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HomeMy WebLinkAboutMiscellaneous - 109 BLUEBERRY HILL LANE 4/30/2018 / a� goy 109 BLUEBERRY HILL LANE J/ 210/098.0-0095-0000.0 r r _ 1 Date.....,A... �P 4....... 40RTH 4 ° ,�`'° '••"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSCHUS This certifies that ......:�......;- ...... .r. .... ... .�f ................... has permission to perform ................................... wiring in the building of....... ...... , f�- - 'er,....................................... 6-7 at/e1...?.. �<.. ................. ,North Andover,Mass. ... Fee,..�+,.'�f..!! 3 ..... Lic.No G?r�t`. f.��F � 2f�. ...... ELECTRICAL INSPE� �,�"' Check # (/V//// 6912 1�f\ Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services o� Occupancy and Fee Checked c - — ` a BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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: - ) - ©G City or Town of: 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) SQL'{ 1�2(,J4' �� �.-c\\ L W , Owner or Tenant rL poc e.tin 7 Nov" Telephone No. Owner's Address IcQW Is this permit in conjunction with a building permit? Yes FX No ❑ (Check Appropriate Box) Purpose of Building S c rQUtility 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: v�(��tx�( etd,&to &dLj\ 4 o 0F\ 15 Fa•k •u�4, ��� Completion of thefollowing table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans ' No.of Tota Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- El o Emergency 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 InitiatingDevices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons KW No. of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Munk'palConnection El Other No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent Heaters No.of Water Kms, No.o No.o Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of lectrical Work: -4�M•00 (When required by municipal policy.) Work to Start: q- )-0S, 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete,,_. FIRM NAME: `�C� C)OVC>eJ LIC. NO.: E 363 Licensee: ���' bJQCd' Signature LIC. NO.: L 3to (If applicable, goer "e ,empt"in the license nu+ ber line.) \� Bus. Tel. No.: 7 Address: `I lac�ev Qc>�.� `�� �o ��V� Cy Alt.Tel. No.: --y 7 614 f *Security System Contractor License required for this work; if applicable,enter the license number here: 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. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $�'� �M �� .�. � � r Date. 8966 TOWN OF NORTH ANDOVER �: �.� .,, .• CL PERMIT FOR PLUMBING 40 ,SSACows� This certifies that 7.0 t . . . . . . . . . . . . . . . . has permission to perform... . . . . . . . . . . . . . . . . . _ plumbing in the buildin s of . . . . . .�lA[�l�la��.� . . . . . . . . . . . . . II at . . .,���. . .��f�:. :G!1✓.T�,l:�c . . . . ., North And`©fve�r:, ass. F�.�.S.• U. .Lic. Noc�U.��.�. . .�� . .f . . . . . . PLUMBING INSPECTOR Check " MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: kV W`115�� MA. Date: Permit# Building Location: /D 9 //VcrafzOwners Name:/tee-V.514S Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No FIXTURES DEDICATED w z SYSTEMS F- z W Y z v) LA O H a � Z < Y Q y U FN- W Z z N x LU ,A Q W Z F- W Z �„• N Z M h W W In W Co Cn W C I-- � } C � N Y to 0 O a a Z Z 0 Y H ?� o = 3 w a O D w w J Q Z a x x u R W Z W W x a O Q Y of U I- Ln v� O ~ u > > O O a z Z �n F- H w I Q F- x 0 h W Q NQ a m m e o LL °x Y g 3 y h 3 3 3 0 ¢ 3 SUB BSMT. BASEMENT 1ST FLOOR 2"D FLOOR 3RD FLOOR 4m FLOOR ST"FLOOR 6T"FLOOR 7'FLOOR 8T"FLOOR ` / _ , (Afv Check One Only Certificate#` Installing Company Name h 31•� 9r�wooer v/"tea El Corporation Address: ity/Town: Stater , El Partnership Business Tel: q, q F�G (7 Fax ❑Firm/Company Name of Licensed Plumber: FINSURANCE COVERAGE: ve a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No , If you have checked i Y ked Yes lease indicate the — p type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSU NCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachu s neral Laws,and that my signature on this permit application waives this requirement. Check One Only ®� Signature of Owner or Owner's A ent Owner El Agent I hereby certify that all of the details and information 1 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. By Type License: Title Plumber Signatur Licensed Plumber City/Town Qwrcter Licens O APPROVED OFFICE ourneyman e Number: USE ONLY LI NSE®AS A JOURNEYMA 'PLUMS R ISSUES THE ABOVE LICENSE TO: DOUGLAS J LAFOND 86OLD LOWELL RD. c WESTFORD MA 01886-3825 26805 05/01/12 79212 ' The Commonwealth of Massachusetts ► Department of Industrial Accidents Office of Investigations �I 'U 600 Washington Street Boston,MA 02111 t 3- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Lelzibly Name (Business/Organization/Individual): Address: �4�� City/State/Zip: 3e1ij�? Phone izo,�qgc/y Are you an employer?Check the appropriate box: Type of project(required): 1.