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Miscellaneous - 11 OLD FARM ROAD 4/30/2018
( 11 0LD FARM ROAD 2101035.0-0097-0000.0 I I , Libe� Mutual. Liberty Mutual Insurance New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 July 1,2015 Town of North Andover Attn: Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address: 11 Old Farm Rd,North Andover,Ma 01845 Policy Number: H3S21810321540 Underwriting Company: LM General Insurance Company Claim Number:032157142-0001 Date of Loss: 1/26/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, S 9, or Mass. General Laws,Ch. 111,§ 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Date....... r NORTH °� •�~ TOWN OF NORTH ANDOVER fir • . PERMIT FOR WIRING •• s 8`9ACMus� 1 This certifies that ................. ....... ..e, S l'ol �TIL....... . .................. ........................ has permission to perform ......k�TC GZ��/ ..................................................................................... wiring in the building oCf......... /J .CTI�..................................................................... at . F ................................. North Andover,Mass. ..........� ..... ......... Fee. I,z�-��p"'Lic.No. ..�../....7/.?� �/Y .... .� ..........r...., �.... .. .............. ELECTRICAL INSPECTOR Check# 'i 1. a x commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services ,�1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] aeaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: iS City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her' to perfo the a ectrical work described below. Location(Street&Nu er) / rtion r ✓✓1 Owner or Tenant Telephone No. Owner's Address _ Sl IR 6I?3 '27�;32' Is this permit in conjunc ion with a building pe mit? Yes No ❑ (Check Appropriate Box) / d� Purpose of Building Utility Authorization No. - Existing Serviqg�b �(D & Amps Volts Overhead❑ Undgrd KP No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of roposed Electrical Work: © t"'! Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers K 'A No.of Luminaire Outlets No.of Hot Tubs Generators IVA Above Ei In- o.o mergency ig ting No.of Luminaires Swimming Pool rnd. rnd. ElBatte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Detection and No.of Switches No.of Gas BurnersTot Initiating Devices No.of Ranges 4v No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons J.KW No.of Self-Contained P Totals: Detection/Alerting Devices + No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water I No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wtres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,itnder the p at s and penal ' s gf.�erjury,that the inforn ation on this application is true and complete. J �( FIRM NAME: . W,,,c� G'� cc��< r C c LTC.NO.: Licensee: W C'�d{ C S C�<< Signatur� C.NO.: (If applicab nt r " empt"in the license number li ' s/ n Bus.Tel.No.: Address• vt--P �V'�' t'Z V alt.Tel.No.: *Per M.G. 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 Signa e el I hereby waive this requirement. I am the(check one owner ❑owner's agent. Owner/Agen ? ��3933 ptmff FEE:$ Signature Telephone No. I __ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the y 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 Re-Inspection Required($.) Inspectors Comments: Inspectors Signature: Date: d SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ , Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass n Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP TION: PassIV Failed Re-Inspection Required($.)❑ Inspectors Com en Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold(a-),townofinerrimac.com t The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lease Print Legibly Applicant Information �� c�� Name(Business/organizatio dividual): Address: I City/State/Zip: Z�/�(� hone#: Z Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction part-time).*) employeesfull and/or have hired the sub-contractors � p listed on the attached sheet.� �• El Remodeling 2. am a sole proprietor or partner- ship and'have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers' comp.insurance. 9. []Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions required.] officers have exercised their ht of exemption per MGL § 11.❑Plumbing repairs or additions 3.Elri p p I am a homeowner doing all work g myself. [No workers'comp. c. 152 1(4),and we have no 12.