Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 11 FOXHILL ROAD 4/30/2018
11 FOXHILL ROAD 210/037.C-00340000.0 10108 Date . .r �. . . . TOWN OF NORTH ANDOVER f PERMIT FOR PLUMBING This certifies that `. 1�. .��c��G . .�11�j y. . . . . . . . . . . . . has permission to perform . . �4. �(1�-1. , , f Q Jt-!. . . plumbin in til e�uildin s of. .i-�rti.� . at . . . . .��. North orth Andover, Mass. Feel"�).--- . Lic. No. IZ?�.I. . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check 4 �' If MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY p MA DATEj PERMIT# JOBSITE ADDRESS _ __ OWNER'S NAME F POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:® REPLACEMENT:121, PLANS SUBMITTED: YES[] NO® FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 l BATHTUB �S CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD-DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW r � . LIABILITY INSURANCE POLICY[] OTHER TYPE OF INDEMNITY® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. s CHECK ONE ONLY: OWNER [] AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application a Yru and ate tot best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com ian al nt rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i . PLUMBER'S NAME Nicholas Sawas LICENSE# 15234-M I AT MPo JP® CORPORATION®#®PARTNERSHIP®#®LLC®# COMPANY NAME Nicholas Sawas Plg&Htg ADDRESS 15 Silvestri Circle Unit 24 CITY DERRY STATE NH ZIP 03038 TEL 9788043303 ra. FAX CELLI EMAIL Sawas I mail.com NonZLIi I �r ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1 N Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation . 6 �t"- , , , , , , , , , , , , , , , , , , , in the buildings of. . . . . . ec. . . . . . . . . . . . . . . . . . . . . . . . at . . . . .11. .T�7(\�A1).► ... . . . . . . . . ,North Andover, Mass. Fee . —: . .�f�. Lic. No. 1 . . . . ND . . . . . . . . . . . . . . . . . . . . . . . �SZ GAS INSPECTOR F Check# E 8828 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - ) MA DATE PERMIT# CITY ) __ JOBSITE ADDRESS _ i OWNER'S NAME GOWNER ADDRESS TE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL® RESIDENTIAL PRINT CLEARLY NEW: J RENOVATION:® REPLACEMENT:2j PLANS SUBMITTED: YES® NO® APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ® �® MAKEUP AIR UNIT OVEN POOL HEATER ® �® ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER ® �® WATER HEATER }OTHER INSURANCE COVERAGE have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITYF] 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. SIGNATURE OF OWNER OR AGENT ' CHECK ONE ONLY: OWNER ® AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true aA 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 comp'[' n h all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -y PLUMBER-GASFITTER NAME NICHOLAS SAWAS LICENSE# il SIGNATURE MP EI MGF® JP® JGF® LPGI® CORPORATION®# PARTNERSHIP®# LLC®# COMPANY NAME: NICHOLAS SAWAS PLG.AND HTG. ADDRESS 115 SILVESTRI CIRCLE#24 .CITY DERRY STATE NH ZIP 03038 TEL 9788043303 FAX CELLI EMAILI SAWASPLG@GMAIL.COM 9�� s >� �l/6�8 � a °�6�0 (1 i ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 W` Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Nicholas Sawas Pig. & Htg. Address:15 Silvestri Circle Unit 24 City/State/Zip:Derry, NH 03038 Phone #:9788043303 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. E]Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. ❑ t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LM Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors 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:Automatic Data Processing Insurance Agency, Inc. Policy#or Self-ins. Lic. #:76WEGEV9494 Expiration Date:1/1/14 Job Site Address:[ I. 1�� City/State/Zip:. , 6iV. 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 herebyrtify nd a pains and penal ' perjury that the information provided above is true and correct. Signature: Date: Qllqll,3 Phone#: 9788043303 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense # 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 COMMONWEALTH OF MASSACHUSETTS ` _ ri y •5 • • • •' $ a. a r s LICENSED AS A MASTER PLUMBER ' s `'ISSUES THE VE CENSE TO:: t r NI"CHOL-A S,9[-Pf/r(/,SAVVAS a r 15" SILVESTRI CII .;DERRY t —NH: 0 3 0.3 I 8, 1329. . 05' 14 145211 s I Date... (, .. ..':.f.. ........ I �NonrM,tia TOWN OF NORTH ANDOVER PERMIT FOR WIRING '@`4gCMUg� This certifies that ................. ............................. ..T...... r....,. ' has permission to perform ........... .................................................................... wiring in the building of.........�,,�I.t...-' L4-. .��.............................................:..... .` tf C C ...... ....,North Andover,Mass. Fee... Lic.No. ..... �! '7.. . ... a �t ........ ................. ............ . .. (LECMC`AL INSPECy1�'w Check# 733-5 1182 C mmonwealth o f Mama-,A aet Official UseQO'nly cc�� cc�� Permit No. 2,partment o�}ire Swvic. BOARD OF FIRE PREVENTION TREGULATIONS Occupancy and Fee Checked [Rev.I/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL MFORMATIOI9 Date: a& 1&q 0(3 City or Town of 1U6 ((a& )oV%/ 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 i Owner or Tenant MAl(p`m W V1 j'AeA� Telephone Owner's Address Lj F-0f—. (~}tel( l Is this permit in conjuncts n with building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building -jL U Utility Authorization No. Existing Service �-,00 Amps qD Volts Overhead❑ Und d gr S- No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Loca and Nature of Proposed Electrical Work: Completion of the ollowin table may be waived by the ISLector of lfires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o•of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires oZ Swimming Pool Above ❑ In- ❑ o.o mergency i ng rnd. d. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices ` Tons g No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW ` ' Local❑ Municipal [I 011ier Connection No.of Dryers Heating Appliances KW Security Systems: Q.l Ballasts No.of Devices or E uivalent Heaters No.o Water KW No.of No.Bal of Data Wiring: Signs No.of Devices or E uivalent No.Hydromassage BathtubsNo.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 of Elec 'cal Work: 1A 00 (When required by municipal policy.) Work to Start: Mf 3or3 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 perinit issuing office. CHECK ONE: INSURANCE JE� BOND ❑ OTHER ❑ (Specify:) 1 cetdify,under the pains and penaltieso perju{u,that the information on this application is true and complete. FIRM NAME: � Cr��l c v1 5i 4 Cz, LIC.NO.: Licensee: Signature LIC.NO4,V 1 7 l (0'applicable,a er"exempt"intt�license number li Bus.Tel.No: 7�7C� L Address: D 1 � l�M 1/"(1 �lil Q y / Alt.Tel.No.: - h 3 / *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ ,�. 10 1 30 Date •�b�'�,t�ro�swr ' • 3,r, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . . . . . . . . . . . . . . . . has permission to perform . . .�Zz. . . ,,�� . . . . . . . . . . . plumbing in the buildings of.�.,.�r. . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . .North Andover, Mass. Fe . . . Lic. No. /y..Z 3.y. . --- . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check# i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK wi - I . . 4 CITY MA DATE PERMIT# 0 JOBSITE ADDRESS ! ,� -1 OWNER'S NAME POWNER ADDRESS I TELE IFAXI TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL El PRINT CLEARLY NEW:Ej RENOVATION& REPLACEMENT:® PLANS SUBMITTED: YES® NO® FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN 'SHOWER STALL SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING EQ OTHER 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 CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] 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 AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true nd accura a to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp' nce th I Perti sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I Nicholas Sawas LICENSE# 15234-M MPE] JP® CORPORATIOND#®PARTNERSHIP®#®LLC®# COMPANY NAME Nicholas Sawas Plg&Ht ADDRESS 15 Silvestri Circle Unit 24 CITY DERRY STATE NH ZIP 103038 TEL 9788043303 FAX CELL EMAIL Isawasplg@gmail.com v ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . &f7!l11 !f,�'�. has permission to perform . .//?!t . .7 T'. . . . . . . . . . . . . . . . wiring in the building of . . . . . . . . . . . . . . . . . . . . at . . . . .I.I. .rOX. /-47�,. ( . . . . . . . . . . ,No h Andover, Mass. Fee —1-22 .`. . . Lic. No. /J— ?!fes . . . . . ELECTRICAL INSPECTOR Check# 11078 clmmonta.&o/rr/16611hu6e16 Official IUs Only ad 1e artment 0/-%e�eruiced Permit No. P l Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 91 s a I City or Town of: lyo gj-�t /j,-N P a V(e-- 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) kA Owner or Tenant j Cp l (/lf jrl �i E,l Telephone No.77 k-6 8) -715r, Owner's Address 1.j Fo>- Is this permit in conjunon with a building permit? Yes No El (Check Appropriate Box) Purpose of Building_2;5 c Ln CA, Utility Authorization No. Existing Service '100 Amps 17,-) /.240 Volts Overhead ❑ Undgrd FA No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: -845-e ©ye,too ' Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires I L j 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- ❑ o.o Emergency Lighting rnd. rnd. Batte Units No.of Receptacle Outlets pZ No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches a No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number I TonsKW._ No.of Self-Contained Totals: `� -' -- Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal F-1 Other Connection No.of Dryers Heating Appliances KWSecurity Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail i(desirat or as required by the Inspector of Wires. Estimated Value of Electrical Work:`l+ 1500 (When required by municipal policy.) Work to Start: 9 1(o)Ion Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under thSpains andpenalties ofperjury.,that the information on this application is true and complete FIRM NAME: /VI VVI.e �. �-✓t c n( Sc? i�t t,e 5 C LIC.NO.: A 15"71 Q Licensee: KICU,%i R• t:'1�n,�v�c.� Signature LIC.NO.: 4/C,-7/ _ (If applicable,entt "exem t"in the license number line) / Bus.Tel.No. - `' 7l1 Address: /� O �R ?g �l t c1 ��fis 6 O/ `T`Y Alt.Tel.No.:-92e . �'7y Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safe "S"License:nse: Lac.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. 1 am the(check one)❑owner ❑owner's 2gent Owner/Agent Signature Telephone No. PERMIT FEE: $ M9G Z �2 f �. ctFiJ ' r �� The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 ' Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AP121icant Information Please Print Legibly Name(Business/Organization/Individual): t:M10 CF77— L/d—C 7-12 ICA L S5W-A V1 c SE'S xv)c Address: �O O 7 g `� City/State/Zip:ft L l Q'1 j 1M/1- Q l 4(/g Phone#: 97 k 7 9 7 '70 Are you an employer?Check the appropriate box: general contractor and I Type of project(required): 1.SJ am a employer with � 4. ❑ I am a g employees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. E]Building addition required.] 5. ❑ We are a corporation and its I0.aElectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors 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 I Insurance Company Name: /'7 IMI FORD ENS V"M C e Policy#or Self-ins.Lic.#: g N1 C C L'li 9!5,2(0 Expiration Date: a 610 1 3 v Job Site Address: // fel)t City/State&ip: Ill#�,at s ��r� Al 0/M_ 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. :Siature.