HomeMy WebLinkAboutMiscellaneous - 112 LISA LANE 4/30/2018 (2) 112 LISA LANE
210/098-A-0067-0000.0
i
Date...... ........Vi=.....a... ....
.4 NORTH 4,
3r°.';�`"-. °"a,� TOWN OF NORTH ANDOVER
- ; p PERMIT FOR WIRING
Is
�,SSACHUS� '•
This certifies that .......,�%.
has permission to perform .... 0
wiring in the building of..... ..........M.. .r !i ...................................... =
�...S/� L ...,North Andover,Mass.
at............................ ! ...................:...
,...,
Fee. �............ Lic.No.,5 .................� >+ /�...
ELECTRICAL INSPECTOR ) y
Check # ��
7134
x Official Use Only
Commonwealth of Massachusetts
Permit No. _�-G
Department of Fire Services
l Occupancy and Fee Checked
BOARD. OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank
APPLICATION FOR PERMIT. TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR:TYPE ALL INFORMATION) Date:
City or Town of: /()OX I;V A AJ J o 1/er To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street&Number) //a
Owner or Tenant /G Z..4r) _
Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ . No �4 (Check Appropriate Box) ;
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd El No. of Meters
New Service Amps i Volts Over ead V Uadgr d ❑ ilo.of Meters
Number of Feeders and Ampacity
s Location and Nature of Proposed Electrical Work: Installation of Security and or Fire alarm systems
add Cell odee4,P
Completion of the ollowirkq table maybe waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Sus addle Fans. No. s Total
P�(Paddle) Transformers KVA
No: of Luminaire Outlets' - No.of Hot Tubs Generators_ KVA
_. —_
7.
- - o.o mergency ig.,,.tng
Above Ej An El -
1�10 of Luminaires _ _ - -_. Swimminb Pool grnd.__... .-.grnd. Batter Units
No..of Receptacle'O.utlets . FIRE ALARMSNd
, No.of Oil.Burners 'of Tones
-
�S No:of Detection and
No.of,Switches ' 'yt No.of Gas Burners `_r Initiating Devices
Total
No. of Ranges No.of Air Cond....' Tons No. of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No. of elf-Contained
P Totals: -� Detection/Alerting Devices
Munici al
Other
Space/Area Heating KW Local ❑
No.of Dishwashers Sp g onnec t
Heating Appliances KW curl S ste •*
No. of Dryers g pP a evices or Equivalent__-_
No. of Water KW No. of No. of Data Wiring:
t
Ballasts No.of Devices or Equivalent
Heaters Signs .—
'T'eler_ommunications Wiring:
t
No. Hydromassage Bathtubs No.of Motors .dotal HP No.of Devices or Equivalent
OTHER:
7 Attach additional detail if desired, or as required by the Inspector of GVires.
Estimated Value of Electrical Work: a J (When required by municipal policy.)
Inspections to be requested in accordance with MEC Rule 10, and upon completion.
Work to Start: q
o P
performance of electrical work may issue unless
INSURANCE COVERAGE: Unless waived by the owner, no permit for the p Y
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 cert jy,a�nrler.the pains and penalties of perjury,that the info-mation on this application is true and.complete.
FIRM NAME:-ADT-Security-Services Inc.. LIC. NO 1533"C
Licensee. Kenny Wong "`` Signature LIC.NO.; 5.966D _
(lftjpplicable, enter "exempt in the license number line.). Bus.Tel.
Address 18 Clinton Drive Hollis N.H.03049 Alt.Tel. No.: 603-594-5930
*$ecurity System Contractor License required for this work; if applicable,enter the license number here : SS CC 001975
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: $ 'S
§nature Telephone No.
e
- t •
COMMONWEALTH OF ,'k5S1%!_hLSETTS »
'OE ELECTRICIANS
REGISTERED SYSTEM TECHNICIANwt .i
ISSUES THIS LICENSE TO I
1
- KENNY Q WONG m
k� 22 FIELDSTONE DRIVE
g7.
