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Home My WebLink AboutMiscellaneous - 116 HICKORY HILL ROAD 4/30/2018 / 116 HICKORY HILL ROAD 210/062.0-0108-0000.0 BUIL 1 N G FILE s Date . . g7-7��- Z TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . .,tom,��;.T', has permission to perform . . . �u . . . .� � . , Uc�,ca- wiring in the building of . . .0 L . . . . . . . . . . . . . . . . . . . . . . , , . . ,North Andover, Mass. Fee ...2�>-. .- Lic. No. . . ,1.1. /.9'. . . . ELECTRICAL INSPEC;rOR Check#-L� - !i '1031 'r I Commonwealth of///a j"Letti OtIicial UseOnly .[ partmed ol3ire Services Permit No. d l I Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELE TRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( ),X27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE LL INFOR TION) Date:ml /G L City or Town of: /r ,�� To the Inspector of Wires: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location(Street& Number) 1 //" Owner or Tenant L f uL Telephone No. �7� o?3ti sow Owner's Address r�ilsa Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Approriate Box) Purpose of Building Utility Authorization No. -770/ Existing ServiceNCO Amps iZc / Zt4b Volts Overhead ❑ Undgrd � No. of Meters / New Service Amps / Voits Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I Completion o/the/ollowin table mnv be waived by the Inspector ar{1'ires. ? No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above E] In- ❑ o.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self--Co—ntained otals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of Heaters KW Si ns Ballasts Data Wiring: No.of Devices or E uivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wtring: No.of Devices or E uiva OTHER: lent ,(Hach additional detail if desired, or as required by the Inspector of(Vires. 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 F1 BOND ❑ OTHER ❑ (Specify:) certify,under/it mi-Fe—halliov of perj rp,that Nle in)rmation on this application is true and complete. FIRM NAME: LIC. NO.: /7//&11 Licensee: 1 %/ iwSignat LIC. NO.:j/yj6 (If applicable, enlc• -e emp!-in the license number line.) Z— Address: ,[QOMSQI/� Bus.Tel. No.: � �S'� f��G(� !;1 OI��G Alt.Tel. No.: *Per M.G.L.c. 147,s. 57-61,security work requires Dep rtment of Public Safety"S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nol hove 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: $ SS `'v i �� - � �. 8 � � l��Z .. L i AUG-16-2012(THU) 06; 56 P. 001I001 A+C� DA'rQIMMIaPon�YrnDL ��- CERTIFICATE OF LIABILITY INSURANCE 09116112 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT6 UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATTVI_LY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES S&OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be andorsW. If SUBROGATION 15 WAIVED,subject to dile terms and conditions of the policy.certain policies may require an endorsement: A statement on this certificate docs not confer rights to the certificate holder In Ilou of such endoreamen s. 0RDDUC411 979-777-2220 CAMTACT Elite Insurance Services,Inc. 979-777.2833 rLQPAR 85 Constitution Lane Ste 20 Ne. L Danvers,MA 01923 -" Douglas 4UCCIan4 MR'R tD w FOURSr1 Ml>WIeNMItiI AMMDROD1e COV�RAos N=x irmliReo Four Star Lighting&Electric • 'INSURQR A:Peorloss Insurance Joseph Sllverlo imsuRSRa:The Hartford - PO Box 9 INsualla q:Travelers Insurance Go Tewksbury,MA 01876 INSURJ±R D. INSM111C, INSUROR F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIMCS OF INSURANCE LISTED 861.OW 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/$SUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUH.IEC'T TO ALL TME TERMS, 13=11SIONB AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED gY PAID CLAIMS. TYPE OF INSURANCQ pOLNC NUMeeRI .M ' P 41MITS OQNQRALUAOIXY EACH O=URRM CF S 1,000,000 1A X COMMCRCIAL OCNQRA4 LIAAILITY 445879911 07113112 07/13113 MAGE TO ItONTt ► GRyI � ICn bcarnm,a,1 s „ 300.00 AIM&MAN IJ OCCUR ME°D W ene fId11 f 5.00_ PERSONAL&ADV INJURY 4 1,000,00 GGNSRfIL AOOpIIOATE S 2,900.00 OPM4AOMOATCLIMITAPPLIES PGR: PROOLICM-COMPIOPACC S 2.000.00 POLICY X LOC S AWMMODU LIAa1LITr COMRINFD SINGLE LIMIT C ANYAUTO 13A9B43N45A 07113172 07113113 Ira _ s 19000,000 BODILY INJURY(Pv person) s A"OWNIO AIITo5 SCHEDULED AUTOS H0014YINJURYtpernwida0) S X — - ... HIRED AUTOS PROPERTY DAMAGE i tpw•cuaelnl UMDRSLLA LIAtl HOCCUR EACH OCCURRENCE t - 00=VAD CLAIM".MADC AOORFOATEE f 17GDUCTIRLE f R!'rFNTI N � t WORKQRSCOMPQNSATION X WC5TATU. ANo 4MKOY9Rs URORRWN TQKr..LjMtT9 QTF- �S ANY 0YNNfA03WECl_BM2 11120i1t 'II=112 B,LEACHACCIMNPOrMCr=FMWAtvxUEC9US SOOOO ' pNenaetmV In NMI EL.DISEASE•EA EMPLOYE12 $ 500,00 If tleurlha under ., RIP 10N OF OPFRAT 10 Nblow R I..016FAS15•POLICY LIMIT S 600.00 I T1 DQOCRIMMM OF OPERATIONS I LOCATIONS 1 WHIC483 rARtreh ACOM 101,Add"IMW Ranwim 50mcluh,R mon epm is fequlnA) ALL OPERATIONS 117SURL AND COSY' TO 'ZM NAM= INSMW. CERTIFICATE HOLDER CANCELLATION NORTHAN SHOULD ANY CIF THE ABOVE=CR=D POLICIES BE CANCaELL n BEFQRE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN A=CMPANCE WITH THE POLICY PRCVMIONS. ATTN:ELECTRICAL DEPARTMENT 16 OSGOOD STREET' •, ' AUTuglas LI{PRQSQIF=AT15fQ NORTH ANDGVER,MA 01645 Douglas ucclano a, O 1988.2009 ACORD RPCRATION. All rights marvad. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORO FOUR STAR LIGHTING FAX TKAN505510N To: FOUR STAR LIGHTING 1-978-446-1405 Date: 08/16/12 Time: 05:57 8/16/12 6:OOA No messages k r y 1 Date../��. �. . ..... 40RTry TOWN OFNORTHANDOVER PERMIT FOR GAS INSTALLATION SCHUSE� This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . .L. . f in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . ,/ ./G . . . A "' . . . . ., North., North Andover, Mass. Fee. .�Q.�. . . Lic. No.. � .` . . . . . . , . . . . . . . . . . GASINSPECT F Check# 3 ?(( 6877 MASSACHUSETTS UNIFaRM APPL` cATIaN FOR PERMIT TO.., Da .GASF1=i NC (Print or Type): . AA IM Oaie 2o0 Permct . . Edlding Lacatiorr L /f?'p owner's Name �dtl1� YPe of _ucaricf�/1 . New fie.^.cvauan Q: . Reriacsma. Mari Submitter YesC Nc : QCL 4u u7 im— g n, Q3. .' Q ct 4!L ;yr ,;, ' _ow C as N ' .LLL; U.L .: Ci } ur �. LLL. UB to ILL C .411. a. E C I . - SUIT : : BA�i:.MEx�- , { I� �.. I � I . I°: I'- �I I i :i= h. i ! I ! I �_• anII:FTtfl:CA: BTH'.F1►0 a R... ' !. •`: I:.,. ST.x rt¢QFt:. I( 1 1:: 1. i I: I' 11. .1 it I J I 7 oQR- ` 1-. I, l I I: . .. 1 . l I 1 I ,..I •I l I:. x'FtaaR : {. .. { 1 ,` !' I { { ! I '; ;I Cns�lling•Ccm r c: ane Ca nc3te .�� Address � ratlOrr �0'i'AT FCT-rtirn n c Q;S-r.off' Name-cf Luted Flumter cr Cas•Fitter- Sf . . 