-y erebcertify der e p ' and penalties of perjury that the information provided above is true and correct:. Date.. �� G f 1 _Z_ Phone#: 97 F ` &Y `7- g 9'70 Oficial 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#• f J Date.......... b.......... --. - ,kORTM - °f,"'° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SS�cHU This certifies that ......... /Lll. �. G �/��G C { has permission to perform ......P465. ,. wiringin the building of ".C..k........................................... ._ / a t-t C C, „b..................... .North Andover,Mass. Fee..35 ®.. Lic.Nol, .71 ......... . .. E ECTRICALINSPECTOR Check # 10721 " l,ommonwealth o� aa�achu�e Official Use Only r� eLJePartmen�o�}ire�ervicee Permit No. _ 1072-1 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 EWORMATIOA9 Date: City or Town of: JV&e—TI-1 /In�1G,i.� 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) Owner or Tenant x'1'141 ro/,,,, Ltl, �� j >L..4,e)e j, , A5fv(c_e Telephone No.cl ?Y -L?/- S� Owner's Address I 1 Fa ,t_ 14,, Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building � S J-,CA- Utility Authorization No. Existing Service 2 CC) Amps I du / P7,1oVolts 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: 17/7S h+i I U✓G 4,u�_N Completion o the ollowin table may be waived by the Ins ector 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.o Emergency Lighting a g rnd. rnd. Batte Units No.of Receptacle Outlets p2 No.of Oil Burners FIRE ALARMS I 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 Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: " "'"'"------.--.-'-""""" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of ' Heaters �' Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: )) 000.00 (When required by municipal policy.) Work to Start: 3 11 zs-j 1'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 A- BOND ❑ OTHER ❑ (Specify:) I certify,under thepains and penaldes-ofperjury,that the information on this application is true and complete. FIRM NAME: CM vv,e+j C I e c _ll1 C LIC.NO.: 9 P5 7/9 Licensee: a Signature LIC.NO.: (If applicable,eqkr"exe pt"in the license number It ) �g e� Bus.Tel.No.: 78 'lad'7- �7J Address: VC) ?0 r; 7`�V !41t If 114 0( Alt.Tel.No.:g78-4rYP Slo31 *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. 1 am the(check one)❑owner ❑owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. N /f I � 1 - A Th e Commonwealth of Massach usetts De prartment bf 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 Leeibly Name (Business/Organization/hWividual): Address: City/State/Zip: ^A 0 ( 5 '/?Phone#: ot ? X 7 — 9 y 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 employees (full and/or part-time).* have-hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ❑ pr pn r p ship and have no employees These sub-contractors have 8, 0•Demolition working for me in an capacity. employees and have workers' } g Y P t3'• 9. F1 Building addition [No workers' comp.insurance comp.insurance.t 5. ❑ We are a corporation and its 10.Wlectrical repairs or additions required.] officers have exercised ter 3.❑ I am•a homeowner doing all work. eihi11-0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information- t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they rgust provide their workers'comp.policy number. X am an employer that is providing workets'compensation insurance for my employees. Below is the policy and job site ilrformation. ' Insurance Company Name: `— Policy#or Self-ins.Lic.#: C 5 Expiration Date: �' / / c i �2 Job Site Address: City/State/Zip: Kldf 11'1 / ►clo,s� l71 yJ� 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 coverag6 verification. I do hereby certify u der pains andpenaltres ofpeijury that the information provided above is true and correct. S' afore: Date: ign Phone#: Of 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#: 9342 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING • � a ♦ o • j: ,*SA CMUS� This certifies that . ... . . . C� CA.—'. C'G�/�/ `,, has permission to perform . plumbing in the buildin sof . . . . `. . . . . . at . . . . �.� . . }� �. . . . r?. . . , N rt ndov(et Mass Fee .'� .Lic. No..`. . ..�2�. PL MBING INSPECTOR Check # b� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING 111f'ORK .. I�o � vlei� • . ;� +CITYI F,. . . I Mal DATE131f3 111' �# .� IPERMIT3 42- JOBSITEADDRESS I kw 1�,t I -Rd `OWNER'S NAME) NMCkV 01 t 01 P OWNERADARESS JFAXI I TYM-OR OCCUPANCY TYPE COMMERCIAL } EDUCATIONAL I RESIDENTIAL I-11, PRINT ,( CLEARLY NEW,I 'I RENOVATIQN:I/f RtPLACEMENP PLANS 8U0MITTED: 'SES I I NQ( I FIXI•URES-1 FLOOR-* 13SMA 1 1 2 3 4 5 6 7 89 10 1f 12 73 14 l. 13ATHTUB ..... ...i . . .. . . .. _ CROSS CONNECTION bwici: _ .. .... DEDICATED SPOIALWASTE•SYSTEhi DILATED GASlOIUSAND SYSTEM '. ' j i I. , • ,�- - l ,.� ..... ._ DEDICATED GREASE SYSTEM : .;. .:._.:. i.. .. ...:.....: _.. .__. .......•i. .... ._.__:, ..._..._ ... DEDICATED GRAY WATER SYSTEM ..:._. DEDICATED WATER RECYCLE SYSTEM DISHWASHER ( DRINKING FOUNTAIN i FOOD DISPOSER FLOORIAREADRAIN INTERCEPTOR(INTERIOR) 1 - -.-_j ... I _. i .. I I'.• I �; KITCHEN SINK .. �::-:I..... - - --� �... '.� .•.