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Home My WebLink AboutMiscellaneous - 109 NUTMEG LANE 4/30/2018 (2) I i �, �Nb�7' �/ Insurance Adjustment Service 172 Route 101 Unit 25 Bedford,NH 03110 Phone: 603-606-7901 Fax: 603-606-7911 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139, SECTION 3B Date: Feb 15, 2015 TO: Board of Health/Building Inspector 120 Main Street, North Andover, MA 01845 RE: Insured: Robert Gorman Property Address: 109 Nutmeg Ln Andover, Massachusetts 01810 Date of Loss: Feb 10, 2015 Policy Number: BCCHSP Type of Loss: Ice Dam File or Claim Number: 15091935 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, locations, policy number, date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, Jonathan Brady Adjuster 603-606-7901 ext 123 I ® MAPFRE The Commerce Insurance Companysm Citation Insurance Companyw Commerce " Gore Road,Webster,Massachusetts 01570 INSURANCE- 508.949.15001 www.commerceinsurance.com February 11, 2015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: ROBERT J GORMAN!ELIZABETH M GORMAN Property Address: 109 NUTMEG LN Policy#: BCCHSP Date of Loss: 02/10/2015 File#: JWRX09-HNMNPO Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. REBECCA MCGOVERN THERRIEN Telephone: (508)949-1500 Ext: 15189 Sr Claim Representative, Property Toll Free: 1-800-221-1605,Ext: 15189 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. February 11, 2015 CIC 254 (Rev.4/95) MAIL M33 �qA Date . '.�. . � 6k�,trrn.raar toTOWN OF NORTH ANDOVER PERMIT FOR WIRING l �� 1This certifies that . . .. . ?? . . . . `0. ... . . . . . . ( . �d©Lvq�2a� L>. . . . . . . . . w`�'p4 has permission to perform . . . wiring in the building of . .M V.L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .I. . /Uv7� 97 . . .G/� . . . . . . . . . . . , orth Andover, Mass. Lic. No. . . 3C�xT,�. . . . . . . u ELECTRICAL INSPECTOR Check 4263, Cglz z 1 '1 0 ve i Commonwealth of Massachusetts Official Use Only Permit No. I /d el F r Department of Fire Services Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 C 12.00 ((PLEASE PRINT ININK OR TYPE ALL)NFORMATION) Date: 10 22_ (Z City or Town of: NORTH ANDOVER To the Inspector of ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) / N H" Owner or Tenant fll r. i�' (`'^f-'7 Telephone No. Owner's Address _ ) 0 r N ki Is this permit in conjunction with a building permit? Yes -No ❑ (Check Appropriate Box) 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: L j} 'r-4ft., a A Q C VJR•'-'� Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA 1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- El No—.Of mergency ig tingNo.of Luminaires Swimming Pool rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. of Gas Burners No.of Detection and No.of Switches Z Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Hear tap Number Tons KW No.of Self-Contained Detection/Alerting Devices Municipal ❑ Other No.of Dishwashers Space/Area Heating KW Local❑ Connection No.of Dryers Heating Appliances Kir Security;Systems:Y No.of Devices or Equivalent No.of Water I No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value oflectrical Work: 'Z d 00 (-c-) (When required by municipal policy.) Work to Start: do 22.4E l L 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 [4�BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete..^ FIRM NAME: . I�•- • c L��Tr`' LIC.NO.: / - 3 ? - LIC.NO.: Licensee: ��t� Signature 0. (If applicable,enter "exemp in the licens number line. Bus.Tel.No.-G,e 3 44?`-T o L Address: 2 o �� '�•'-� 1, 'tea S7- C5$_ L� Alt.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 I PERMIT.FEE. $ Signature Telephone No. I s r ^ • .+�Julu�.Ri-�+1.'V�.7.�.1'IJ.fJi-R.�.t l®w .^ ..•s•l�J..+1`L.sJ+.A�J.7 J.'�J.®J,•'.�o . . 32�ssec�--,C � --�'aile8.-•[ � �e-�zspeefzoxtx'equzz'ec�($�d.OU)�C � (7(nspee oxsy Szgnatuxe o- t�a'Is) r Pate (nsieefozs' Snafu e �zofxtxfZals) Pate ` assets--�' j �+'azlec�--j � �te�xuspeefZo�xec�u'rxet�(��O.OQ)�[� tw eetoxs'comments; (�nspectozs' ignatuxe��ouas} Pate ' �I,'ZiC fr'rrUWRIi0NNI�CAR1I ,-sec - [ I ,'[iaileti--Ce-xnspeeox�xequire ( 50.�D) (knsp ectoxs'ozgn*ra-io jsufzaxs) Data r eta--.0 � �'azfer��-C }. '�te�nspectfonxe�uit'e�($�0,0a}-•[ � ' S • .. �l�sp eefoxs°�zgnafuz'e�oto initials} date . n-P q,A 6--V A72't-r!'7f'dl T��'i Ft 7(, ,i 7�OTTV AM T,'P,' `f d D7�7 R7`7f'O W moi;.A'PVdLTO 33E IMPEeTED Rq NOT r 'L The Commonwealth of Massachusetts rn Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual):. jC Address: Z © p City/State/Zip: .` --:C S'7-z:, Phone#: 61© 4-1 c .— G Z 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.,F]New construction employees(full and/or part-time).* have hired the sub-contractors E]Remodeling 2. a sole proprietor or partner- listed on the attached sheet.$ ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition A [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i 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. 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nformation. nsurance Company Name: 'olicy#or Self-ins.Lie.#: Expiration Date: ob%'ite Address: City/State/Zip: Utach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify undef the pains an penalties ofperjury that the information provided above is true and correct i ature: Date: 'hone#: G c, 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#: sf 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 w 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 permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 tevised 5-26-05 www,mass.gov/dia Date. 9578 TOWN OF NORTH ANDOVER 9 PERMIT FOR PLUMBING ,SSACMUS This certifies that��,�OCk . ."'�.'e". . . . . . . . . . . . . . has permission to perform . CoA6A.,-,4. 5. .:(.�}X !�. . . plumbing in the buildings of . 4 '.00?yyy. ?. . . .. . . . . . . . . . . . . . . . at . . . . 1 bl. . .lv.LAA VV--0. . . . . . . . . , North Andover, Mass. FeeJZ . . .Lie. No.)��Z . .