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Home My WebLink AboutMiscellaneous - 111 BOSTON STREET 4/30/2018 (2) 111 BOSTON STREET 210/107T 6=0042_0000.0 i I Date/? No / r, ,,ORT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHus� fff r This certifies that . ./ . . .:'�: . . . . . . . . .'. . . . . . . . . . . . . . . has permission to perform,. . . . . • . . . • . . • • . . . . . . . • • • • t plumbing in the buildings of . '�' — ': . . . . • . . 4// . . . . . . . . . North Andover, Mass. Ffte�'. . . . . . .Lic. . . . . ... . . . . . . . . . PLUMBI G I PECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICAT N FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Location �� Owners Name b A � C ,40ts) Permit# y Building G Amount �= _ Type of Occupancy Q%S*0 it ti CR New Renovation Replacement Plans Submitted Yes No FIXTURES r z w x aCra s z Cr a a kC Gs+ zC4W F H A A a H d SC>l3BS Z &�SHIVIHTII' M FID(R Z' 1FU]QtL+-41 �FLOCi2 4113 FLOOR 5M FLaR 6M FLOOR 7M FLOCR M HJ00R (Print or type) Check one:' Certificate Installing Company Name /1gn�,�os� / i�6i�GyF' y/le,/' Corp. e,ddress �e r,-�n s e .� �y�' Partner. Business T61ephone _ Firm/Co. Name of.Licensed Plumber. a 10-1 Insurance Coverage: Indicate the type of insurance coverage by dhecking the appropriate box: Liability insurance policy �T Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance ignature Owner 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus toP umbing C and Chapter 142 of the General Laws. of4o By: 7-g—RaTilfe ot.Licens lumuer Type of Plumbing License Title 4 ' City/Town icense um er Master ® Journeyman APPROVED(OFFICE USE ONLY Location No. G Dated Z, NO�TM TOWN OF NORTH ANDOVER f A i Certificate of Occupancy $ -T Must�� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �� 7 TOTAL $ r Check # l"7 71h, Building Inspector TOWN OF NORTH ANDOVER. BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: /„ DATE ISSUED: / SIGNATURE: Building Commissioner/I ctor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 111 Boston Street Map Number Parcel Aumber North Andover, MA 01845 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7Water S ly M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System SEC ION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record Mr. LVonard Crawford 111 Boston Street c, ' a nt) Address for Service: �J i 978.688-1516 Signature Telephone r 2.2 Owner of Record: Name Print Address for Service: M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Paul H. Ramponi Licensed Construction Supervisor: CS 073831 License Number 2 Grove Street Address 04/15/2002 E. Bridgewater, MA 02333 Expiration Date Signa Telephone 508.378-0056 3.2 Registered Home lTpwv6ment Contractor Not Applicable ❑ Company Name Registration Number Address Z Expiration Date Signature Telephone SECTION 4-WORKERS e.OMPENSATION(NLG.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 building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check au a Ucable New Construction ❑ Existing Building N Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition I7 Other ❑ Specify Brief Description of Proposed Work: Temporarily support structure with steel beams and wood rribbing ;n order to partially demolish the foundation and basement slab to excavate Goll contaminated with no. 2 fuel oil; restore foundation and basement slab. Temporarily relocate furnace and oil tank and reset in original location. SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beOFFICIAL>�TSE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee 20 000.00 Multiplier 2 Electrical (b) Estimated Total Cost of Construction }� 3 Plumbing $6,000.00 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Leonard Crawford as Owner/=¢lJgof subject property He b thorize Cle H bo s Environm 1 Services Inc to act on M i4lf,in all ma rs a ti rk autho ' ed y t s building permit application. j 12/22/2000 Sig attue of Owner Date f SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION r I, Clean Harbors Environmental Services, Inc. —as 0[ /AuthorizedAgent ofsubject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Daniel R. Douthwri ht Pri me 12/22/2000 Si atrue W /AQent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3RD SPAN DIMENSIONS OF SILLS DWENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINE,TEY IS BUILDING ON SOLID OR FLLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 7 ? 