� . -.j � .. .. .1 .. .._I . _.l _. - _. LAVATORY I I ROOF DRAIN 8"OWER STALL SERVICE/MOP SINK TOILET URINAL - WASHING MACFIINE CONNECTION WATER HEATER ALL TYPES. WATER PIPING ..... .. — —-- .OTHER ; INSURANCE COVERAGE: - have a ctirrent.liabilit ihs'imjce polig.ctr its stilistaortal pq[liValetit wlilcli meets the fegtlirenients of MGL Ch.742. YES�/ND I I IF YOU CHECKED YES,PLEASE INDICATE THE TYeE OF COVERAGEtiY CHECKING THE APPROPRIATE13OX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY( ( BOND(, OWNER'S INSURANCE_VVAIVER:I ani aware that the licensee.ldoes not have the insurance coverage required by Chaptei•'742 of the Massachusetts General-taws,and that-MY signature on tliis perttiit application waives this recittiretiten't. CHECK-ONE ONLY: OWNER I I AGENT. - SIGNATURE OF OWNEUR AGENT I hereby certify[fiat all of the details and irifonnallon I leave submitted of entered regardingahis application are. nd accurate to the best of hey knoeriedg'e and that all plumbing work and Installations performed under the permit issued for this application twill be in ance -'llm it Pdrtinenl provision of the Massachusetts State'Plumbing Code an Chapter 142 of the General Lays. PLUMBERS NAME��l GItiO ICC S �Ct��u LICENSE 1a 11523 $NATURE MP� JPS CORPORATION) .1111 IPARTNERSH.IP' Tial LLC 1, 1,0 COMPANY NAME d4 lit aVJ4,5 PIJ f,4+1 1 ADDRESS I _P, d, 3 CITY STATE w .I 21P ©I q TEL I _ gDl4 - 7>c73 FAX ]CELL] IEMAIL I —jC 1.1VCc�_PtS 0 S VOC 1 C0144 I f i _]R�9tJ�;k)f Ti?1LU71 ]d]�7�l[1"�TSti'7C'�]C7[i�N'1�Td� S armo"'JrT rorz-0 , g,VJSr:ONLY FINN NSP MO1q 1VdSTE5 Yet 140 Tti[S APPLICATIOM'-S8RVE-S AS THE PERmri- Q: E . FEE:: PERiUIO d" P LATI 3 E"MM, ..NOT ES i i i t �� �'Ir��p�itt��fotjtr•►efi�llr�,j��{t:€�li�litcs�il� + p2fi(rr`firx2irfr��'1'tttTirsCt�litl�Gc(r�itfs ;�>= 7��ic�'o,J`Xr�tr�sfigir[iorr� fOfl�f�rslrFrrgCoir=�SYr��f • � Y. Boston.,li?Ei Q�rIX . - ��� '[F'tPfl►.ttr{rss�oi�(frl �titai:Tics`s�{E�ntjielisnt�ole�Els1►,irtt!tc��4t�_i[1`�tt+i� �3iiifctcisl�.`oIi€�•Eirtol'side€#•►�ici�t�tsl��t�t����e1=� � 1rtrI'ic(ltt€lilfor17uliioii . p7ltis-'.l?ti1!;,i I4tt12it; Iri73'uut�trUlniritieitrltrifividualy��.� . �S ..�a yv�3° J(4.: 4�c�trsc�ice��i��V�l`C/-�1��+�`rY►l Yl �l�u.��►uoil���� � ��-� csG`�.,,.:Lf' �-:�3�� i !:I ON Il iteiiiiitrlxr?GitecT thetiliFiEolirintef(tirt ' tribbirttbjccl�et't(Ylei ` 1� Iitp�teehi ib crt�it(t . ?! 1.�• t�'latnngenetalcoitlrt<cto,mini " G, bHoivcd,striicti4lt �nilttc�ecs�@1fn»cLfoc�%�t�iilic};= f(6te[t!►•c<illtcsn��cori�tnctots il.QXnutttsoT•citroprtetorol•pog11or-- Ilstellolithon[(RFtiellslipej.4 • dRci»ocicii)tg stlipand:14t'Gitocntl►tgycosS �Ttescsnb•coil(roi[drslittvc ► Delilolilic+it torfiing.fori»�titnnyprq�(lci[}t �sor"�;ers'col»p:iasilrinlce, •�.[('�Tni[tiiitg'tilltliEion; •[I�a ICor�cts�CO(ttp:f t1501'�tict: �:[�1�eijge a cbipora;igfl anis its � �;gitlril]j ofuCcrsLnvccicrclse<i lltetr IO Q I:(eetricaliepctir5.orntiditiotis ; .❑I;itmti:ltm»eoutiertitiil>sntliXai� i!l,�itto�'cteauptl9npcilYl(ZL 11•�1'Tiinl�trlgrv�lir'sorttttdi[io»� In3•self,[tfa•1torRcr cot»!►. 'C„t k l(�i),RitctiEcitaicilo i• ;Qnpotrepait ttisurnnclrcquil'el]jt piilj�toycCs.[Nrzvor�eis`' cell]p,iiisIlrj,,tccreiiulrecfj 1 + 0ETlcr E�nsi�ittilcnt(h�tettxisG.�1'(rtr[lriiofi[Itt+IlTtes�ilienf�tto�t3iwuui�lG:irumii(>COfIt��1L'nl(Ol1fJi[sy'taCantt�[iaf `t;em..itvt:islrimsttitiittlitie07;=frit(nriicain ll:cyrrecte9n�oJitr.pit:utdlit:rtttireouG[Qe(ett(r,�atisnto;lstIT%fritn[i v efGxielMil'o.in�sueIf. ' �,,L�:tri:a<fault]lctra�ifisLtiataoi(,'+:toaxdr!ntadilitt,Zl�latlshtitiin�lt:�itsntci+fl`a:stib¢ea]rt.(dri:ndllrri[iti�ii3r [�Li:' t +• . �tttt#rrtrFuirl t.'t=ffP[R �P1 . . •, * -- - .�. :.�-•�—. ' r;. l ftvl:trlitrb norlcrs ctrrirjicrrrscrlioitfirsrrtrir(re r/filld1wroold+s,X3elc+rt*lslle��r(tllc4•nttrlfnUslfi� fi�orarorPart. ),nsnrauceeontl�an���lil(lt��.. .hoiicjsfF�otSell=ins I;ic./k ,. .. ..•:... , t° . •. } ;job Site JLt(neTt tl coj►sb�ilietvafrC(s'coiu�iettslilloiiiiol���ttgtnlof,Q(rLi,, etsJlgttt(itlielloilct�(iittirlle(itirlt:Ct�lCi�tTio.'tiTrtCe). (iif((rc taa��ur:toici<tge?ts requu'zct u»[e►SeciidtiS(t oTMGfsc.i52 r6n�e,tcl(o the litiltoslllo»Qfcrniliiinlpit»ttics pla il�IgrCo' I�SOPAQBtltl101'Qfjt-k�ea►unprso»(»eiil,rtstvcl[nscivifPei iajlics.ittlliefottttoE(ISTOP:II'ORKO bE[ttiiitliGfiti tiftiltto$250.Opndayo."tst[CiGviolator. lTcndviscit(ltathcopyaftlitss[aiEntctitiutlyGefons%arterl(etlteUfffc�oi —• Invest! OfonSorill T. o insumiiceco�crngeweriGca[ion: Xctlrtlrerr•L��' rtrJ+ rrrl liepu rs Frf'retrtrttiesn,/'lJ� tr,[�llirl[lrc=IrtCmiutF(ouprb.I itc•(fn of ltfirgrirrt dr��•cf 'SFetl�itrt ii ie: ) 3112- fie, d 3 fZne f1ljZirtir`ll.S4Q(rlle jlarrnFltl�lrrrfrrtiel�rrrerr,folr�earilil�lei7l;I�c7��ot-lailtolJtcFril: � �� • i Ciry^orloiti(<< ::• L?etltiT(!(�fcgitsetf 'TSSitill��TlII10riltt:�C(l•Ct•COI►CI, • gtlrcto]itenttG 2.Building DoltnKfilitill 3.Ci(YII'oSrii Ic is �}.CISMrirnt usiiec(or IJlitcnGinglns)IeFCg(� G.Qtttet- Cplile(.E'ci�oit� iiott�fr; 1 n'IxssnetiusEfisGzni't l4�tt>'scl aplesX521e(�iiiWtilt,elhplbffersio,IlYat'id ltior et'S'ctfrip i its t oitforihei>OmOPo�'ees, I'(tsdant to'(nl�slatitf�anerr�i"o����.is tlefiitecns.`:.,�i�e�yperso�•iii�te�et►�ica o€�tJotlier iu$�rziiy canfrarf o£Iiiter, etu�s ariitipliecl,.urnlak f<ti7itieit ° . 110vesined'as �nirtilivr(i;i'��T,goiTiters�lto;,a�s��iatioh;cpXp�r��ionQto4liet�e��IelitiCytolrau}tftk45�'iiibXz ' 111e4 6 1 ;gob engag�(titia ontFeuteipfise,.aiti iu licdiitg[heIegalizpr�sCntatic��sbl'a le�easecfetgptoj�et orae •�:eoeis�erdrCi�t�teeofeum(1Eti+id�tal;I►ar€ttersTii�J=,assoct�tion:o>•otltorlegll'elilit};�i�,pld}�ii�g:eJvpIayees Hot�texe�rthC 4uitz�b£ttct�vgllmglionseltavil�gllatinorzitiautiu>eapartntents:ancl:i'r)ibrzsiclesTtiereiiJ;:ortheoccupantol fhe ciiSel{iitgltotts ofntiotltern�Itoefit}J1b}�s ietsbustad6miaiiJten.adc$,CotJSlYltetlOFlOFt�pair�tar;:oil tapll(T}VAN-ltoiis6 tf1 plJ:(It grountiso billding plitlrienatlFfllereFos alltnolUzctlttseoftliclt oil lJlo}'ntenfbec�eetite(T`[6U 4uempfd ger" �t!�GL;cT;aplci�$2��25C'{6).also'sfntesthat'`•`e�c1•�l�pife;o�r<octtl•IieenSiitgiigettej��7irtlCil?it33I'toai7fltejsstlat►ceor• �cletEai•al'st.lice»��b�perutibfaapertfeabtisfllesso FO:catlsfi�ilcElJtiildingsinf6etonuribittiealtU;I'oi•ntt� :tlpilicarlFii l'ras liotltm(lueeil ttece�Jf:tbl4ei xcl'eltce of canilt)imtce�vitlitllein`stiff tiueeokertge>e(Itlit eco Additibitaliy;lrl[G r 1;pler ISS25Ct7j stales" IeiQler "1 10', aIt11 ttoraa}•of ifs paliticalsubdiyjs)on s1Ta11 iltr weo nn}F contracE-TTI ofpltUl ig it orb Tuil)1 accetatJTeevidEnce oft ompliauceieitli tliFinSttrtlnee 1_ ii)retnenlsoftIusc)tapferltz�rei�eenptgsziite(lfotIieeoiitr�ctingeul�toXit};" tcnitls c Please flfototjtYitot(tts'cb3yt)eilsittiotzifiiitittani IeFalt USE.