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HomeMy WebLinkAboutMiscellaneous - 1075 SALEM STREET 4/30/2018 1075 SALEM STREET 210/106.A-0259-0000.0 09987 Date . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . •M�. '�.j.(', .i. • • • • • • • • • • • • • • • • has permission to perform . �l'1(�wr Q r`�� "�•�Q �e,0.b plumbing in the buildings of. . . Ji North Andover, Mass. Fee . Lic. No. PLUMBING INSPECTOR Check i i I �3 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK MA DATE PERMIT# _ CITY dOSSITEADDRESS __ OWNER'S NAME. i - ' ....._.__.- OWNER ADDRESS TEL _1 Q1�._ TYPE OR OCCUPANCY TYPE COMJLL MI=RGIAL[ EDUCATIONAL, Q RESIDENTIAL PRINT PLANS SUBMITTED: YES[3 NOD CLEARLY NEW:ID RENOVATION:[� REPLACEMENT:� 3 —s BS4d. i 2 ; 3 4 $ fi 7 @ 9 . 10 ii i2 13 14 FIXTURES`1 FLOOR ------ BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND 5YSTEM .l I 1 - DEDICATED GREASE SYSTEM _I " _I .... DEDICATED GRAY WATER SYSTEM - QEDiCATED WATER RECYCLE SYSTEM DISHWASHER - - --- DISHWASHER J _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR 1 AREA DRAIN INTERCEPTOR INTERIOR rs KITCHEN SINK i J LAVATORY ROOF DRAIN - - - SHOWER STALL SERVICE l MOP SINK TOILET URINAL } � ^. ---•- - `_. { WASHING MACHINE CONNECTION ------ WATER -WATER HEATERALL TYPES WATER PIPING - I - ---- - —I —- ! ------ - i t - 1NSURANCE COVERAGE. I t3ave'a current Itabli -insurance policy 6T Its substantiae equlvafent which meets the requirements of MGL Ch.'142. YES _," NO IF YOU.CHECKED YES,PLEASE INDICAT27�€OF COVERAGE BY CHECKING'HE:4PPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY[ BOND( . OWNER'S IDIS -R NCE WAIVER:I am aware that the licensee does not havethe:Insurance coverage required by Chapter 942 of the Massachusetts Generale Laws; d thatrmyyature on this permit application waives this requirement. d CHECK ONE ONLY: OWNER AGEN'r SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information 1 have submitted or entered regarding this appticaffon are true and accurate to the best of my tcnowledge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance vft a runent provlslon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. — PLUMBER'SNAME ._ (1Q _ LICENSE SIGNATURE _._._.- MP[d ,!PD,I CORPORATION F ]OF PARTNERSHIP[ # COMPANY NAME ADDRESS CITY Fo __. - . ... STATE TEL Z�rt FAX _ J CELL EMAIL -- fb '—O. rl._____ 0 I ��//��{{'' t A� �� e !_ M_ a � -� �� i act CERTIFICATE OF LIABILITY INSURANCE DATE �x`2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE.CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 confer rights to the certificate holder in lieu of such endorseRnent(s). CONTACT PRODUCER NAME: .it8ren �FOtreat orse Insurance Agency, .Inc. PHONE (781)784-8444 Fac MNo?(781)784-4147 12 Post Office Square E- A11 .k'arenforrestWnoreeins.coml - INSURERS)AFFORDING COVERAGE NAIL If Sharon MA 02067 INS URERA:Peerlesi Insurance . INSURED INSURER BAGN .Insurance .C21iTany 14788 DONALD BENOIT DBA ABR MEQHANII A INSURERC.Associated Employers Ins. 36 OAK STREET INSURER D :.INSURER E:' FOXBORO MA 02035 INSURER F: COVERAGES 'CERTIFICATENUMBERmaster 13=14 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,ITERM OR'CONO ITION.