� . �. . . . . . . . . . . . . . . . . . . . . . . . . ��-7PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY i v1,- ti, n,. ,� �,� i MA DATE t - L _( PERMIT# JOBSITE ADDRESS OWNER'S NAME P OWNER ADDRESS TEL _ ___ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL [JI RESIDENTIAL PRINT CLEARLY NEW: -_ RENOVATION:© REPLACEMENT:E11 PLANS SUBMITTED: YES NO©f FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM w ._.....__( � J ._.____I ____.1 ._ ___.•I _�_f ..._____ . _-.___J ._ ___I ___...__1 �•_ I I - _f DEDICATED GREASE SYSTEM __---_..-! DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM { ---..-._..J -,.� ._.._-_J ..:_.._._.I _ I _..__..__I f _-.---I .._._..._._i ._...__..._f ...---.J --_ I .--------I DISHWASHER _f __.._..____{ -__..-�. --_____f ___J ___._i .-_.._-_{ --•--.___.! ._.._..._! .Mv.....J _____._.! _._.__I __f ._.._.._._.f DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN 1 ___._..._.f __I __.__J ( .--___..J _.__-..._J __.____I _--.__-► .._-_-_{ .......----f ...._...__..! ._- _f ____.___f INTERCEPTOR(INTERIOR) En KITCHEN SINKLAVATORY i I I 1 � f I l f } : ( ( { ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILETI _._. ; I ._- ---_.1 E _.__._( ..J I ._.__ I _.__._J ____..1 -------- _.--_._J ._._....__._f ....._...._._f ___.,_.1 URINAL .--- WASHING MACHINE CONNECTION J J WATER HEATER ALL TYPES WATER PIPING OTHER -'r----I f ( ._..___I _... INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ..- NO P IF YOU CHECKED YES,PLEASE INDICATE THE T OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L OTHER TYPE OF INDEMNITY f BOND 0 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 Q AGENT I-1 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicati are tr nd accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be c plian ith all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME� a -1, y► Ccs�q�r _ s LICENSE# - /SSS.,y I SIGNATURE MP w_ JP D•.i CORPORATION n. 1##L=PARTNERSHIP_j PARTNERSHIP __i#=LLC 0� COMPANY NAME C, _ -?i y��;' `� i ADDRESS S-� V�� Wyws - W_�/� ------------.._--- CITY �i' �- ._..._ ._. i STATE / ZIP an d oeo__i TEL -17.6, FAX ( CELL — EMAIL �'r .C .t�f# . Y .S^ _.__C�. t_�'. �%.-- �1IL_ _._( ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES THIS APPLICATION SERVES AS THE PERMIT Yes No FEE: $ PERMIT# PLAN REVIEW NOTES a The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations uv�, 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly n � Name (Business/Organization/Individual): ` LJ t� & ' ,q cj Address:��i � G tM, !C City/State/Zip: Sol viS (,Vld ar(q a(o Phone#: 6 ( Z Are 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 employees(full and/or part-time).* have hired the sub-contractors F1 New construction 2.E] I am a sole proprietor or partner- listed on the attached sheet. EJ Remodeling 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.❑ 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.❑Roof repairs insurance required.]I employees. [No workers' 13.n Other comp.insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nformation. assurance Company Name: 'olicy#or Self-ins.Lie.M Expiration Date: ob 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 irre 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 ,f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certi i der t e penalties of perjury that the information provided above is true and correct. i nature: // -' — -7 Date: 9� 6loZ hone#. .1� � q — 1! 6 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." 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 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 any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 .evised 5-26-05 Fax#617-727-7749 www,mass,gov/dia Date .�� '��-. . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . ��. � ,,,,�.. . . . . . C' 6.0',. . . . . . . . . . . . . . . . . . has permission for gas installation .G f: in the buildings of. �`--- « . . . r.�^S�` at . Qcl . 14tdT.Oxf--�, KP., . . . . . . . . . , North Andover, Mass. Fee 3600. . . Lic. No. . . . 7.44 4 . GASINSPECTOR Check# 8353 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY /VO W - i'-1,•1/�,i Z s _ MA DATE 1,0 oa ►'a PERMIT# JOBSITE ADDRESSo di _�1 J?rh 2 6 L// — OWNER'S NAME GOWNER ADDRESS TEL _� jFAX F __ TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL D RESIDENTIAL PRINT CLEARLY NEW: ..___.. RENOVATION:I REPLACEMENT:0 PLANS SUBMITTED: YES 0 NOR APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ( : 1=j=j L:-._ =j�_—...j I L.. 1(. f=i 1„ ...� BOOSTER ( _ CONVERSION BURNER ---- COOK STOVE DIRECT VENT HEATER : DRYER FIREPLACE FRYOLATOR FURNACE L--------- ._.�- l__.-_=-f GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS —J ._J.-_.—�I MAKEUP AIR UNIT ____j I—.-- FI. ..--a OVEN -j IL.-,_-J I. POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT . TESTIn��l UNIT HEATER 4_ L_— I i — UNVENTED ROOM HEATER r_._^- L. __('___:- ._ 1_� I_._-_. �.._ •:.__.___f!=_,_v f!__� ;__._ _.f,__..-. r_ (_. .._.._! WATER HEATER i- - J;---1 i__ . ---I 1—j 1--I OTHER I l J h � -— I�- - (� 1.�1 -- -- _------_ ..__------- ----- _-�_(��1.=_-'l._ 1i�►._-_-!-----�_.; .�i�__�_�_:_I+___�_(l_____t�__ _.__.��. INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I HNIO D 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY © BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Q AGENT 0 SIGNATURE OF OWNER OR AGENT 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. PLUMBER-GASFITTER NAME SNAu✓ LICENSE# i ay6 SIGNATURE MP Or MGF 0 JP [ JGF LPGI _ CORPORATION # �PARTNERSHIP D# — (�LLC[ f# COMPANY NAME: PL 4;,- Ni G =ADDRESS ...-3 --Pi CTS...--S-`---------------------------------- --�i CITY STATE _. ]ZIP 017 y � hEL FAX — CELL y�� u33G EMAIL -_ ____.�----- - ._---- -.