❑Roof repairs insurance required.]r 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. tContractors 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: 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one.-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ins andpenalties ofperjury that the information provided abotte is true and correct. Signatur Date: Phone#: � I 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#: 1 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 employeils 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 loeal 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." r Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealtll,of Massachusetts Department of Industrial Accidents pfUce ofIavestigatitons 600 Washington Street Boston.,MA 02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax#617-727-7749 _ w�v.xnass.gavfdia 09899 6Yq+CT.R17lyos TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that � p- . . . . . . . . . . . . . has permission to perform . .!`t . . °!.!. .. . . . . . . . . . . . . . plumbing in the buildings of. �Gl L . . .�"-4 at . . . A . . . . . . . . . . . . .North Andover, Mass. Fee /.. �. Lic. No. + .7.A-�. . '-y PLUMBING INSPECTOR Check# 'l/C�D MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ �Ti MA DATE[—� /�'- �� PERMIT# JOBSITE ADDRESS OWNER'S NAME POWNER ADDRESS L=41____a _ _ _ ,� I TEL � � � ` � FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ( EDUCATIONAL RESIDENTIAL PRINT � CLEARLY NEW: Q RENOVATION:[! / REPLACEMENT: 0 PLANS SUBMITTED: YES E11 NO�I] FIXTURES 7 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 ( . ._..._! j I._-_.-..-J _._ i DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM I ...___..1 f-—_ __I DISHWASHER _. ... ! . ...._i _...._ ._-..._! .._._� -..___! .-......._! __{ _..._._J __.... ! _ —T-7=== DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK . .. - - ! -- —( ..._....._.....( - f - I - _ —� 1 - -- .! _. ._i LAVATORY ROOF DRAIN. K) SHOWER STALL _! ... ..._! ._._._I SERVICE/MOP SINK TOILET URINAL .._...... ._...__..' ..____._.! _ ._._ _.( ....-..I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ( 77 — — _ F-71 I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 71i IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE OF INDEMNITY Q 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 Ej AGENT JE-j ` 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. '��.v /' .��-C�� PLUMBER'S NAMEGGc%(�D_ �l•I�CF/Z !LICENSE# /3,_i SIGNATURE Mpg JP�-I CORPORATION n# PARTNERSHIP]#=LLC # COMPANY NAME ���v�!C't9 �, rl,( e �',�/� ADDRESS I / , CITY _�rk S ,�.2 STATE ZIP TEL q •,�$l — `��' s _ - - ---- _ FAX CELL Sd�-s3� � MAIL \\ o 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 The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Naive(Business/Organization/Individual):� � �.✓ `L Address: _ Grvc' -4Q) City/State/Zip: dlefZ6 Phone#: 20 6=57 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.M I am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. [J Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3. I am a homeowner doing all work right of exemption per MGL 11.E]Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs a insurance required.]t 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 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: 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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenaldes ofperjury that the information provided above is true and correct. Signature: Date: 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#: t r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the .f members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of l dustrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel.#617-727-4900 ext 406 or 1-877,7MASSAFE Revised 5-26-05 Fax#617-727-7749 Wwwanass.8oV1dia COMMONWEALTH OF MASSACHUSETTS- LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: ` EDWARD C FULLER1 21 PINEWOOD RD T.EWKS$URY MA 01 ..876-2053 .: 8713 a5/U1/14 ¢ ]42812 ' a 4 x G "z i i i 75i6 Date.. 3 ........ NORTH 3? TOWN OF NORTH ANDOVER O 9 ' PERMIT FOR GAS INSTAL TION . o ACHUSE� This certifies that . . . . �'. .`.'. . . has permission for gas installation . . i in the buildings of . . .//C .0 .7`G . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . 