street Boston,MA 0:2111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax it 617-727-7749 wmrv,-mass_.gov/dia l 1 Date.�� A1.V. . . ...... .. WORTH o� TOWN OF NORTH ANDOVER F D • PERMIT FOR GAS INSTALLATION • a 9 9 �9SSACHUSESS t This certifies that . i16!'ham. . . , fi^u r o b�. ,,pp . . . . . . . . . . .... has permission for gas installation . .Vu-- - �5�. . el yr''. in the buildings of . .Al -.S:.. . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . Pvt. . North Andover, Mass. Fee—94'. " . . Lic. No.iii.q ... . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# 'y 0 I Ti 78 MASSACHUSETTS UNIFORM"PLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location /a 7® Date z / Permit# Amount Owner 'eh4�G aTS New rl Renovation Replacement. Plans Submitted Yes No FIXTURES S[SEM Bila" T M11" I 2M IIOCR 1 3M ELOCR 4M IIOM 51H KIM 6M ELUR 7M EMM S>(HRfm (Print or type) `� -�' Check one: Certificate Installing Company Name 1146!�8.I `p R o i)C I C w! -4 if �`C�- �6' Corp. 14��' 4, ,t4/P PGL Iz a, Address ❑ Partner. GyeC f 3 c/VLc}, %'yz 19 O IS 7 G, Business Telephone d'- $ / ,- s de t 9,2d,--F15-61 ,76& Q-Tirm/Co. Name of Licensed Plumber: �yy"'0-s `66 f)o()&- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond El Insurance Waiver: L the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance signature Owner Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S,,taft Plumbing Code and Chapter 142 of the General Laws. . By. Signature of Licensect r-rurnoer - Type of Plumbing License lTitle (?S-City/Town rcense ITEM Master Journeyman APPROVED(OFFICE USE ONLY The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Uf 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /<1Ot"las -Tp/L0,04r Address: 2 LZ a'� Z_ lfJlOo« dZ 17 City/State/Zip: ���.r /.9 c 2 d , - Phone#: e! 2 ol — 6"-D 25-' Are you an employer?Check the appropriate boa: Type of project(required): 1.Qum a employer with -7 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. ❑guilding addition [No workers' comp. insurance 5. ❑ We are a corporation and its irequired.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself[No workers'comp. c. 152,§'l(4),and we have no _ 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.[:]Other +Any applicant that checks box i mast also fill out the section below shoving their wary ers'compensation.policy nfo.--oration. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Namej�_",� { . Policy#or Self-ins.Lic.#: Expiration Date: Sob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirarion date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Simature: Date: 1,rlwo�D 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):L1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es) and phone number(s)along with their cerdficate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be:shoe to fill in the permit/license number which will be used as a reference number. In addition,an applicant ' that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A�copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.rnass.gov/dia i Date...... .... ... .... ... .. ... .... _.-160 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4CHUS Z ........................ This certifies that ................................................... ..... A -7 has permission to perform ...... . . fwiring in the building o ................................................................................... 7'0 54 L S7......................... North Andover,Mass. at................................................... Fee F: .. ... Lic.No. b7'6 Y6............ ... ........ .............41....... ...... ELECTRICAL MpEcTAR Check # 8049 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No._.)?o Z1kip BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 10 1-0 cSAIE 6n s , Owner or Tenant (; C.pp h h1A 4. Telephone No.qN196 Owner's Address 19 .510- Is Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Boz) Purpose of BuildingI Utility Authorization No. Existing Service /00 Amps / is Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity r Location and Nature of Proposed p sed Electrical Work: S ©. 