7- FORM - U - LOT RELEASE FORM e �CA v U ZA-1 --/-o oil s <!l INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ............................................................................ APPLICANT Clean Harbors Environmental Svcs. , PHONE 7r81J.849-1800 ASSESSORS MAP NUMBER /J LOT NUMBER SUBDIVISION LOT NUMBER STREET Boston Street STREET NUMBER 111 OFFICIAL USE ONLY RECONM1ENDATIONS OF TOWN AGENTS 000,00000 mass on an 0 Nunn a on 0 a nownsaw Masse munnewman we dwimeNREOSEN t-- 5� DATE APPROVED ` 7-7 P COKSERVATIONADMRMTRATOR A n DATES)REJECTED COMMENTS U 2 V In t_ �+^^1 J / A., DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED ( DATE APPROVED _Z 2 SEVIT ECTOR-HEALTH DATE REJECTED PUBLIC WORKS-SEWER I WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North Andoverof ttoRTH tlp� l� t Y a O Building Department f°- 27 Charles Street North Andover Massachusetts 01845 Z y a (978) 688-9545 Fax (978) 688-9542 09P-?'Ll,'� Ca�usy DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in/at: Deloury COnstruction Co. , Inc. , 46 Lowell Junction Road, Andover, MA 01810 Facility location Signat of Applica la/ZZ - q� Dat - I NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. 10/31/00 15:58 FAX 0 002 .: ............. ... ......;.. ..... ..x: •r. :>:.' ,,�,� � DATE(AAM/bDm} ;<• %•r:v.% .% .ata. i. v.< n n•n.: : `.%. .S? S'^'r �:%•Vw'.S:YYS4�,.:. �,�� y'a•n URQ :1;a10/31/00 t: 'r :ia., T a .. ..%a;r.atn:r.vn•rn;.a•%••%�Y.•.v.a.n '•' ..l..% :.....: t vn.nvnv;v:v%•!;^:t.v:v%.%�. ... i%.r:a.:<.v,: a. R••n•n•r:••n•i•N:•.a:nY.a.r.a..a•n••.a.r:r:•'v:•'a•r.<r.>:.n•.:•w••S•:tn;r.v.a;rn•^y.avYr:<•Sn % 'a• . ....rn•..•..:r:rr...:.....r..t..r:••Y•.;n{.,.t:..a•n•Yt•at.>:nY.tn:t•>:n:n<••�''•�:•::�•�:�.....................nn,a•..vn•.:m.r.a . PRODUCER FALTER HIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION LEIllign Gallagher Associates NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance. Smokers, Inc. OLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 200 State Street THE COVERAGE AFFORDED BY THE POLICIES BELOW. Boston MA 02109-2694 COMPANIES AFFORDING COVERAGE ELUI 0'Connor COMPANY 7 A Pacific Employers Insurance Phone No: 617-261-6700 Fax Nm 617•-261-6720 -• •_.__ INSURED COMPANY Clean Harbors Env.!=*- ental B Rational Union Fire Insurance services, Inc. and. All subsidiary and Affiliated COMPANY C Zurich-Ataerican Insurauae Grou Companies 1501 Washington Street COMPANY Braintree MA 02185-9048 D steadfast Insurance Company ....v.............. .at•avn•.vn•r,v,a•nva.,a.••a,,. v.vr.vn•.;...:.... r .�..... %4:^Y�v.vn•nM1:x:%•YYynn;n•r.X.�v,a:r.v,v.av.�:r.Yi vn.%..Yn�r•wnvn y.a•r.a•..v.vnv.a•%Ynv.ay.v.•nm.. .h...tnv,.•r..r:n....n:nvn..vnv�v.a.n•w•%v>.�%•.. n.<..%n.r.v.a.n..nv��a.a...v�..r.vn...v/.....•.. � .. t.X4'rn.Ya.% Ovn.nv.a.T•A.a.nv.v rtv:<..<•%•% %t•%•'% i <••Y•YHn nv.v.vn nv.r.t%a•n:<•vn•nvn•n v n•r%•%n:<•vnY•a n,rnv:v.<vS+y,vi:•t.•• n%:••�r•yn;.v%>%%O%•�nY•vnv%•,:�,r.vrt•YH%n:nvn.X.Rv.v%a'•t'r:'rvY%:>Ya:...nv.a.n.%^r^4!'^';�':'r�.:..vr��r:nvn n:Rv:•<v%w•nv avY..vn.nv ea'rn^.�......:..•..�;'i;.rwmr.vn>hn•^•,:..:r..n•r.v.vla.11v:•t0%-0:.v.w.vn•rtv�0%JS•CY'. '�:;�v..vnv.a..wSr:4Y:0X.>Y.Yn.nv.a n•Y:'^•.a:.............:..vnvn.na.n.t.v.v%X. ................•..va•w .. THIS 0 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY Be ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POWIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Co TYPE OF INSURANCE POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS LDATE(MM/DDlYY) DATE(MMIODIYY} GENERAL LIABILITY GENERAL AGGREGATE $3,000,000 A X COMMERCIAL GENERALLIASLmr ED0020577010 11/01/00 11/01/01 PRODUCTS,COMPIOPAGG S :L,000,000 CLAIMS MADE ®OCCUR PERSONAL&ADV INJURY $ 1,000,000 OWNER'S&CONTRACTOR'S PROF EACH OCCURRENCE 51,000,000 X CONTRACTUAL FIRE DAMAGE(Any one Era) $500f000 XCU CdVElk�M MED EXP(Any one pernn) $10,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S1,000,000 A X ANY AUTO ISAR07968533 11/01/00 11/01/01 ALL OWNED AUTOS TPD Pc'BODILYINJURY g SCHEDULED AUTOS MIRED AUTOS BODILY INJURY 5 NON-OWNED AUTOSnn V{�,�.1j► (Peracaidenl) T PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY.EA ACCIDENT S ANY AUTO OTHER T14AN AUTO ONLY ;;;;•a•R•< .vh ;•' EACH ACCIDENT $ _ AGGREGATE S Exp LIABILITY EACH OCCURRENCE $5,000,000 8 X UMBRELLA