1. . . .G. .c f . . ./,? .L, North Andover, Mass. ' v Fee. . . .9. Lic. No.. ��. . . . . . .:��. . .�._.�:-.�y!�::. . . . ¢ASINSPECIOR Check# 3 G 9 73G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) T - NORTH ANDOVER ,Mass. Date MARCH 7, 2011 Permit# r� 11 OLD FARM RD. PAUL ACETO Building Location Owner's Name Owner Tel# 978-683-9332 Type of Occupancy RESIDENTIAL New W1 Renovationt Replacement Plan Submitted: Yet No[:] FIXTURES cn o, v� W u x �4 z < W) U) a a U0 a w x p z J a H z � m E~ w w p O a a w Q ) w w ¢ F nn > z W c� w z J F z F W wW o > o W � a ~ w t a z a w a x oa z O z o x w W > W w z ¢ x ¢ ¢ O O w ., O w F = O (D x w O 3 A C7 a U x > Q a F O w SUB-BSMT BASEMENT • 1ST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name Eastern Propane & Oil, Inc Check one: Certificate Address 131 Water Street Corporation Danvers, MA 01923 Partnership Business Telephone# 800-322-6628 Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a cures liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yesl ✓ I No 13 If you have c ecked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policyd❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the G erayt�ws. By Type.9f License: (�)S mber Sign0S."Number of Licensed Plumber or Gas Fitter Title Gas fitter D•Master Lice Q City/Town •-Journeyman APPROVED(OFFICE USE ONLY) Aug. 12. 2010 9: 36AM No. 3096 P. 2 r The Commonwealth of Massachusetts Department ofIndustrial Accidents Qfj'lce oflnvestigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance_Affidavit:Builders/Contractors/Electricians/Plumbers Apvlicant Information Please Print Lettibly Name(Bust ion/individual)• A_ /r0 low e Address: City/State/Zip: ,��/l�/cn�s,/�� Phone#: Are you an employer?Check the appropriate boa: Type of project(required):. 1.1pI am a employer with �S 4. ❑ I am a general contractor and I 6. [-]New construction employees(full and/or part-time)." have hind the sub-contractors 7. Remodeling i 2.❑ 1 am a sole proprietor or partner- listed on the attached sheek x ❑ g. ship and have no employees These sub-contractors have a. []Demolition • working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'camp,insurance 5. ❑ We are a corporation and its ` required.] officers have exercised their 10.11 Electrical repairs or.additions " 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.(No workers'comp. e. 152,§l(4),.and we have no 12.0 Roof repairs ' insurance required.]t employees.[No workers' comp.insurance required-] J I 13.4 Other Go'S *Any applicant that ebedcs boa#1 must also fll ant the seWoe below showing drum workers'mon policy httbandcm r Homeowners who submit this affidavit indicating they ate doing alt work and then hire oubdde eootrae tors moat sobmtt a new affidavit'md=fml;such. tContmotom that check this box muse attached an sddi*xnd elect showing the name of the sub-contractors and their work=*cmgL policyiofomf `om I am an employer that is providing workers'compensation insurunce for my employees Below&the policy and job site inform,060.M Insurance Courpany Name:— Policy#or Self-ins.14c.#: (itl C '�— y/—`���X66 03d Expiration Dated / 20/� n � Job Site Address: I ( d►el fa,,d►•, ReJ PcL City/Stateaip:to o,1J% toy(cn,e-o 0 18 y S Atacha coPY of the workers'compensation policy P�a(showingthe policy number and aziradon-dste). _ .. ._ Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposKon.of criminal penalties of a fine up to S 1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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. X do hereby certify under thepalns and p perjr informadon provided above is true and correct Phone#k - Officibl use only. Do not write in this area,to he completed by.city or town ofj?etal City or Town: Penni Ucense# 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#: Date.....-7. 3.-.6..>.... of ND oTM 1� TOWN OF NORTH ANDOVER * y PERMIT FOR WIRING cwusE� This certifies that ...............� .......4&rvm-l�. ............................ ....... has permission to perform .C /n .......... ........ ....................... ......................... wiring in the building of...........f.7. .t/�.� ............................................. at......,.... ... �� ......!�.'6........... ,North Andover,Mass. Fee ................... Lic.No.3..�' z/ !. ... � ��. ELECTRICAL INSPE&OR,j Check # 7362 Q0 q//// I Official Use Only //�� t..op%gWnWi0J,4 of 1 rla6daduoea.9 ?