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HomeMy WebLinkAboutMiscellaneous - 11 CAMDEN STREET 4/30/2018 (2) 11 CAMDEN STREET 210/085.0-D021-0000.0 ` I h I 4 - I E 8862 Date.73-J.1. . o',"•�Itr:��o TOWNF NORT NDOVER r PER , IT R PLUMBING "wc ,SSACMUS� This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . .l. . . . . . . . . . . . . . . . . . . . plumbing in the buildiJngs of . .4: !�`i �.p!9. �. ... . . . . . . . . . . . at . . . . . . . �. . .... .. . . . . --.... . . . . . . . ., North Andover, Mass. Fee kqq. .v.Lic. No .I. �. !'�. PLUMBING INSPECTOR Check ff ��� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/TownAORY MA. v// Permit# Building Location:_/J bu ey Owners Name-, ,geU &*1 Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration: Renovation:g- Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED LU Z SYSTEMS wW) O > Y L1 Z Vf O H a D: Z r.. Y Q J rU F- W OC Z Q 3 Ln x Ln Q W ? r"' W Z �¢" h G Q Z �_.. N H W IW- p ¢ W ¢ Z arc z z Z ti z j c x = � a 3 Y = 0 C' 3 = �.., W !n J Q Z = tY = OZS O W 9 Q Q to to O 0 F- > > O O Oa Z Z of F- F- _ I a > to V1 W a m m o S x Y g 3 z h rQ- 3 3 3 0 ¢ W 3 ;BASEMEINT B BS TFLO 2ND FLOOR + 3"FLOOR w 4'FLOOR ST"FLOOR FLOOR 7T"FLOOR 8T"FLOOR Check One Only Certificate# Installing Company Name: C�iV/3'P�.y�'1�)r�f��G71� Corporation Address:�U(,hd!) P- — City/Town: I State: ❑Partnership Business Tel: -i(�j ? Fax: 9't-V _37-2- ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,please indicate the.type of coverage by checking the appropriate box below. A liability insurance policy (j� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner [I Agent El I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title dumber Sign re of Livens Plumber City/Town 1 `Master ' APPROVED OFFICE USE ONLY) [-]Journeyman License Number: 7 5 9 Date.3.-2. .1.1. ..... .. N°RTN 3= TOWN NORTH ANDOVER f O 9 PERMIT FOR GAS INSTALLATION . 9 • �ISS ACMUSE4t This certifies that(.e?�d. . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . at . . . . . . . . .//. . . .!'?O!.. . . . . . . . r.1, North Andover, Mass. Fee. & . . . Lic. No.. . . . . . . . . . . . . . . . . . . . . . .s7. �w GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: A), 4X10W-11j-& MA. Date: Permit# Building Location: 0&1010A/ Owners Name:71)4�C�/L(J t'/✓ Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation:�Replacement: El Plans Submitted: Yes EJ No El FIXTURES Cd Z HY a U) L) Z M = O W W U N H 0 = W W 0 z z O W W 0 Q F=- v5 CO 0 Q a I-- O 0 w K W w m O > tz w t¢ W o xLL W H Q W w z y x W � z w > U W z O J P P O z J (7 u- N = W W W z w } W M J Q a m w O z 0 W z � c0) o a LL 0 � _ = g >0 a W > > > 0 f SUB BSMT. BASEMENT -iFLOOR 2 Nu FLOOR 3 Ru FLOOR 4 TH FLOOR 5111 FLOOR 6 1 H FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Ceo/i/&r- J�t'Corporation Address:L &GAAV YW City/Town: 17612t State:__ ❑Partnership Business Tel: /2_nx-a13 Fax: ❑ Firm/Company Name of Licensed Plumber/Gas Fitter: Al- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,please in ' ate the type of coverage by checking the appropriate box below. A liability insurance pi 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. TTy Iof License: Byumber Title [ISas t Fitter Sign e of Licensed Plumber/Gas Fitter Master City/Town ❑Journeyman License Number: APPROVED OFFICE USE ONLY F] LP Installer 13)0 The Commonwealth of Massachusetts Department of Inclustrial.Acciclents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov1dia Workers' Compensation Insurance Affidavit: Biiildexs/ContractorsIBlectxicia>n.s/JPlu mbers Applicant Information Please Print Legibly Name(Businessiorganization/Individual):—.� Address: City/State/Zip: Phone#: Axe you art 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 employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.? 1• 'emodeling . 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 54iKwe 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 1 I.❑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.] 13F]Other !Any applicant that checks box 4l must also fill out the section below showing their workers'compensation policy information. T Homemyners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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: Policy#or Self-ins.Lic.#: Expiration Date: rob 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 ado hereby certi un der thepains andpenalties ofperjury that the information provided above is true and correct. Si ature: Date: IDS 4AAO ZD 1 Phone#: — l Jn E[6.Other only. Do not write in this area,to be completed by city or town offkial wn: PermitiLicense# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.EIectricaI Inspector 5.Plumbing Inspector son: Phone#: MetLife Auto&Home® Homeowner Operations Field Claim Office Attention:Claims P.O.Box 6040 Scranton,PA 18505 (800)854-6011 09 January 12, 2015 North Andover Building Inspection 1600 Osgood St, Suite 2035 North Andover, MA 01845 Our Customer: Rebecca A. Wildes Claim Number: JDE84497 4X Date of Loss: January 8, 2015 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten (10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 