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. INSR R POLICY EFF POLICY EXP- .. LIMITS TYPE OF INSURANCE POLICY NUMBER (MMfDDNYYYI tMMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE R $ 300,006 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oceurt c /8/2013 /8/2014 15,000 A CLAIMS-MADE Q OCCUR KS 55417838 MEDEXP(Anyoneperson) $ . .. PER ADV INJURY. S .1,000,000 GENERAL AGGREGATE I S. .. ..2,000,000 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPIOP AGG- $ -2,000,000 X -POLICY PR0. LOC _. AUTOMOBILE LIABILITY °' Eaacciden4BINEDSiNGLE IMTf 1.000 000 - .... BODILY INJURY(Per person) $ . ANY AUTO ALL OWNED X -SCHEDULED1T4625D /8/2013 /8/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS -"- NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS _ er 'enl $ .UMBRELLA UABHCLAIMS-MADE .00CUR - - EACH OCCURRENCE "$ EXCESS UAB AGGREGATE _ $ DED RETENTION$ - $ - C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY - PROPRIETORlPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ _ .500 000 ANY OFFICERIMEMBER EXCLUDED? ® NIA CC5010684012.013 /8/2013 /BJ2014 - IMandatory in NH) E.L DISEASE-EA EMPLOY 3 50 0 0 0 0 H yes,dascnDe under EL.bISEASE-POLICY LIMIT $ 500,000 .DESCRIPTION OF OPERATIONS betow ._ - - . . - i DESCRIPTION OF OPERATIONS f LOCATIONS i VEOCLES(Attach ACORD 18t,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover Building Department AUTHORIZED REPRESENTATIVE 1600 Osgood Street Bldg 20, Suite 2-36 North Andover, NIA 01845 Karen Forrest/RMF ACORD 25(2010/05) ©198&2010 ACORD CORPORATION. All rights reserved. INRn756ninnR%ni The-Af f1Rr1 n�mn earl(nnn ore ro.vicfn►nrl rnorlr�of 6/lfAtl i+FyeL��f.47 ;�i �,�L L< •�._=sem ,: PLU VERS APD GASEITTERS LICENS.Ol AS A MASTER PLUMBE ISSUE fNy 601Jc LICENgE 710: _,JOIES P ,,-:s:.R tANDEZ s 6.RE,AT P 1!in'.R1' J 15478 05J0:i%14 165096 •'.t-s�-�'�+•-t �'j�`zr-Ff�°�`; �'�f.. !t1 t 3 e �J"t ftr� 14•��--i i t 3 4 3 ! 4 { f Qd Eastern Bank awtm MA o2110 •�.. eagembankcom �Aa tr A.B.R. MECHANICAL. 1400-EASTRI4 360AK"STREET 53-179-113 FOXBORO,MA 02035 W d PAY TO THE $ 6 ORDER OF �Z�n C ia(U' � �-i1V�J C DOLLARS x SIC, (( f"\ AUTHOR NATURE MEMO j� 1 n 4J - _.r=- .. 112003I65i1' jb L b3,01?981: 06 0035946 ?10 A.B:R.MECHANICAL 8165 A.B.R.MECHANICAL 3165 I PRODUCT SSMN 116E WTH 91663 ENVELOPE 00 040 Date. .1P.!.1!.. ..... . i T1y Of aj TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION �,SSACMUSES - 'Q This certifies that . . . .q . . !? . . . . . . . . . . . has permission for gas��llation . . . . . . . . . . . . . . . . . . . . . - in the bu1il4ings of . . . at ' . . . I � . Ut. North Afidover.%Mass. Fee. . � `.DaLic. No.. 1 . . �: . . . . . GAS INSPECTOR ; Check# 1/2 S x` 8298 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .' CITY _ _____JMA DATE _ _ / PERMIT# JOBSITE ADDRESSV �' �✓,(c',� � OWNER'S NAME OWNER ADDRESS _ TEL — �FAXI __1 TYPE OR OCCUPANC YPE COMMERCIAL EDUCATIONAL _, RESIDENTIAL PRINT CLEARLY NEW: . . RENOVATION:© REPLACEMENT: �! PLANS SUBMITTED: YES -1 NO APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ! [ 4 I I_ _ _ ! i _ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER _ FIREPLACE FRYOLATOR I . FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT _ ( T ^_ Tf. -�.--a . I _-AL_I J OVENPOOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST _I I _ UNIT HEATER _ _.. -� - _ 1 UNVENTED ROOM HEATER WATER HEATER OTHER -.� I ... I - - . I f I ._ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAG Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 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 E] AGENT£ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-G..SFITTER NAME LICENSE# SIGNATURE MP MGF Ell JP 0 JGF 0 LPGI Ell CORPORATION 0#=PARTNERSHIP©# LLC 0#= COMPANY NAME: _. _..- "' �,� _- _S " .