__- 'V ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# 'TZ7 �J �� ' o�(LC- PLAN REVIEW NOTES V �� C�IL�LL ?'0 �`v�— ,moi The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations IV 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leafty Name(Business/OrganizationAndividual): �A t S 0,,)5 P L(;,i N 1-C Address: 3 Fo 0A o,., ',)7— City/State/Zip: City/State/Zip: ^-e -x !tutrJ' O\A o 1 o H Phone#: 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. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling 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.❑rJumbing ical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11. 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.] 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they gre 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Me r C 11#I.-A S I'/S Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 13 N v T fn CG LA--c City/State/Zip: NOr-%hA--,Oj,e, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 certlo under thepains and penalties ofperjury that the information provided above is true and correct. Signature: A_-Z� V Date: Phone#: 77 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 J, Y 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 ofhire,- 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 j oint 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 any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,M.A.02111 Tel,#617-727-4900 ext 406 or 1-877 MASSAFB Revised 5-26-05 Fax#617-727-7749 www.mass,gov1dia COMMONWEALTH OF MASSACHUSETTS ` -PLUMBERS AND GASFITTERS LICENSED AS.A MASTER PLUMBER r ISSUES THE ABOVE LICENSE TO:. SHAUN P. -PARSONS y: 3, FULTON ST 1 t METHUEN MA'-01844-7010 12465 05/01/14 142697 Fold,Then Detach Along All Perforations f, i t Location/y*/ d l o? ydlj4e,�' //V . No. s3 J Date a ` M01fTM TOWN OF NORTH ANDOVER f � w i # 9 + ; ; Certificate of Occupancy $ ss�cN�sE< Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ �� S Check # r?oo i AIN, t� Building Inspector 39.9.}," 34 98 I Zo.7 G' 0 0 Lo-I' 2-I 8 14&,,9q' �o0,37Cvh�) tea, 'o o. N P 2�P /a q � I ZS.oo• LAN,5 • r traRaBY crRfzFY fn rsa No, PLOT PLAN B►-cis, vEPr, imr um F pro. m am IN MF LOT AS SHOWN AND nUr Zr DOrS compo" WITS rxa-roWq OF uo, APC;VV52aoMj; RaauLdfroNS I.1a�TI-I RCadR=V MRders FROM MCRff,• Lor LIXrB' • r FURrm CrRMY mr flits F-PT- (, 18 Nor LOCi[!`rD rN ! ' FnCJUL FLOOD BAKM ARBA AS DRU IN FOR S80I11i « ;� PAM so 0,7e, 0006C y PAT 9P 6--7-_93 4 jL1.4 MIT , jw;i.r•.r ;::t?;�L)a Nor FOR eoUMW rlom- eouAmARY tNmmnrav YWRA=Cjr RNCtNRMMC RVAUCES rA=N FRar r1 NMO SDs' 88 PAM SMAS ACRUSi rrs 01810 Date..h;2 .. 19 .... .................... 4, TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 41 S CHUS This certifies that .....n-,......... 'y.................. X............................... has permission to perform .......... wiring in the building of...........' ..... .............................................. at..../ 6 North Andover,Mass. ......................... ........... ....................... Fee`." ............... Lic.No...........7?�...............t:;� .... ........... ELECTRICAL INSPECTOR Check # 9 1 5 5 Commonwealth of Massachusetts Official Use Only r nElm. Department of Fire Services Permit No. 0'^ 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 PRW INK OR TYPE ALL INFORMATION) Date: _ _ p y' INT 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) ��5' hJ Owner or TenantLS Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 0 t-&L.C�_i r✓(r Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: 2 _ 99 Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans 0.01 Total . M Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o,o mergency ig g d• 9mad. 1 Batte Units ---, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones a No.of Switches No.of Gas Burners No.-of Detection and ------ InitiatingDevices A No.of Ranges No.ofir Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number. Tons_. KW _ No.of Self-Contained Totals: "' Detection/Ale rtinry Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of water No.of No.of Devices or Equivalent Heaters KW o.of Data Wiring: Si s Ballasts No.of Devices or Equivalent " No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent { Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal.policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete- FIRM NAME: H AJ JtQ_ LIC.NO.: 6 3 6 Licensee: S A m%zl- Signature uj LIC.NO.: (If applicable, enter "exempt"in the license number line.) Address: Bus.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.L cl.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability 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 No. PERMIT FEE: $ '�Or- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, A" 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Address: City/State/Zip: l'U v 3 F 7 U Phone#: Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction emrployees(full and/or part-time).* have hired the sub-contractors 2.OYI am a sole proprietor or partner- listed on the attached sheet 1 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me 'many capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5- ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 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' 13.❑ Other comp. insurance required.] applicant that checks box 91,must also till 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 and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for nzy employees. Below is the policy 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 certify9under the pains and penalties of perjury that the information provided above is true and correct Signature: c�'Gfla,4 ��7 Date: Phone#: SZ�— �3 — V9 70 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." 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 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 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 permittlicense 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 j 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 fol 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 fnvestiptions 640 Washington Street Beoston, MA 02111 Tel. # 617-7274900 ext 4406 or 1-877 NIASSAFE Fax# 617-727-7749 Revised 5-26-OS w-w,w.mass.gov/dia Date.