11 Camden St,North Andover, MA Sincerely, Larry Branco - FLD =_ Metropolitan Property and Casualty Insurance Company Senior Claim Adjuster =_ (800) 854-6011 Ext. 7177 Fax: (866) 958-0736 -_ Email: lbranco@metlife.com MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698 MetLife Auto&Home® Homeowner Operations Field Claim Office Mail Processing Center P.O.Box 2201 Charlotte,NC 28241 (800)854-6011 A t 0 14 TOWN OF NORTH ANDOVER September 9, 2014 HEALTH DEPARTMENT North Andover Health Department 1600 Osgood St Suite 2064 North Andover, MA 01845 Our Customer: Rebecca A. Wildes Claim Number: JDE62768 89 Date of Loss: September 6, 2014 Dear North Andover Health Department : Pursuant to M.G.L. 139 § 313,please be advised that a property loss at the address referenced below has been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten(10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 11 Camden St,North Andover, MA Sincerely, Adam C. Cole Metropolitan Property and Casualty Insurance Company =_ Claim Adjuster (800) 854-6011 Ext. 7449 Fax: (866) 283-1360 Email: accole@metlife.com MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698 MetLife Auto&Home® Homeowner Operations Field Claim Office Mail Processing Center P.O.Box 2201 Charlotte,NC 28241 (800)854-6011 U f September 9, 2014 North Andover Building Inspection 1600 Osgood St Suite 2035 North Andover, MA 01845 Our Customer: Rebecca A. Wildes Claim Number: JDE62768 89 Date of Loss: September 6, 2014 Dear North Andover Building Inspection: Pursuant to M.G.L. 139 § 313, please be advised that a property loss at the address referenced below has =_ been estimated to have damage to the dwelling or other structures that will exceed one thousand dollars. Please let us know within ten(10) days if there is a pending or existing lien against the property as provided by M.G.L. 139 § 313, or if there is an intent to initiate proceedings to perfect such a lien. Loss Location: 11 Camden St,North Andover, MA Sincerely, Adam C. Cole Metropolitan Property and Casualty Insurance Company —_ Claim Adjuster (800) 854-6011 Ext. 7449 Fax: (866) 283-1360 Email: accole@metlife.com MetLife Auto&Home is a brand of Metropolitan Property and Casualty Insurance Company and its affiliates,Warwick,RI. MPL MA-REGDEPT Printed in U.S.A 0698 f .� 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the (/ \ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c.166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the.permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shalLbe limited as to the time of.ongoing construction activity,and may be_deemed.bythe,Inspector_ofWires abandoned.and_invalid_ifhe—.. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was �- "in effector existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. Permit/Date Closed: ** Note:Reapply for new permit��/ 3E ❑Permit Extension Act—Permit/Date Closed: i '10079 Date..... .: :..1 . 3:;•�;�`".•�."',� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SAC14USE� @�This certifies that has permission to perform DelsfiC ..w...�-.�........... wiring in the building of............N.PtA.d .6F......... ........................... gr��il?�h/.....ST'....................... at......:�.................... ...... ..... ,North Andover,Mass. oc 6 , V f Fee.3O....�..... Lic.No. ..�..��6....�........... ............... ... ......... . ... .. ELE RICALINSPECTOR Check 'I Z 3 i !/ x Commonwealth of Massachusetts Official Use Only t Department of Fire Services Permit No. 1,007!j Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) I I C,AnAen St Owner or Tenant Lau rA N Aockol\e Telephone No. (01'7 G,9 UI�7 5 Owner's Address t A U vCt` IWne Is this permit in conjunction with a building permit? Yes Z No ❑ (Check Appropriate Box) Purpose of Building S., � r Q,,,f� �j 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: Zv•Settta- %,\A-r" bd,._,g.tX v� Com letion of the following table maybe waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of ot al Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting nd. 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 an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons I No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained , Totals: Detection/Alerting Devices i No.of Dishwashers Space/Area Heating KW Local❑ Monne p on 1:1Other Heating Appliances Security Systems:* No.of Dryers g pp KW No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent • No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications NDevices uiv No.of Devices or Equivalent 1 OTHER: . Attach additional detail if desired,or as required by the Inspector of Wires. ` Estimated Value f El ct Work:U 3W - (When required by municipal policy.) Work to Start: LJ , 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 covera i to 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 infor o on t 0app kation is true and complete. FIRM NAME: LIC.NO.: Licensee: Cr,� DV W l q_(� Signature LIC.NO.: ,-)p466 A (If applicable,enter "x mpt"in the license u ber line.) Bus.Tel.No.