��_ - L1/07 ,borarfrwJ oI JiP9 30""'Ced d Fee Checked BOARD OF FIRE PREVENTION REGULATIONS leave blank) K �PPLICA►TIQN I�C�R PECMRRMIT TO PERFORM ELECTRICAL WOR All work to be performed�n accordance with the Massachusetts Date* �/ INK OR TYPE ALL INFORMATION) �— �-- (PLEASE PRINT IN DY ORnd�P V To the Inspector of Wires; city or Town of: application the undersigned gives notice of his or her intention to perform the electrics#work described below By this app � a /r1 Location(Street&Number) Telephone No. ----; Owner or Tenant 0 .==E� "^ �v. —! No �C.heck Appropriate Box) Owner's Address permit? .. f 1s tilts permit in conlunctlou with a building F 1Jtliity Authorization No. .` Purpose of Building Undgrd No.of Meters . Volts Overhead >t+,xisting Service Amps --- Undgrd ❑ No.of Meters Amps —Volts Overhead { Nnmtt Feeders and A.mpacity Locatto..-. Nsture of proposed Electrical Work _� / D ' Co-TO o'the ollowin table Ina be waived h the InI utu o Wires. �._..4 0.o KV A No.of Cell.-Sit c)Fans Transformers No,of Recessed Luminaires _----,-- KVA Generators No.of Plot Tubs a•o Vii: cy g r ng No.of Luminaire Outlets _ _ Abave °' (� Units Swimming Pool rud. Q rnd. Bette No.of 1,uminalres FIRE ALARMS No.of Zones Receptacle Outlets No.of Oil Burners o.o etec on an No.of initiatingDevices No.of Switches No.of Gas Burners ata No,of Alerting Devices o.of Ali-Cond. Tons o•o e .onta Be No.of Ranges um at utnp ons Detection/Alertin Devices No,of Waste Disposers Totals: unic pa Other Local E] Connection No, of Dishwashers Space/Area Heatlng KW ecurlty stems, kteating Appliances KW No.of Devices or E ulvaient No.of Dryers o,of �10.of data Wiring: o.o stir KW S# ns Ballasts No..of Devices or E ulvalent c ecommuntcations it ng kieaters ------g----'-"--"— N fo Aevlces or E uivaicnt - No,of Motors Total iii' No, Hydromassage 8ath�tuhs� OTHER-• " Attach additional detail if desired, or as required by the Inspector of Wires. (When required by municipai policy.) Estimated Value of Elecis l Work: work to Start: CbvM Inspections to be requested in ermitdfor the ance tiof eirctrdical wok may is uupon completion.e unless INSURANCE,COV RAGE: Uniess waived by the owner,no p performance the licensee provides proof of liability insurance including-completed,ahas exhibited proof of same to the permitisse or I uingloffi ial eu'svalent. The rce and such coverage i force, undersigned certifies that s Nr/e- h -VAS 6 OTHER � (Specify:) Z e, NNDid com let ' CHECK ONE: INSURANCE I..� a� Q l cert(f}�, under the pains Irenalttr s of perjury, that the lrr orrnarian an this application!s true as P LIC,NO,: 3L FIRM NAME: Mie'-5 eo tie Y LIC.NO., Signature 7 Licensee: ---- --:- Bus.Tel,No.:d�c�-=z (4fapplicahle,erste empt"in rhe tic rse r1u b r ii 1 Jn„ D/ pit•Tel.No.: Address: �r *per M,C c. 147,s, 57-GIWAIVity v ]rlk requires aware tDhat�t rt int o PPublic not have the ce liability insurance overage normally OWNERS INSURAN+CT required by law. By my signature below,I hereby waive this requirement. I am the(check p,�,RMIT FEE: $wner's agent. Owner/Agent Telepbone No._ Signature - �.... Cus�-i -� - � you �i� T� Date..... ..3- .2.. .. NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMUS� n w This certifies that ........... ?....[.� .�... '.f.2 L. ,.. .Z .�• ....... has permission to perform AnA77,)";,)"; ...-:...... ... l........... ..... wiring in the building of.........../ .. ... ............................................... at 0....!!;kb YA ate..... North Andover Mass. o� Fee..�..�..': .'". Lic.No.3 1..7/..t............. ........... .A /IO,.r........ ELECTRICAL INSPECT � Check It OR 7037 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Z� 3 Occupancy and Fee Checked i BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) M 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:T1 Lo, City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intent. to per orm the electrical work described below. Location(Street& umber) It !t7 Owner or Tenant ct'A C P/V-0 Telephone No. Owner's Address rj A-uu-e-_. Is this permit in conjunction with a building permit?"" Yes No EJ (Check Appropriate Box) Purpose of Building /Y)( 16 �� fetyl.t�ed Authorization No. Existing Service ;100 Amps / / o?�bVolts 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 the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans [Battery s Total sformers KVA No.of Luminaire Outlets No.of Hot Tubs rators KVA u No. of Luminaires Swimming Pool Above ❑ In- ❑ mergency �g mg rnd. rnd. 