BURLZNGTOM MA. 01803-4213 {
., 5966 D07/31/07 981761.
z : •
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•v�*•t. -ew.r :`1YP^' .,'Y, :z= w,k�. ,::;XG 7 •.S!y. t •,.'+c„^:[k�".xe:.. !4 i� $ - �}
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3?' � .rte-1�y'„�-i��.t�•�'..�"..�`
- � ..._.. ....................DEPARTMENT
�
pp 1ie 'LOaa>rmanweall�c
� OF PUBLIC SAFETY :.,h f.ir^ ''i•
License: SEC SYS CERT.CLEARANCE
Number: SS CC 001975
Birthdate: 10/09/1969 -. it t �r•,
Expires: 10/09/2007 Tr.no: 110.0
t :._ Restricted: 00 tRtK^
KENNY WONG
22 FIELDSTONE DR
BURLINGTON, MA 01303 G--
Commissioner
`.f, �-',T•. ....R:.-. .fie t. til �N 't •ttKSl ,a
w Date//
. Date/.r .......
HOR7p
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
VSs^cwusE�
This certifies that ...4. ..... .4� ..... ......L.../.Zr
has permissiolNo perform .. G2 1. .....�!y .�`1�4. ...................
wiring in the building of...J ! .`'G........ ...................................
........ .i,/..r'- ........ te...................... .... . .North Andover,Mass.
.. ............ Lic.No...a.�?. �.. .
M)L INSPE
Check #
9'122
i
COmmonuwea&of Masjacl eM Official Use Only
2Permit No. cff
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMAT N) Date: /t 19 Lc
City or Town of: vQs✓ To the Aspkctor of Wires:
By this application the undersigned gives notic of his or her intention to perform the electrical work described below.
Location(Street&Number) (12 -Q 0 L-A)
Owner or Tenant D A 1/t f R f,'N,' Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No IS (Check Appropriate Box)
Purpose of Building Utility Authorization No. -]7 } 1 0
Existing Service f Ou Amps 29 f"Volts Overhead❑ UndgrdZ No.of Meters
I
New Service Zan Amps 8'Volts Overhead❑ Undgrd.1 No.of Meters j
Number of Feeders and Ampacity `
Location and Nature of Proposed Electrical Work:
R
Completion o the ollowin table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool bove ❑ In- ❑ o.o Emergency Lighting
rnd. nd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners o.o etectton an
Initiating Devices
Total
Ranges No.of Air Cond. No.of Alerting Devices
No.of Rang Tons g
No.of Waste Disposers eat Pump um...er Tons o.oSelf-Contained
p .......................
Totals: �������� �� Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal Other
Cyyonnection
No.of Dryers Heating Appliances KW SeCN of Devices Lf
or E ivalent
No.of Water KW o.of o.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications iring:
No.of Devices or Equivalent
OTHER: �
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: J 1 �t o % Inspections to be requested in accordance with NEC Rule 10,and upon completion.
INSURANCE�VERAGE: 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 cert,under the pains and penalties ojperjury,that the information on this application is true and complete"
FIRM NAME: ,50 L .e f LIC.NO.: 2f try
Licensee: � .T n ro (Z<.f Signature 4L LIC.NO.: 36 SZ
(Ifapplicable,enter "exempt"i t e lice se number line.) Bus.Tel.No.-
Address: a, c _ Alt.Tel.No.: �9
*Per M.G.L.c. 147,S"57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE•
Y
`(
e r
it
A
Date
N2 4634
,OR
'" TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
cwusE�
This certifies that . . /��?' "
.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . . . L-*... . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of
at . l!if?. . .Z.4.. . . . . . . . . . . . . . . North Andover, Mass.
Fee. . G r.Lic. No.. . 3 . . . . . . .�'h
PLUMBING INSPECTOR
Check #
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
I ZD
;� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type
fn U° 0V Mass. Date Permit # 3 1
Building Location Owners Name
4;0 Liz .4-124 Type of
v
Oz<c
cupan t yr..
E to Ti 41 L_
New ❑ Renovation ❑ Replacement RPia ubmitted: Yes ❑ No ❑
FIXUR S
Z Y
O Z >
J
r
¢ x
O W f- W N F- 0 ¢ N N W Z s.