__. ADDRESS CITY STATE[ ZIP �. TEL - -- - - FAX CELL _ EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES -��-12 6etr"zcdW f Yes Ppb• - THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i The Commonwealth ofMassachusetts Department of IndustriqlAccidints Office of Invesdgations IV 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): Address: J� O /3 elk City/State/Zip: '` Phone#: )L 3(, Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. F1 New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.I 7• F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] 3111 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie 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 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 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 cert under the pain and p Ities of erjury That the information provided above is true and correct. Simafore: Date: CJ Phone#: U 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,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-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 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 an questions regarding the law or if you a Y Y q g g y re 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 futureb r ermits or licenses. A new affidavit must P e 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 bum 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 ludustrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO,#617-727,4900 ext 406 or 1-877:MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass,govfdla Date.�.Wr�.......... .. r10pTly TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ....P�1.......-6e.U,.I.- AZ. .......................................... .................... ............................................. haspermission to perform ........................................................................................................ wiring in the building of....... ....................................................................... at f5........... ................ dover,Mass. ..... ....................... .......................... Fee... ..........Lic.No. ...... ...... . ............. ....... ELECrRI AINSPECrOR • Check# 'DAD 11620 N Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. - Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. ]/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEQ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S^9a";o)3 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 electric work described below. Tj Location(Street&Number) Owner or Tenant / Telephone No.972 093Q\ Owner's Address o, vim(/ Is this permit in conjunction wR a building permit? Yes No ❑ (Check Appropriate Box) Purpose of BuildingLPW Utility Authorization No. r`aJ Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location anp Natt r�a of Proposed Electrical Work: (,6, I io%f Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets ''�rNo.of Hot Tubs --- Generators KVA No.of Luminaires `�_.� Swimming Pool Above ❑ In Elo.o mergency Lighting rnd. rnd. Battery 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. Total `"i Tons No.of Alerting Devices No.of Waste Disposers r►^� Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers �� Space/Area Heating KW Local❑ Municipal El Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KWI Signs Ballasts I No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent JX�DD OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work.., : � n CWhen required by municipal policy.) i Work to Start: ASAP 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. \ CHECK ONE: INSURANCE„k BOND ❑ OTHER ❑ (Specify:) I certify,under tf:e ns an p hies of rjury,that the information on this application is true and complete. FIRM NAME: Y LIC.NO.: 31 ;� Licensee: 31 s Signature C4 LIC.NO.: (Ifapplicable,ent r "exempt♦"in th license i9mber line.) PA/Lot Bus.Tel.No.