5i 64 , w�a11 1:Jhk2 a ®at1e1� Com let:on of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus addle 0.0 Total p (paddle) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above In- o.o mergency tg g rid. ❑ rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. TotTonal -No.of Alerting Devices Totals: No.of Waste Disposers Heat Pump Number.Tons KW No.of Self-Contained Detection/Ale Devices No.of Dishwashers Space/Area Heating KW Local[IMunicipal Connection ❑ Omer No.of Dryers Heating Appliances KW Security Systems:* o.of Water No.of No.of No.of Devices or Equivalent c� Heaters KW Si s Ballasts . Data Wiring: No.of Devices or E nivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: N No.of Devices or Equivalent OTHER: alent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ,�D0O r (When required by municipal policy.) Work to Start: Insppeccttiioons to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Lti S S�,Vg Signature LIC.NO.: 10'7 1.y $ (If applicable, enter"exempt"in the license number li e.) Address: _ S3yoh S� . ' - M./� a. Bus.Tel.No.: '11 It-Z63-RRZS �tAlt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) [�owner ❑owner's agent. Owner/Agent Signature Telephone Nol�f 8'6� x PERMIT FEE: $ 4 • 1 PAW i I! Date. . . .?. 'w NORT" .�� TOWN OF NOTH ANDOVER PERMIT FOR PLUMBING F This certifies that . . . . s r- -s. ,r-r�—t.�!!��—s-�!-. . . . . . . . . . . . . . has permission to perform.,��. ... t plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . t at / . . . <. ._._`�:� : .�f:: .�^. -r:��:`._. . . :.. . . . . . . North Andover, Mass.�, ` a.F. / . ,g Fee/O� . . . .Lic. No.In ` f .. . . . . . . . . . UMBING��ECTOR/ .17 Check 9 t: 7672 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date a'df- Building Location m SI" Owners Name ��/� 6/a� Permit# Type of Occupancy IW— Amount New Renovation Replacement Plans Submitted Yes No FIXTURES in Cr C4 CA 9[B)�VVIC 4MHfM 7MHD>R 81H HAOCIR t (Print or o type) Check Certificate Installing InstallinComp any Name IC( Q Co� 7a7 Address eSPartner.0 Business Telephone 1 Firm/Co. Name of Licensed Plumber: �►�//�91yI /tJ�i�� Insurance Coverage: Indicate the type nsurance.coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: Tignafure of Licensedm Type of Plumbing License Title (U al w City/Town License MITI= Master Journeyman ❑ APPROVED coma USE ONLY �, ,� ,_..- _ - _ ': , b . :� -� t� � p t � :-. Date. .- '�. ..-....... . NORTIy TOWN OF NORTH ANDOVER O F • - PERMIT FOR GAS INSTALLATION Ito. SAc HUSE�ty This certifies that . .. . . . . . . . . .- �-! - .� �'-•�->-''' . . has permission for gas installation :: . . . . . . . . . . in the buildings of r'` . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at e>. .7 . . . . . . . .-' , North Andover, Mass. o� F e . . . . Lic. No:. . . . . . . . . ^ . . . . . .. . . . � `G7CS`INS� .�.OR Check# 6356 MASSACHUSET'T'S UNIFORM APPUCATON FOR PERMIT TO DO GAS FTrnNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locatlon�/to f �'•/ v' Permit# Amount$ � 009/y �1i4 Owner's Name New® Renovation ❑ Replacement S/ Plans Submitted ❑ 0 o U z c H c c c A z w w �, a o• °o oo w o SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR n (Print or type) lj � J/� C ec on� Certificate stalling Company Name ° Address a W � u Partner. ❑ usiness a ep one ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Wf d h INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked Les,please indicate the type coverage by checking the appropriate box. Bond ❑ Liability insurance policy Other type of indemnity ❑ 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 ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with ail pertinent provisions of the Massachusetts State Code and hapter 142 of the General Laws. Ali[)/GL�%N�+ T S' ature of Licensed Plumber Or Gas Fitter By: Plumber 0 a �' Title City/Town ❑ Ga Fitter License Number Laster APPROVED(OFFICE USE ONLY) ❑ Journeyman i Date.. ............................ NORTH. °ft"`°:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SO^CMUSES U � SIC13 S Thistcertifies that ........................�..��...............o o � � has permission to perform ..... . wiring in the building of....�...c �:E' 2 1 r a n .............................. ............................... ........ ....�......S......t.................5.4— at .............N rth Andover,Mass. Fee..... 1• ..... Lic.No.1��`IS� .....��-.. 2�4.!.�.. t. L . ..!�....................... ELECTRICAL INSPECTOR Check # a R 45u6 THE COVIMONWE4LTHOFAWSACHUSETTS Office 5� nl DEPART112BV_('OFPUBLIMFLYY Permit No. C") BOARD OFFIREPREVHMONREGHAHONS 527 0 W 12 M Occupancy&Fee Checked VPLICAHiONFOR PERMIT TO PERFORMEU 1 CTRICAL 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 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) /,--) Owner or Tenant f Owner's Address Is this permit in conjunction with a building permit: Yes No P=r (Check Appropri'Zi Purpose of Building horization No.Existing Service Amp 4Q /jy&olts Overhead Underground f..D aQ s New Service Ampy/1J i zjvoits Overhead L Undergroundi Ivo.of Mecers Number of Feeders and Ampacity 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 Below Generators KVA round ground 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 OTHER• hmtrartoeCovaag�Ptaa>intmthe�gtritar�a>Lsof�Ga�a-alLaws - IbawaamatL aWdy}Ycaan PokyuridTc Dict CMWor ts&kAM1 lWvalat YES 1:3' NO IhawwbmiuDdvaldptoofofsarrl iDdr011iim YESLJ If}ouhawdreledYES,Pimwitrbc& tetypeofcoWWby drddngtbe box INSURANCE BOND OTHER (PlmwSpe*) y� EqimtimDue EsftmVedVak&ofEbchAWcdc$ WotktoSlatt. hqectionDateRecgtested Rough Final Signed under$iePmalties of pew FIRMNAME IkensseNo lum'see I� ILg Slgttahae Licer>SeNo BusQmTeIM ' OWNER'S INSURANCE WAIVER;I am aware thatthe License does not have the irmanoe covaabe or its substaatal equivalent as aepred by Massachusetts G=TA Laws andthatmysignatuieonthisp anitapplicabonwaivesthisaequaim)ertt (Please ch on O her . Agenti — Telephone No. f6dRMIT FEE$ 7V Igna ure ot UWner Or Agent Z The Commonwealth of Massachusetts M , Department of Industrial Accidents \ b , W d Office of Investigations Boston, Mass. 02111 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 n-y employees working on this job. Company name: Address City- Phone# Insurance.Co. Policy# 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 c rkninat penaWms of.a fine up to$1,500.00 and/or one years'irnprisorr.as-vias-cant,penaltiesjn26elam-dA-STDPYll9PoC Raad-afire-dA$I1t M)-atiayagaiast,m I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify under the pains and penalties of perjury that the information provided above its true and correct Signature Date Print name Phone# Official use only do not write in the area to be completed by city or town officiar City or Town Permit2icensing. C7 Building Dept pCheck if immediate response is required p Licensing Board, E] Selectman's Once Contact person: Phone#- E] Health Department Ei Other Town of forth Andover f NORT1f Office of the Zoning Board of Appeals y A Community Development and Services Division 27 Charles Street North Andover,Massachusetts 01845 Is CHUSEt D. Robert Nicetta Telephone(978) 688-9541 Building Connnissioner Fax(978)688-9542 Any appeal shall be filed Notice of Decision within(20)days after the Year 2002 date of filing of this notice in the office of the Town Clerk. Property at: 1070 Salem Street NAME: Margot Lindau DATE: September 13,2002 ADDRESS: 1070 Salem Street PETITION: 2002-029 North Andover,MA 01845 HEARING: 7/9/02& 9/10/02 The North Andover Board of Appeals held a public hearing at its regular meeting on Tuesday, September 10,2002 at 7:30 PM upon the application of Margot Lindau, 1070 Salem Street,North Andover,for a Finding as a