• b 11—$9 ^Via► Address: 4 t�1.aC (42 , ���� " oa.C�:b 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 El owner's agent. Owner/Agtt �����Telephone �' �Qa(� PERMIT FEE: $ Signature No. Mayr nWf11?ns05:22 PM T & G Electrical 17814070889 PAGE. Pago 2 of May 04 11 03:08p Laura 9782088189 p.1 The Commonwealth of Massaehuseds Department ofThdusirialAceldents j Q(gice of Invesdgations i 600 Washington street 5 Boston,MA 02111 •j www.rnas&gov/dia Workers'Comtpensatioa Insurance Affidavit:Builliders/Contruetors/Eiectricians/Piumbe>rs Alpylicard fni'armation Please Prixf Leldb l\TaMO(BusincrXOrganizatioa/individual): Address: Cknn City/Stlate/Zip: �1t D Phone It: Areyau an empbyer?Check the appropriate boat: Type of project(required). 1.0 1 atn a employer with_•_ 4. l] I tun a general contractor and 1 6. El-Nen+v constructias toyees(full and/or art time ," have hired the suis-contrectars p P ) 7. Rcmodeling 2. [stn a Buie proprietor or partner- listed on the attached sheet._ 1 ship and havello empltsyvas "Moe sub-conhactare have 8. [[Demolition working for me in any capacity. workers'comp.insurance. 9. []Building addition [No workers'comp.insurance 5, [] Vie area corporation and its 10.0 Electrical repairs or additions required.] officers Weexercisrd their 3.C� 1 am a homeowner doing all work right of exeauption per MGL I I.CI Plumbing rapaira or additions, myself.[No workers'comp, a 152,§1(4),and we have no 12.[]Roofrepairs insurance required.]t employees.[No workers' 13.0 Other comp.insurance required.] Arty applicant that checks box B l must alio fill out the seodon below showing their wod=1 compensation policy iafortrtation. t Homeowners who ribmit this affidavit Indicating dray are doing all work and do hire outside ccniractore must submh anew atlZdavil Indicating such tConkaatora t1w check this boot must attached an add ttonal shat showing dm maim of the sub-eontmaton add dick workers'camp.pul ivy informatlon, I am an employer that is prowMag workers'compenurdon i'raurance for my amplaywm Below is the policy end job site Informadaft. Insurance Co ripany Name: _ Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address:_, City/State/Zip: _ Attach a copy of the workers'cosnpettasltion policy declaration page(showing the policy number and'expiration date). Failure to secure coverage as required under Section 25A of XGL c. 152 can lead to tfte imposition of criminal penalties of a gine up to$1,500.00 and/or one-yee.r imprisornoenk as well as civil penalties in the form of a STOP WORK ORDER and a fine 1 of up to$250,00 achy against th Iolator. Be advised that a copy of this statement may be forwarded to the OfUco of Investigations of the DIA for in u cc coverage verification. I do hereby eeQkA&et air tadpe altles of-perjury that the infor aiiun provided is true and earned.' .Q_hone#: —��l" S�L Q tcial use only. Do not wrlte 1p at4 area,to be completed by el0i or romp officlal. Cily or Town: Permit/License 0 Lsrsuing Authority(clrcle one): 1.i3oat of Health 2. Building Department 3.City/Town Clerk 4.Elecui¢al inspector 5.Plumbing Irncpector 6.Other Contact Parson: .Phone#: httnc-//annl .mtafastlnne.cnm/(R(rafki l ioovhcr45 5mke7.c345)F(IWhmT IR WmT7,w 1470096... 1/1/?.011 Date....G ................. ..................... OF NORT/i.�� 3�; oo� TOWN OF NORTH ANDOVER 0 9 PERMIT FOR WIRING ,ssACHUs�t This certifies that .......���,�n.....(NG. rI//I........................................................ has permission to perform ./ .................................v� 1'00 ,d .., o � � l � ) wiring in the building of....& .....N/1c°5....................................:......... at ........�..�..... �-�.. .r�P.✓?.......... .......................................T .North Andover,Mass. . Fee..J�.�.-........Lic.No.44ZGL�E`....WMIJ .C4.....r.� dam`` //?? ELECTRICAL INSPECTOR Check# /J 7 � 33 r Official Use Only � Commonwealth of Massachusetts Department of Fire Services Permit No. Occupancy and Fee Checked aM BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/o7] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 C 212.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspecto of ices: By this application the undersigned gives notice of hi or her intention to perform the electrical work described below. Location(Street&Number) rot Owner or Tenant ,` Telephone No.qf,�_ '7_j��f�y Owner's Address 4t, i 0Z 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: Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: -'' ""' """' ........... ""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Securitio o Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent WirinNo.Hydromassage Bathtubs No.of Motors Total HP TeNo.of Devicesons or Equivalent OTHER: 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 CO RAGE: 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: INSURA=NCE ❑ BOND ❑ OTHER ❑ (Specify.) I certify, under the p ns and penalt'es penury,that the ' orn: tion on this application is true and complete. FIRM NAME: . �/ 4, LIC.NO.: Licensee: C )Al Signature LIC.NO. (If applicable,ent r "ex pt"in the lice a numb ' .) Bus.Tel.No.: ' Address: Alt,Tel.No.• *Per M.G.I c. ,s.57-61,security work r quires Departure t 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 FamiTFEE.