V Z 6 m 0 = ¢ } < FW.. y 2 c a O Q a < � x
= O O ¢ N W ¢ Q W p < N Z .¢ a ¢ O W
V < 0 Z
2 x n. Z 2 Y d O ~ _ _ < W k Y W
> F- O N f'
sue—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
�. 3RD FLOOR
4TH FLOOR
"
STH FLOOR
6TH FLOOR
7TH FLOOR
STH FLOOR/
Installing Company Name AOjr Ee,-r mA7Ae7 Check one: Certificate
Address C O C H ❑ Corporation
�r. !�} mr3n) s.r rpo
l7'1 E T N 1,1 F_ A) Al A 01 ❑ Partnership
Business Telephone_ 19 7 I p-Ar-M/Co,
Name of Licensed Plumbed ,3 r=;P_T fr# A n�dyl r4 rr4/�c"
INSURANCE COVERAGE:
I have a currentffability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes Q' No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box
A liability insurance policy 2/ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
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 ormed under the permit issu for this application will be in compliance with all
Pertinent provisions of the Massachusetts State Plum ' g e and apter of the oral Laws.
Title re ot Ucensed Plumber
Type of License:Master % Joumeymah ❑
Qty/Town
AFFHONED(OFFICE U ONL License Number �3 3 5
I
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
f
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR
V 2265 , /
V Date.-�: ao
C t NORTH
3?��,'r��•��a°��ppL TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
,SSAGiIUs�
This certifies that1-1,D
.. .. .............................. .............................
has permission to perform ....... !:: '% z -''..............................................
wiring in the building of !?' "1........... .....
at & .__ ._ _ ............................,North Andover,Mass.
Fee.&5....u:.... Lic.No�?? :� ...... ��._. �.,-�r�J�.r..............
ELECTRICAL INSPECTOR
yU�7 yo J<� I. .....`_
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
(..omnwnweallh of I11cujachwelLs OClicial USC Only
c� �] Pcrrnit No.
3 s 1JaParlmanl o�}ire �erviced - �1
Occupancy and Fee Checked at'
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 ticave blank) --
APPLiCATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perrormcd in accordance with the'Massachusetts[lcctrical Code(.',I[C).527 F,,IR 13.00
(PL CASE PRINT 1;V INK OR TYPE,ILL GVF0R,4�:1710X) ll a t c:
City or Town uf: dV��j /U 7/ To the Inspector of Wires:
By this application the undersinned gives notice orhis or her intentions to perforni the electrical work described below.
Location(Street& Number) A .-164 Zo o<—
Owner or Tenant CIJ�iC n'J 1 L }q/ Telephone No. l 17 yy
Owner's Address
Is this permit in conjunction'with n building permil? Yes ❑ No (Check Appropriate lion)
1'urliose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑
No.of ilIeters .
New Service Amps 1 Volts Overhead❑ Undgrd ❑ No.of Meters'
Number of Feeders and Anipacity
Location and Nature of Proposed Electrical Work: w-o LC(/Y) y- e o
Coni lesion of the rolluuing table uiav be waiti•ed by the his'cctor o(Mres.
No.of Recessed Fixtures No.of ceil:Susp.(Paddle)Falls No.of 'Total
Transformers KVA
r
No:of Lighting Outlets No.or lint Tubs Generators KVA
Above In7 o mergencyIg sung
No.of Lighting Fixtures Sivimming Poolonsd. ❑ rnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARI%-IS No.of Zones'
. .: • Detection a .. .
No.of Switches No.of Gas Burners n o.o id_' Initiatino Devices 3
No.of Ranges No.of Air Cond. Tans No.or Alerting Devices
\o.of Waste Disposers HcatPunip Number Tons KW No.of Self-Contained
Totals: DetectiolllAlertinQ Devices
No.of Disllivashers Space/Area Heating KW Local ❑ 1tiluuicipal ❑ Other
10I1
J ' No. of Dryers Heating Appliances K11: Se rity Systems:
.o.-o IcescrEquivalent -216
No.of Water KW No.of No.of Data'+tiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydroniassage Bathtubs No.of Motors Total H-P Telecommunications Wiring: _
No.or Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
INSURANCE COV ERAGE: Unless%%jived by the owner,no perrnit for the performance of electrical work may issue unless
the licensee provides proof or liability insura»ce including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to[lie permit issuing office.