3 r INSUWCE,c v I have-'a.:rin'errt1 aY.Insurance pca►c/ ce its suCsiantial equivalent whica.mees the,reputcerrtents of MCLCtr 1`4Z Y Ncs It have ate-.. i ves`pieasa:fndi +=the type coverage byeYing tine:appropriate b= A•liabii�lnsurand poitc tithe ty 4of it'''demnitj_Cr I?oind. 11 . OWNER'S:INSUtt4NCE~.WAALVE3...1 anr,aware tinat the Itcansee•`dces ricr have the.insuranc f-coverage;requuecL by aver 142 of the;Mass:.Cenerai. Laws:.and:that my signature^on:this permit appiicaticn-Waives:this reluireme iL Check,,.,.ane: Gw ieri� Agent Signature of Omer or Cwrrer'S_Agent.. I hereby mrt*" that all:of the details.and information I have submitted:(or enteied)ir4 a' v application ar true r e to t i best.of my kaowiedge-and' hatail plumbingworkandinstallationsperformed under the permiti u d for-this appy tion i with al) PertinOt provisions ofthe Massachusetts State'.Cas Coda and er 14Z of the.C ral.Laws:. By TPlu mber ar CasiterTrueerLiceMumbec.CitylTown . � ' . � yrtian. � A P ROVm(0 r-C uSa.Ot4 . 3570 Date... pOR7M TOWN OF NORTH ANDOVER j PERMIT FOR WIRING ,SSACMUSE� This certifies that .....1� ...... ... J �' f . ..1::.......... .......................................................... has permission to perform ......X 77-- .�?.S....t�t7 r n.......................................... wiring in the building of......t— at.....�Z ....... !... ............... .!P......... ,North Andoxer, Fee. 5..... Lic.No...' ................._ ........ LECTRICALINSPECTOR Check # I Official Use Only Permit No. �� U Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:0 (Please Print in ink or type all information) Date 16fs To the Inspector ofWires: Town of North Andover The undersigned applies for a permit to perform the electrical work described¢elow. _I Location(Street&Number `C o r I /l K� Owner or Tenant L, p TO`— 6 '/ Owner's Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) r Purpose of Building f 11 f(s 014 -2- / 1MLI( / Utility Authorization No. Existing Service Amps 2 q0 volts Overhead 21 Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Q Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers SpacelArea Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = u have checked YE plea indicate the�'�yof coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify)T.7Z P!2% h4L' 6 /G 2. (Exp ration Date) Estimated Value of Electrical Work$ Work to Start L-1!1—D 2 Inspectiog to Resquested Rough Final Signed under the Pena of ryury: FIRM NAME r G r LIC.NO. Licensee leleSignature v4 LIC.NO, 2—Y 1 7.,2 Bus.Tel No. Address aye �u�t� '�// • AR Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ rsv v (Signature of Owner or Agent) --------------------- ---------r _ PEk\IIT NO. � 7 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS./,l //�/PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK :PAGE ZONE SUB DIV. LOT NO. �r Lj � t � 0-q� // J OCATION i Q I , �— PURPOSE OF BUILDING tl * / OWNER'S NAME o i - NO. OF STORIES L SIZE �A .,)/� �%X?S OWNER'S ADDRESS IfGrV = 1� ` BASEMENT OR SLAB ARCHITECT'S NAME - irL1 SIZE OF FLOOR TIMBERS IST 2ND y f;J'7 3RD BUILDER'S NAME Zhj , ZaA YZ k& SPAN lcl- ' x+/� DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET * 7 POST / 1 J' DISTANCE FROM LOT LINES-SIDES `� ZZ' ' REAR )q�,} GIRDERS /(/j Z 1x (/ AREA OF LOT Z-Z iggo FRONTAGE/fy/ /� /' HEIGHT OF FOUNDATION l`�Y f� (a THICKNESS P/ IS BUILDING NEW X 77 SIZE OF FOOTING X Il IS BUILDING ADDITION Jj8 MATERIAL OF CHIMNEY t IS BUILDING ALTERATION ,,./t IS BUILDING ON SOLID OR FILLED LAND 56 t r WILL BUILDING CONFORM TO REQUIREMENTS OF CODE � IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY NIS BUILDING CONNECTED TO TOWN SEWER >/61::� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 8 PROPERTY LAND COST INFORMATION :*��y �Q twoFIEE ` � �✓V V SEE BOTH SIDES T �y � � � EST. BLDG. COST • G1 GG�z t PAGE 1 FILL OUT SECTIONS t - 3 tmF,U_ME6 EST. BLDG. COST PER SQ. FT. s 0 PAGE 2 FILL OUT SECTIONS t - t2 9M FRAME PERMIT $Y�' EST. BLDG. COST PER ROOMgg SEPTIC PERMIT NO. w1' 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 BUILDI G INSPECTOR DATE FILE �J y BOARD OF HEALTH S GNATURE OF O OR AUTHORIZED AGENT F E E ov OWNER TEL.