�� ".��1�. MORTM 3= �` TOWN OF NO TH ANDOVER • - • PERMIT FOR GAS INSTALLATION 4 • h SA US This certifies that . . . i has permission for gas installation . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . v. at �� - �?` '� . . . .,. ., North ,Andover, Mass. Fe : . . . . Lic. No.Aq�� . . / AGAG S-INSEC Check 5BU9 MA%ACHUSETIS UNIFORM APPLICATON FOR PERNIlT TO DO GAS FITTING (Type or print) Date l-`Z V0 NORTH ANDOVER,MASSACHUSETTS G� Building Locations L ! —14 U -f -t--L-e Permit# Amount$ i Owner's Name Ga flit �� New❑ Renovation ❑ Replacement Plans Submitted ❑ s zw `n n U C4 ; O x w � d o o z c7 w x F a x > w -Itw � za ¢ x x a w � w � F z F z w w O > w F .a z > d a z Q a d d o 0o w $ w O A a U x > A a F C SUB -BASEM ENT BASEM ENT 1ST . FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . F L O O R 5TH . FLOOR 6 T H . F L O O R 7 T H . F L O O R 8TH . FLOOR (Print or type) QS J^ ��G� Check one: Certificate Installing Company Name /` , /T Corp. Address ro /3 DSC/--,o A � - S7 Partner. -14 0 . CJ --Z-"--¢, 0/ r V f a Business Te ep one S 7 9- 0 K 7167 U R aO Q-Firm/Co. Name of Licensed Plumber or Gas Fitter y 4�1 /�-24-4e -00r a INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [a No If you have checked yes,please indicate the type coverage by checking the appropriate box. 13Liability insurance policy M 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 E] 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 • r this application will be in compliance with all pertinent provisions of the Massachuse+ e Ga ode and Ch t r l4�of e Genoa aws. ignature of Licensed Plu ber Or Gas Fitter By. c�3 Title Plumber City/Town M Gas Fitter t�c,ensc um er 0tAlaster APPROVED(OFFIC'E USE ONLY) Journeyman �f (/v c•Nc!H�y o Town of •`�__��_�' NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT 38 i (�o�ar+� - 3 , - ,, ss ug- PERMIT NO.: PROJECT: i OftUWX DATE: l f3Q UNIT NO.: rttefi: 3 ��alt U�1 �y'` WING: BUILDING NO.: ^© a t /Q7 A) REMARKS: 654 Cos+ T" 32,) 1101 cD�3 ,Q":) I s Excavation-depth and soilconditionsFraming- Other: Date: / �� Date: Y r 0 � Date: Inspector�/1�//II�G'`^-f Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: 'a µ-a I� V Date: �� f i6 ' �' j Date: Inspector ./U/Il ^^ Inspector A M �" Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: -� a Date: _�/ Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date- Date: Date: Inspector Inspector Inspector 1 9- r '-ire Dept- \...jil burner,tank,stove,smoke detectors Final inspection Certifica Use and Occupancy Date: `�� Date: 3 ate: C of O# Inspector Inspector� Inspector Form#995 Action Press,685-7000 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number. Date i'_a ® O THIS CERTIFIES THAT THE BUILDING LOCATED ON �� # �� 7 /v C�tin c/ `d �— MAY BE OCCUPIED AS 5 ry 4 JL L4 /y /4 IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND OTHER °oRT"E,G�ULATIONS AS MAY APPLY. 11,P, 00 6/ 3 / /,34 Th S 's/a// 0.SH A-1CERTIFICATE ISSUED TO 14 R/0. t ADDRESS /D y� �v�.v�Ji 14- �� . 4cj"u��2 $ACNUSt TTS Building Inspector�i�� F NORTH Town of Andover No. � o ?-= LA o � dower, Mass., e2 aao COCHiCHr- K ADRArED P'P�- C7 S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System Vft�� Iry BUILDING INSPECTOR THISCERTIFIES THAT.../ ..D................. ..................... ..................................................... .. • Foundation A4(CC,-- has permission to erect....................�....�........ buildings on Rough ��rtC0 • /, rChimney to be occupied as �.. .. .. ........��...�..............�......�.......�.... k..= ....................... ... .. provided that the person accepting this permit shall in every respect conform to the terms of a 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 ��' Z- Buildings in the Town of North Andover. M i3 L; P 1 69 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION START LECTRICALii PE A......................... ce BUILDING INSPECTOR7 a Occupancy Permit Required to Occupy Building GAS INSPECTOR 111�Roug _v'R� Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTME T Until Inspected and Approved by the Building Inspector. Burner - Street No. .� SEE REVERSE SIDE smoke Det. '�� i i Town of North Andovero tt,.�p� NORTH f.Building Department ,`;, • 1.'6 - 27 Charles Street North Andoer, Massachusetts 01845 * ` (978) 688-95 5 Fax (978) 688-9542 04w Yo.wiiwi K.y1� 1 �9SSAC HUS�� t APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS L LOT NUMBER SUBDIVISION i DATE REQUEST FILED _T DATE READY FOR INSPECTION I FIVE 5 DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED i ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY-FIVE($25.)DOLLARS WILL BE CHARGED IF STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. r 4. F SIGNATURE 4?dm.A� OFF CIAL USE ONLY ************************************************************************ ROUTING CONSERVATION DATE PLANNING DATE Z 7 kPV D.P.W. —WATERMETE _ DATE .• D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN,INSTALLED ' PRJOR7P PECTION REQUEST DATE. SIGNATURE PW AUTHO ION i i Location / l D l 106(tT-- )X- No. _ Date a l NORTH TOWN OF NORTH ANDOVER 3? � . 00 10 9 i y �V + i : , Certificate of Occupancy $ �'s'^••°'E<�' Building/Frame Permit Fee $ � swcMv' Foundation Permit Fee $ �Q U Other Permit Fee $ TOTAL $ J� Check # /17 9() 1p /p-c, Building Inspector +r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: AN 4 Building Commissioner/Inawor of Buildings Date Z SECTION i-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 10a rum+&Ne-Q /!.,:Ayyp- 3g O + ` Map Number Parcel Number Q 1.3 Zoning Information: 1.4 Property Dimensions: S oal e FQ.nn* T IC�Dt`37(o t 9L 5" ZoningDistrict Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided C) t X5+ 9. 