•C1 V 374 Address: 4 4 Y 1 Alt.Tel.No.: *Per M.G.L c. 147,s. 57-61,se urity 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,1 hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. F A s t t C "It . .i ki QM,1- , :.1.. r F.M b,€ �::�, 1� Z3 �,..�': 'e S�.S4�,,�,•�'- M-.-' r.. •.. ,�� :'- 'A t 4�.� at,'� t. ��� �:'� � �• t,, 4a: , �1t. � �. � j. a !i �. 1.1•}, X131`•�,,+�� .�f ,1 #tr.y� _t�, 4r�1,t,1 ,�= » 4� t q` 4 „ • 1 4 �'t, =.1 tit •t, 14,_ �a! It;:.,.if� ' .1. M :. i ° .r. � a l�. ,� .�s,.. 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' MIKE l D►1�/ I1�1► 3 1F P'Rt S� 1 A LIME Mlr-R' .` GAR(D � F , IV ROWSE- O,d 4 ;.!!s i V, z` ; ' + # i �'. - €R � i c. F'= � t` 4".fie i> _� �' � '� xa a' $-.� a' _ s �� .} .�.� ,1• ! (� i 1 y'�t ! h � �� + .� �' ,- s § xSF #s #.�. ., �'_� .3 � � ��..X. fk s 'r` i� .�- i� lr•*. � 1 � � 1 y. , 4 : -_, [ /. f . � .� ...� #A. �,.. .�.�i� �-� t - ! #l•� -� 3.-�- � #, # .,.y � � �' k.. A� ` ,:..3 JF 3 �# ,� •. _ '�:'� iYc � � (1 1•# �.,�, � 3s � ) t �. � k�• A �. ._ .Tk ,.� � d 1 R i "� arJ 4 dl♦ , ., �. t� ..�"� �..� , .;.. ,�. '! _! i .,r ,a�_ I �l:.! .X €. I. �. a<. x e i i Page 1 of 1 9 1 Attached Images I+ =Cts EATS .R w ELECTRICIANS AS A REG JOUR.1nYMAN ELECTRICIAN ISSUES THE ABOVE UCENSE TO.' �pq PAUL R BRUNELLE i 62 LEDGE ROAD PELHAM NH J3076-2600 31053 E 07!31!1:. 164410 http://mail.aol.com/37752-111/aol-6/en-us/Suite.aspx 5/29/2013 3: s Location. . �a e� `�G � �✓r . No. " ` Date NpR*PI ` TOWN OF NORTH ANDOVER& A Certificate of Occupancy $ ' ; Building/Frame Permit Fee $ 9619 Z Iv° Foundation Permit Fee $ SSAEMUSE y Other Permit Fee $ Sewer Connection Fee $ : ` Water Connection Fee $ i s TOTAL $ Building Inspector _ ' 9722. Div.Public Works Location No. - Date r „0RTpf TOWN OF NORTH ANDOVER o } ; Certificate of Occupancy $ ' i^ # �� •_ Building/Frame Permit Fee $ �CHus t�f Foundation Permit Fee $ a " i 2 rmit Fee $ Sewer Connection Fee $ '^►._ 3 Water Connection Fee $ { TOTAL $ Z 5 vL VA: Building Inspector 06/24 �fE?4 PAID 9875 p t*} 4 5 Div. Public Works Location No. r Date /-��—/Io "ORTM TOWN OF NORTH ANDOVER 5 p Certificate of Occupancy $ y : • ; Building/Frame Permit Fee $ �� ^°•''t�' Foundation Permit Fee $ -40— CH Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL PAID 15000 (ding Inspector tA4/24/9611:E(B 150.00 9.721 Div. Public Works �D Location s4 No. Date N°to RT" TOWN OF NORTH ANDOVER 1 4 p Certificate of Occupancy $ Building/Frame Permit Fee $ F ��° no I•`,�1 r��� SA AU 'FoU:raAa�ion Pjer)qt e Other Permit Fee Sewer Connection Fee $ Water Connection Fee $ 77,570 TOTAL $ Build! g Ins r 04/24/96�17 ,� 1,077.50 PAID �j Div. blj Works PF.R311T NO-- APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4d0. �` LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK PAGE ; • ON I SUB DIV. LOT NO. RF ar, �, LOCATION ® PURPOS OF BUILDING014 � �i ON%N,ER'S NAME A NO. OF STORIES SIZE , !E 34 OWNER'S ADDRESS C �BASEMENT OR SLAB •O y ` ARCHITECT'S NAME �� SIZE OF FLOOR TIMBERS IST dZ [�/b 2ND JA[f�y/6 3RD BUILDER'S NAME r IkL4e 1606 ca C SPAN DISTANCE TO NEAREST BUILDING �/� ( DIMENSION OF SILLS DISTANCE FROM STREET 51 .