Party Aggrieved of the Building Commissioner's description of Margot's Gallery as a retail business prohibited by the North Andover By-Law Section 4,Paragraph 4.121(4)within the R-1 zoning district. The following members were present: William J. Sullivan,Walter F. Soule,John M.Pallone,Scott A.Karpinski,Ellen P.McIntyre, George M.Earley,and Joseph D.LaGrasse. Upon a motion made by Walter F. Soule and 2°a by Ellen P.McIntyre,the Board voted to GRANT the applicant's letter requesting that the petition be WITHDRAWN WITHOUT PREJUDICE. Voting in favor: William J. Sullivan,Walter F.Soule,Scott A.Karpinski,Ellen P.McIntyre, and Joseph D.LaGrasse. Town of North Andover Board of Appeals, r !� William J. S llivan,Chairman Decision2002-029 Board of.Appeals 688-9541 Building 688-9545 Conservation 688-9530 Health 688-9540 Planning 688-9535 raga 1 U1 1 a �I No ver Mar I ,M_ ., Ma etts ' - 3 �. --.. te .s. .._� .�...�..—y r..>F Furniture anArt for your Heard & Home Add to our Guestbook i Fill in the blanks below to acid to our guestbook. The only blanks that you have to fill in are the comments and name section. 'Thanks! F Your Michael McGuire Building Inspector Buildinginspector@townofnorthandover.com E-Mail: _ North Andover (MA� City: _... ..__.:,State:l_`._._ ___..__.� Country: .............................._..._..._.._...,_........ i Comments: Please contact me @. 978-688-9545 between the hours of 8:30- 10:00 AM or 1:00 - 2,:00 PM as this type of business is not r- a allowed in a residential area. e Back to the Guestbook Entries Home)Visit our GallervI Featured Artl Contact Usj Information designed by: PNERALD CI 1999,all rights reserved � I1L1 ://W W W.IIldi ULS AllCl .CUIIll �' �' y �TUC�Ud.uu�uesL.IlIIIll . 1 JL adv V.L I 3 IM, & � M •F L"�A. t *G a <: ? re IIL L�://WWW.IIldi' ULSdi1C1 y.CUIIU DUL WI1.i1LIIll J/4/U 1 perfect treasure for you,a friend,a child,or the child in you. Bring the World's treasures home today.If you are interested in viewing our complete collection of Shona sculpture or perhaps our custom handmade furniture,paintings or other exotic folic arts from the world over,visit the gallery,contact us for gallery hours and directions,or visit our online Information form. If you're looking for the perfect gift for any occasion,Margot's Gallery now offers gift certificates! Share the gift of art with your special someone-contact us today for details! Design professionals,don't miss out on the endless design potential our gallery holds for you and your clients.Whether you require made to order furniture,custom reproductions,or perhaps have a unique design or decor requirement,Margot's Gallen,has an ample selection of exotic art,sculpture and furniture to fit any taste or specification.Please visit our online Information form or contact us today. Homed Visit our Galleryl Featured Arty Contact Usl Information designed by: IERALDC" lamam ' I C-51999,all rights reserved I161P://WWW.II1dI-gULSgdilCry.00II1/110IIle.IILIIH _ __..... .,.�.. �...... X arc i vi Z, s C No Ver 3t . { ' tt fiCC " ,�r,a .,'.�«a�v"P"c3'Xe',rti ,.�,,.��,c?�..:r.�:�^'seY'2. eM�i.�•.'?""'.^5�: �";.-, aTi.a.,z:`�F-.,sG':.=.'a}.'�'.k:x.FA3. ;xi-kYe ?£'s.,:,.�.T:m^k-�'wu,Cx.Kru,.u':; Furniture and Art for your Heart & Home Art should intrigue,comfort and above all male you smile.At Margot's Gallery we offer a unique blend of folk art,hand-made furniture, and sculpture from the world over that touches your heart and soul. Whether you are an art enthusiast seeking an investment piece for your collection,a home owner looking for the perfect accent to your home decor,a savvy shopper searching fora f unique gift,or a design professional seeking a custom piece to fill a particular design specification,Margot's Gallery has something special waiting for you. Margot's Gallery,housed in a 260 year old New NOW FEATURING ]England home-circa 1740,provides an inviting atmosphere in which to explore the exotic and folk art treasures displayed within its historic -!