- $ !� Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the , notification of completion of the work as required in M.G.L.c.143,§3L. Permits shallbelimited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Ins ion Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F Failed Re-Inspection Required($.) ❑ Inspectors Comments: '1 Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP TION: Pass M V Failed Re-Inspection Required($.)❑ Inspectors Comments: 4 4d Inspectors Signature: d Date: 7--��--�_s` DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please rint Legibly Name(Business/Organization/Individual): G Address: il Fa or f/,?ood hr. City/State/Zip: &r J, / Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑lam a employer with employees(full and/or part-time).* 7. R New construction 2.QKam a sole proprietor or partnership and have no employees working for me in 8. �Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my properly. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I=a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ p 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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.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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio . I do hereby certify d thepains an dp&zalties ofperjury that the information provided abov qis{tr a and correct. Signature: Date: U Phone#: Official use only. Do not write in this area,to be completed by city of 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Date..... ......... ..... ................... ' of NORT#,,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SACHUS� w ��,�,� .- This certifies that .... ...., has permission to perform . ��VIA 0,1e �. . ......................................�.... ............. .. .. ...... wiring in the building of.... :...N... ........ ........................... .� 14 C at ...................................... .............'.j....j...''.....j.....................:...............,North Andover,Mass. Fee...��.15 .........Lic.No.!'..,l.Y•,7f" . i ELECTRICAL INSPECTOR Check# 1324rc. —( ii ,i Official Use 0n1 Commonwealth of Massachusetts _. � Permit No. Department of Fire Services ' Occupancy and Fee Checked aM a BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C) 27 CMR 12.00 (PLEASE PRINT INMK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the In pect r of Wires: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location(Street&Num er Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No [B' (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 Electric Work: J t !7 t Completion o e following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No,of TotalTransformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. Elrnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection ondInitiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices Heat Pump Number Tons" K No. of Waste Disposers W No.of Self-Contained P Totals: - Detection/Alerting Devices Municipal ElOther No.of Dishwashers Space/Area Heating KW Local E] Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of WaterKW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent " OTHER: Attach additional detail if desired,or as required by the Inspector of mires. Estimated Value of E ctr' al Work: (When required by municipal policy.) Work to Start: YNU6 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: 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: INSURA=NCE L4""BOND ❑ OTHER ❑ (Specify:) I certify,ander thepains andpenal les ofperju ,tattle inforntatio on this application is true and complete. FIRM NAME ` LIC.NO.: Licensee: Signature LTC.NO.: (If applicable,enter "exem "in the licens n im er lin Bus.Tel.No.: Address: Alt.Tel.No.: *Per M.G.L c. 14 ,s.57-61,security work req ares Department fPublic 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 PEAWT FEE:$ j Signature ` Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: c Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass IN Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPE ION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ? DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department oflndustrialAccidents _ T d 1 Congress Street,Suite 100 Boston,ALL 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information A Please Print Legib Name(Business/Organization/Individual): !,V Address: W&Jr . City/State/Zip: 1S t Phone#: r - 2� Are you an employer?Checkthe appropriate box: Type Of project(required): 1.❑I am a employer with :.. employees(full and/or part-time).* 7. E]New construction 2.�am a sole proprietoror partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12` • :❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance. ❑ 14. Other 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. ❑ 152,§1(4),and we have no.,pm yees,[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who subii iit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-co'fi6etors have employees,iliey must provide their workers'comp.policy number.' la m an employer that is piovidiicg workers'compensation insurance for my 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Y do hereby certify d the pains an enalties ofpeijury that the information provided abov is t ue and correct. Si ature: Date: 1 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#: s J • Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their pmpr oyees. 