�7te ';itlgfiltbjJotesilttappl},(gyb-tirsilt tfilipu�tltl,if p z jlbco'wlj supply hili-contiadoics)ft�lueCs),ttd(Bess(e���tidpbottenulh�et(s}aloluiE=ithfheucect'iCCale(s�pf nstl>anc .LiiniFed iaT»Iifg Cotnpaities(LLC)orl im FedLiabilitkf 'rttiiieisIlips(LUi4ittt na ettt iFdye?sotltet tiii tr;iiie ?iie�itLers oi•par.Fiters;are2totreottiredfo t;arryE?,vQrkets`'arntjensation iasu�ance.If an L1;C or LLP sloes Jiave e JpIa}eessapolic}rislt;c�uired..B itdt�isedtltabthisiFfFdat�ifluay6estibntitte(ltothe,Deputfilientol Industrial AceidenF�forconFinttaF tiafi:tsntttttce�ovetage. Msobea►tretosignn1;0(In tetllb—,Iffitlawt •fterifeidawalould ilareturltetiCailtscityor(Q1v1llTiaf(ht npplicaFlonfor Ole pe!utitorlicensoisbeingretluestcd,llot�ilteDepartnteuto- 1 IndtisirialAcciiieitFS. Sitatii(lyo;tjttt� atty�'p[[estilonS>:sgattiitl theiawIfyjt(ire,regttiiedto.•oU.tahtni4,orkcrs' buttfl3dpbtionpolicy,Please cAlt310'pei9al,ine ttittftenumUer iste(lbeIoSs�,: o)F3tisttryil,cotttpatiies 7tgtticlenFertiteir eIt igtttalice license numberott;(lleapptopriate line City of Toiril 6mcials Plettse Uv�ttre tlittt:fns ai'ftiav)tis�ot?�Ie4�attttliriJitecl<iegi6l�: l�7iebepattlft@itF ltasproxide(i a.:p?cp at tlt�.Goltoltt ,9filit,am(Tavitfayofttbfi,Ioti in theevettftheCftic�p£Im�estigationslt�5(aCoJltr�cCyourega�cliil ibHnpplieant, please-besurdfofill inthepenttiFllcops�ttuntU;rigl►iciikill.Ue.used'asa:refereuc �iluttTInad(tition,anapplic�tnt tflafmttstsubthitntilfliplepentJiJlicetJsehpplisations`i!t11"YetWil year,ueetlont}=sttbmitonefiffidavitindicating current liolicylJJfonttaFion(i1'necess�ryj�auTiuc�er",ioliSit'��tfciress"tileappiicatit'shotllcltvrite"�i[Ioca[iouslu • (cid+ol I TOY"02"A cgpy*cif(heoffi(T R-tliatliasbeenoffciityst,,uj,pedoimarke(ibyille.cityFort0milibsbaprovidedfotlia ` blip)icantasfJrooftllataYalidaft`t(Iat=itisbli l�forfi![ttreperuiit'sof11censgs.Alietv-.f!!davlflnust6efille(1,0111each l veer.11'Jleres;Jtanteots�nerorciFizenisobtaiiint�. F t{license oi:pert»if ltotrelafe(l fo tlnj�lJttsiiteas orcoliiutereial t'aJtfuie a(1og.Iicense or.''pernlitta bum leaves etc)said persottis N0j rzguv e(t(q cplliplefe(Itls nffidl�zt. >- --- ---flie!(7�cgofjttYestl�atio:ls3�`off:�tilfi�iiblltiiti�'j�oiriiiailc�aticefoPt�blu�ti�pri'�fio{tltiicts�Dl;t(i5�oft-itai�elrli}�o4tiestioits,� - - _ .... _ .. . .. . __ ._. fi <<redo.not lift ifee(oglvattsjj-call: s �'i=c�<<,pat�l,teat'sad(ir�ss=telepltoneattt'iflxYttlnlTiz'r. .. Ii4at_•fnieltt oft tkdusiefjil tzcici6ilts orrice o£lilii'st%ga 'all - fi00-ZVasi�itigtol>.°Sti�e�t �. dos€ot1���I�D�I�;X t TO.it 617-727--4p00 QG 01'1��"17 31�IA1SSA�E �t�=,�c.rSt�ss:gof=ItYia ' F DateAf ..P3...... s ' f r10RTlq 4 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� f This certifies that 1 .......... ........ ................... .................................... haspermission to perform .................... ........................................ wiring in the building of ?^-�—*' 1-4 at... �... 9 .�.�...:...!` ......................... .North Andover,Mass. ............... ... Fee.4A5....... . Lic.No ............ ............................................................. _ ELECTRICAL INSPECTOR Check # 4775 `a Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MR 12.00 (PLEASE PRINT IN INK OR Y E AL .INF RMA TION) Date: Cit or Town of: Cr7- i F Flr T Y To the Inspector of ares: By this application the undersigned gives tice of his or her int t' n to perform the electrical work described below. Location(Street&Nu r) ( _ , Owner or Tenant Telephone No. J Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. i Existing Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters r Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.oEmergency Lighting rnd. grnd. Battery 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 and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers . Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or E uivalent No. o Water No.of No.o Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,oras required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: , (When required by municipal policy.) Work to Start: VZ&3 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under th pai s and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: 140—EMF, Licensee: John S. Bassett _ Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.: 6_3� ?$ Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Li*see see does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Location No. M Date -5110 Z ko RT`,tio '`;TOWN OF NORTH ANDOVER „ T ertlficate of Occupancy $ :'�, �+ uilding/Frame Permit Fee $ CM dation� FiQPermit Fee $ J� UgE y *14,,0 er A40;T $ S 2 • o c� deVfefConnection Fee $ OM Ater Connection Fee'"- �$ ,-2 � ✓ ` Building Inspector �:/7 } ` Div. Public Works PERMIT Nn. !� C APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. ZPA G E 1 MAP 4-40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK 'PAGE ZONE SUB DIV. LOT NO. �— LOCATION PURPOSE OF BUILDING OWNER'S NAME US.S o NO. OF STORIES / SIZE OWNER'S ADDRESSr BASEMENT OR SLAB ARCHITECT'S NAMESIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME � L/1 eI� -.