� walls. Our International collection of folk art, x ' f`'E r, furniture,and sculpture includes: y ® Mavan textiles from Guatemala 3''ws + Hand-made Native American jewelry and pottery e Exquisite Mexican beaded art work. e Festive Mexican yarn paintings 9 Whimsical Oaxacan animal woodcarvings F `' ® Jamaican paintings ® Peruvian textiles and pottery a Eine Spanish handmade tableware e .Land-made folk art furniture . Native American Art i Custom furniture of the 1700's built to meet today's needs ® Inuit carvings mr .. * Lustrous Shona Tribe stone carvings and -P.., d much more.... Each piece represented in our collection is an original and has been hand chosen for its unique form,beauty and message. Allow Margot's Gallery to dell}you discover the I1Ll ://WWW.IIldl ULA AdllCi .CUII I y U IUIIIC.I1LIIll -Qr,G 1 Vl G 1 a r Ou ry F. "v..TC,.di.+t WMI.?3..5„nava' Furniture and Art for your Heart & Home Margot`s Gallery located in historic North Andover Massachusetts is housed in a 260 year , old homee circa 1740,providing an inviting atmosphere in which to explore the captivatingx folk art treasures displayed within its historic k alis. The works represented in our gallery have an a �� international flavor and appeal with pieces ranging from the exotic and unique to the 8, whimsical and folk inspired. :, Acquired from Guatemalan,Mexican,African, Jamaican,and American artisans,each piece of art in our ample collection is an original,crafted using traditional means and hand chosen for its unique form,beauty and message. Works represented in our.Mexican Art collection including intricate Mexican yarn paintings,as well as the whimsical Oaxacan animal woodcarvings,provide most with a smile as well as insight into the traditional culture from which they originate. Our extensive collection of African art including delightful tin animal sculptures as well as stone carvings from The Shona tribe of Zimbabwe. offer not only a modern and intriguing art form but also an astute investment opportunity for the collector and an inspiration to the art enthusiast x in us all. x Other collections at Margot°s Gallery including w4 I artworks from the Inuit,erotic Mayan masks, pen and ink drawings,and textiles as well as paintings from the beautiful Island of Jamaica � offer lush lines and wonderful textures that stimulate the senses and touch your heart and soul. IILLP://WWW.IlldlgOLSgdllel-y.Colll/ganery/galleyy.IILIIII i In addition to offering sculpture and art r' from the world over,Margot's Gallery Is also your source for Vermont handcrafted custom period furniture.Each piece of furniture built using techniques that have been used for centuries,has its own distinct personality and charm and will last for generations to come. Any piece of furniture in the gallery may be ordered as it is displayed or can be '�-r' designed to fit your specific requirements : or tastes.We also can reproduce an Y4 antique that you've always wanted or perhaps design a piece to fit that hard toy , fit area Bring the World's treasures home today.If you are interested in viewing our complete collection of Shona sculpture or perhaps our custom handmade furniture,paintings or other exotic folk arts from the world over,visit the gallery,contact us foralg lery hours and directions,or visit our online Information form.If you're looking for the perfect gift for any occasion,Margot's Gallery now offers gift certificates! Share the gift of art with your special someone-contact us today for details! Design professionals,don't miss out on the endless design potential our gallery holds for,you and your clients,Whether you require made to order furniture,custom reproductions,or perhaps have a unique design or decor requirement,Margot's Gallery has an ample selection of exotic art,sculpture and furniture to fit any taste or specification.Visit our online Information form or contact us today. Home)Visit our Gallgal Featured Artl Contact Usl Information designed by: I LsuJ O a i 01999,all rights reserved II6Ip://WWW.IIlA1'�UL��i1.11Ciy.CUIIU�dIIC1'y/�dIICIy.I1UIll �/c}/V 1 I rage l (it I smosso . .;. - VON- re W� -m � �o . x . i i i IIL L�.