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, artnershP�association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,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 foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law ' 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 Ieaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 4/4/2016 License.jpg i i Fold, Then Detach Along All Perforations TH OF Et: TR 1 SSU4.;.$ As A . EYMA ::..' , -.-;'C WAN I NG 388 FAROO* D 0R I V• IAA Of ORD , - 4 b 3 1:6 . . , https://m ai l.google.com/mai I/ca/u/O/M`nbox/153e2bf7af493cl a?projector=1 1/1 Location ' 'No. . --, Date koftTh TOWN OF NORTH ANDOVER Ot tt�ae a,'10 O? •' •• Off' . „ Certificate of Occupancy $ Building/Frame Permit Fee $ E�� ar-Foundation Permit Fee $ CHUt�jOther Permit Fee $ Sewer Connection Fee $ *WaterCllonnection Fee $ � f; -'�'�"''; t✓ Gam-�`�'.',�' I�f!� i,�k f !r Building Inspector Div. Public Works J44 Location No. Dater - 14011Tty TOWN OF NORTH ANDOVER ptt �ao .x,'40 „ Certificate of Occupancy $ # Building/Frame Permit Fee $ d Y • �a • s # a;'Foundation Permit Fee $ s�CHus a* 9�p� Other Permit Fee $ • i ompe' er Coppection Fee $ : 1 WaterAb"nnection Fee $ 4 TOTAL $ •`' 06 Building Inspector Div. Public Works PERMIT N<9., "U � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 MAP iqO. 0950007. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE — ZONE SUB DIV. LOT NO. T-A 02/oq/65 019zq i 03// LOCATION " G A M D C N ��'2 F Z-, PURPOSE OF BUILDING ��215 .J 4 TTAC lab / ey,,&j. OWNER'S NAME Vl ylgol� ii i/�re{ ��J`^�� ' NO. OF STORIES i SIIZZk 41-0 1 '3 4-IiJIJOgx i l OWNER'S ADDRESS �'lN1I C Ar 1*y hR ail s-r 7c- �fi�SaR BASEMENT OR SLAB C►/�`�08'r rLo o g' ARCHITECT'S NAME 1 `/,t ► 1= SIZE OF FLOOR TIMBERS IST 1= 2ND 1^ 3RD BUILDER'S NAME fw A S 5 IM B fl. p 1 1 . OJZ f N ( SPAN DISTANCE TO NEAREST BUILDING AI'9rAe-H+E 1> DIMENSIONS OF SILLS DISTANCE FROM STREET ' "' "' POSTS DISTANCE FROM LOT LINES-SIDES , /' REAR 9 ! , GIRDERS AREA OF LOTg®o © T FRONTAGE 75/ HEIGHT OF FOUNDATION i THICKNESS /0 IS BUILDING NEW J SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY N /Jq IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND S O WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ao BOARD OF APPEALS ACTION, IF ANY Ri.7 IS BUILDING CONNECTED TO TOWN SEWER �Pi fV IS BUILDING CONNECTED TO NATURAL GAS LINE O INSTRUCTIONS f 3 PROPERTY INFORMATION LAND COST OWNER TEL A �� �� / �- SEE BOTH SIDES CONTR.TEL.# EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 CONTR.LIC.N EST. BLDG. COST PER SQ. FT. f 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 711Ll9 9 G. BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE ` o� a plod Sd' PLANNING BOARD PERMIT GRANTED r/ BOARD OF SELECTMEN BUILDING INSPECTOR 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 B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1/1 3/, FIN. ATTIC AREA N_O BM'T 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\4'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ i j'; 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 _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX() - GAMBRELMANSARD TOILET RM. (2 FIX.( _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 010 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR ^ WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS y OI l B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING � DWG. N0. SH REV. 1 , REVISIONS REV. DESCRIPTION DATE APPROVED 1 • F1 Y O CAMDEN STREET OTYFSCM PART OR NOMENCLATURE MATERIAL REOD NO. IDENTIFYING NO. OR DESCRIPTION SPECIFICATION PARTS LIST UNLESS OTHERWISE SPECIFIED CONTRACT NO. DIMENSIONS ARE IN INCHES ' C n /a TOLERANCES ARE: p rM� FRACTIONS DECIMALS ANGLES + XX± ± ((�� �y XXX± APPROVALS DATE P R O P O S F-b G A R AGC- MATERIAL DRAWN CHECKED A �S �'� 14 FINISH . SIZE FSCM NO. DWG. NO. REV. NEXT ASSY USED ON ISSUED APPLICATION DO NOT SCALE DRAWING SCALE -Too TQ sc45 SHEET f ® � � BISHOP GRAPHICS, INC. REORDER NO.20510 a • i Lr nco •_I CCH'... COAI'i:CI LEO' . bt•,�1 z nay. 1'"C.0 I :.0- t0FYisJ!.idk.:'3:'O ci Q..nc4ct)IMV 2btc G f^y::' 1 b`•Hl Db CVNDEV! 21v-) 1 4t I— --T Fl ar:A -B . :.3r: ' ' U is"1 ::►.:ri SEWERII�IAT ti W INAL N _, �. ' �N ®NS RV FINAL nOT `/ O� 0No. 362 S Nbilth,E ndo�er, Mass., 19?� HIVE1�AY ENTRY PERMIT' �A�PERMIT-TCrB P���� �' Ir UILD BOARD OF HEALTH • THIS CERTIFIES THAT je"Of � � BUILDING INSPECTOR has permission to erect04OaSWthuildings on i11IGi � Rough Chimney to be occupied as....I.�... do ....t..!...................................................... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Al,vter�aitio�n_j�nd`S Construction of Rough Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION STARTS Service -P MIT FOR FRAME/BUILDING .