# _C=`� , MANNING BOARD PERMIT GRANTED cy CONTR.TEL.# Z4 2- 1/ — 19 �-S CONTR.LIC.# Com` )-7 ! BOARD OF SELECTMEN "'" BUILDING INSPECTOR • .tom • • 1 '! -BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES MULTI. FAMILY _V OFFICES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM —_ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION $ INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PIASTER _ DRY WAIL UNFIN. 3 BASEMENT AREA FULL t FIN. B M AREA _ '/ 1/1 '/, FIN. ATTIC AREA _ N_O B M FIRE PLACES I HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 ' DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING ;ARD- D _ ASBESTOS SIDING COMMCN t VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ • ... w....r p STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR BRICK ON RAI_ CONC. OR CINDER BILK. *-t 7+T ^s#��f►++++ STONE ON MASONRY WIRING '`' STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE , 5 ROOF 10 PLUMBING v GABLE MIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) J— F LAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST 11 PIPELESS FURNACE «-- _ FORCED HOT AIR FURN. TIMBE Ol STEAM STEEL BMS. CO . HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING t RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS r B'M'T 2ndELECTRIC 1st 3rd I NO HEATING i 41 ocati n � No. Date U MORTM TOWN OF NORTH ANDOVER o-,•,�O0L p Certificate of Occupancy $/ �3 # x""11 Building/Frame Permit Fee $ , t �SSACMUSE` Foundation Permit Fee $ ` Other Permit Fee $ Sewer Connection Fee $ �:2 S-,�Water Connection Fee $ TOTAL Building inspector :. �� 6331 Div. Public Works Location Date of NORTh TOW � a N OF ( ,�'H ANDOVER Certificate of Occu A �16. - pancy $ • i • • ^ ' • �' ' � Building/Fraiermi0t Fee $cHus Foundation"p�rxeF e _ Other Permit F $ ee tet-573 \ �rIN 9$ Sewer Connection Fee Z& ! 40 ten Z5�3 Water Connection Feecb TOTAL $ ldin Inspector i Div. bli 'Works _'Location t r No. 3zx Date 2 r 4 "0RT" TOWN 0.f,NORTH ANDOVER pf t ..o •,h0 p Certificate of-Opc4pan-cy . $ -i—o, U Building/Frame Permit Fee $ 'ss�CMUS E� FoundPermit Fee $ �/z��"- �� rJ r OtherRP\"eVr1�t e $ Sewer Connection,% $ Water Connection-Fee $ TOTAL $ D CY• ��- Building Inspector V Div. Public Works 15 ' 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: Tl��`n 5 t\U �r Phone LOCATION: Assessor's Map Number 67- Parcel Subdivision /9 ) C i! Lot(s) 2- Street 1 u� CJIl� - St. Number 1 ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Conservation inistrator Date Approved Date Rejected Comments Town Planner Date Approved Date Rejected Comments Date Approved Health Agent Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Dep r�tment, _ Q Received by Building Inspector = Date JUL 1 I4o� "' DING t S I TE ?LAW } NOP.TH `A N-DoVER, MA Sc Pi LE /'Z/013 P 14 YX s �0.mo . l O �,: •o N LOT 2 y o' W 221440 ' s ` t ► r 7 �. 0 �2' g�,. '� ,•'D N In In a- •. O key,' ..1► � ; ,y,��r, S ooQ,�S o S R N 3 0 0', a!''�Y�`A '!'"^r•'1?