CHECK ONE: INSURI\NCE ❑ DOND ❑ OTHER ❑ (Specify:)
pp (Expiration Date)
Estimated Value of.Electri al Work: 0 3 (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NIEC Rule 10,and upon completion. ?D
I certify, under the paints acrd penallies of perjury,that the informaden on tltis application is trite and complete.P.S
FIRi%I NANIE: ADT SECURITY SERVICES, INC. 4. LIC.NO.:C,1533
Licensee: o !'ti✓ S 6A S SE/I Signatur. L1C:fiO.:C1533
(lfapplicoble, enter"crrntpt"in the licensentunberline. Bus.Tel.No.(7 _278-1169
Address, 111 MORSE STREET, NORWOOD, MA 0 0 Alt.Tel.No. 31
OWNER'S INSURANCE WAIVER: 1 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•otic) ❑ owner ❑ owner's agent.
Owner/Agent p1,p;l1IT FIE: S !
Signature 'Telephone No.
_ r.r.,yrr.....6.r-.s..-«.,--i..._..:-�.,-r..•Location _.((�.,....,.,..
__ � Z- -tS� t��3 L }
No. X2'7 Date
A
N°*T" TOWN OF NORTH ANDOVER
p Certificate of Occupancy $ �
Building/Frame Permit Fee $
Foundation Permi Fee $
Other Permit Fe $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $ 3�.S
atc Building Inspector
"2 p 3 20 Div. Public Works
A oJ
PER3flT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1
MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP iDATE BOOK PAGE
ZONE SUB DIV. LOT NO. �I
LOCATION Li A u` RPOSE �/ ! /-Ay 0--
OW 'ER'S E Tc,H
NO. OF STORIES SIZE
OWNER' DDRESS// Lr `fir BASEMENT OR SLAB
'+ 'ARCHIXECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME/ e�/ ��mA SPAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BU ING ADDITION MATERIAL OF CHIMNEY
BUILDING ALTERATION / /11� F IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES ST. BLDG. COST oo ,
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DIyTE F
v/ 8YILDINO INS 1%
SICS AT RE OWNER OR AUTHOR ZJW AGENT
F E E OWNER TEL.#
PERMIT GRANTED q CONTR.TEL.#
S b 19 Lca /
CONTR.LIC.M � 1L71C9•�
H.I.C.N
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY _ SI-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION ?
2 FOUNDATION —I 8 INTERIOR FINISH
CONCRETE a 1 2 13
CONCRETE BL K. PINE
BRICK OR STONE HARDW'D
PIERS PLASTER
_ DRY VJALI
UNFIN.
3 BASEMENT 11
AREA FULL FIN. B'M'T' AREA _
14 1/2 l/, FIN. ATTIC AREA _
NO BMT FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE
WOOD SHINGLES EARTH _
ASPHALT SIDING ASHARDVJ'D
ASBESTOS SIDING _ _OSPH
VERT. SIDING PH. TILE _
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK N MASONRY ATTIC STIRS. & FLOOR I_
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I HIP BATH (3 FIX.) _
GAMBRELMANSARD TOILET RM. (2 FIX.(
FLAT A SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES C
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
NORTI-I
Town of 2 r 4Andover
No. 227
LAKE A. dover, Mass., Cil -
3 19a c
COCMIC EWICK - �
7�ADRATED PPa\��CCl
E BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT ��y-�—
......�!�1�>........ ......................................................................................................... Foundation
has permission to erect-..!s 4�t -Q-............... buildings on ....t2-..... 1 !4..... N' -................................... Rough
to be occupied as;,..�c/� pD ' r
i�Fr1!►.,5 ................ Fr.......