�� ) . .... ... .... Final •,FEE PAID• ' ��' BUI .DING INSPECTOR GAS INSPECTOR DATE., Rough Occupancy Permit Required to Occupy Building Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector A 4k*A, PROPOSED LIST OF MATERIAL The following is a proposed list of materials for the construction of a Garage and an attached Breeze-way at the address of 11 Camden Street in North Andover- MA. ' _ 1) FOUNDATIONS: Poured Concrete, the bottom of the - �v- LA)/ foundation to be four feet below grade, with one foot w protruding above, and a minimum thickness of ten inches. 2) WALLS Walls to be constructed using standard Kiln Dried dimensional lumber, nominally 2"x 4" . The walls height is not to exceed 8 ' from the base of the foundations , the studs will be spaced 16"O.C. and the walls will be attached to the concrete via a 2" x 8" ,Z -Axe-- pressure treated plate, running atop the perimeter of the foundation. 3) GARAGE ROOF: The garage roof to be constructed using vts/ 7 Trusses, spaced 16" O.C. , the trusses to be anchored to Tjs �Vo I the walls by the use of metal clips. 4 ) BREEZE-WAY ROOF: To be constructed by 2" x 6" rafters spaced 16" O.C. and tied with 2" x 4" collar beams. 5) WALLS SHEATHING : 1/2" CDX exterior Plywood, 4 ply A.P.A. 6) ROOF SHEATHING 1/2" CDX exterior Plywood, 4 ply A.P.A. -'� 7) GARAGE DOOR HEADER: 2 v- 211 x 12" x 16 ' to accommodate for a 14 ' door. 8) BREEZE-WAY FRONT DOOR HEADER: 2 x 2" x 6" x 4 ' to accommodate for a 36" do;or. ✓ 'M 'I BREEZE-WAY BACK SLIDINGRADOOR: 2 x 2" x 6" x 6 ' to p accommodate for a 60" sliding door. 10) SIDING Pre-primed Masonite clapboard siding to match existing siding' in appearance. The siding is to be applied onto previously fastened Tyvek housewrap. 11) ROOFING SHINGLES: Asphalt shingles, nailed with galvanized 1" roofing nails, applied onto a layer of construction paper. 12) NAILS,, Walls = 16 pennies galvanized Walls Sheathing = 10 pennies galvanized Roof Sheathing = 10 pennies galvanized Walls Siding = 8 pennies galvanized Roof Shingles 1" roof galvanized Tyvec Housewrap N= 1/2" staples Construction Paper = 1/2 staples ` i i I ,ORT„ OFFICES OF: . 0� Town Of 12c)Main Street APPEALS �,.�.-�-" NORTH ANDOVER North An(lover, BUILDING ;,'';::; ^�'m MaSS;1(-ht1SCI1S O1 H45 CONSERVATION ss"°" °` DIVISION OF r. r ((i 1 7)(ili,�477,, HEAL"I'H PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIIIEC-1.011 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number 6a is that the dcbris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: (Location off Facility) Si ature of Pcrtnit plicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for thisro 'ec p � t through the Office of the Building Inspector. PLOT PLAN 11 CAMDEN STREET No. ANDOVER MASS . SCALE: I = 30' JUNE 25 , 19,92. WILLIAM G. TROY REG/STEREO LAND SURVEYOR 936 EAST STREET- TEWKSBURY , MASS. PRINCETON STREET ` 25' -7 - o CD 0 co �� 50 , 8,000 s.f. PROPOSED GAR. 4.0' BREEZWAY o 0 20" 15' EXIST. DWELL. = N I GARAGE 4.1' 10TO BE 15' RAZED 8' 75' CAMDEN STREET I HEREBY CERTIFY TO THE BUILDING INSPECTOR THAT mow, THE DWELLING IS LOCATED ON THE LOT AS SHOWN AND THAT IT DOES .i01A OF 14.4'p. CONFORM WITH THE TOWN OF NO.ANDOVER ZONING REGULATIONS 0 t REGARDING SETBACKS FROM STREETS AND LOT LINES. ' r4� wiLilAnn ,, 1 FURTHER .CERTIFY THAT THIS DWELLING IS NOT LOCATED IN THE A G. FEDERAL FLOOD HAZARD// AREA *S SH WN ON MAP DATED JUN. 15 1983 � TROY No. 199 47 REGISTERED L D SURVEYOR THIS PLAN IS NOT FOR BOUNDARY DETERMINATION BOUNDARY INFORMATION TAKEN FROM: �'N.E.R.D. PL AN 195. 1 Town of North Andover •` , BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE 7/f 119 q JOB LOCATION Number Street Address Section of town "HOMEOWNER" 1143SIMO n. h7uaait4i 699•33f Name Home Phone Work Phone PRESENT MAILING ADDRESS It CAtIbO ( �f 14 • p t4 boye-2- Moi- 018 L4 5 City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code , Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s ) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be , a one to six family dwell- ing , attached or detached structures accessory to such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the Town of . North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements . HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0 , Construction Control . Locaf!bn S F62C 7— // No. �6 Z Date GA V ! N°RTh TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ Building/Frame Permit Fee $ S b SFoundation Permit Fee $ � SACHUgE Other Permit Fee $ Sewer,.Connection Fee $ -, ✓ Water Connection Fee $ 1�cTOTAL $ � v` ti �,5„,wCC Building Inspector \ Div. Public Works 16 PEI` NOY APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. V PAGE 1 "'-�.kAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK PAGE ZONE: SUB DIV. LOT NO. ` LOCATION PURPOSE OF BUILDING it �'AN1a��✓ ST _ OWNER'S NAME A eSSI x N/J ./C,/ (,J�G�� NO.A OF STORIES SIZE M OWNER'S ADDRESS C� flEli rr. G131K 4SEMENT OR SLAB A CHITECT'S NAME J SIZE OF FLOOR TIMBERS 1ST 2ND 3RD BUILDER'S NAME ASA I A40 •/)+ P/_,�i Alf SPAN -- DISTANCE TO NEAREST BUILDING M. ti(i 7 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 