FORM BE7392772 11/01/00 11/01/01 AGGREGATE $5,000,000 OTHER THAN UMBRELLA FORM 3 WORKERS COMPENSATION AND R TWDRYsT RS EMPLOYERS LIABILITY EL EACH ACCIDENT r� S1,000,000 X m A THEPROPMETORI INCL WLRC43090690 11/01/00 11/01/01 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERSIEXECUTIVE OFFICERS ARE EXCL EL DISEASE-EA EMPLOYEE $1,000,000 OTHER C Contractors PCC365668104 12/19/99 12/19/00 Ea. Cla-im 2,000,000 Pollution Agg Limit 2,000,000 DESCRIPTION OF OPERA71ONSILOCATIONSt E iCLI-�a�''YSPFaAL HEMS (D) Environmental Impairment PLC3743936 5/1/00-01 $10,000,000 ea. ccc./agg, w.n.n..:..a...:..... n.X.l:,.n:r..a.r.n.r.a..a.r.a........ n•na.n.nR wvtv:V%^%%.>1•. .%v:t•%%v :..y.Y rO:vw%•%O:^v�.<n n•rn<..%at•.:n:r:vSn:A%.:ni;nYv.•..n �:<•%�:n.;:;.�in n:ri.v.w t n. a :.�(r.'�j >•Ot<.Yn: RvY.YY.Yn:S>:.urn•%n:to,;.�a%v\Y/'41M�YGL'YYY{Y�X{,}.f.a�T>•[•%^ % %.SA: F <[y�p��y,•��a�ilblA.SA.•TrF.0>{'iiJM.iL•{.Y.C3Sn nv.Y.S'r.a%i.v.a.n•..rM.w.%.t•.Y•v.vn.wv%v�aY.Y.>:n•rn.:a•Rt.a:n:r.Yn. •'.i�..�n r.nr:v%•r:o�t.'�tt'^.• ..n.Id:/•i.....v....r.rn n.t nt Y.>•%^:v:t•l:p:T: .......n..rwn nr.r.r..aY .. nr. r. ........ <TS.T.M1. 4:r.%n:rn.nvn.y�vn vY nv.Y.:>YY:r.Y .r:....•......r.v . v.v. S.t•).Sv ..:r.v,,.,:r.a•n••.v.v%.a'l:n•n••:•>:••Y•: .r.a.a r.vn•r:r:a•:t•l:m:nY,4%.Y:v% .vn• •• FONR FE SHOULD ANY OF THE ASIOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DUnRATION DATE THEREOF.THE L95UING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, For 1teference Purposes Only BUT FAILURETO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTNORUM REPRESENTATIVE CA)a a .. ...a•.:.vr:............. %a<vv;•,.•v..vn•.a•r:r:.:v.....,..O:f•:.S.:r:a•%%.vwvn•n..Y.%.vn••%...:r.v%v%.l::.Yn:r.vT.%n:'n'S�'•'•n• .. p ...Y>Y .n.Y..:.a.w.a...n.>:r:a.:a•%. Yn:.a:.ay. n.r.a. .:%•Y:.aY.a. a�.a.�.a.r....,a..y;,�.,;... `y ' i AsSbciates LnftQ , n a.n. .......aaa oRATiG>• a %..YYaay.v.v.a. .v.a..a.r.a•n•%S:SY.Y.a.i v ..rw.r:v �. .v.v.a. ......r.a•: l !/V VVII//IlVllrrVVIUI v! "I--VU lILJ,./1...LLJ Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers'Compensation Insurance Affidavit Please Print Name: Location: Citu Phone am a homeowner performing all work myself. aI am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name' Clean Harbors Environmental Services, Inc. Address 1501 Washington Street CitV: Braintree, MA 02185-9048 Phone*- 781.849-1800 Insurance Co. Pacific Employers Insurance Policy.# WLRC43090690 Company name - - - Address City Phone*: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 1527 lead to the imposition of criminal penalties of a fine up to$1,5oo.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cert, er the pains and /ties of perjury that the information provided above is true and correct Signature Date 12/22/2000 Print name Daniel R. Douthwright Phone# Ext. 1308 Official use only do not write in this area to be completed by city or town official' C Building Dept []Check if immediate response is required Building Dept p Licensing Board E] Selectman's Office Contact person:_ Phone#. r-1 Health Department Other FORM WORKMAN'S compENSATION ,.10 R Tly TONM of over 0 No. ` x - - _ �. �o LA o � dower, Mass., /a 4Q42 -o 0 COCHICHEWICK V ADRATED PPa�,�Gj S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT v W,4.0 .... ........ Pa.�.. .......�44................................................................. Foundation has permission to erect.T+PM.041............ buildings on ..,� .......Boa *S,.. ......... Rough to be occupied as... X S �, Chimney p S�,u�/ ri- 5... '' .............. ..... .. . ....f............... ......t �V .�.... provided that the person accepting this permit shall in every respect conform to the terms of theapplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration nConstruction of Final Buildings in the Town of North Andover. TO `I.PA40 401& & *# 0 4 *&.40s PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. M P4 rot Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough A. ... ............................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. NORTH Tolm . of gAndover . �� O ~I�,*., :,4• ( .fin, � C0%o LA o � over, Mass., A21-IQ 01 --O 0 COCMICMEWICK ADRATED S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.... ...ev 44.Rd.....co...aiw.. .......e�................................................................. Foundation 0 7'e S+ft has permission to erect.To/r1./ ............ build'ngs on .. .... ...... .......... ..................................... Rough to be occupied as... I� .. ....,,,,..� Stft� "N � Chimney p S� �/A!�' i..... .......f.................... ......f. .....�V............ provided that the person bccepting this permit shall in every respect conform to the terms of theapplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration nConstruction of Final Buildings in the Town of North Andover. TO (r1#040 Oft & **I, 60404/10e PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. M p q ll P4 it Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough /."..PI C....................................................................... 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. 4��Location /,// No. L�,� Date ORORT" TOWN OF NORTH ANDOVER •"�ao # # Certificate of Occupancy $ Building/Frame Permit Fee $ ss�cNust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i I �� -Building,Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: .� Building CommissionerA for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Addr 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 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 ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHMAUTHORMED AGENT 2.1 Owner of Record Name(Print) Address for Service 22y—(,�Zroo:z � (/f/^ r Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Z M Signature Telephone SECTION 3-CONSTRUCTION SE CES 3.1 Licensed Construction Supervisor Not Applicable ❑ Licensed Construction rvisor: C/ r oa ��/A License Number mn ess / / 790 Expiration Date SiTelephone nae U < 3.2 Registe Ho Impr ement Contractor Not Applicable ❑ p o� ��- l �� i i� -� rn Com an N me Registratton1�umber Adce7&. Z "% Expiration Date Si natu a 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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: v SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to beFk'ICiA ,USEONLY •- -::- Completed by permit applicant 1. Building /. C' (a) Building Permit Fee 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 OWNERS AGENT OR CONTRACT APPLIES FOR 11JAMING PERMIT as Owner/Authorized Agent of subject property Hereby authorize .I to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNERJAUTHORIZXD AGEN ECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements d information on the foregoing application are true and accurate,to the best of my knowledge and belief yo, Print e Si a of Owner/ e Date N F STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE V L LLam ...... _ _ .✓/Le 10am..a o�✓� ac�ic�5ed`6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR I Number: CS 068424 i Birthdate: l0/01/1951 ` `Expires: 10/01/2064 Tr.no: 3362 146stricted: :60 I JAMES J SHIELDS 40 PRESTON RD • SOMERVILLE, MA 02143 Administrator i S= Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registration: 101562 Eitpiration: 6/26/2004 Type: DBA NORTHSHORE 4,VINDOW&SIDIN I fames Shields 4 40 Preston Road z l,».. �il�''� 'Sd;rervfle,MA•02143 'Administrator NORTh ® of 0 - LAK -O cover, Mass., COC MICME WICK ADRATED A ,�5 S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................ . .. ....... Foundation has permission to erect........................................ buildings on .... ......... Rough $0 b8 occupied aS.. Chimney Vithh1an ....................................................................................................................... provided that the person acceptingmit shall in every respect conform to the terms of the application on file in Final this office, and $o the provisions ofes 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 ELECTRICAL INSPECTOR UNLESS CONSTT�UCTION T S . Rough ...... �1 " „�`............».............. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RougR nal h No Lathing or Dry (Nall To Be Done FIRE DEPARTMENT Until Inspected and.,,Approved by the Building Inspector. Burner Street No. Y -J SEE REVERSE SIDE Smoke Det. NORTHSHORE WINDOW & SIDING Page No. of Pages Residential -Commercial PROPOSAL 40 Preston Road SOMERVILLE, MASSACHUSETTS 02143 (617)628-7204 All home improvement contractors and subcontractors engaged in home improvement contracting, unless 1-800-439-7205 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submitted �10 4- the Commonwealth of Massachusetts. Inquiries about To: ................._........,.........................._. .................._........C ......../' U /�c��,� 4 ----- ------........ registration and status should be made to the Director, / Home Improvement Contract Registration,One Ashburton `.� / G�/t .........c.3......./.........:.............................................................................. Place, Room 1301, Boston, MA 02108 (617) 727-8598. 00: Owners who secure their own construction related ..........v...- , . ......., j(/� .�G'?i'�/ i�' ii� ,�',�rf! permits or deal with unregistered contractors will _ S� be excluded from the Guaranty Fund Provision of MGL c.142A. PHONE DATE REGISTRATION NO. 1A111195 --�46 2— JOB NAME/NO. JOB LOC�N We h ubmit specifications and e's ates f�work o be erformed and materials lobe used: P ..........................................................................................._...................... ............................................................ ' d•..J'..%:c�Li...... ...................._� itf✓l .......J.'`........ ....._ d .y.....1"7r' ..�_/2 A ......................................................_...................... ...... w �,�,�,��rn . .... .. .✓ ..... a........... G..:...._�.. a % a2..._ /......._ tint. '%:=- .....v�.-....�� J,�' �... ....lti. T'N��3�e%�vYv� /Qt�✓rti�. G✓��17i� .................................................................................... p..i ,_ tiS"� /1 1 �,c��i-�Ta !s111_1y4o, �/.-�,�' �%`'l's7`' 'ra�: ... Q3.t...i'Q..f-L. .................. .''.._y.................................✓�...........................J.(.c7r✓.L....................... ........................................_ .............................._...1............... ..._ I^:'.�.�..�./....._...". i"5:f.1 �"�^...._...._.._....._._... -..... �...►.................................................................................................a::................................................................................................._............ ........................................................................................ . . � 7�r`�d Lc1�Yom' /S�Gv .'%'P• `(.�. ?�W ��'A c��' v r ,�y p 56 ...................................................... .............. / -- ...................... ..... .... .............` .... ............ .... ...... ........... ............ ...... ................. f........... <...`.... �.�....V`... ....... ... ............./....V ...... ,f .lAi�..T� ........................................_.................... _ ..................... ie� ?................./ '........G?Y/....................................................... ........../Q/ ...........v....................................................... .' Y.........s ....~�C '.V...:.. _................._.........._...._._._. > Construction related permits: C� !�✓�-�r;�:a.. /77 ��..�.._.�,��.r.�'_f..�._.,/_CJ�"Y.i3'�'/i7��it;,l y��j�J�l WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about�J�g;Z : (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by�]�rA.J :1'Q(date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period ofy� l�iJr following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied, repaired,or replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of dollars ), Payment to be made as follows: % ($ ) upon signing Contract; j . lyY Name of Contractor/Designated Registrant % ($ ) upon completion of o �' i n� �T..........z l' ��J .... '. •� Street A/ddr�ess ................. ................................................................... 1_ % ($��6 "�) upon completion of I�O !3 Cv� y1�; J.._ .�'� �'24'41/' ...._. '` ��`........lJ�?/ .............. f City/State ($ shall be made forthwith upon �!7 G-�46 . completion of work under this contract. ....... . ..................................................................... p Phone Fe ral ID No. Notice: No agreement for home improvement contracting work shall require a >down payment(advance deposit)of more than one-third of the total contract price Name of Sales or the total amount of all deposits or payments which the contractor must make,in advance, to order and/or otherwise obtain delivery of special order materials and Authorized Signat equipment,whichever amount is greater. Note: This proposal may be withdrawn by s' not accepted within days. Acceptance Of Proposal -I have read both sides of this document and all attached documents and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be n/d'_Jh writing. ;? DO N TH QNTRACT IF HERE ARE ANY BLANK SPACES. f � � Signature �'G Date Signatur DalXw ," 1 PORTANT INFORMATION ON BACK i►, - B-241UW--3 B-231MIM-2 Bulkhead b ` 1 �,' d. '� - ., } z :. Rt`^.