�.... ...... Q ......�."'..... .!!�! 47�M............. tmn y
Ch' e
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
Final
PERMIT_ EXPIRE MONTHS - -- -
ELECTRICAL INSPECTOR
UNLESS CON U S
Rough
Service
BUILDING INS CTOR
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
PLANNING FINAL CONSERVATION FINAL Street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
f
• !- ... z... _..-_.._...,.' ... .�� r -�+`,�-7.pgt.k-`i_.,�lY+."a ''^�`n.°yn"Y.k'��o�t;: -..._ �..-. .. .. .�...-.=._...�.•.-..,.,.-.. .
—ae.� �� OEPARIIt�I E�I OR LICENSE t1►date•. ,
CON51RUC110M 5UP p6102 49
ExP�YeSII4
', CS 18 1G
_ 3 4eStClcteb•_ OAt14N0USSE 1R
Rw''tt E Ul LANE
=�5 gU11ERN
A1
-
SAW
DEPARTMENT OF PUBLIC
COMMONWEALTH 1010 COMMONWEALTH AVE'
tt
OFi . BOSTON,MA 02215
MASSACHUSETTS EEp SE
CAUTION
T R`I C U p E R V I S 0 R PROTECTION AGAINST
I_ CO F NS OR P
• FJCPIRATION DATE LIC-NO. THEFT,PUT RIGHT THUMB
1 /19 94 EFFECTIVEDATE PRINT IN APPROPRIATE
t
2S/T�ICTIONS kT1()/31/1992 (146636 BOX ON LICENSE-
IG
ICENSE.
1G& . 2 FAMILY' gRA`IMON1) E OAMLANESSE JR BLAN
NGQ.�ERATORS
PV-
s75 BUTTERNUT MUCLI�PE P
028-40-7187 ' mMETHUEN NA 01844 uU_
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NOT VALD WR OF THE
100.00 STAMPED OR-SIGNATURE
Az HEIGHT: r:
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6/02/1948 OFUCE «
THUS DocuME►+T MUST
EDONTNEPERSON
COMMISSIONER
THE
•' , THE HOLDER WHEN
6AC
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PRINT , .THISOCCUPA
l1
Location --U,A FZ
' No. ?Z.;7 Date S
:F
MORTM TOWN OF NORTH ANDOVER
j,. 3? •... a 0
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
> Ss�cHusE
Other Permit FeeS•—
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
Building Inspector
p 07/11195),DM 1 4 p
. :� 8565 Div. Public Works
PERMIT NO. Z'�^ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
MAP i-40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE
ONE SUB DIV. LOT NO.
LOCATION Uz 'c-.4 A PURPOSE OF BUILDING
i/1/sfi4[L W IIVo 0w- S'
OWNER'S NAME NO. OF STORIES SIZE
OWNER'S ADDRESS /1/z / 6' /L,F W/_ BASEMENT OR SLAB
ARCHITECT'S NAME _ G /°f `, SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME �/ —Ac //S Ory SPAN
DISTANCE TO NEAREST BUILDING /l DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES-SIDES REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES
EST. BLDG. COST
PAGE 1.FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. •l
PAGE 2 FILL OUT SECTIONS 1 - 12
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY -
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
ATE FILED
iIJILDINO INiP6CTOR
SIGNATURE�F W R O AUT RIZED AGENT
F E E 1���' OWNER TEL.# e-711y5-3
PERMIT GRANTED CONTR.TEL.# � (0 7
r7( 19
CONTR.LIC.#
H.I.C.# .-"/ 7
i
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY I_ SrOR1Es THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- Z
APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION _ 8 INTERIOR FINISH
CONCRETE _ d 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE HARDWD
PIERS PLASTER
_ DRY VJALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'T' AREA _
lh 1/2 1/1 FIN. ATTIC AREA _
N_O B M FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH __ _
ASPHALT SIDING HARD\N'D _
ASBESTOS SIDING _ COMIACN
VERT. SIDING ASPH. TILE
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STIRS. & FLOOR I_
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I� POOR _
11,ADEQUATE
No
5 ROOF 10 PLUMBING
GABLE I HIP BATH Q FIX.) _
GAMBREL MANSARD TOILET RM. (2 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
r
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
IL
O
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING
NORT
Town of � � � - � over
32 5
_ rt dower, Mass., l 19
y r _ -
T O -- LAKE
COC MIC HE WICH �
ADRATED PPa\ '�2
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
• 1.THIS CERTIFIES THAT ... .. .........&.* ...................................................................................................... BUILDING INSPECTOR
r _ Foundation
has permission to epee ....61l.Ci4............... buildings on j.1 ..�.... .&A...(,A.mP............................................ Rough
to be occupied asC-�.L!....... ......wt4o .v;:�.!:........ ......................................................... ......................... 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-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
Final
PERMIT EXPC) MONTHSflwls� ELECTRICAL INSPECTOR
UNLESS CONS S Rough
.. .......................................................:.................................... .......... Service
BUILDING INS CTOR
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
PLANNING FINAL CONSERVATION FINAL street No.