6 9 L+A 1 "-3O I Ano-t- v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 5i--"Private ❑ Zone Outside Flood Zone Municipal C>i On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record n A b bo+� ,r Ocue (oo,�Qn-i- Co ,n ! D t-(C1 ='vr n.a;k e s f-• 1U0 A n&.2 �(v` Name(Pri Address for Service or, Of Sign r Telephone O 2.2 Owner of Record: Q Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ W`0ki'aey% iSarre it- Licensed Construction Supervisor: C S 0,5 Q a 1_i I O License Number c T t. &b. A n ova mn Address '7-1923Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address ra Expiration Date ^� Signature Telephone Y♦ SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) a Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: II C O r\ S i-r 0c,A-WA) Q� 011- Ow e(fin p w i 4-k Q Cal e— n ex.ra&n g SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a)(a) Building Permit Fee oC tD 0 000 Multiplier 2 Electrical (b) Estimated Total Cost of 000 Construction 3 Plumbing 00 Building Permit fee(a)X (b) �^ 4 Mechanical HVAC f 500 �� ' 5 Fire Protection N 4 6 Total 1+2+3+4+5 000 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - - 1 r�'�C�'�'a t7R� r .,�� ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 � n Ab I, t L!%k k',a r+N G c.r r c f resii ,e"\t opo;o. as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 1 W Pri s Qi Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMERS 1 1(( 2 `dJ�Q 3 RD SPAN i y` DINvIENSIONS OF SILLS DIN ENSIONS OF POSTS L4 3el DUVENSIONS OF GIRDERS 14 — akJOL HEIGHT OF FOUNDATION THICKNESS i0 SIZE OF FOOTING 10" Je on L4`� X MATERIAL OF CHININEY (JrtCbC IS BUILDING ON SOLID OR FILLED LAND S 0 a IS BUILDING CONNECTED TO NATURAL GAS LINE �( FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirement. APPLICANT W iI I 13 a rr e PHONE 6o$;3L – a n ASSESSORS MAP NUMBER _LOT NUMBER SUBDIVISION A � n`ft- U e l LOT NUMBER a 1 � STREET A LJ+ �Me�►+� �at:V■ -..........—.STREET�NUMBER . .....�........ OFFICIAL USE ONLY .■■■.■■,r■■■■■■■. ■■.r■.■■.■■■■■■■■.■■■■■■■■■■■■■Ill■■■■■■■■■■■■■■■■■■■■■■■■■■ �RECOIONS'OF TOWN AGENTS iMMIENDAT rr ■■■p■?'.■■■�....................................................... V° DATE APPROVED CONSERVATION MR4StRATOR i�(Jj -4 DATE REJECTED c � ''JJ f . �v 4 +wr7 uW� 1�0' l V. DATE APPROVED TOWN-PLVINEW- DATE REJECTED CON BENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED r CONDAENTS PUBLIC WORKS-SEWER 1 WATER CONWCTION DRIVEWA P RMIT 2-1 DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMM&-NTS RECEIVED BY BUH DING INSPECTOR DATE MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2. 0 Checked by/Date ; CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE : 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 1-24-2001 DATE OF PLANS: 1-23-01 TITLE: 109 Nutmeg Lane PROJECT INFORMATION: Abbott Village COMPANY INFORMATION: William Barrett Homes COMPLIANCE : PASSES Required UA = 916 Your Home = 812 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA --------------------------------------------------------------------------- CEILINGS 3229 30. 0 0 . 0 114 WALLS : Wood Frame, 16" O.C. 3926 15 .0 3 .0 262 GLAZING: Windows or Doors 756 0. 350 265 DOORS 58 0. 350 20 FLOORS : Over Unconditioned Space 3183 19 .0 151 HVAC EFFICIENCY: Furnace, 86.0 AFUE ------------------------------------------------------------------------------ COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 d J4. 4. Builder/Designer Date GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDINO DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. AhbQA7 nets. (•h( P 109 /Vutm pa (ary e- 33 K R,7 Permit Applicant Property address Map/Parcel to a :3 ao Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached bulding permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providingthis form does not absolve me or any party to this permit from the requirements of obtaining other permits required priorto the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date ofthis bylaw,provided that no additional residential unit is created ✓ The lot(s)was/were created prior to May 6,1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all ofthe conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%permanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least tet buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved by the planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a one time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building permit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING FF OF A ABOVE EXEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT ISG F R REFUSAL BY T G DEPARTMENT TO ISSUE A BUILDING PERMIT. APPLICANTS SIGNATURE { DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR - Number. CS 052241 Birthdate: 10/10/1952 Expires: 10/10/2001 Tr.no. 7876 Restricted To: 00 WILLIAM K BARRETT. _ 1049 TURNPIKE ST - /Avl" N ANDOVER, MA 01845 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity �am an employer providing workers'compensation for my employees working on this job. Company name: CDI0-k Ui11 ., > ncJ crn r)0n - 12Lkn•tr nr' ) C.Dro Address i' )ti!� City: ).�-., Phone - Insurance Co. c-� a.