//WWW•IIlcLI�ULy�A.11CI y•GUIIll�AllCIy/DULLUIl.I1LIIll k i Y gip`' Y y.� f inrroduang native american ewel :and dotter r; �Y p Y ar. ,31 J. y� KK v d t' World Folk`Art�' 'a i and Furniture fq' Your', HAdrt`, jomA mz � R `�{^1070$AI,EM�$TREET�wNO'�ANDOVER,MA•978 683 6333,,, >.�, _, www marpotapc�ll�[y,cym Tie Wad�Q 2pm•FTbu 10 Y m 4 7 m� } i N2 Date.....r/ ��/U/ N- 2994 NOItTM °f'"`°:•�"� TOWN OF NORTH ANDOVER ° A PERMIT FOR WIRING �,SSACHU`�� This certifies that ..... �! ;'1 ...... ........... �w�iC FS .... ... ......... ............ ........................................ has permission to perform ���. to S���n- .. ....... . .............................. wiringin the building of U . 4 at../ .w. `'�i�GL7..... ...............................orth Andove`r,-Mass: Fee... ,-.� Lic.No. J ....... / �...1�.............. j; ELECrR'iC �L�NSPECTOR G Check # J� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Official Use aily Department of Fire Services Permit No. '. ._. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CIvII�12.00 (PLEASE PRINT IN LYK OR YPE ALL FORMATION) Date: "[ City oz Town of: (� , tndmgx- To the Inspector of Wires: By this application the undersigned a ersigned gives nota of lus or Tier intention to f rform the electrical work described below. Location(Street&Num`ber) a Owner or Tenant Telephone No. Owner's Address V Is this permit in conjunction with a building permit? Yes ❑ Nog (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / 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: P6 &6C46 Coni lesion of the following table niav be waived by the Inspector of lfires. Na.of Total No. of Recessed Fixtures No.of Cei1-Susp.(Paddle)Fans Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No.of Libhting Fixtures Swimming Pool Above ❑ n- ❑ o.o Emergency Lighting ornd. ornd. Battery Units No.of Receptacle Outlets ---]No- of Oil Burners FIRE ALARMS No, of Zones No.of Switches INo. of Gas Burners INo. of Detection and Initiating Devices Total No.of Ranges No. of Air Cond. Tons No. of Alerting Devices No.of Waste Disposers IHcat Pump Number I Tons I KW INo, of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating I,'W . (Local ❑ Municipal El Other Connection No.of Drycrs Heating Appliances Kit becuritySystems: No of Devices or Equivalent. No.o Water KW Ito.o o.o (Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eq uivaient OTHER 9ttach additional detail if desired,oras required by the Inspector of Wires. INSURANCE COVERAGE: Unless«•aived 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 undersi!zted certifies that such coverage is in force,and has exhibited proof of same to the permit issuingoffice. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) 1 - _ .-L_ - - (Expiration Date) Estimated Value of Electrical Work. T� (When requited by municipal policy.) Work to Start: Inspections to be requested in accordance Nvidi NEC Rule 10,and upon completion. I cettifi,,under the pains andpenalties of perjury,that the information nn this�app11 atinn is true and complete FIR I NAME: ADT Security Services 111 Morse Street,Norn-44 MA 02062 LIC. NO.: 1533C Licensee: John S. Bassett Si-natur LIC. NO.: 1333C (!f applicable,enter"arcntpt••in the license number line.) / Bus.Tel. No.: - . — 1 Address: Alt. Tel. No.:603-594-5928 resi ONAINER'S INSURANCE WAIVER: 1 am aware tint the Lii`ensee does not have the liability insurance coverage normally ONLY . required by law. By my signature below. I hereby waive this requirement. 1 ain the(check one)❑ o«mer ❑ owner's agent. Owner/Accnt turc Telephone No. PERJIIIT FEE: 3'66 3313 Date. NppTM TOWN OF NORTH ANDOVER 3?py 4��ro ,e,tipL p p PERMIT FOR GAS INSTALLATION ,SSACNUSES This certifies that . J..r:L"/ .