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 No.of Waste Disposers Heat Pump I Number TonsKW No. o 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 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 Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. .a Estimated Value of Electrical Wor - 2.5-0 (When required by municipal policy.) Work to Start: f/ og' 0 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:) 1 certify,under the pai s and a alties of perjury,that the inform r(on on this application is true and complete. FIRM NAME: is ccj \ �C` LIC. NO.:.59 7t Licensee: S cd ( Signature IC. NO.: (If applicable, ent r "e pt"i he license imbine.)� Tel. NO. Address: (� Alt. Tel. No.: *Security System iontriktor License required for this work; if applicable,enter the license tuber here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. Date. y e NORTH , TOWN OF NORTH ANDOVER ° <• �O PERMIT FOR PLUMBING ,SSACMUS� X17L t- This certifies that. . . . . . . . . . . . . . . . . . . . . . has permission to perform !�" l�S�(�4 r�- 1. !?!.!.!.. JI—. : . . . . plumbing '•n t by' dings of .`.lJ. .(. ., t. .[-.!.:� . . . . . . . . . . . . . . . . . . . �. �i�} 'C7w� K . . . ., North Andover, Mass. l Fee._-��r-7�Lic. No... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `l PLUMBING INSPECTOR � Check # C/' 605 MASSACHUSETTS UNIFORM APPLICATION FOR'PERMIT TO DO PLUMBING (Print or Type) // �� Permit # Mass. Date ' s Building Location / — 4=1 Owner's Name Type of Occupancy Residential New ❑ Renovat on ❑ Replacement N Plans Submitted: Yes ❑ No ❑ FIXTURES NC NC < V) U N o z r w O W Y J N Q .F (11 0 N N W y N 1 W O 7 W < tr .T' Q W y O ¢ J ZCC cr ¢ Q .� x x W x < z 3: 3 O Z S Y a O F < Y .( W Ll 1L •�Yy r u o x ° a r z o o (n z x W ~ o H 3 x m v1 0 0 3: x 1- (n LL u a < 3 a m 3 3 SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR JTFF STH FLOOR Installing Company Name Heritage Htg. &Pig. Co. Inc. Check one: Certificate Address 35 Pleasant Street IX Corporation 714 Stoneham, Ma 02180 [] Partnership Business Telephone 781 — -77764 3 8 i1 Firm/Co. Name of Licensed Plumber Gordon Switzer 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 indicate the type coverage by checking the appropriate box. A liability Insurance policy 19 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner El Agent ❑ 1 hereby certify that all of the details and information i have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of toe General Laws. By Title S gnature of LicensedPlumber Type of License:Master[X Journeyman❑ City/Town APPROVE C S L O License Number 191322. � f i r f I i BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES_ PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING PLUMBER i PERMIT GRANTED i DATE 19 I PLUMBING INSPECTOR y y` Location ZZ No. Date ' r►ORTN TOWN OF NORTH ANDOVER Of . o 1. 41 f 9 s i Certificate of Occupancy $ Eta' Building/Frame Permit Fee $ sACMUs '= Foundation Permit Fee $ Other Permit Fee $ TOTAL $ fir' Check # 1 Building Inspector � K TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ,,37 / /M SIGNATURE: L� Building Commissioner/inspector of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: n ib BC m i-Z A Map Number Parcel Number 1..3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Ards s Frontage tl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R uired Provide R red Provided R red Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑' - Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 _J SECTION 2-PROPERTY OWNERSHM/AUTHORIZED AGENT m 2.1 wner of Record L e+� �J G N me(Print) Address for Service: r Signature Telephone (� N 2.2 Owner of Record: Name Print Address for Service: O Z M S' nature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Licensed Construction Supervisor: License Number O mn Address D Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name m Registration Number r Address r Expiration Date z^G) Signature Telephone SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the build trait. Signed affidavit Attached Yes...... No.......