-t- m�> r" ' i POlicy# P C ( 9 I S a Company name: Address City: Phone#• Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.. I do herby certify under the pains and pens s Of pe 'uqf.040-the-info afion provided above is true and correct. Signature , ` p� Date G 2t> Print name l��l�i->~�� /}i r �� Phone Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check d immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION i I REQUIREMENTS FOR BULDING PERMIT SIGNOFFS BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Buildin Permit application 1. What is the proposed project? Deck pool addition new house other 2. Are plans attached? GDNo (For additions and new houses on septic systems, complete floor plans of proposed construction and any existing house must be submitted. For pools and decks,a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is municipal sewer available at this location? Yes No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes ©° 5. Is the location served by private well? Yes No 6. If this project is an addition and the house is served by a septic system, has there been a Title 5 inspection done recently on the septic system? Yes No �V 7. If,yes, is the inspection report on file at the BOH? Yes No N(� Town of North Andover NORTH OFFICE OF O R COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street '!' North Andover, Massachusetts 01845 '°�..,o %•",5 WILLIAM J.SCOTT SSS^C usts Director (978)688-9531 Fax(978)688-9542 CHIMNEY APPLICATION AND PERMIT DATE PERMIT ,# LOCATION--LOA, I J 4it In e L N a OWNER'S NAME _F- b bo BUILDER'S NAME C.y i I( i CL m 0, ;or e MASON'S NAME --r6 n „ P r ro,ru e- MASON'S ADDRESS A y,,r MASON'S TELEPHONE__ Lo — Qq y Cl MATERIAL OF CHIMNEY A r I a I/ INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES I __3X I `L THICKNESS OF HEARTH ( � t � Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: e S DATE SIGNATURE OF MASON,r CONTR. LIC. # EST. CONSTRUCTION COST/CON CT PRICE PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REOUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES Town of North AndoverNORTH Of t�ao ,6'q.yO 6 L Building Department o 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 '� `°`w�~'K• ' �` SSACHUs��y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in/at: S'(�C' f en ��Na (.�► Src�s� G� � �� Facility location 442JVC—A��io- Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J WILLIAM HMURCIAK, P.E. Telephone phone(978)685-0950 f NORTH Fax(978)688-9573 �Oa ,.ao ,a 9�0 3. o O F- p �9SSgcFHuset c DRIVEWAY PERMIT DATE a dv � LOCATION 6 Uhl-IPr 2� BUILDER hone OWNER IN l�Gll�Li� q //� hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. 1029 APPLICATION FOR WATER SERVICE CONNECTION TWO North Andover, Mass. 19-- Application by the undersigned is hereby made to connect with the town water main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. 1,047Z-4 e'e Street' or subdivision lot no. 2 W Fal LD 1 Ke Owner Address Contractor Addre Applicant's Signature cf>�� )41 00 kl�)Pa PERMIT TO CONNECT WITH WATER MAI The Board of Public Works hereby grants permission to �J, dlaa ��to make a connection with the water main at N �� Street subject to the rules and regulations of the Division of Public Works. Bard of Public Works By Gyfid Inspected by Date See back for rules and regulations L`'`l of i 1625 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. A v oy /1 Application by the undersigned is hereby made to connect with the town sewer main in_A) Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. 0 / Street or subdivision lot no. Z Owner Address Contractor Adnr 14 Applicant's Signature PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to_ ��h`C le�6ttADe-, / to make a connection with the sewer main at �✓j Street subject to the rules and regulations of the Division of Public Works.. Division Public Works By pG// Gl1 Inspected by Date See back for rules and regulations D"W 293 Date .....�pt,l...`iv. 2 NOR Tey TOWN OF NORTH ANDOVER RECEIPT 1 ' SSACHus� i This certifies that .............Ir .....I ................. has pai,d�^..�.. ..�.,.,.�....(....-4 . ;..`'CVLJ l.�t� for .........` ulC�.. Received by................I......../!. ...(/'.l.C��`�4!.. T77 Department ...................l..U'fJ.`.!Ci .............................. WHITE: Applicant CANARY:Department PINK:Treasurer ORT►y Town o �� , ...:. Andover O No. z _, � - _-� o � ndover, Mass., a - o?oo/ O CAKE COC HICHEWICK STE DuSG,`'(� CH 44` P I T FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ... ... I'wC!Rrp. has permission to excavate and pour foundation at .1009'..../..x .......... . ......�1��r for the purpose olllvom ..3.s.je ..�.. '�..vI�/ ti! .... .�!V ... la(*'%*aG�. The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. M a e 4 / 18, 1 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. c BUILDING MSPE'GFOR NORTfy Town of over 3 g * - X_ i a� No. L A E o dover, Mass., aft COC MICHEwICK ADRATED P'P��,�Gj S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ve�v �My� C&P � BUILDING INSPECTOR THIS CERTIFIES THAT...A.. .. .Q..............P..................... ..................................................... .. • p Foundation has permission to erect.................... IT ./ buildings on.Lef.a�.40�4. .... . Rough to be occupied as O.F.0...D...M.. ..�3.!.�..Q/� 1.� .. ...... . .. .. ... ' Chimney provided that the person accepting this permit shall in every respect conform to the terms ofZhe 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. m a O Piag? PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough ...................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner • Street No. SEE REVERSE SIDE Smoke Det. i i i I I i u I i /9 Iqq i '• rr Y �kl.t�S _� W40 E'fl,.�rJCJ P. >u tr,�c�IS AsCeA -1___t----1 �2 \ p wz in ►q4 1 �THOFq DANIEL yGcn /J o KORAVOS CL No.I 2 ALE , HOPI rl E P v L-LAK— I 1 � � r I I I i i I I r� II II II II II I I ❑ ([�� LLL II II II II II II ❑ � � I I I II II II I II IIII I I I I I I I I II ' � II II II _ I-i IIII I I III1� II I II �` I I ❑ ® .III I II i II ' z II II ; I I I IIII II II II ❑ � � II II � I I IIIIIIIII � I IIII II it II , II II II I I I I IIIIIIIIIIII I I IIIIIIIIIIII IIII III II VIII I (IIIIIIIIIIII III IIII II - II I I (IIIIIIIIIIII III I IIII II I I IIIIIIIIIIII 'III III ' I I IIIIIIIIIIII I II � II II I I I WILLIAM C3Apl��1'1' pyo cr fln�; NUTM �AN� nor 21 b �"1/811_11- nA ,I (/ 15/ 01 PUl�n�l� OF FINS NOMAS MONT UVA110N nmwN t3Y: A- 1 I IL - I Uffm [Ell -------------- I I � II j II I. I II I II II II II II II II VIII II II �7 II II II Il II II II II ' II II - 1I II II II II II II II II i II II II II II II II II