Smoke Det.
SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT
i
w, u
FIT
- DRIVER'B LICEN73 ;°.
i 4,
)j� a 17309961.."
1 , 25-39-
HOME
5-39'HOME IMPROVEMENT CONTRACTOR
Registration 103547
' Type - INDIVIDUAL
Expiration 07/08/96
Phillip S. Jackson
4 Rita Lane
fence MA 01843
ADMINISTRATOR _
-1\- COMMONWEALTH D=P!!RTMENT-CSF PUBLIC SAFETY �.. . '.
OF ONE ASHBORTON PLACE
MASSACHUSETTS BOSTON,MA 02108
L I C E N S E } CAUTION
EXPIRATION DATE CONSTR. ISUPERVISOR
//?? _ FOR PROTECTION AGAINST
EFFECTIVE DATE LIC-NO.
RESTICTINS1 ��� != v r,. + i "THEFT;PUT-RIGHT.THUMB_,�_
I- PRINT:IN APPROPRIATE
1 05/31 /1994 050976 o ebk,,,ON LICEf SE.
1 & 2 FAMILY HOME 2I PNTLLiP S J ACKSCN --
B NG OPERATORS
• �; 2 4ITA LANE ��T�
SS 017-30-99b1 Rt LAWRENCE MA 01843 m ,.t Ml79� OL@D OT'0. 1
.
E 1 ,
c I
PHOTO(BLASTING OPR ONLY) FEE: I .
1 a NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY
STAMPED-OR-SIGNATURE OF THE COMMISSIONER -. 1 ..•� ... �
HEIGHT: �_._.....,.m. �.r. ...s ..
03/25/1
3
S+ - {t,
'/ ✓^ti✓ "��'�' 41 SIGN NAME IN FULL ABOVE SIGNATURE LINE
THIS DOCUMENT MUST BE SIGNATURE OF LICENSEE
CARRIED ON THE PERSON OF
EN-THE HOLDER WHEN
THUMB PRINT GAGED IN THIS OCCUPATION.
'
The Commonwealth of Massachusetts
_ - Department of Industrial Accidents
�� � I1�ks dlores�stlios'
600 Washington Street
Boston,Blass 02111
Workers' Compensation Insurance Affidavit
name: — 1/ h/��/ T r A/S oN
location: 2 /7-A L./i/
city L/�ki/j�'�� /7li�SS phone#
r7 I am a homeowner performing all work myself.
(�I am a sole proprietor and have no one working in any capacity
r I am an employer providing workers' compensation for my empiovees working on this job.
comRanwname:.:..
address
city: _. phone#:
insurance co: policy#
❑ I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers compensation polices:
company name:
address:
.. .- -. _
:
�tv: _- Rhone# :..
insurance co.
policy It
company name:
address- ..
city: phone Al-
.
insurance co noEiev#
......
2 ona ee necessary
Failure to secure coverage as required under Section 24a of NIGL 1 can lead to the imposition of criminal penalties of a fine up to S1.S00.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Ofrice of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjure thm the infornsation provided above is true and correct
SignatureDate 71111,9S-
Print
11/9SPrint name Ie T/d c S an/ Phone# 6 9 -7—6
official use only do not write in this area to be completed by city or town official
city or town: permit/lieense# r`Building Department
pLicensing Board
check if immediate response is required CSefectmen's Office
QHealth Department
contact person: pb�ox#; MOther
(Mvued vos PJw)