�' � /�� is �ti r. .C• O O JOHN F. ZAHORUiiKU o No. 20563 f` \ ��O,vT��c4 r 1 r . CERTIFIED FOUNDA T/ON PLAN ` LOCATED /N _No.ANIbV � 1 (111 SCALE: I"= 40' DATE: Scott L. Gi/es R.L.S. 50 Deer Meadow Rood -- North Andover,Moss. I Y r� AUG 41993 � LJfF,DIN- : DEFARe�l 1.NIT 1 LeT 2-- 2Z,44o' S.F c� H ICWoKS L, Koblkp / CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE =''" THE OFFSETS OF THE SU/L DING/NSPEC TOR ONLY n SHOWN COMPLY AND SUCH USE IS FOR THE WITH THE ZONING DETERMINATION OF-ZONING rL BYLAWS OF CONFORMITY OR NON-CONFORMITY , �" ` �•MA WHEN CONSTRUCTED. '� WHEN SU/L T. g�LAM 82 � CERTIFICATE OF USE & OCCUPANCY Town of North Andover i Building Permit Number .-i / y Date THIS CERTIFIES THAT THE BUILDING LOCATED ON Z16 MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. MORT" /1 • _;.'� o .CERTIFICATE ISSUED TO ;; •• k'j"e°,. ; ADDRESS JACHUS� I . Building Inspector y i � s - - o Nott- 0VM over U ,�-..;� �-_i•s4 to y North f dover Mass. L 19 Tq T-E D H' BOARD OF HEALTH PERMIT To Food/Kitchen BUILD Septic System��t� BUILDING INSPECTOR THIS CERTIFIES THAT.. , .#*Vp�• .40.........•••LP Foundation has permission to erect /l , buildings on ... ... .... � � ��L.. .....® Rough 5 � .�• .� .. � . .� tmn Yet Wl t0 be OCCUpled a Ch' e provided that the person accepting this permit shall in every spect conform to t lain e in Fi al ��Gc tv C this office; and to the provisions of the Codes and By-Laws relating to the Ins of uK Gic_ shy Buildings in the Town of North Andover. C piro`&V� 4.1 �� PLUMBTG NSP VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT _ { DATE - FEE PpAI rc> PERMIT FOR FRAME/B II DI�i ,� (,'�)I� ^]. I�� 1( - j )J� "1 �\R_ � ' ELECTRI" A CTOR py Rough �— DATE FEE PAI .6 - .. ... .... ... .. .. .......... Service LDING IN OR ' Final —' Ocri(1)C111Cv . ,(.'111111: ��c_'C 1f1Yt'(i 1!) (- ?c'( ii�)�' 13tt ! ;l 40 Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing Y or Dr Wall To Be Done ` Until Inspected and Approved by the Building Inspector. FIRE EPARTMEN �/ M Burner r PLANNING (MAL CONSERVATIO FINALS Street No. ! (�y 4 `r CV Smoke Det. .qPM/PPR /IA/ATFR ��-1clt''�C/'Ida z � � �^ lG�u1 DRIVFWAY ENTRY PERMIT-4--V Location No. 3 S b Date I C/ „°RT►, TOWN OF NORTH ANDOVER F s ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check # 5 L 5 '/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Swr"for 6MICiat Use Ual ` % . BUILDING PERMIT NUMBER. C'�IS-0 DATE ISSUED: / X ic SIGNATURE: Building Commissioner/Ingwor of Buildings Date Zr SECTION I-SITE INFORMATION O 1.l Property Address: 1.2 Assessors Map and Parcel Number: Z16 �z Map Number Parcel Number "j 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required 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 ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record _ L ;54 SDE L a} 5 Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: U J Name Print Address for Service: yOy _ rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ i-c.✓N 0 I. 3 . I�a Efj Licensed Construction Supervisor: S Q z y S O // License Number Address �� .. ��_ �D O Q .—. z A ' ZO Expiration Date I p _ S e Telephone r. 3.2 Registered Home Improvement Contractor Not Applicable ❑ Cv kFrN CcwA13!akIC-+ a � C Company Name d 3 g 3 m Z, ` C W 1 *fT fid C IV14tin 6 v f Registration Number r Address �! r g -� Y - Zaoo Z Q Expiration Date ^ tiit Telephone Y/ 1 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'ng permit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) Addition ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by pen-nit applicant 1. Building (a) Building Permit Fee 50 `c C Multiplier 2 Electrical (b) Estimated Total Cost of Construction �J 3 Plumbing Building Permit fee(a) x (t,) 