��f. . . . . . . . . . . . . . has permission for gas installation . .7 1 ` . . . . . . . . . . . . . . . in the buildings of < :'5� at f/. . . . . . . . . . . . .. North Andover, Mass. Fee.�.v: .:". . Lic. No..,,.�.t �.n;, . . . . . YGAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer i MASSA I I APP CATON FOR PERIYIIT TO DO GAS FITTING Y f _ ��Type or print) PARCE Date 199? NORTH ANDO Building Locations l020 Permit 9 33 /3 Amount S ,20 r- � h do v e r -441 Owner's Name �.e � CO h �j / a� New❑ Renovation ❑ Replacement Plans Submitted ❑ L4 n n — w C Z v U -t ? " N n z SUB-BASENI EN 'r BASE ,vt ENT is'r. FLOOR 2ND . FLOOR 3RD . FLOOR d'ril . FLOG R 5'r If FLOG R 6'r 11 . FLOG R 7'r 11 FLO G R NT II . F1, 00 R (Print or type) // '� Check one: Certificate Installing Company Name ,�&b e Rwd Pli iu atg Yllsiztin7 6cirp Corp. /&09 Address &X 728 ❑ Partner. /Jo 4Ad Ov er- "119 Business Telephone 979' 97!5 4-299 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Po.b e rf D t a ne h e# INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes rqvl No❑ If you have checked ves,please indicate the type coverage by checking the appropriate box. Liability insurance policy (R] 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 ❑ i hereby certify that all of the details and information 1 have submitted(or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit [ss d for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and hapten 14 f t eneral Laws. Signature of Licensed Plumber Or Gas Fitter By. ❑ Title Plumber 8 S 137 Citv/Town ❑ Gas Fitter [cense Flumoer Master APPROVED(oF(-(c:r_use ONLY) Journeyman ' 1��6�// �.rt. ...._r-.u.'Sr.....`t.3;;;. �: ..,.�;:,, ,.Ott.•. .i ..-+e'•,� r "'^—?'a;.. �'�'.--^• - _ . . .fi Date. 1763 a NORTH TOWN OF NORTH ANDOVER 0 t ,,ao .e,'4, .ti F� ICU `p PERMIT FOR GAS INSTALLATION Y • ♦ f .` i Y vq •� SS CH 5Et aO This certifies that has permission for gas installation 1 . . �.. , •'�! ! in the buildings of,. t`�:. . . . . Cot ' / T . . . . . . . . . . . . . . . . . at . . !\k. , r 1 , North Andover, Mass. Fee. . "". Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . CV [S7?14-1 GAS INSPECTOR ,WHITE:Applicant CANARY:Building Dept. PINK:Treasurer GOLD:File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) NORTH ANDOVER Mass. Date 3-QS E uilding Location l0 20 S 4le/`►9 ref Permit # \71 (0 �U 0 X411 do u el , 221 G/- Owners Name f'R COC! /Cl f 1L NO Y • - _ New 77 Renovation Replacement Plans Submitted =] .S FIXT(_( N Ga 4VF- N t- I 1 S NowCPo < ¢ 0 G1 .z II 0 C3 WW O ¢ W 4 N CC W Z U W a. N W K Q in y W W W d7 < + n CC a W W h Z t7 ¢ O F- x , H z W N U 1 W F- W Z d W G a (' Y- N pj O Z O N Z Q ys y C W J Q G 4 d O O W p W !^ O C7 u. O to .1 U ¢ } Q d F-' O SUIT—SS IMT, t BASEMENT I ST FLOOR 2140 FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 6TH FLOOR FI (Print or Type) Check one: Certificate Installing Company Name j Alle /20GI P # (20rp Corp. Address 60 K 7 -;t-& - Partner. No- r4mc4c)v er 10 M z Firm/Co. Business Telephone: q7-!5 Name of Licensed Plumber or Gas Fitter 120'1-3Lot4 Insurance' Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [�< Other type of indemnity 0 Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. L�4e oej 9VAY=� — Signature of owner agent of property Owner 17 Agent 1 hereby certify that aU of the detsils and information 1 have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and instAtivioas performed under Permit issLed for this application will be in compliance with all pertinent provisions of the Massachusetts Slate Cat cude and chapter 142 of the Genctal Lawa. By TYPE LICENSE= `C- - '-1 '�) ,N er Plumber Title lSignature of Licensed fit Plumber or Gasfitter City/Town: Mas69 559,9 Journeyman APPROVED (OFFtci_ USE ONLY) License Dumber =r.-R._3*'jai..�:iS..''Yrt-.'-i-✓'":vs' _...�v-�t./' �,y y mow..._._,. ,r..�.i.w.�,.y,....••�.v.