❑ SECTION 5 Description of Proposed Work check appUcable New Construction 11Existing Building Z Repair(s) [IAlterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify ti ! Brief Description of Proposed Work: •V Z SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee -C9 o Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN 4 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, Owner/Au 6rized Agent of subject property • Hereby autho ' to act on Py behalf, 'i ma ers rel ive to work authorized by this building permit application. Si tr f ter Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief r r Print Name Si ature of Owner/A ent Date 150 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST2ND 3RD SPAN DlIv1ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS -HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHUNEY IS BUILDING,ON SOLID OR.FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover Building Department °< 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta .Building Commissioner . (978) 688-9545 978 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print DATE joe LOCATION jI G LD ;4r^m K•d� �� N umwer Street Address Map/lot "HOMEOWNEf V p (��3 �j Name Home Phone Work Phone 'RESENT MAILING ADDRESS / O 1_ City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two 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 Budding Code Section 108.3.5.1) .DEFINITION OF HOMEWOWNER: 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 or two family dwelling, attached or detached structures ac_ cessory 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 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 hPishe understands the Town of No.Andover Building Oepartment minimum inspection procedures and requirements and that he/she will comply with said procedures and requireme HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL NORTH Town of Andover No. w3 o z== AMo dover, Mass., COCHICHEWICK ADRATED pP �5 S H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System Cp u / /4 C -P-4p BUILDING INSPECTOR THISCERTIFIES THAT.......... . .................................................................................................................................... Foundation has permission to erect...?A4Cw.... buildings on ... .......p/W... . ' fir! ..... .. ............. Rough to be occupied as...... V -f�°. .e. ^. ....... �.......(y.. .......O.N............r S ./. Mme.« ........ Chimney provided that the person accepting this permit shall in every respect corm to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Lays relating to the Insp tion, Alteration and Construction of Buildings in the Town of North Andover. � 7 �O• �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STTS ELECTRICAL INSPECTOR Rough ... .............. Service ...... . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Location I I OL C) No. r7 Date !(, NaRT� TOWN OF NORTH ANDOVER Certificate of Occupancy $ ` Building/Frame Permit Fee $ 33-0 . � , . cMUSEFoundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ " Building Inspector 08/16/99 14:46 33.00 PAID Div. Public Works 'V ' APPLICATION 1,012 PERMITTO ANIS() _ [FORWARD 8-147" NI%I'N0. © LOT NO. OO 2. RECORD OF011'NERSIIIP DATE' BOOK PAGE YuNF. SIM DIV. LOT NO. I OC.A MON - &/ 0WNC.k'SNANIE �CL�© IN OF STO111F.S /C SIZE (l AA'Nt:lt'S:ADDIit:SS S.IJ � BA S ENI E NT'O 1t S LA 11 .A 14 CIIII I"CF'S NANit: /77 �2 SIZE OF FLOORTINIBERS 1 ' 2ND 3RD ItDIi.DF.Ii'S NANl I: (lhlroyzy� SPAN - I)IS(ANCF"IONEAIt ESTBI.IILI)INC DIVENS IONS OFSILLS D15TAN'CE FRO"'I S"TRFET 1)INIENS 10NS OF POSTS UIS]"ANCE FIMNI 1-0'I"LINES-SIRES REAR 1)1NIENS ION S OF G112DFItS _ _ I MEA OF LO'1" FRONTAGE IIEIGIITOF FOUNDATION T]IICKNESS I';BUILDING NEW SIZE OF FOOTING x IS BUILDING AIIDTTION NIATERIAL.OFCIIININEV IS Rl11LDING ALTERATION IS BI1ll MNG ON SOLID OR FILLED LAND Wil I.BUILDING CONFORNI TO RE:QUIREN1ENTS OI'CODE IS BUILDING CONNECTED TO TOWN WATER BO kill)O1 API'EAI.S ACTION,_IF ANY IS BUILDING CONNECTED TO TOWN SEATER IS BUILDING CONNECTED TO NATURAL GAS LINE 1NSTUCFIONS 3. PROYLUT'Y INFORMATION LAND COST - EST. BLDC. COST PAC,F I I'II.I.01IT SECTIONS 1-3 EST.BLDG. COST PEit So. FT. EST. BLDG_COST PER ROOM 01 1CTItIC Nil:I"ERS NIUST IlE ON OII"1"SIDE OF R111LDING SEPTIC PEIINI1TN0. "I-I.kCIIF.I)CA12.AOLS NI UST CON FOIINI TO STATE FI12E ItECtILATTONS a. .APPROVED 1111: I'L.ANS NIIIS-I-RE FILED:AN1)AI'PROVE:D 11 111111,DING INSPECTOR RIIILDING INSPECFOR � DA I'1:1:11 Fl/ 01A'NERS TEl.11 CONI'12.T'ELN Slia\'ll"IIItE OF OWNER OR:1lIT`T1,OR�1"Lt:�D}QaGL•'N�I CONTR.I.IC11�--- -7 L/ II.I.C.11 