(�O)!S SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES-SIDES REAR "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X i IS BUILDING ADDITION G/er+ MATERIAL OF CHIMNEY i lr C=.n IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �JeS` IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INS7.";tt;C7t0"i:: 3 PROPERTY INFORMATION (508) 774-6024 LAND COST SEE BOTH SIDES EST. BLDG. COST �i (� OQ ARTHUR BERNARD & SONS -EST. BLDG. COST PER SQ. FT. 7 PAGE 1 FILL OUT SECTIONS 1 - 3 CARPENTERS & BUILDERS PAGE 2 FILL OUT SECTIONS , - Iz EST. BLDG. COST PER ROOMKITCHENS-ADDITIONS :�� y SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE or lufl-01 tREMODELING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO GTATE:O'USTOM:FINISH WORK PLANS MUST BE FILED AND APPROVED Csl'I5;Locust Street:-as Fully Insured - Danvers, Ma 01923 and Licensed DATE FILED J BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZED AGENT 4/ FEE 5 OWNER TEL.#(g-,'?-- PLANNING BOARD PERMIT GRANTEDCONTR.TEL.#. CONTR. LIC.# 35 0 !!� XOCU S T BOARD OF SELECTMEN BUILDING INSPICIOIt r ' I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY fCI S ORIES 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 k 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE _lll 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ —— _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/, 1/2 '/, 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 HARDW D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. q STONE ON MASONRY WIRING 2 STONE ON FRAME — (/ SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) ' GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE I NO PLUMBING — C TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR s TILE DADO r 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 3rdNONO HEATING t JOBI/_lll1LoV�S �A• SHEET NO.— OF ! ��o / {^ {//� Com,, CALCULATED BY K 1' DATE !b X IL w +y rC l PWP4�'^ Ii J`ke w CHECKED BY DATE Ad SCALE_/L + a 'P /f ..... I . Fac;c2 �X b' He c ye+ ... ... x� �,Q . ....... y.oN . ....... .. ...Sc2e�u$ .... ...... .......... // /o'�Co�tcE�{e Colum �_ _._.. .. ... ..... �B cn�c Gs /4, Owe ......QN.....c�F'.Ck.. ......,........ .......................3' ,(Glas1 Q el.r.�+.G a(I P,i ........... ............. . axg + PRODUCT 205-1•��/Inc,.Groton,Mass.01471.To Ontat PHONE TOLL FREE 1-800-2256380 Location ' Date No. .NORTH TOWN OF NORTH ANDOVER Qt t �a0 c? - `; Certificate of Occupancy $ 41 ? mit Fee $ ; Building/Frame Per < Foundation Permit Fee $ :s �sswcMust Other Permit Fee $ Sewer Connection Fee $ .:i SC/Q ` Water Connection F �✓U"�"' TOTAL k-52 Buliding Inspector 5170 Div. Public Works r� , !� o� own of � 6 o ndover 161 Y ENTRY PERMIT - � . �� y_ r� � E ro t er, Mass A -11C K MW or or 0RF Pay a BOARD OF HEALTH PERMIT osso L 0k THIS CERTIFIES THAT... .. •� ��,���.••••.�•• BUILDING INSPECTOR has permission to erect ..................... ... buildings on/./. •....•• Rough 0 Chimney to be occupied asA� ,�'�1 .� ... � � �.....D � Final x 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 th' I PERMIT EXPIRES 6 ONTHS ELECTRICAL INSPECTOR UNLESS COIF RUC ATS service Final .. .. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough i 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 Location 1 f 0. (/1. S, n, j' Date 7-7- f' ,.ORT#j TOWN OF NORTH ANDOVER L F - a Certificate of Occupancy $ Building/Frame Permit Fee $ ��5 Foundation Permit Fee $ M Other Permit Fee $ oA�y Sewer Connection Fee $ D U! Sewer Atter Connection Fee $ •q�dp`� �� TOTAL $ ®r. Building Inspector rS Div. Public Works PE&31IT NO. S ar APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP KBO. LOT NO. 2 RECORD OF OWNERS141.P iDATE BOOK 'PAGE (,37&0- _ ZONE SUB DIV. LOT NO. (, 0o 7a 7LOCATION L PURPOSE 00=0=000& OWNER'S ,NAME 7!1 � �SS� NO. OF STORIES SIZE �+ i� iOWNER'S ADDRE S N/l' / BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND I WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE 3 PROPERTY INFORMATION INSTRUCTIONS LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS f - 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 BUILDING INSPECTOR DAT LED Z BOARD OF HEALTH SIG TORE OF OWNER OR AUTHORIZED AGENT FEE PLANNING BOARD PERMIT GRANTED - C7 19 BOARD OF SELECTMEN ev A .sLE 449aq BUILCRING INSPECTOR ' �s j - WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer 1 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 I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/. 1/7 '/, FIN. ATTIC AREA _ NO.B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAABOARDSB• 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING H_AR D_VV'D ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH. TILE —{I_ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME I - — CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE rj ROOF 10 - PLUMBING _ GABLE # HIP BATH 13 FIX.) — GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED .,WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 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 NO HEATING KAREN H.P.NELSON ?• "��° Town Of 120 Main Street, 01845 , Director NORTH ANDOVER (508) 682-6483 BUILDING CONSERVATION @"`"8DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT i Date: ~SuL.`� 7 195 To: l 1 F"ox 1'E l l.L Z Mr t7 tJ aDoVt'�, lujor, D 18 ' From: North Andover Building Department Re: Wood Stove Installation It appears, by the visible aspects of your woad stove available at the time of my inspection that the installation complies with the requirements of the Massachusetts State Building Code. Yours truly, RNs I�CZ�'�o►.