II II _ II II II II cR Cp�C I � I I Uml JU II II Z I I -- II II II II II II II II — II II ' II II II II � II II � II I II II II I I _ II II II II I II iII II II II �� I I ✓' II ' f i I i II_ I II — W I I,L— IAM C3AI�I��"� ppo.Ucr ring; - _ _ ��: ' PATE: sE-�Fr: NUTMEG LAN� bor tib i� i5�of f3Ul�n�p OF FINS HOMFS 5HEEM M: P\W ��FVAION r A--wNr�Y: r ci t s i II �i II ' II i II II � it II II ' II II ' II /-73 it S II � II C� II � II oII II II II I II z II II II ! I II II II II II ' II II II i II I II II II it II II II II II I I II II II II II ' II 'I II II i I rRo-rCT THEE: - - - SCALE: PATS: 9ff f: - WILLIAM f3AI�I��1"�i" NUTMFG LAN� Of 26 i�811_i�.ol� DUlL,n�p OF FINS NOW5 SNEETTIILE: VICK �LMWN r � �Y: I I i I"I II I I II II II II II II II I I II II II II II I II II I I i I I II I II II I - II II II � II II � II II -CSC I I cD z II II II II I II II II H II II II , II II II _ _ II II � II - i i 13AI�I� ppoxcr-nriE; - I.O�"21b sc��:--- � n�r�: sf�r: WILLIAM CA NUTWLA4 _ 1/Bll=it-oll ,NOMAS 1/ `/0i SNC�f f11L�: IN AWN OF FWN 6Y: INS 51n� ��MI0N5 i 1 I ' I 3�,o,r ala'o" I I I I I I I I I I I I 19' 2" 6,_61 I b _`t�� _ T-6" T-8" i i jl I — - tor'OF cOI�cC flL( ) 8" I � = + I POP I I I I s I I rnN I I I ? o0 a 1�j I O I � `l « Al ' I I � • �`n - I CD nT_ I I O 73_„ -A i �co I I I Qr N -- a` �� _ I I I 1 I v -� Oil ��•Ou, I � I I O - I I = I I I I i I ' I I I I Ion" I'J' I I N I I d -I 3-I 3/ X 9112' I 1 I I LVL LUM I I b I I ern I �I/ I I A CJ Aa-EINI9i ' � I I N.L WOOtg coNSTnjrTF 7 W/V-f-S mg ' I CEILING t0 NAVE 5/8" T)n- "X" FII ' MT O WN1130PW INSrAUR9 f b I I f. I 1 9'-O'X 7'-01,ovEU/V 1700r?5 f30rrOM F t W&L f oofING,q'- " f3E OPV GLADE(MIN) A ? 6 - d� I� ��o�cr nTLr. WILLIAM I3AI�p�1"�f"! N fW6 LANA I I.Of-Zib 5C i 811-i .�Iof I "T�i� i��oo Er: I3UII,I2�I? OF FM NOMAS "frntif: FOUnA110N PLAN npAWNr3Y: 801-01, 18'-32' I5'-82' � 22'-O' �,- 24'-0" 71-611 20// i FAMILY p00M PACK A FA --- - - -- 5'-O" 2'_0'3'-22' con -0" \_ KaLF V✓ALI 8" 5TEP PW91 _ - - I O ----------- _ 3 - GUS5T p00 - o PIN�1"�' i'ANTPY nINING 15Ln 7'-10" 2'-b"i i Q 1L1 2 10 -2 61-211 4� _ ------------ ------ REF, I - ---- �- p - =L -TS�IzoC - —T� z o fio -o'�co--- z� ----- fl- � I fl ----- DOOM 5TUPY o I ING FOY P\ OM - I 1L1 o o � 1�8► , h'-F3, ---------------- '12, ---- ---- 26�'-O" 2 -O" 3'-b" �'-O" 6 -O �'-O 50 2 -0 2 12 -o oF Ip5f FLOO\ PLAN — z 5CA(,E 18" - 1'-0" SL 2'-All 2k, O 1U Ft;5T FLOX. 3,183 5.F, 801-01, _> \ I I ------------------- ' I I I 11 C) ' i \ II I I N pj fl I FEI o } MA51'Fp ��np00N� -011np00M o I u, 15'-Io-" VA11'1 - z � --------- -� 2'-6" I I 15'-10 I/All DN 11� MA51�p C��np00Nkpp\oom - OM 00 - b I3F;I. v Co OW DD o S p. } -- ------ ------------------- i I ' T-0" 3' 9" 6' 6,. 3,� 6._0.. 6'-0.. 1L -------------- - 5�CONn FLOOP, PLAN O I 5�CONI2 FLOX- 1,993 5,r, I i i I I i I i i I C IPQN rJl-r o 350 Joists @ I6" C.C. --- - o-2 x 12-655 at 12"o.c. ----- - MIbGiNG ' c N � > — � N � -- _ InGING co -75 i 7 I I I I I I I I I I I I II y z IIIIIIIIII IIII I � I I I I i i l III I I I I I I I I I I I - I f�117GIN � li I m117GIN I 2 x 10 Joists @ 16"o.c, I Pro i I crnE; sc��: 9fFf:Wll,I, IAM �� i -o��2b 1/8 - - -- -- I/ Woi PUU21�pl OF FINE HOMES 5trr-nnr: F15f FLOR F MING PLAN RAN PY; s i 4 I I I i I I I i j 2X10@16" II x 13�InGiN � O N � � � L 3-2XIO O o 4 C10 � o a o C1 - y � O N z � I O � I z O _ n z S1 r-- I i i I i � I i i i WILL 116\M / 15 NIM W6 SMF 1.01 - Ii I/8"=I'-O•� ' nnr� /01 ��r: f3Ul�b�p OF FINE NOMAScrn :.. _ --- --- S�CONb r�OOp MMING PLAN np\Am pY: 4 I I I 2 X 10 At 16"O.C. i I I n. \ I 11 1 I i � � I I (� I � O 0 e II O � I ( > O I I I I I I I I it — I � I I I I I I I I I I . I I I I II I I I I I I I I I I I I I I I ;I I I I I I I I ` I pP,O,Ecf IME: 5CM: nA1�: 5 Hf.. WILLIAM NU1'M CA ANF DoT-21b DUILnF,p OF FINS NOMAS S �r�n�: I7!? MEN: A - 10 AflIC MAMING PLAN i I I i i i N X C1 N� >G 0 t-3 cx z v� S1 I i WOJECT 111LF: SCW.�: 17A1�, SIf�T, WILLIAM [3pt?F A �f'�i' NU1"M�_G LANA X01 Zlb 11811-0�� i� 15�oi DUILn�f? Or FINS NOMAS Cr�ri�: p00F TAMING PLAN C01QTiNU0U5 kIGGE VENT �_ O 2 X 12 PIP2(SEAN, I x 8 MLq rEs c�'-o'' o,c. ZOTJ`F05n POOFING 13UI!-nING riM Imo--' 12 SHEATHING fl C, - -- 2X10@16" O.C. -MlATION --- -- --- - -0- 11 I� 2 X 8 c 16" O.C, >v 1 N9TA110N ;a� I VAPOP\DAIEP FP50A 6OAW 1/2" IA/AUOAP — 5OFFIT VMIf VENTIIJG N O II'-6" „ I 9 8 551PIN6 AKtA-nV, 2 X @�16" O.C. Z TT IN51k,l�N,VAPO?6 dl? Q 1/2" VVALI(SOAW Z F(,00� n 3/+' 51-rcATHIN6 II 7i 8" p20-350 IN91AT10N First Floo Level j 5U6p,T.,l -2X6K,17, CONfIINUOU5 51!.!SEAL 1/2" PIA.X 12" LG.ANCHOF POLT5 c 8'-0" O.C.(VAD o \ 11� FOUNnA110N r TO"00NOTTE 1^rl&L O 10" nEEp I'-8" VOPf CONTINIOU5Foo lON vAWF' 001`EXVIOP 51,111?FACE 1L' /-41, CONCIETE 9-V � z 5�CION TiPu FAMILY BOOM - O No 2 ^ Date... ..... .......::.. ........ f MOR7M� 3 ;.,�`` :•_:"�,� TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING +► oma+ ��++ SSACNUSE� This certifies that ......7- .................................. ............... .:.............................. has permission to perform .....:-" .`!.....��/................................................ wiring in the building of . - ..�. �,...... -1.�- ' "> '*•* '.".'........—..�. r. .. ................................... at.Z:...<............. .- * ...................North Andover,Mass. Fee.... - .`.,........ Lic.No .:r.... . .x... .......................... ELECfRICALINSPECTOR Check # ,1 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer a�, V TJWC0MMONWF.ALTHOFMAS,5 a1U•'SLM Office Use only DEPARTAMWOFPUBLICSAFM Permit No. BOARD OF FIRE PREVEW0NRWUTATI0AN527OR 120 � Occupancy&Fees Checked ■��,�.