�a .� d. .t' ti�s i.,d �•� � � z -..) r•k 4 E 'T, t � �.... + ,�. � _� r,.• a d d�'"`r'j..s� �a:�� qZ�:"r+".a -5... '`�a..,. �. � ,� e�."��, � � R ''s 1 t t•:y'„r..,r '+ is r r"� Y'� :1� � � +g a #i/� �V 1 !:. Stairs GarageF y a M a.r.. •.r .( .a§ ,y + sem . '' i J z5 $y� ' +fir t •"r. t.+-.acr '.tr `v:Fir + .iSi c".,x^ .'#` r` t"Ps�YT�... r'AI AFti: �f Y•}��I t �,>e.; ►r44 '—s i« « « —i ia-':—i i i i—i< t i sr '----E--i sai��s�tr''� I B-9 To '4..� I I "• r '° yh'rFz iM'` a +, F- t'� tF t , ..tz t5:.' �----- r S�ytr,. + 4111 Column it �s...� / S ,J. d'.SuYY„`.'rt't+11'''), Boiler r x} M ' limit of ; s.. :t '',•« fix' RW i i ;F'�`, Y _R �1.., y . � ',¢� /.s�; Excavation tr : S �.`._�+W,� .r.%' a � ;..4 s/A 't a-i.s .+ 9 # )•; Location of Failed YP rx ;+ .= �'r Fig M , e 'I `v3E •+ 'Sw, xx,,yi f r t„ ?�',a�hi.i.77 p I � a(9..•• i k n Feed Line �f3xv5 .g « aR yx n4 � F % 7' L7-1� , � 4�tv%k �+ '� + rrr 4': y: r k ,ra is q( ` } 4 0 B-2; til I.t .275 -.'q ••`f _•• ..2 �1,- l' .M' / .rte . Proposed J ; grafi v.. Excavation Limits t AST` v ; '; e 04 / � e. s Iii ''�''' .•Y••:''-:':'•: .j ,' '� -+� ^,?•. •r e,..- i Z . / s ez.• _..YS• ,F K�g s+'4+ss �� -.r +'�'W�, .^ v� Ph„3! '/ '�. �:a, 1 01 1 �3 I _ H Y j �, ' 'r by 'i,`,}sY• E-- e-*�'' rs y' . <xi`t s ..:,.r { ' +. y: . A. PRELIMI RY: \1 B-22 ISSUE .,I)ES6RIP-nON p I DRWN CHKD APPR DATE t = Legend: i " ` #2 FUEL O ELEASE - soli Semple -+.,. r _ ... _.-Y _..__.�._..--._ - . leanLocatbn , .__. _ �._� : :�-� _ �: . aro 3� �'11't�BOSTON�STREET - = Monitoring Well Location Environmental Services, Inc. NORTH ANDOVER, MASSACHUSETTS -1� =Test Hole location Remedial Technologies Division PROPOSED EXCAVATION LIMITS RW-1 1501 WASHINGTON STREET = Product Recovery Sump BRAINTREE,MASSACHUSETTS 02185-0327 JOB N0. EN-26458H DWG.NO. C (781)849-1800 SCALE: 1"=^•5' r I R n C C Date. .h.: �: 4125 A + TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that. ... . . . . . . . . . . . . ��.J.!. . . . . . . e has permission to perform . . . . . . . . . . . . . . . plumbing in he buildings of . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . ., North Andover, Mass. 0 Feat. -" . .Lic. NoP a . l fes. . . . i PLUMBING INS% TjR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer �z. 1 j s MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type)..._ _-- .__:._.. Mass. Date —3 19F,19 Perm,it # Building Location- Owner's Name Pct 40 Type of Occupancy i /lvf4 Vi^ New ❑ Renovation Replacement ❑ Plans Submitted: Yes ❑ No FIXTURES zN z O N O Z r N W N W w Y J N .4 .. Q ti O w H Z N < ¢ _ ~ Z O Z _y O W F- w y rL ►- u N S D: ~ U W V) Y Q y - a 3 X W O 7. d W Q W G Q y z LU z d z 3 o z i j y � � Q Y � � � LL s ~ U > ►- o x a z (a �. Y a 0 z z W W u.! Y w 2 O N _ _ W Q Q Q S N_ N_ O O W O U x Q Q Q- J J Q fr C. Q 3 Y J G1 N O D J 3 = !- '.VY LL 0 a Z 3 O co O SUB-BS MT. I BASEMENT IST FLOOR j t 2ND FLOOR ;r b 9R0 FLOOR i 4THFLOOR 5TH FLOOR 6TH`FLOOR 77H FLOOR 8TH FLOOR Installing Company Namef rC- V OZ Check one: Certificate Address oration � Q ❑ Partnership Business Telephone — ❑ Firm/Co. Name of Licensed Plumber Jkl. INSURANCE COVERAGE: ( have a current IiptirCy nsurance.policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes m/ No ❑ If you have checked yes, please dicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ I OWNER'S,INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by . f Chapter 142 of the,Mass. General Laws, and.that my signature on this permit application waives this requirement. Check one: Signature of Owner or Uvner's A ent Owner ❑ Agenti0 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 Pertinent provisbns of the Massachusetts State P�ignWatureo be nd Chapter 14 of the General laws. By Title cense lumer City/Town Type of License:Master�/� Journeyman❑ APPROVED Ucense Number �� • i FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS BELOW FOR OFFICE USE ONLY FEE N O, FOR'PER.M17To DoPLUMBING - - ---- -- NAME &TYPE OF BUILDING * LOCATION OF BUILDING j PLUMBER_ - .:<. - - PERMIT GRANTED DATE 19 • "�' ;'- PLUMBING INSPECTOR, Location No. —32v Date O'ttNaRT� TOWN OF NORTH ANDOVE% p? `•o ,`1hO� � M Certificate of Occupancy $ 41 t i Building/Frame Permit Fee $ /00' JCMOs Foundation Permit Fee $ � Other Permit Fee $ — g Sewer Connection Fee $ _ z 0 Water Connection Fee $ g TOTAL $ /,3 6D, IA� �7 Building Inspector Div. Public Works II J IAkAAAAA Pr.;RiViCT NO. APPLICATION FOR C'T'I2IYITT TO I3UTLD RTII ANDOVER, NT ��11D ` I.o"rNo. bd 2. RECORD OFo11NEltsIlll' DATE BOOK PAGE L11 2Z Sun Dn'. Lo'r No. �k S . I(1('\ZION ) t ��w 5� PURPOSE OF Ill ILDING ll\1'Nlai'S N:1\I`l: !