w f a SIZE OF FOOTING X IS BUILDING ADDITION /,/ MATERIAL OF CHIMNEY IS BUILDING ALTERATION Jay , IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �S IS BUILDING CONNECTED TO TOWN WATER /�/,�/t BOARD OF APPEALS ACTION. IF ANY w'0 IS BUILDING CONNECTED TO TOWN SEWER 0 ,Y IS BUILDING CONNECTED TO NATURAL GAS LINE N 0 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST f PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 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 AAIA BOARD OF HEALTH S16GNATU E GIF OWNER OR AUTHO ED AGENT If F E E �-,a CONTR.TEL# CONTR.UC.0 PLANNING BOARD PERMIT GRANTED 4C is 91 BOARD OF SELECTMEN BUILDING INSPECTOR 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 —I 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS ikPLASTER __ - _ DRY WALL U,NFIN. ..r..�.. 3 BASEMENT, AREA FULL FIN. B M'TAREA _ 3/4 FIN. ATTIC AREA _ N_O B M T 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%tJ'D _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASQNRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAMEt _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLEHIP BATH 13 FIX.) — GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & 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. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st ) 3r, NONO HEATING t � f J { own of ver f— DRIVr er, IVlass., 3uNO i 199 C HE WICK oR ?� SS BOARD OF HEALTH PERMIT * T L.0 � N1+1, �I�i L THIS CERTIFIES THAT... ... ................. .. ..............; ..... � BUILDING INSPECTOR has permission to erect ... . buildings on ....1./.... .. �• ......!S7_?• •••••••• Rough Ad =now�. Chimney tobe occupied as.......... . . .p ...C�� .�T .............................................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR ST S Rough � service 4. Final ... ..... .... .... . •BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner REET NO. No Lathing to Be Done Until Inspected and Approved by Smoke Det. 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F..�+-��� Y�`'?�.r�" <w t.','•.iF ._fin` 'c :.,,�.;� ;,F - t' ;.. y�rc ,� ., s - :" �CIi4l :.'{.,4.w .y•y., � .v(;'.�d a �."t.'x�c� �,'�.'� .,:.,y ..,._n Vis. .�,_ ,k't� �}y'y x, t%. +,'�^�,,; `��- _L's a�,.- �.,.'�'+ F. -;2�'i' r• '�vG;• .,..,`h,;."'�''�'-��"r.:tt;'t� ' ;ysf'w'�. _,"�-�� _zk+�.r., -t h� - ,w "�.- s'F;*, �S, :ya * anxney •.,t` '� ota€ r `r� '-. .s''�. `, ., .5 .•�+s„�,fr '',fit+�.,iG ..� � �..- �x x Sectlon��of 0 7oriln Ordinance WWEREAS,;`vlolatrons bt_ Articie Ssi loo. buiIdIng Colo hive seri.bund on,, ` � ,�c�yr a(��y[.+k��y� -e.,ye•...'�p{y��g sy,>,. ;t n�/.►.�'r�.is,L �S'� �'�, �. �Ei�' , Mai��"' x -`y_-�•�VpV��M�•V µ �!.'�,�.:�'i: 74ia• ..,Q i #a e # d •ii6 "�i� `eisis4 "s},w_, t �sr-srY �. .•,r!-b? �'a...d' y� r•� ,�"�sx a �tf'�A, ��- �r t i s�o - ,���r����\r��:n��< o .,�-,... �a. '�ki,� �'w +V�- - 'kSF�,o7 .. `��"�� tr.`1rw ye *w .. {¢�,?�.cr'"�`� e-�. '�`t, 3 ° 'ti.,"a'�,.-��'�Ma s� �� + ,,� ,� �,� 3,, x,.,x. �� �•°•. `1 �`rl ��:�,�. '•1 RR -.,v� �`���t� �4i4 �# ., 'r.J�. � "t•..�. �k« t ;:;fir ,.x ,�.p t��Ff t i be v ,•e±4•.- ',:m 4 k7'g• t � • #�.r '� art`� i >t^�' •t<' .«, 't'"k Y.4A' �.. Q. �k r � .. �.xS� yy rt{ax F,«•C a r'�'}x �' r�tn7.,., ,e�yy �y '�, ♦ �. .! P �s+ .At tib' x °���r"$ �., �, ~�a e.}_-•v'air; ,�.� t f x4 'ryv''q,.�^« -.•7 s K e - � 's':''G - '` 5 r. Y,. r .+49'fi•' ^� v U5 w S vis .d! t ,r", w;.��" ,h .d 1' � �.F n• �+15 .,z r t y�"`++s ' •�,�f* �SC r �' t �`• ., t!i, m .:_ �' pati t once pertain�r "to' ooi� ri�ctfon;c ales err�e air°on-these �iremises known. ` All persons acting contrary,to this`�order�k or 'kai�ovingti�or mutilating this notice are liable to arrest unless such action is authorized by the Department; w : ; 3.ha:F "t1 n r F: �?�` '�"^ �, ire w +wS•� ♦h. � ����` t �,$ �/ k: ie BU/LDIM OFFICIAL I • �, w Iba o o r v r �j'R ra if CA 137 N PEl _.... APPLICATION FOR PERMIT TO BUILD -- AP''-4O LOT No. NORTH ANDOVER, MASS. ZONE 2 RECORD OF OWNERSHIP PAGE 1 n S^UB DIV LOT NO. DATE BOOK PAGE LOCATION / l f?/1� /✓ r OA"""R o NAME�r �Ji �/ PURPOSE OF BUILDING R� OWNER'S ADDRESS SS a AJC• /'�F� �/�N���,' NO. OF STORIES -" /,/ r �•� SIZE A CHITECT'S NAME /V • SEMENT OR SLAB /BUILDERS NAME SIZE OF FLOOR TIMBERS 1ST V MASI ae n M at, �C( J� 2ND 3RD DISTANCE TO NEAREST BUILDING � SPAN DISTANCE FROM STREET DIMENSIONS OF SILLS DISTANCE FROM LOT LINES- • POSTS SIDES REAR AREA OF LOT GIRDERS FRONTAGE IS BUILDING NEW HEIGHT OF FOUNDATION IS BUILDING ADDITION Q N( SIZE OF FOOTING THICKNESS X IS BUILDING ALTERATION MATERIAL OF CHIMNEY -W 1-1 L BUILYCJ DING CONFORM TO REQUIREMENTS OF CODE IS BUILDING ON SOLID OR FILLED LAND B -OF APPEALS ACTION. IF ANY ES IS BUILDING CONNECTED TO TOWN WATER /vo IS BUILDING CONNECTED TO TOWN SEWER Nd • IS BUILDING CONNE ED TO NATURAL GAS LINE Q INSTRUCTIONS Al D BIDES 8 PROPERTY INFORMATION LAND COST OUT SECTIONS 1 [ EST. BLDG. COST .hUT SECTIONS 1 . 12 EST BLDG COST PER Sp. FT. EST. BLDG. COST PER ROOM •.' PS MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. GES MUST CONFORM TO STATE FIRE REGULATIONS 4APPROVED By ' ,.`ILEO AND APPROVED BY BUILDING INSPECTOR VR -..ADENT BOARD OF HEALTH .. 