� -i,d�.rc: ht+.S i Ft�ffb2 D. Robert N i cet t a, Building Inspector^ DRN: gb c/K. Nelson, Dir. i f July 2, 1992 Attachment To Application For Permit To Build, No. Andover, MA Application Submitted For Permit On Fireplace Insert Unit ID--Vermont Castings Winter Warm Fireplace Insert (Specs Attached) Applicant: Vincent T. Russo 11 Fox Hill Road N. Andover, MA 01845 Home # 508-688-8014 Work # 508-762-5292 1 purchased the above home on 1/31/92. Prior to my purchase, I initiated several inspections. I was made aware that the insert in question did not have a permit. I was not familiar it required one since I had a similar insert in my home in New Jersey and a permit was not required there. I called the N. Andover Building Dept. in December, 1991 and inquired about getting a permit. I spoke with Bob Aldenburg. He advised he was an inspector and said I must get the unit inspected by a contractor who does installations of these units and get him to certify in writing that the unit meets MA codes. I called E.G. Washburn in Danvers, where the unit was purchased, and asked who they used to install these units. I was given the name of Arthur Bernard & Sons, Contractors. On 12/26/91 , Mark Bernard came out and inspected the unit and found the unit and installation met all codes. But the hearth did not and must be extended. See attached Work Order 1779 1 called Mr. Aldenburg back to update him and he verified that once the contractor did the work on the hearth and signed off that all codes were met, I would get a permit for the unit. But I must own the property to get the permit. I closed on the home 1%31/92 and recently had Mr. Bernard do the required work. Attached is his statement and signature verifying that all aspects of this insert now meets code. See attached Work Order 1687. Thanks to everyone at your department for their time & courtesy. ARTHUR BERNARD & SODS �0 ° MDMA MOM Carpenters & Builders N 0 16 C 7 115 Locust Street o DANVERS, MASSACHUSETTS 01923 DATE OF ORDER 774-6024 774-6698 CUSTOMER'S ORDER NO. PHONE 6MECHANIC HELPER STARTING DATE BILL TO ORDER TAKEN BY ADDRES /pot DAY WORK CITY / CONTRACT - /��/1_ _ EXTRA JOB NAME A D[LOCATION Ina - JOB PHONE DESCRIPTION OF WORK: p \ � deA TOTAL MATERIALS TOTAL LABOR TAX DATE COMPLETED WORK ORDERED BY TOTAL AMOUNT $ ❑ No one home Ej Total amount due Total billing to Signature, for above work:or be mailed after I hereby acknowledge the satisfactory completion completion of the above described work of work a ARTHUR BERNARD & SONS jam MOM ORM Carpenters & Builders N® 7 7 115 Locust Street DANVERS, MASSACHUSETTS 01923 DATE OF ORDER 774-6024 774-6698 CUSTOMER'S ORDER NO. PHONEMECHANI HELPER STAR TING DATE BILL TO ORDER TAKEN BY ADDRESS� - 11 E) DAY WORK CITY CONTRACT f EXTRA JOB NAME ND LOCATION - JOB PH ONE f r t- DESCR TION OF WO - E s... I i I TOTAL MATERIALS TOTALLABOR TAX DATE COMPLETED WORK ORDERED BY TOTAL AMOUNT $ N on ome Total amount due Total billing to Signature for above work:or be mailed after I hereby acknowledge the satisfactory completion completion of work - of the above described work. WOOD STOVE INSTAL LAHON CHECKLIST Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove '..:` A. New Used B. Typeiradiant - Circulating C. Manufacturer j? CLrtot,) r C 4S7-/;J 6 Lab.No. Name/Model No. Collar size Dimensions/Height 71,? `' Length / " Width /4' Z `' Chimney A. New Existing ✓ B. Size(flue area) _ C. Other appliances attached to flue(NUlrlber and flue size) �fl D. Prefab(Manufacturer—name an type) E. Masonry/Lined Flue liner Unlined -type 3 manulacturer( F. Height(refer to diagrams) cap OVER, IC s�'ER IC I 2� vtlty Z:tA!ti. -+ (o - 3WHIN t �t MIN. \ ` Ign MIN. n, HEARTH CHIMNEY HEIGHT Hearthnon- m u ti I ( co b s,b e) A. Materials 57--OA) F-/ 4,AU_!C B. Sub-floorccnstruction7'a A)� s u� � C. Minimum dimensions(refer to diaoram) S C o)£S — o of(t /7/i �� � ,°^r t' Clearances and Wall Protection(see stove installation clearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) i FIREPLACE CORNER WALL/CENTER 1'? { WINTERWARM FIREPLACE INSERT SPECIFICATION CHART Range of Heat Output* 10,300-30,000 BTU/hr. Primary Air Control Manually set, thermo- Maximum Heat Ou ut** 50=BTU lir. I staticallv maintained Area Heated*** up to 1,500 sq.ft. (450 sq.m.) Secondary Air Control Self-regulating Fuel Capacity 40 lbs. (18 kg.) Glass Panel High-temperature ceramic, Size&Ty2g of Fuel 20"-24" 500-600 mm. wood 5 mm.thick Loading Front Blower rating (each) 130 cfm.(115 V,60 Hz) Flue Size 8"(50 sq.in.)minimum Clearance to combustible Mantel 9" (230 mm.) (200 mm.,1300 sq.mm.) surfaces (See Installation Top Trim 9"(230 mm.) Flue Exit Position Shallow or deep lintel Manual for details) Side Trim 6"(150 mm.) Weight 475 lbs. (216 kg.) Furnishings 48"(1200 mm.) *Under specific test conditions used during EPA emissions standard testing. *"This value can vary depending on how the unit is operated,and the type and moisture content of the fuel used. Figure shown is based on maximum fuel consumption obtained under laboratory conditions and on average efficiencies. ***These values are based on operation in building-code conforming homes under typical winter climate conditions in New England. If your home is of non-standard construction(e.g.,unusually well-insulated,not insulated,built underground,etc.)or if you live in a more severe or more temperate climate,these figures may not apply. Since so many variables affect performance,consult your Vermont Castings Authorized Dealer to determine realistic expectations for your home. 00 350mm. 550mn-L 44 (13-3/4")__� 000 0440 2(X (7-7/8") 600 mm 4400 (23-3/4'x ----------- 0044 _ t- OV44 (66-- /4" `--840 mm.(331 120 mm 444 . (4-3/4'7 04 04444 (400 mm. (00� r L 190 mm.(7-1/2") - 04444 '-- 040 900 mm: (36") 470 mm (18-1/2") 1040 mm. (411 77 O O O till L 11 1ROO�Q O A 11 760 mm. (29-7/8'7 870 mm. (34") 7_1_ G � 640 mm.(25") 650 mm ff�(25-1/2'7 2 PERAPPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP iqO. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. r i LOCATION / PURPOSE OF SUILDI,N:r I° OWNER'S NAME Q SS �9 NO. OF STORIES /mil a� SIZE' ry6 ^f OWNER'S ADDRESS f Folk 1 I i •tea —_ �c n✓L L �f �r{ {1 1` BASEMENT 6 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME e 1 t (w k A ,,r -h -a � SPAN DISTANCE TO NEAREST BUILDING �y DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION / / IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE V IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER A?,� IS BUILDING CONNECTED TO NATURAL GAS LINE �e-$ INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST %— SEE BOTH SIDES EST. BLDG. COST � f' PAGE I 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 FILE AND APPROVED BY BUILDING INSPECTOR DATE FILED G f "0'r Zk- BUILDING INSPscroR SIGNATURE OF OWNER OR AUTIPORIZED AGEN 6V— WL F E E OWNER TEL.11 PERMIT GRANTED - per CONTR.TEL.q \ CONTR.LIC.# H.I.C.k oj u 241997 c. BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY W S;OR1ES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT ANDDISTANCEFROM 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 F� CONCRETE _ 3 1 2 I3 LIDI1l,Tk `Q t,, CONCRETE BL'K. PINE W f` _ ✓ — Lv BRICK OR STONE P PIERS PLASTER DRY V. 1" (' UNFIN. � �. 3 BASEMENT AREAFULL FIN. A'M'T' AREA '/, 1 /1 �/. FIN. ATTIC AREA /� NO 8M'T FIRE PLACES �Q'F ��- Vp&i HEAD ROOM _ MODERN KITCHEN 4;v 4iv 4 WALLS I 9 FLOORS - - & C4 `� ie , a CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE — �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ'D �r ASBESTOS SIDING _ COM/dCN VERT. SIDING ASPH.TILE J in STUCCO ON MASONRY STUCCO ON FRAME Vow BRICK N MASONRY ATTIC STRS. 8 FLOOR I_ Poll; BRICK ON FRAME ► a� CONC. OR CINDER BLK. 1 STONE ON MASONRY WIRING �/t� f /4 '66 „ STONE ON FRAME � (� ,r SUPERIOR POOR ADEQUATE I� NONE 5 ROOF 10 PLUMBING woo oo f fI+* GABLE I sem' HIP BATH 13 1 GAMBREL MANSARD TOILET RM.M. 12 FIX.) /�y+ FLAT SHED WATER CLOSET 0064 ASPHALT SHINGLES d` LAVATORY, .`Ks WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL ALL SHOWER � o*� jsg �i ROLL ROOFING MODERN FIXTURES �� tai , WL TILE FLOOR TILE DADO ` t 6 FRAMING 11-11 HEATING � [A � P'fs[• 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 i RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL A'M'T 22d _ ELECTRIC Ij"� 1st 13rd I NO HEATING { o�../�aeaar,�ivaeCCA! r 9EPARTNENT OF.PUBLIC SAFETY .`q d CONSTRUCTION„SUPERVISOR LICENSE Nu�ber Expires: Birthdate:'' CS 'OS318T 11/14/1991 11/14/1941 Restricted To; 00 3 __CHARLES I PISCATELLI 1"FLASH RO NO READING, NA 01864 FEB 2 4 097 Office Use Only u E Cfammnnuiralth of _qW5ar4USEftg Permit No. 7 llepartmEnt of 11ahiic % tg Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGIJUTIONS 527 CMR 12:00 1 3/90 (►save blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12: 0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date r (M)Jr or Town of NORTH ANDOVER To the Insliector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant J�!`r Owner's Address 45ll/1I : Is this permit in conjunction with a building permit: Yes No ❑ (Check Appropriate Box) 3 Purpose of Buildina /VL2 F0,01 1-r 84 &4-4 r NV Utility Authorization No. Existing Service Amps _J Volts Overhead L-) Undgrnd No. of Meters New Service Amps _� Voits Overhead Unagrnd r No. of Meters Number of Feeders.and Ampacity // /� g Location and Nature of Pr000sed Electrical ` ork 'f-AI3 464 (J Gig WU211 No. of Hct Ubs No. of 7ansformers Total No. of Lighting Outlets t o I KVA No. of Lighting Fixtures Swimming Pcc+ Above— ;n- ! grne. - crne. — Generators KVA No. of Emergency Lighting No. of Recectacie Cutlets I No. of Cil Bunters I Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones of Air Ccnc No No. of RaneTotal No. of Detection and es I . . - i ;ons Initiaund Devices Noor Hea; Total Total No. of Disposals Pumcs ;ons KW No. of Sounding Devices No. Seif Contained No. of Cishwasners I ScaceiArea Heatird !(IPJ Detea ction/Sounding Devices ,. — Municioa! No. of Dryers I Heaund Devices KW Local Connection _Other No. of No. of Low vcitage No. of Water Heaters KW I Signs Ballasts Wirnc No. Hvero .Massace Tubs 1 No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the reeuuements --f Massacnuse7s general Laws ^- r r i substantial equivalent. YES NO _ I _ I have a current Liability Insurance Policy inciucmg ,,,,mo:eted Operations Coverage o is subs,a a have submitted valid proof of same to the Office- YES NO = If you have checked YES. please indicate the type of coverage cy checking the abproonate box. INSURANCE BGNO = OTHER = {Please Scec:Yl (Expiration Oatei Estimated Value of Electrical Work 5 WorK to Start insbecaon Date Recuestee: Rouch Final Signeo uneerthe Penalties of perjury: }� _ FiRM NAME .� `IJ-w'tf v 6- LIC. NO. Licensee /HJ 114-2 Signature Gtl LIC. NO. 1-17 JJ Rus. Tel. No. _ L;���'�' 2 e Address 5) /70,16'J�irD�/ Si (tJ�yQv p n/ Alt. Tei. .... OWNERS INSURANCE WAIVER: I am aware that the Licensee eoes not nave the insurance coverage or its substantial eciuivalent as re- du,red by Massachusetts General Laws. and that my signature on :his permit abpiication waives this requirement. Owner Agent (Please cheek ones Teiecnone No. PERMIT FEE s Y� v (Signature of Owner or Agents f7- r db 4 . Date..... /...................... a`T0 8q7 ,F Ot NO oT s SMO 3: -•._,° o� TOWN OF NORTH ANDOVER E PERMIT FOR WIRING This certifies that ........:. ..... Y��. ... P pe .. I?. N1C . .1.. G1.P.Ud... has permission to perform .. . . ................. wiring in the building of 34 ta........ : S S e t ...... .......................:... at....... .....i= � ... ... ..:: Nor?Andov s. Fee,NO.......... Lie.No.d.�1.. LECTRICAL IR 04/03/97 13,02 .40.00 PAID WHITE:Applicant CANARY:Building Dept. PINK:Treasurer •_ -a.-..+vim �. ...•...�.,�,-.r,v 9-' ..r--r-. -�. �.i..r n _ i r• ` k f Location No. /��l/ "- Date E • - TOWN OF NORTH ANDOVER oxCertificate of Occupancy $ Building/Frame Permit Fee $ ?UO Foundation Permit Fee $ Other Permit Fee $ TOTAL $ .w ) Check# f Building Inspector 30264 r