❑ lam a employer with 4. ❑ I am a general contractor and I 6. ❑New construction empioyees(full and/or part-time).* have hired the sub-contractors ,,��,,� 2.�I am a sole proprietor or partner- listed on the attached sheet. $ L1d'Kemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.E_] I 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 12.0 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 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 acid their workers'comp.policy information. I am an employer that is providing 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 c trfy unde the pains andpenalties fpeijury that the information provided above is true and correct. Si nature ^� Date: G 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#: 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." w. 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 �i 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 numbers)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 cavy 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 confinnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pennit/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 pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pennit 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. #6171-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 5-26-05 www.mass.govldia = � The Commonwealth of Alassachusetts (J Department of Public Safety lf� Occupancy S Fee Checked ki BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datea City or Town of A)n �c��,��✓ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 16,9 iOwner or Tenant Owner's Address_ ,S Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building C a c Utility Authorization NO. Existing Service 20-6 Amps /24 / 0 Volts Overhead ❑ Undgrd[D No. of Meters New Service Amps / Volts Overhead 1:1Undgrd❑ No. of Meters 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 /8 Swimming Pool Above ❑ In- ❑ grnd. grnd. Generators KVA No. of Receptacle Outlets No, of Oil Burners No. of Emergency Lighting Batter Units No. of Switch Outlets / No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges Total No. of Detection and g No. of Air Cond. tons 7 Initiating Devices No. of DisposalsNo. of Heat Total Total Pumps Tons KW No, of Sounding Devices No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal 1:1 ❑Other Connection No. of Water Heaters KW No,nsf Ballasts No. of Wirinoltage No. Hydro Massage Tubs No. of Motors Total HP -� I-dw OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverageor it substantial equivalent. YES[.r NO E] I have submitted valid proof of same to this office. YES NO E] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE BOND ❑ OTHER❑ (Please Specify) [ 1�f2•o _�it< >r f /Z F Estimated Value of Electrical Work SExpiration Date) �,p���f Work to Start Inspection Date Requested: Rough L-)Z�_Final Signed under the penalties of perjury: FIRM NAME ,E/a LIC. NO. /D/2S� Licensee ? oma. f� �,�,; p;X Signatur ' LIC. N0, d= p Address s. Tel. o. :Z-b ' Alt. Tel. No. " OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) �/)o l Telephone No. PERMIT FEE'S - Signature of Owner or Agent `� w . � , ,;` Date... f /.../�.. '- 2918 I NORT1� °`,�``°.:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� 1. 4c [P `% �..��Vt . Ctt This certifies that ............J.. ................ .......................................................... has permission to perform ......0..q..5x.. .......tnl.�.:1.:. `I`J /► , wiring in the building of.....1.�!.`.?..41.!.�f..S..�/...'L............................................ at.....li)..�.... e".411-5. P. �'�'Y...,f./.� 4! ,North Andover,Mass. Fee ,��dO..... Lic.No.�a..a11........................................:.............. ELECTRICAL INSPECTOR C , -44 6r03/14/ 75.00 pAID 96.12:15 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer G/ N° 2800 Date...az/� �)�.... µORT" O�t.�ao�a,ti0 .,, .. .