--..r.;+'—•.. Location No. Date � 27 rca TOWN OF NORTH ANDOVER$ - p� t�ao ,a,tip �? t• _ '_ a pL _ p Certificate of Occupancy $ 49 • Building/Frame Permit Fee ,SSACHUSEt Foundation Per ' Fee $ Other Permit F. t $ Sewer Connection Fee $ ' 1 Water Connection Fee $ TOTAL $ Building Inspector F j� 8307 Div. Public Works I PE&JiIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP +40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE - MON E I SUB DIV. LOT NO. LOCATION w PURPOSE OF BUILDING P1 ' OWNER'S NAME ,p NO. OF STORIES 'I SIZE OWNER'S ADDRESS /IC-' BASEMENT OR SLAB ARCHITECT'S NAME -(/ SIZE OF FLOOR TIMBERS IST _ 2ND 3RD BUILDER'S NAME A I mi raed Q � SPAN DISTANCE TO NEAREST BUILDING .JJ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION *1," �n�' IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Y IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST WOO _ i V PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. i PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. `+ ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY 1 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR � DATE FILED � BUILDING INSPBCTOR SIGNATURE OF NE R AU HORI FjD GENT 1. F E E 3Co D OWNER TEL.# PERMIT GRANTED CONTR.TEL.!t 199 CONTR.LIC..�N H.I.C.# l J J0 i X83 0^1 I BUILDING RECORD 1 OCCUPANCY . 12 SINGLE FAMILY STORIES .THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY oFFICEs _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- a APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER DRY VJALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ V, lh '/. FIN. ATTIC AREA _ N_O 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH __--- ASPHALT SIDING .ARDVJ'D �— ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASP..TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRIC ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ' ADEQUATE 1 NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH 13 FIX.) _ GAMBRELI_d MANSARD TOILET RM. (2TOILET RM. (2 FIXE FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR A TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING NORTIy : TO" of r R over -. L 'No. 212 -- A K E art dover, Mass., Z 19`j,S I� COCHICMEWICK ��' 7�ADRATED H BOARD OF HEALTH PERMIT T Food/Kitchen Septic System F` �OQ i3l, BUILDING INSPECTOR .............................................................. . THIS CERTIFIES THAT...... .�........................�.................................................. Foundation has permission to ereet../E1 cmc ................ buildings on .10..0....54......... .....5................................ ... Rough to be occupied as... .....�? "...... .POC . .......t.�...5�....... . I ......T'.C� Chimney Chi e provided that the person ac pting this permit shall In every respect conform to the terms o he application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final to PERMIT� EXPIRES IN 6 MONTHS. ELECTRICAL INSPECTOR UNLESS CON U T T Rough . ........ .... ...... Service BUILDIN SPE OR 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 Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT OFFICES OF: Town of 120 Main Street APPEALS NORTH ANDOVER North Andover, •;� : BUILDINGMassachusetts 0185 CONSERVATION `" rDIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KARE H.P..NELSON, DIRECTOR In accordance with the provisions of ;LiG: c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be -disposed of in a properiv 'icz-1sed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location of Facility) Zx"52 Signature of crmit Applicant Date NOTE: Demolition permit from the Tours of :forth Andover must be obtained for this project through the Office of the Building Inspector. A f U __ ✓�e 'l nnr:nro�eraaa�C/t, c`�lli uc/ru eCl Restricted to: 00 . — DEPARTMENT OF ?U8L!C SAFETY CONSIRUCIION SUPERVISOR LICENSE 00 - None I IF — Nuaher: Expires: Birthdate: lA - Masonry only' CS i 056683 08/14/1991 08/14/1950 1G - 1 & 2 Fasily Hoaes Restricted To: 00 r e RICHARD 8 SIIVA m 11C 30WERS RO � - .con+M�ss��H£. DERRY, NH 03038 t