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 1 ,as Owner/Authorized Agent of subject property Hereby aiithorize�t t NAl EA J3. ke X/ /`,EN C� jod1Z.V c--�&OA _to act on My behalf,in all matters relative to work authorized by this building pennit application. Signature of Owner 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 Print Name Signature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB ND SIZE OF FLOOR TDABERS 1 2 3 r SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS —HI-IG I IT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND !S IM11,DING CONNECTED TO NATURAL GAS LINE I FORM U .- LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits� p 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. q s. *****************************APPLICANT FILLS OUT THIS SECTION *********************** APPLICANT ,�s /Li4 -,,- PHONE_ LOCATION: Assessor's Map Number dID2 PARCEL_Q/8 SUBDIVISION LOT(S) STREET 116 ST. NUMBER *****************************************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 SEPTIC INSPECTOR—HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS � DRIVEWAY PERMIT first DEPARTMENT 01-A RECEIVED BY BUILDING INSPEC OR DATE_ Revised 9\97 jm KEEN CONSTRUCTION CO. 21 HEWITT AVE. N. ANDOVER,MA 01845 (978) 691-5201 Israel, Joel & Lisa 116 Hickory Hill Rd. N. andover, MA 01845 (978) 688-3001 Contract# 1593; Appendix A Date:01/01/02 Remodel Basement: • Frame walls to create @ 216 sq. ft. of finished area • Insulate exterior walls • Supply& install blueboard& skimcoat to smooth finish • Supply& install 2'x 4` suspended ceiling(tiles to look like F x P tiles) • Supply& install trim on existing doors& base • Paint walls&trim(2 coat finish, 2 neutral colors) Electrical: • Supply& install outlets to code • Supply&install one phone outlet& one cable outlet • Supply& install electric baseboard heat to code • Supply& install six recessed light fixtures in ceiling • Supply& install switching to code Plumbing: • Replace two sprinkler heads with decorative ones in ceiling • Move existing heat pipes &add one section of heat to existing zone Total Price:$5580.00 (fifty five hundred eighty dollars) Price does not include cost of related permits, carpeting or extra labor if existing electrical pipe chase is insufficient. 1 I n�`T, �/t¢ l�amvneoruue2cc�a a�,� .c�tuJv.�b BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058245 •;, Birthdate: 03/24/1943 Expires: 03/24/2002 Tr.no: 18312 Restricted To: 00 KENNETH B KEEN _ 21 HEWITT AVE ( «..� . N ANDOVER, MA 01845 Administrator HOME IMPROVEMENT CONTRACTOR Registration: 108383 Expiration: 8/18/02 Type: DBA KEEN CONSTRUCTION CO. Kenneth Keen ADMINISTRATOR 21 Hewitt Ave i No. Andover MA 01845 i The Commonwealth of Massachusetts I. _ Department of Industrial Accidents { _7 Officeot/nvestigations 42 � 600 Washington ` 1_170-,f b Street \� Boston,Mass. 02111 Workers' Compensation Insurance Affidavit RM nt to orma�ton r�� „1e1se ,itl e '� name: location: Z �( /� city �� !"( N U� Lt�!/l.•, /I'1 A l��SI ane#! 7� � �� •-� Zp�. ❑ I am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity ,�i'�"�.3'%�,�.u�,:�% ❑ [ am an employer providing workers' compensation for my employees working on this job. �'� company name address: city: phone# insurance co. pohcd# - al...�9x �..-....1.......,.. ` .x�;,E.�+ ...�..�ic/�iz�,Gr6i,.� ❑ 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: b. Address: city: phone insurance co: ohc 7-W,., .u�.i�: O , company name- - address. - - city. phone9. insurance co policy# Attich additionat siief if�e�css Yy #, 5k....'I: 'zX' ,-, ,, .if, .,e. c,�su..