�. , TOWN OF NORTH ANDOVER F • P PERMIT FOR WIRING s o� `tip 3 7Sg.4cm � This certifies that A! -L/T.........<.L�'. .1:.....}"�S has permission to perform ......1.... .............. .............. wiring in the building of.. 1> .�.. :.�:?.:.....� ,..................................... . , at....(.0.1......1.1�.a,�. ,.r..! c! .... �:.��......L �' North Andover,Mass,.,,/'. Fee. ...i.:v�.... Lic.No. ... .x.... - .... .. .... '...��:::..... /� ELECiRICALINSP Check # ��'� �.� (/ WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. �� -- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/991 (lea,e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wort:to be perfo,:ned in accordance%with the Massachus tts Electrical Code(MEC),527 CMR 12.00 (PLEA SE PRINT IN INK OR TYPE a ALLINFO ", Date: r-Cee,-nbe- �-I, Coc, City or Town of: Qr �lJan L To the Inspector of Wires: By this application the undersigfed;fees noticeof his or her intention to pe rm the electrical work described below. � Location(Street&Number) L©O L- e- r �l Lo ,.t Q� Owner or Tenant D m W` (�l Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boa) Purpose of Building Utility2thorization No. a Existing Senice Amps / Volts Overhead❑ Undgrd❑ No. of Meters New Sen•ice Amps ! Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion orthe following table may be waived by the Inspector orT ires. No.of Recessed Fixtures INo.of Ceil.-Susp.(Paddle)Fans INo•of Total Transformers KVA Na of Lighting Outlets No. of Hot Tubs (Generators KVA S)cimmin Pool Above ln- a o meraenc fgyntfncy No.of Lighting Fixtures Q ❑ ❑ d 3 b b ornd. grnd. Battery Units INo.of Receptacle Outlets INo. of Oil Burners FIRE ALARMS INo. of Zones INo. of Snitches INo.of Gas Burners No.of Detection and Initiating Devices INo. of Ran-es INa of Air Cond. Total Na of Alerting Devices Tons e Io. of Waste Disposers (Heat Pump Number Tons I KW No.of Self-Contained Totals: I I Detection/Alertin2 Devices r INo. of Dishwashers ISpacelAreaHeafing KW . Municipal [I Other ctfon No.of Drvers (Heating Appliances ecunty ),stems: es or Equivalent No.of Water K'W !Na of No.of Data Virtring• Heaters i Signs Ballasts Na of Devices or Equivalent No.Hcdromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No of Devices or Eouiv lent OTHER .4noch additional detail tfdcsired,oras required by the Inspector of Wires. INSURANCE COVERAGE: Unless)waived by the o)tmer,no permit for the performance of electrical work may issue unless the Iimnsm 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 per nit issuing office. CI-MCK%CE: INSURANCE ❑ BOND ❑ OTIER ❑ (Specify:) Estimated Value of£le:-tri Wor1c (When required by municipal policy.) (Expi auon Date) Work to Start: (� �/% Inspections to be requested in accordance with MEC Rule 10,and upon completion. I cert fi,under the pairs and penalties of perjury,shat the information on this�application is true and contplete.. FIRM ttAME: ADT Security Services Ill Morse Street,Non o MA 02062 LIC. NO.: 1�-33C Licensee: John S. BassettSi;natur/ TIC. NO.: 1S33C Of applicable.enter"ercmpt"in the license number linc.) Bus.Tel. No.:- - - Address: Alt Tel. No.:603-594-5-9 lresi 0«'NER'S INSURANCE WAIVER: I am aware that the Lii ensee does not have the liability insurance coverage norrraliv ONLY reauired be lay. By my signature bclow. I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owncr/Angcnt - Si-nature _ Telephone No. PERAfIT FEE: S8,�� Office Use Only 01 4e Tommonwe# of fflttssot4usetts Permit No. 19epartment of Public tufetg occupancy,& Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 1 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date (XV or Town of NORTH ANDOVER To the Inspector of fres: The udersigned applies for a permit to perform the electrical work described/below. Location (Street & Number) Z42� L Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes L 1 No ❑ (Check Appropriate Box) Purpose of Building ef Utility Authorization No. Existing Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service Amps _J Volts Overhead ❑ Undgrnd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work f H Tubs No. of Transformers Total No. of Lighting Outlets I No. • •t KVA No. of Lighting Fixtures Swimming Pool Above In- No. g grnd. ❑ grnd. ❑ I Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Ranges No. of Air Cond. Total No. of Detection and No. of Ran 9 tons Initiating Devices Disposals No.of Heat Total Total No. of Dis P Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal No. of Dryers Heating Devices KW Local ❑ Connection ❑Other No. of No. of Low Voltage No. of Water Heaters KW I Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP / OTHER: �Q D / ,g ¢� INSURANCE COVERAGE: Pursuant to the red,61rements of Massachusetts general Laws I equivalent. YES NO _ I i including q I have a current Liability Insurance Policy g Completed Operations Coverage or its substantia have submitted valid proof of same to the Office. YES = NO :: If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE —`- BOND OTHER (Please Specify)/^/11 _ (Expiration Date) Estimated Value ElectN I Work S Work to Start /�' l Inspection Date Requested: Rough Final 101, Signed under the P alties of perj �� vJ +� FIRM NAME LIC. NO. Si natur LIC. NO. Licensee Bus. Tel. No. Address OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) J Telephone No. PERMIT FEE S (Signature of Owner or Agent) x-6565 t C-/ Ced 3 _.. :e �•.+xs-�.F-- -.-,.;+:a>�:•or.--•.'v+,.ir"'�vhi:r,.'•ta'li"^5`"`"Ziti'.G.�„`��t+- YE��•"'i'i�'...r- r-. a.. 2986 H°RTM TOWN OF NORTH ANDOVER °` PERMIT FOR WIRING • Y �S7ss^CHUS� This certifies that :......1.r;1.L,...... .................................................. has permission to perform ........ U:.. nC......0.°l ..................................... wiring in the building of.... at....../.. .`L.........��..��t,f.,� �1���.... .:..i�........ NorPAnover,Fee....lj :.W.... Lic.No.�. .�r��...... LE RI C F 3 04112/96 11:43 15.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Location At �C3.�uc'/3��Pi2y /ALL No. Ulo 8 Date Ae9,1; �ORT� TOWN OF NORTH ANDOVER •;� •'.1 .• OL 0 9 Certificate of Occupancy $ * ; ; Building/Frame Permit Fee $ 33 ^ry° Foundation Permit Fee $ Ss�CHust F Other Permit Fee $ Sewer Connection Fee $ k Water Connection Fee $ ti TOTAL $ { 7,t iii _1.1 PZILL Building ector 03/14/%.,12:14 83.00 PAID 9595 Div. Public Works PERJi1T NO. 01,12S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1 MAP 4-40.oc� I LOT NO. �,(`� 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE — ZONE SUB DIV. LOT NO. LOCATION `�\ PURPOSE OF BUILDING OWNER'S NAME\� i �+1, �`i►C ���\ \ Y' NO. OF STORIES ` SIZE OWNER'S ADDRESS ��-Pcs3 , BASEMENT OR SLAB ARCHITECT'S NAME .._ -T- SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME��� SPAN -- DISTANCE TO NEAREST BUILDING ]•► C, 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 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 11�e IS BUILDING CONNECTED TO TOWN WATER i(�B BOARD OF APPEALS ACTION, IF ANY ` J IS BUILDING CONNECTED TO TOWN SEWER ` IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS ` S�,e�5�,�V`� ,e��k`,nC 3 PROPERTY INFORMATION �('� p�(]�( `(� LAND COST ' SEE BOTH SIDES ` mj ""'p- < "v `�1`S� EST. BLDG. COST Y c'�c , Uc' PAGE 1 FILL OUT SECTIONS 1 - 3 6xv`� �`l��v`� EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 NUILDING INIIII R SIGNAT�FApE �OER OR U'TH IZ � � p �} \ 9 1 F E E 4 A\3-s,W C1 ego ni4-i!� Solob w1/1��- fgek4f7— OWNER TEL.# C4 C) s'"1 `L PERMIT GRANTED CONTR.TEL.# f (� L319 �_ CONTR.LIC.# u I' � l H.I.C.# CCAS :Its-112 '9s9� n T BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAII _ UNFIN. 3 BASEMENT AREA FULL FIN. BM'TAREA _ '/ '/2 '/ FIN. ATTIC AREA _ N_O 8 M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD!✓'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY- ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR a ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I IP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT 11 SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. d COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS' GAS L B'M'T 2nd OI _ ELECTRIC 1st 13rd NO HEATING NORTH _ F own of Over 0 No. 069 4� � r dover, Mass., J�rac a 13_ 1994 COCHICHL�vK V A0RATED P,OL 5 BOARD OF HEALTH PERMIT T D. Food/Kitchen Septic System / THIS CERTIFIES THAT...3�1.�....�.�#.�1.!.�So�...`/.....M1�-kt.!q�.......fo...1D�E'N........................................ BUILDING INSPECTOR Foundation has permission to eW......R1-��................ buildings on ...� cl...�...�.��W.ORY......V+4. ................. Rough to be occupied as............... tv.i-o.14 ....�a;z4z0 u..�!�t�f��o2�.{��..4� !Y!�.......... i�r.. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIO STARTS ELECTRICAL INSPECTOR Rough ............... .... .. .................................... .f^':�..................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det.