( �p " POSTS 61"/SLI DISTANCE FROM LOT LINES-SIDES REAR GIRDERS 6► AREA OF LOT FRONTAGE Q / HEIGHT OF FOUNDATION THICKNESS O il IS BUILDING NEW SIZE OF FOOTING �® X �® IS BUILDING ADDITION - MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILL D LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE o IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 1 44 IS BUILDING CONNECTED TO NATURAL GAS LINE Ser Ake Y—lf 45634'G INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDESZ,/ I coo, ? EST. BLDG. COST , PAGE 1 FILL OUT SECTIONS 1 - 3 / U EST. BLDG. COST PEW SQ.,FT. � PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM a SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED if 7 SYILDINO INSP<CiOR SIG UR o0w E R T RIZED AGENT f F E OWNER TEL.k PERMIT GRANTED �Q CONTR.TEL.# l� ^-Z BLDG.PERMIT IFEE � 19 " FFF NTR.LIC.# -104;Lg/ q� • H.I.C.# .......... I DING RECORDPA ,1C, 1 OCCUPANCY SINGLE FAMILY I 'sIn 12 THIS SECTION MUST SHOW EXA DIMENSIO F 11""DIS B FROM MULTI. FAMILY o I s LOT LINES AND EXACT DIMN I NS G�, JIL GS. ITH P CHES. GA- APARTMENTS RAGES. ETC. SUPERIMRbSb6-T RE-1 Aii T�1J CONSTRUCTIONtJs 1`N 92 9 TZ 2 % ATION INTERIOR CONCRETE d I t OD •1t ��� gyp,► Jj 'f CONCRETE BL K. PINE 00�� BRICK OR STONE HARDW D PIERS PLASTER , _ DRY YJALI UNFIN. AREA FULLBASEMIL\ I FIN. B M'TAREA 1/1 1/7 '/ (>> FIN. ATTIC AREA I, N_O 8 M FIRE PLACES 111 HEAD ROOM MODERN K C%N 4 WALLS I FLOORS CLAPBOARDS B 1 2 3 �'� DROP SIDING NCPETE ——�— <.I WOOD SHINGLES EARTH ---yyy '�JJtJAIy� ry � ASPHALT SIDING HARD1!J'D �_ '^�+� 1•� .y ��iy.y ASBESTOS SIDING _ COMMCN T �1 VERT. SIDING ASPH.TILE �'QEOO STUCCO ON MASONRY STUCCO ON FRAME BCK N MAS yitYATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR C 1 R BILK. STONE ON I SDNRY WIRING STONE ON FRAME SUPERIORPOOR _ 11,ADEQUATE I� NONE f 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) t GEA M8REL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR - TILE DADO � 6 FRAMIN 11 HEATING WOOD J `T Q QPELESS FURNACE - - RCED HOT AIR FU RN. yp ��_� �1 j#{Q1 TIMBER BMS. d COLS. STEAM _ , r 1 Si�'t)u- --i a iW STEEL BMS. L . OT W'T'R OR VAPOR WOOD RAFT 5 R CONDITIONING '.33 mi"i aij RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING s i `O R i` Tollir". ofdover 4 No. 1,V3 North,: Andover, Mass., 19 r BOARD OF HEALTH PERMIT TO BUILD Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........................................ �... .G�. A.......� .Q ,.... 4. ....................................... J Foundation has permission to erect........................................ buildings on ....../0_7 ....... �/ .........5✓l�..r........ Rough to be occupied as ............810000 ............1 C l?l (.� Chimney y............................ 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-taws 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 _17 Final f_ re vh ; f " f 4 3.ty S ELECTRICAL INSPECTOR Rough ......................... ... . . ... ..... .. ... . .. .... .............. ................ Service B ING INSPECTOR Final I._ ing_ GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Registry of Deeds Northern District of Essex County Lawrence, MA 01840 04/19/96 ARJUNA CONST CO AN # 45 Rec:time 0157 Type FLAN 16.00 Inst 9338 Copies 1.50 # 46 Rec:time 0157 Type DECSN 10.00 Inst 9339 Copies 0.75 Postage 0.32 Total 28.57 # 47 Payment Check 28.57 THANK YOU! Thomas J. Burke Register of Deeds , Town of North Andover yITr�vl_�, NORTH J OFFICE of JOYCE CE ORAD111A �Og"«ao �pO COMMUNITY DEVELOPMENT AND SEINK"DOVER •- p I 146 Main Street ��8 �l 2 ?4 P �y #• North Andover, Massachusetts 01845 9SSACMU`•ES 1 is to csrtffy t;at hventy(20.;aa; ^:�e ejapsed from aata Of dadslo:i':ad ,_",Out filing of an appeal. Any appeal shall be filed JnycsA Tc3raa�hatj ::r�G(erk within (20) days after the date of filing of this Notice BOARD OF APPEALS In the Office of the Town NOTICE OF DECISION Cie'k. Property: Lot B Salem Street Arjuna Construction Co., Inc. Date: 2-27-96 160 Pleasant Street Petition:#003-96 North Andover, MA 01845 Hearing: 2-13-96 The Board of Appeals held a regular meeting on Tuesday evening, February 13, 1996 upon the petition of Arjuna Construction Co., Inc. requesting a Variance pursuant to Section 7, paragraph 7.1,7.3and Table of the Zoning Bylaw. A variance for this lot was previously granted on February 14, 1994. Since the grant of the variance, a question has been raised on the title to the portion of the lot under the New England Power easement. The following members were present and voting: Walter Soule, Joseph Faris, John Pallone, Scott Karpinski and Ellen McIntyre. The hearing was advertised in the North Andover Citizen on 1.24.96 and 1.31.96 and all abutters were notified by regular mail. Upon a motion by John Pallone, and seconded by Joseph Faris the Board voted unanimously to Grant 53,000 square feet of the lot dimensional area requirement of 87,120 square feet. and 25 feet relief from the rear setback requirement of 30 feet. The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that the granting of this variance will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. ,, p Board of Appeals AM ST: Walter Soule, Vice-Chairman ATrue Cc-,y I.S:Tlid 99,9T ddU BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 f • kAWREI`jCE, MASS.A TRUE Copy. "tGISTER OF DEET • LIFORM U - VER`IFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary . approvals/permits from Boards and Departments having jurisdiction _. ; have been obtained. This. 'does not relieve the applicant and/or landowner from compliance with any applicable local or state law,t regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: /T r l VL,& �- \.% SAN. C Phone ok-&, LOCATION: Assessor' s Map Number AD i /1 Parcel Subdivision Lot(s) Street )r h i S= St. Number �d ************************ fficial Use Only************************ RECOMMENDATIO S r TO AGENTS: Date Approved 9 • Conservation Administrator Date Rejected Comments C T kIl a Date Approved n Planner Date Refected Comments f Date Approved Food Inspector-Hie\alth Date Rejected C 1 Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections • - driveway permit _—TO Fire Department Received by Building Inspector Date 4 0 own of )rth, � Aiid No. Y3 ` 41 North. Andover, Mass.; BOARD OF HEALS H Food/KitchenPERMIT TO BUILD .. . - _. Septic System BUILDING INSPECTOR. THIS CERTIFIES THAT........................................� C- Foundation has permission to erect........................................ buildings on ...... ..�........::.>. .L.�a........ :. .. .. .�........ .. t0 be occupied as........................................................: �...�:`.fi! ^. :./'rte it`1�11 �! }� Chimney provided that the person accepting this permit shall in every respect conform to the terms of tWapplication on file in this office, and to the provisions of the Codes and by-Laws relating to the Inspecti a�llt ate ���dd Construction of Fina Buildings in the .Town of North Andover: - - �KM1�f U�FOt�NDATION ONLY } REGULATED 6Y NARr,. 114.E- . 