� i..s� .0 a rz�,«s..�a ir'',G£:w Failure to secure coverage as required under Section 25A of v[CL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 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 Office of Investigations of the DIA for coverage verification. I do hereby certif under the in a penalties of perjury that the information provided above is true and correct. Signature l � .-� �O Z Date Print name G'� �' /J/� �"h f��C10 _ ._. Phone# official use only do not write in this area to be completed by city or town official - city or town: permit/license# nBuilding Department check if immediate response is required QLiceiisingBoard ——" " pSelectmen's Office contact person Health Department phone#;p Other (revised 3/95 PIA) ;, Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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 section 25 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, 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. .4.. v1✓;;. ? r ''-s.,F �kti ref .f�rr '�F �/l %s�ry iiy" 3 r„�'rij /..." ..,., ,._ ".'' .r..: >. s,,� ,...:,;i".,^ew r �,ly/r afr��r,y„i,si"r✓ Gxr..9.a/�/ / �,.;,6i,�.i/„" gli5Nx fj Applicants Please .fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address.and phone numbers as all affidavits 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. '� �.r::»,,.@' +*.%fie,, .��r, iF ks>✓.:.y n,3�Y r ��i�»Gi E r/_9t �r�,/lF{r//'s'��.,5' /wry,7Yr,�/'y./v r$'// gk37/� f Nr"'t f% -�n,,l �,,� �"' �../,N,_, 9�K, .,f. trfs�sr�,,✓;� r6>"y.�.r! k„+.73r.�;:�.�.i��W,v�+n F��"Y�">s..Me.?r �,w,4:;,i�"�r°�:,�s,tp,� � City or Towns 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 permii/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Nv rc r1y Town of E over � �s....�. .. .�. No.3s� = X — 9'-, o� o 0 o� CoC,;,C ,� dover, Mass., a S FATED H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......A/.s..d...... '... �.' ....... .��. .��../.......................................................... Foundation v 1OL has permission to e�eet...F�.�.`.5.�'`........... buildings on ...�..�.. .......� lCKm..•. ......�14..1.1......�' ......... • , Rough to be occupied as . �� 1 'V „N 4" JP0 9 IZ,.* .,,,,hm O �� Chimney p .......................................................... '. 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. &,A / ` 0 8 4 ,3cy. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ............../I 1....................................>�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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. BUTTERWORTH & O'TOOLE, INC. ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY claimsna,butterworthotoole.com SALEM,MA OFFICE DOVER,NH OFFICE P.O.BOX 8294 P.O.BOX 734 SALEM,MA 01971-8294 DOVER,NH 03821-0734 TEL. (978)741-5731 TEL. (800)298-5330 FAX (978)740-9109 FAX (603)218-6760 REPLY TO: ❑X REPLY TO: ❑ April 03 , 2008 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Carolyn Caulk Address : 116 Hickory Hill Road North Andover, MA 01845 Policy No. : HP2386133 Loss of : 04/01/08 File or Claim No. : 080-0404 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. If no reply is received fromour office within thin ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Larry Racine Adjuster v s � y Member of National Association of Independent Insurance Adjusters I BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTERS/APPMSERS FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX(978)740-9109 March 17, 2010 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 3B TO: Building Commissioner or Board or Health or Inspector of Buildings Board of Selectman ADDRESSES City/Town Hall City/Town Hall North Andover, MA 01845 North Andover, MA 01845 RE. Insured: Carolyn Caulk Address: 116 Hickory Hill Road North Andover, MA 0184 ER-EE� Policy No.: HP2386133 05 I L 2010 LOSS of: February 22, 2010 TOWN OF NORTH ANDOVER HEAL-T!1 DEPARTMENT File No.: 001-0706 Origin: CAT 96 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen Law Chapter 143• Section 6 to be applicable. If any notice under Mass. Gen Law Chapter 139, Sec. 3B is appropriate, please direct it to the attention of the writer below and include a reference to the captioned insured, location, policy number, date of loss and file/claim number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Thank You, Brad Doherty Adjuster BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTERSIAPPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX(978)740-9109 March 17, 2010 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC.3B TO: Building Commissioner or Board or Health or Inspector of Buildings Board of Selectman ADDRESSES City/Town Hall City/Town Hall North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Carolyn Caulk Address: 116 Hickory Hill Road North Andover, MA 017845 [M Policy No.: HP2386133 05 Loss of: February 22, 2010OWNF NORTH File No.: 001-0706 Origin: CAT 96 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen Law Chanter 143. Section 6 to be applicable. If any notice under Mass. Gen Law Chapter 139• Sec. 3B is appropriate, please direct it to the attention of the writer below and include a reference to the captioned insured, location, policy number, date of loss and file/claim number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Thank You, Brad Doherty Adjuster l/� fel/Ci�i 4911Y 1 1 1 i f f f t i i 310CMR.10.99 LE Form 8 DEP File No 242- 474 I no ue wovioed by DEP) DIV low, North Andover _ Commonwealth ' f==. of Massachusetts ADor,canr George R. Barker Jr. (Lots 1 2 3 4 9 10 11 15 16 17 SFr 18,19,20,21,22,23,24,25, 26 & 27) Hickory Hill – Barker Street Partial Certificate of Compliance Massachusetts Wetlands Protection Act, G.L. c. 131 , §40 NORTH ANDOVER CONSERVATION COMUSSION Issuing Aut-harity. From . Georg a R. Barker Jr. , 1267 Osgood Street, North Andover, MA 01845 To I (Name) (Address) Date of Issuance Aril 18 1991 — This Certificate is issued for work regulated by an Order of Conditions issued to George R. Barker Jr_, dated Oct. 4, 1988 and issued by the NAGC 1, :1 It is hereby certified that the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. 2. It is hereby certified that only the following portions of the work reaulated b�, the a`)ove-feler- enced Order of Conditions have been satisfactorily completed: (11 the Certificate of Compliance does not include the entire project, specify what portions are included.) Applies to the above Lots ONLY. . . . . . 3, It is hereby certified that the work reaulated by the above referenced Order of Conditions was never commenced:The Order of Conditions has lapsed and is therefore no longer valid, tJo future work subject to regulation under the Act may be commenced without filing a nev: t,olrce of Intent and receiving a new Order of Conditions. ................................................................... Ileave Soace Biank) i