rru�uTrr,It.ANTFI � ,^� ���� l 19 l"!visc11 56/99 .I 1 i • Town of North Andover f AORTA, , OFFICE OF ,?o ° ti o COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street _ °, ;.,_ _,_ • . North Andover, Massachusetts 01846 WILLIAM J. SCOTT S.3AC HUS` Director (978) 688-9631 Fax (978) 688-9642 In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Q, Number / is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MCL c 11, S 150 A. The debris will be disposed of in: (Location of-Facility) A-17 Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project throug-h the Office of the Building Inspector BO�TcD OF ATFE LS 633-9541 3UiLDr,iG 68S-9545 CONSERVATION 689-9530 IiE.UTi3 688-9540 PLA\WNG 688-9535 Commer�la f. : 'les� Licensed&Irisured O� lj .. � Roof Leak Experts ($08)794-3883.1-800 WAIT 4-US 'd PROPOSAL SUBMITTED;TO PHONE J�33 L DATE 3 � STREET JOB NAME l/ QLO �i9r2✓!i CITY,STATE&ZIP CODE JOB LOCATION / e/ AL ARCHITECT DATE OF PLANS JOB PHONE We Propose hereby to furnish material and labor in accordance with specifications below, for the sum of: Dollars ($ 36S d G ) All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized J manner according to standard practices. Any alteration or deviation from specifications below involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary NOTE:This proposa(killay be insurance.Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: �'r/�L``if' .S�i/�G.� li���'l.�/ri�•vi /y'C�GFs1- /f'LG 6a l lG� �'`�cr'�' /%�' / C'G �yLG /9lG- -�, e G-I& C� oU C</lr�ic rrf ��o,�i',G •ty'/ �;�i�'Qc i2�`- �cy��-i- '! Cry% ��"4.i s~�r��:�c�- -.r•--may c Cvs� �. ��� �1i�.< �i iz/ �o�"') -�o-a �` We Propose hereby to furnish material and labor in accordance with speclticatlons ueiow, 10 Lilt,:,' Ou O'- Dollars ($ Ca All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from specifications Ale below involving extra costs will be executed only upon written orders,and will become an Signature i extra charge over and above the estimate'. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary NOTE:This proposa ay be p withdrawn by us if not accepted within days. insurance.Our workers are fully covered by Workmen's Compensation Insurance. We hereby submit specifications and estimates for: ` ��r C i41a -140 C'G' �9CG Amf' z�,-T l,C--ts i�l/z<slLs-CGl%� O a J-`7Z Cvs Thi Acceptance of Proposal — The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: Signature I 4 pp r, 67 (Policy Provisions: WC 00 00 00 (NM ONLY) , WC 00 00 00 A) 29 vM INFORMATION PAGE -WCIP WZ WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115 NCCI Company Number: THE lf Company Code: 6 HARTFORD OD 0 0 0 Suffix LARS RENEWAL POucY NUMBER: 1 77 W7 Previous Policy Number: 77 W7 1. Named Insured and Mailing/Address: NORMAN GAY DBA ALL UNDER ONE (No.,Street,Town, State,Zip Code) ROOF/PEST IN PEACE N O 70 JEFFERSON STREET FEIN Number: 028349269 NORTH ANDOVER, MA 01645 State identification Numbs0s): tl•i The Named Insured is: INDIVIDUAL its Business of Named Insured: ROOFING Other workplaces not shown above: 70 JEFFERSON ST, , NORTH ANDOVER, MA 01845 2. Policy Period: From 11/09/98 To 11/09/99 -�—� 12:01 a.m.,Standard time at the insured's mailing address. s� a Producer's Name: MASS WORK COMP A R DIRECT LENNOX INSURANCE AGENCY PO BOX 462 : LYNNFIELD, MA 01940 ss� Producer's Code: 083477 Issuing Office: THE HARTFORD 4801 NORTH WEST LOOP 410, SUITE 200 SAN ANTONIO TX 78229 (800) 852-7991 i� i no poiicy is not Dinding un,,ess countors+gned:)y our authorized representative. /* ?7e� Authorized Representative NORTH VR4 X35 O of dove RCEL 0 No. _ L 0 dower, Mass., AcAuy IC, 99 C 9 H OCHI RA T E D P' C-1 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....I... pvo_07b.. LIL ........... ... . .. .... ....... /. ................................ ........e ..................... Foundation has permission to 1 .....................................1on ............IA...©.Lb..PPfE.W .................. Rough to be occupied as............ST72L.fD ............. ...... Chimney . ........ zX1 .7/ZG -7� /;Jq� .................... ..... ....��.wa ................... ..................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough ..................... ......................... ............................. ........ ..................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner •S• ":> Street No. SEE REVERSE SIDE Smoke Det.