13.C.. ... P UM G I ECTOR :. . .. VIOLATION of the Zoning or Building Regulations Voids this Permit.. DATE FEE PAID lt$R IC -..INSPECT t i > k� ......................... ... .. g.... Service _ rt � ' B •ING INSPECTOR rte.i �r �,+ ��� ,mi." � •� k n y ltilltaS( (flp('r t f _- . GAS INSPECTOR ,Display !na Conspicuous Place on the Premises - Do Not Remove / m ;�.. O�/� � g \ •�t x �>� }�e . y No Lathing or Dry Wall To Be Done,,- , I Inspected and Approved by the Building Inspector. FIRE EPARTMENT i��� „a,, _.,�• ; �, - Burner , Street No. '° Z ;AT Y a. Smoke Det. * *�.z t � C �tt ri CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 143 Date MARCH 25, 1997 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1075 SALEM STREET i MAY BE OCCUPIED AS SINGLE FAMILY DWELLING IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. MORTIS o,,. • ,.��a CERTIFICATE ISSUED TO Ar'una Construction 160 Pleas t S . ADDRESS over '°a CHUS� tl i spector TflDate. . 2632 &ORTM TOWN OF NORTH ANDOVER a A PERMIT FOR GAS INSTALLATION 8 £s �9SSACHUSE<9 - :4 n This certifies that .�.-t (": • • . , , , • W4 I!•.I C,sr has permission forPd ; 5r" i tallation . . : .�SwS, , . . :. . in the buildings o C/l . . . . -'.3Z�. . . . . . . at . 7. . .(f . . .. . . . . . . .. North Andover, Mass. e Fee. Q Lic. No.. . .�,�., .. . . . . . . . . . . . . INSPECTOR lit`'�- WHITE:ApplicantRw Buildirig;Dept. PINK:Treasurer GOLD:Flle V-Ij- . The Commonwealth of Massachusetts Dcpartmcnf of PAiblicScfcty �•••" '• .2632 Occvrawcy 1 Itt'o�eetvtr — BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1200 3/90 V3� �laa•a •IMI) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL �1111ORK t All wrk to be performed In accordance.with the Macaachusens EJectrkal Coda.S27 CMR 12:00 (PLEASE PRINT IN nm OR TYPE ALL, INFoPymON) Date )�- 21 �' C City or Town of Al, /�}vd/ ���c To the Inspector of 'Wires-. The unetrsigned applies for a permit to perform the electrical work described below. }y Location (Ctreet b Number) ZG 7✓"_ S4 0.'ner or Tenant_ o,z� �`— Owner's Address 6 �` Is this Permit in conjunction with a building permit: Yes ❑ No (Chet Appropriate Box) Krpose of Building_ Utility Authorization le/2e,3 —l/ Existing Ser-.ice Amps / Volts Overhead 0 er..� Undgrd C of New Service Asps 1-7-49 / z y0 Volts Overbead f_J UndgrE ❑ No. of Metes W�, Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs Total No. of Transformers XVA '•o. of Lighting Fixtures Swimming Pool Above In- grnd.❑grnd. ❑ Generators ICVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Cas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total tons No. of Detection and Nr. of Disposals No. of Heat Total Total Initiating Devices Pu=Ps Tons No. of Sounding Devices .Vo. of Dishwashers Space/Area Heating 1W No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices lac _ Local❑Municipal ❑Other No, of o, o Connection No. of Water .eaters xW Silms Ballasts Low Voltage Wirin No. Hydro liassage Tubs No. of Motors Total HP OAR: INSURANCE COVERAGE: Pursuant to the requirements of hastachusetts Central Lava I have a current Liabilit Insurance Policy including Cot:pleted Operations Coverage or its substantial equivalent. YES(�NTO I have submitted valid proof of same to this office. YES "M Ii 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 S tExpiration ate Work to Start_f '2/�` Inspection Date Requested: Rough tj Final Signed under the penalties of perjury: FIRM NAME LIC..N0, Licensee � Signature LIC. N0. �3 s.' Address BuTel. No. �G8'-vlfl'7— x/04/ Alt. Tel. No. O;N R'S INSURANCE WAIVER; I am aware that the Licensee does not have the insurance coverage or is sub- stantial equivalent ay required by Massachusetts Cenera1 v3T.a . and that my signature on this permit application waives this requirement. Owner Agent (Please check one) y Telephone No, PERMIT FEE S Signature of Amer or Agent