/ f!N (L pz_AW -j NO.OF STORIES / SIZE O\YNEIi'S:U1DIttas h R.1SLAIEN"I'ORSLAII \tt( IUTF(.I'SN:oIESIZE OFFLOORTINIBERS j I 2 N 3111) -ISIIII.DEIt'JNANIE Go �6 Rv�S� 5y— ,q-L_ J� SPAN -DISTANCE"1'ONFARES"fUUILUING R 3 to DIMENSIONS OF SILLS � G►}�[ti"J 1)1S'FANCE Fit 0N1 si'REE1 DIMENSIONS OF POSTS DISI'A\'CE FRONI I.O'F LINES-SIDES �?® RFAR 3O DIMENSIONS OFGIRDERS ARFA OF LOT /FRONTAGE IIEIGIITOF FOUNDATION 1'MCKNESS IS IilII1.DING NE11' SIZE OF FOOTING x IS Illlll-DING ADDITION MATERIAL OF CHIMNEY IS DOWDING AI:FFuATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIRENIENTS OF CODE ,/<- 3 IS BUILDING CONNECTED TO TOWN WATER CS Ii O:11t[)OF API'EAI.S ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER /v D IS BUILDING CONNECTED TO NATURAL.GAS LINE INSFlICT1ONS 3. PROPERTY INFOIINIATION LAND COST - • EST. BLDG.COST 00 I'.\GF. I FII.LOUTSECTIONS 1-3 EST.BLDG.COST PER SQ. FT. EST. BLDG.COST PER ROOM I'I.FCTIIIC NIF:TFt1S NI UST 11E ON 01ITS IDF OF BII11.1)ING SEPTIC PEItNIITNO. .\I'1.\('IIF1)G:\R.\CES NI USI CONF'OItNI TO STATE FIRE I2 FG IILATIONS 4. APPROVED BY: I'L.\NS 1\11 S-I'Ill:FILED AND AP11RO\'ED 111'111111.DING INSPECTOR II1II1.DING INSPECTOR 1)\T I'l1.FD 0WNEitSTE1.11 ✓ ��(�' �' `�!p CONTRA 10 EIJ/ 9�(g �J �J /�Y /_ey 9 S 3 t7(D� • i��A%"' SICN.-1IIIItE OF-O\1SVF:R OR All"fl101il"LED ADEN"1'X CONTI2.1.I01 1,3 Revised >>s/99 .IN1 --- — - — — -- — -- - - - BU1LDiNG DEPARTMENT - 1„ xwL•+rr• SL..'a..:,at:i. 1 .'a r-,k r t: .. saw '. - _ - -. t'� �l2C 1Da/�7�no�/ZU�ea� O�✓//CadQd,!,/2CC6P.� E' BOARD OF BUILDING REGULATIONS ri License: CONSTRUCTION SUPERVISOR Number:.CS 046149 • e, 0 _ Birthdat 5/23/1950 x Y Eres:#05 r' /23/2001 Tr.no: 10102 Restricted To: 1G t1 MICHAEL S PACE r. 70 RUSSELL ST .•• v.�z jt. W PEABODY, MA 01960 ! Administrator ' .- . - - �fLC 0�114)tOILGJCCLC[/L '�dJClCltlldP,Cyb - _ . HOME IMPROVEMENT CONTRACTOR E =�. Registration 128451 Type - DBA Expiration 04/11/01 tr MICHAEL S. PACE t 77 MICHAEL S. PACE G�Lo�r�o7"i RUSSELL ST ADMINISTRATOR- lz— W. PEA90DY MA 01960 r r t FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. :t****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT l`�1I�� GD PRONE LOCATION: Assessors Map Number PARCEL SUBDIVISION LL LOT (S) STREET ST. NUMBER I J **�E * tr*OFFICIAL USE ONLY*************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD,INSPECTOR-HEALTH DATE APPROVED �-� DATE REJECTED C IKSf ECTOR-HEALTH DATE APPROVED �99 DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR r r • Revised 9197jm 4031 r� • BUILDtNo DEP _ ARTAer. ,- NORTH own of ®veer 0 or dover, Mass., lee C/ \� ORATED P' -11% y .S SE BOARD OF HEALTH Food/Kitchen PERMIT TU D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........I�. /V...........e/..'.. ✓.. ...a.. ''. ........................... . �• �� •-•••••�••••• Foundation has permission to erect.......... 0r. . buildings on .........I............. Qis....................... ................... Rough to be occupied as.......C.40* ........I....... �.M�./�/........mof��..................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-taws 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 y�r� p f3 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTIONS ELECTRICAL INSPECTOR �� ( Rough R�c�C '3 ........ ....... . . ........... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. wK oo _-------------- MICHAEL --_'--___MICHAEL S. PACS D B:A--. MIKE-. : CO 7Q_ .0 . ._.L . _T. W. PEA�DY, MA 01960 ' (548 .535-5326 -fib r wo El o X r - - r I i s 1 i r i 19 N� "� c'. .............2.............. Date....... ,FORTH °ft"'°;•1"° TOWN OF NORTH ANDOVER AL p PERMIT FOR WIRING ".T .T. Cu This certifies that -Q has permission to perform .......:�- ................................................................. wiring in the building of..:...... ..............................................................w i at..................r,.........:........................... ..................... ,North Andover,Mas S8 t� cM Fee's.... ..... Ltc.Ncs'-�3�:'�;! .....r ,r'?..