2 69'33/2 CONTR.TEL.# CONTR.LIC.N PLANNING BOARD In qY 19 �— BOARD OF SELECTMEN BUILDING INSPECTOR ' � • • �tj j `.��� �*! 1�..,✓'' F 9 own of 0 ndover \ �H er, Mass., S�N F / 199/ ss PERMIT T 0 BOARD OF HEALTH 1 , THIS CERTIFIES THAT..M� �44 N #. .. „ WI"e'.11.,,�5� � L "��� 4, has permission to erect ... , buildings on ....t. ... .. � ,,,,,�, ,,,!,,,,,,,, RoughU ING INSPECTOR ILD • � to be occupied as.........IZ. e.P- 0-*9.A4. .Io '�................Q?'0_)jFinal Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applicatiton PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Conn of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR ST S Rough Service Final ... .............. ..... ... .. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by STREET NO. Smoke Det. Building Inspector 1 �jl�f:� a . J t �. A�NNnd t pa� o fkF r� \� ti..� f:°jY•�t��3�'1y!�J. f f' rglyn, �''�+�'F�}������^'�?(�� + ' "'T xY C .Z•LF.r-'i:' •�.*. '� ..�1i �' "'1� c y�t, � 'F1+`�, 4 *{fir�,,. ' Y� ' .tom 'y� *t >• � ir�7 - 'L Nro, , XK S rP r- .Yr t�>a,iBJ� M �' " : `4Yy Z t^° - y�✓�- a F 'rgg 'w„l. "S '+4� y aj�' f + 4 t; r �i� rf�1rr �r r,}`�•y Y��i.'•��r�.�a'Y—"'��'`r' _4, a a s,'�`s�'s °'r'�''c..;tt7'•'- D r' •�._ .,.� . rt��•.*. ?''�"�•:�-�'ifF r i..`� rr y' '0�it •- s x _�4+�Y'�y `°`F � ate /��) YWN �`vjola r Article � o res of Art16ln x �s to i �rlihD Onlinanc� " } '" n r trf, d Cbiie have bNn found , do � � �t���i�s��y;j�e�siiisf • ` ertfiiri rhLpt 5 a t once pV y ![, yyy �� 5�r♦'}+�� ' +!�„'L'. f�P r r�. known as an it'premises { + All persons actin k g`contrary to this `order s or a �smovin :> unless such action Is authorized °r mutilating this notice are liable to arrest r 1 Kv by theAA Department. xa�o C ' BIHLD/NQ OFFICIAL 6 Location5'7-- No. Date f f ,kORTN TOWN OF NORTH ANDOVER p� t ao ,•,'46 Certificate of Occupancy $ 41 Building/Frame Permit Fee $ ,ssACMUSEt Foundation 'Permit Fee $ X Other Permit Fee �� rSe v6r 94 lection Fee $ Water Connection,Fee $ Capp; n PTAC Building Inspector Div. Public Works PERMIT-No.. �l APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE SONE I SUB DIV. LOT NO. I LOCATION 1 C A M PURPOSE OF BUILDING f4/1/'1 c iM o Ven f yr De-,De OWNER'S NAME 14ASQrM© 1004CY PP Lf /?p_QINI NO. OF STORIES rJV11iG- SIZE iw OWNER'S ADDRESS ' �dnDQ wl Sl-f�F-Vf BASEMENT OR SLAB d,'!• ARCHITECT'S NAME �'�'1 �i�j SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME M ,A.Qr n o I '. Pr2 L J- Q '�. SPAN ---- DISTANCE TO NEAREST BUILDING 1r� DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES REAR �p "" " GIRDERS 4 AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION slt-q THICKNESS %� �/ K /4 P1 IS BUILDING NEW SIZE OF FOOTING lw II � x 2 N' '7 IS BUILDING ADDITION MATERIAL OF CHIMNEY 4 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND YE WILL BUILDING CONFORM TO REQUIREMENTS OF CODE ES IS BUILDING CONNECTED TO TOWN WATER ft0 BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER N0 IS BUILDING CONNECTED TO NATURAL GAS LINE N N INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 2j OAO PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 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 BUILDINGIN PECTOR DAZE FILED �/ L� BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGEN 4 -J31Z OWNER TEL.# F E E a CONTR.LIC.# PLANNING BOARD PERMIT GRANTED BOARD OF BELECTMEN BUILDING INSPECTOR 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 _ _ B l 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M AREA _ '/p 3/, FIN. ATTIC AREA - \ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS I B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW 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 BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING ' 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G. UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING-----d— o N EATINGFN EEtrb REVISIONS n ZONE REV "DESCRIPTION DATE OWN APPROVED y' tlPT P s p: C t 5 g�� EP_IA L_ , r ` F')ODATIOfI $"CoNcQETt; n)CtaS SEP PC STSA' P.1_ i I+Ro r-,-Li-Tb 2.10 FtooR .IoiST5 xg'X I ' P.' oZXi�-l6"O C DECv.iN 6r 5/4'y,6"x 16' PT R KAIt ING "��" svlHDt FS G A c HGF 1 J I Q , i I r I 'r UNLESS OTHERWISE SPECIFIEDA 4 DIMENSIONS ARE IN INCHES APPROVALS` DATE BREAK CORNERS.005-.020 OWN F, . L R N FRAC- DECIMALS SURFACE I ';1 XXf .. t MICRO IN CHK ;11 .: C F4 rl D E r•A, ST ' .XXX*. ..` / DSGN ♦, DEC , V MATERIAL - ENGRG pp pp 'S SIZE FSC N0. WON . n CUPsp£I'� MFG C 21 8s I '�� L . L> 6R ��� SCALE, NIA. SHEET ' OF V %o ft ni vv ® FINAL F N 9 own Of6 ®Ver No. o ti ,i �4YY ti V r-WAY ENTRY PE R"07 * -� -- A CY.„,E er, Mass., 1V7 P SS i, BOARD OF HEALTH ERMITLD1 • THIS CERTIFIES THAT...�A". .��..� ....�.....�............. � ��,�V.�.... BUILDING INSPECTOR has permission to erect ......................... son .... �...d104 W Rough ,. ��'..... !;?4 �� Chimney tobe occupied as....... ...�............................................. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR ST • Service Final .. ... ... ... . .............. . . . ... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by Smoke TREET NODet. Building Inspector