� APPLICATION FOR PERMIT TO PERFORIN[ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 ' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat 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) o dA JdrWr6 Owner or Tenant Z G d Owner's Address h </',0/�/g: J Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building t ), ry z T Liz/Ly .1)"a., Utility Authorization No. Existing Service Amps Volts Overhead M Underground No.of Meters New Service Amps_ /` Volts Overhead r—J Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work &U/,/t A4 A/ ti LY, SUS i_t NL No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundg1:1round 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 Wtiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of gryers Heating Devices KW Local Municipal r7 Other Connections No.of-Water Heaters KW No.of No.of Signs Bailasis No.IiNro Massage Tubs No.of Motors Total HP OTHER > � Laws o Iha%eaaut%tLmbtkyhs==Pcbcymd dffgCanplete Covwdg critssibshttiale*ivalat YES NO lhawabnadvdtidptodofsamelodrOffm YES M NO If}culnedx&WYES p&meit *&tAxcfw&aWbydada<gthe. wsURANCE �BOND OTHER ftMSpX y) Evizem D* EstmakdvalttedUmincal Wak$ Wokostat htspeWWD*RowMWd RD# Final Sigtted tttxie3'�ie I$tal�es ofpajtay: FIRMNAME Liomwlsh > Sig 1-f0 O f f i><1 No &-f BtsaxssTeLNa Addles.— .� �, Z_ /C�� . i� leu /A/ AkTeLNa OWNERS RWRANCEWAPME Ianmatett I velheitstsanewvmWoMsubsWWe*yw1oltasttmedbyM Laws anddxtmysigr rnm ispan i v dtismw*ffm t (Please check one) Owner F-1 Agent Telephone No. PERMIT FEE$ `� � f e No 3 j 0 Date. �....".........!.-' ........ f �aORTM 1 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS mus Q This certifies that :......................................................................................... ° has permission to perform .:........'...:..:..�!✓...../:.... ....................................... wiring in the building of ' ............ ,North Andover,Mass. Fee.-..'r ............... Lic.No.............. ................` .:..'.:...... :- .................. ELECTRICAL INSP R Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TE09Aff10AEi LTH0FM4S`4CHUSEr N Office Use only DLPARTMENTOFPUBLICSAFM Permit No. L3 BOARD OFFIREPREYEVHONMGULATIOAS527CMR 120 ' Occupancy&Fees Checked APPUCATTONFOR PERMITTO PERFORM ELECTRICAL WORKS�z.o f ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat_ 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) ldOX IVU7/"I r 6 Owner or Tenant d'e'- Owner's 'e/Owner's Address Is this permit in conjunction with a building permit: Yest=No (Check Appropriate Box) Purpose of Building 12.Q S /CC Pf'1 / Utility Authorization No. Existing Service Amps Volts Overhead ED Underground No.of Meters New Service Amps /� Volts Overhead r--1 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 271 V Ir '7/ No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and 0 2round No.of Receptacle Outlets No.of 0il Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 1 ' 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 N,p.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 a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER Ir><aranoeCo�aage PtisttatYtothenagtritattatsafTviamdt�Gata'alLaws i"haw a airentI-ximlity hnr&=PchLy indidng CaTO&Opwatiorls Caaag criesleWit alas YES F41 NO Ihaw submittedvaWpoofofsametothe0ffi=YES � lf}w haw drdced YES,*me idr&thetypeofwyau-Pbyducki gthe II K RANCE BOND OTFIER M ft=Spt&y) a* f &nvMd V"dEleclnd Wc&$ 74 D t�Z7 WaitmSWt '7 -off 7- r hsp"mD*R4xsWd Rage Caul Sigred utdaTie P&lalties of FIRM NAME .S / v Q r /V A I�ar�seNa 8 7 s C— Jv1_ swum // &wlessTel.No 'ZZ L -' V 7 Address..27 /tel e/d h UT S� 1W i L/2Z 7 At Tel Na OWN©t'SVs1SURANCEWAIV ;IamawazethattheLioalse�not sthe eWhvJaitasmgxedbyMassadmemCard Lam andhetmypeonduspenn6 wanesthism m Trot (Please check one) Owner Agent a Telephone No. PERMIT FEE$ I _ ;I ° G / 0 Date.....O�. ( ' (J NORTI{ Of t�`ao;�1ti0 TOWN OF NORTH ANDOVER F 9 PERMIT FOR WIRING •o'"'444``` _.�-0q�• ,SSAci/us� This certifies that .........f..!./o.?.....!.�%�?........./'t.......r.�.`'��.1..'r.�...�..... has permission to perform ............... t ,.....................� � `Q ff � wiring in the building of......�. .�!. ?..11 ... ..[-1 CJ S z� t'S ........... ............................... at.......1 U �....��+...vfh�. T.... �\....... i�cirth Andover, /Mas s 4 Fee... Lic.No..°�.STG ...... '. ( E[.ecr[ucAr.INSPECTOR Check # / WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TI&00AM0A E4LTH0FM MCHU`.77S Office Use only 1 DEPARTAfflW 0FPUBLIC&4FM Permit No. BOARD OFMEPREVEMONRWMT10AN527CMR 120 Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,S27 CMR I2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat 0,) d 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) Ilk i ' 6 1 ,Jj,,ye6 i,o Ali rew Owner or Tenant P/Gt Owner's Address l 6 `� l akAl P /�S It Is this permit in conjunction with a building permit: Yes® No (Check Appropriate Box) Purpose of Building Utility Authorization No. 166 .,2, Existing Service Amps / Volts Overhead o Underground No.of Meters New Service 4 00 Amps�i/ '. 6 Volts Overhead rI Underground ® No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �>1-0 T?t '/ ,,4 6 W 511-yka �C C�r 4�c�i�.✓ sF �i*Z a� _ lzy No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total _ V. KVA of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ound 17 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 y No.of Dryers Heating Devices KW Local a Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER. h>SiraroeCo R>rs�ttbthera�atialtsofMassad>tGata'alLaws Iha%eaomatliabtldyhmm=PobymdubtgCanpi& C vaaWcriisskgartialecgnvalat YES NO Iha%tabntedvandproofofsarebtheOffim YESIfjcuha%ed�adWYES pleaseadcwthet)Wcfw&aWbydr durgthe iWop a. bcL�11 INSURAN E �1 BOND OTI-ER F-1 ftmSpacdy) Esti nAd ValuecfE7edtilal Wok$ WakoStwt hspeaicnD*RapcWd Rough Final Sigtted Wd0M%WbeSofpetjtey. FIRMNANE l e 4L L/C- Lioa>seNa g I�oa—�� G'✓�M t�Sri f j_f�ss�7� Sigr . Lioa>SeNo B sin ssTdNa Addles,, V �l611 L d� � /.t/l AI<TeLNa OWNER'S Ps SURANCE WAIVER,I.amawacedAtheLdoew theinstraroeooyaageani ssbAwfraleqxvaetasteqLmdbyMmadnscus Galal Laws andt utmysigi m,on spmdWpkmmvai*esdtmwitanat. (Please check one) Owner a Agent Q l� Telephone No. PERMIT FEE$ /v