�!-�.........:::�.............� .... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer p 1 TIM C'UMMUNH LTH0 A1_VSARUS= Office Use wonly � V DEP9RT�VTOFPUBLICSAF= Permit No. 7' / BOARD OFFIREPREVEMONREGU HOAS527CYRZ12.E Occupancy&Fees Checked `—��5 APPLIC'A TIONFOR PPRAET TO PERFORMELE=(RAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. PARCEL Location(Street&Number) 42 Z's7�,tJ . Owner or Tenant le-0 11/,.}-,12� C,e1'9-C,0 G� Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Serviced@r--round No. of Metel:� New Service Over ound No.of Meters___ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work �v No.oting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA ground ground No.of feceptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals ,No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other :r'; Connections No.Df Water Heaters KW No.of No.of / Sign 5 Bailasis No.Hydro Massage Tubs No,ofMotors Total HP v s ' OTHER- kMa=Co%eage.Plnsnar¢todreregtmalrr�soiFMa�dase�s Iaws Iha�eac�uartliabthtyhn�dtrePalsyirrhr33algCarrp Ca�aageaitssulale4m'a�nt YES NO Ilnwsinntbdvabdpccfofsarnetothe0fficf-- YES Fv1NO F7 Ifymba�drdgodYES,pleasei tre Fof=uaWbydvda%dIe gVepiatebm INStJRAv,LT �Bor>D Q MHER Q (Pleasespe&y) ` EstmatodVahr dE]e=alWbrk$ Wc3k'DSimt .. �� 1=ticnDa(e mpes�d Rough Final sigrredutxla�ielof r- FIluv1NA1v1E ` Lica�eNo T/_ Lica �'a�r t Sigr> Bt>SnxssTeLNo.Mdr�I <Er P&O�krA A Alt Tel.NTcL OWI,'SINSURA CENC WAIVER,IamawdrethatteLmisedoes mthwedr.muari cr�s aistntalegm1aitasralmedbylvb-,md�CnadLaws andd-firT n tzeendmpmrlalpbmtKnwaiwsttnsreqmurat (Please check one) Owner Agent Telephone No. PERMIT FEE$ Signature of-Owner or Agent 'r4= N2 Dater .:. �.... NORTN e` " TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� l This certifies that ................. ..... .�`.:`' .t.'.....�......... . . ....................... has permission to perform -`- t� '� TI'' =~ .. ....................... . ........ Cn wiring in the building of...:.-.4... G.�. .�� .................................... at.............../ -a - -..............�......—................. ,North Andover,Mass. fee <... !.... Lic.No Z-7/:-J............. ....................................... ELECTRICAL MpEcToR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer THE COAMONWEALTHOFhM&YACRU,S'EM Office Use only D.EA9ItT 1�VlOFPUI3IlCSAFE7Y Permit No. Ue / BOARD OFFIREPR VEMONREGUTATIONS527CM12:(XI r Occupancy&Fees Checked S F D PEST TO PERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 _ �' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date� �� Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. WAP le) 7 PARCEL Q Location(Street&Number) Z/ Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization Existing Service -�— Amps Gd/9 olts Overhead Underground No.of Meters New Service IZ QV Amps c4 24� olts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _ - �/e„ 77F'7 77,77,777 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total J KVA W l'lo.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Bumers No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges 'No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals :No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local MunicipalF Othcr �'• Connections No.of Water Heaters KW No.of No.of Sins Bailasis No.Hydro Massage Tubs NO.iotMotors Total HP r ' OTHER I _ �Co4a-ag.;.Ptustm�tot6eiagmetna�saflvlas�da�Ls Ibawa&.mertLiabllilyhr>stua>rePolL'urh�dMCUITi Camageoriisaislarlialegtrivalalt YES NO El lba esubrril>e whdgoofofs�eto*rO15m YES M NO r7 IfymlmednizdYES, m:b�thr,ypeofmNeaWbydwknglhe bcx INSURANTCE crll�R (lase spac&y> ,. E�SafiamI�ate \' Estn�VahrdE1 aricalWcik$ WdktoS>art lt,sgciatLaleRegt� Ro# FirB1 l nlhaSotlJaJt><rr o/�G-- 1i -,,-652r FlIZMNANE Licalsae �-.~.��1 �iLt— Sigcrahue C, —Lio�eNo � BusirmTeLNo. Alt Tel Na OWNER'SngSURANCEWAIVEP,Iamaw&udiattheLcensedfAsnoth,n,etru3st==o7aagecr �eWdiatasiegmudbyNbsmdmsetC,amlLaws and1fimysgoWiecti isapplimt1cmwaiVsthism4mami (Please check one) Owner a Agent Telephone No. PERMIT FEE$ Signature of Jwner or Agent