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HomeMy WebLinkAboutMiscellaneous - 116 MASSACHUSETTS AVENUE 4/30/2018 (2) 116 MASSACHUSETTS AVENUE 210/006.0-0008-0000.0 �l 980 Date...l.�.f� .... 4 N' Tot o:;•t; °-{'.."°off TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHUSEt This certifies that .................. L:....................... has permission to perform ......{r G �,��,��,�` ?-;�?!'.�....5.��..../-�.-.N.....................1 RSI wiring in the building of......... ei .......................................... I l6 M� !nn at7 ..............................,North Andover,Mass. Fee....�- '�"--... Lic.No..306yA .......... cN.lNsracroa y Check # - -'' - Commonwealth of Massachusetts Official Use Only Department ®f Fere Services Permit No. ��j O "7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRMTEV INK OR TYPEALL INFO TIOA9 Date: City or Towin of: P� WATo the Inspector of Wires: By this application the undersi ed gives notl e of his or her inte—,"#� ntion to perform the electrical work described below. Location(Street&Number) Owner or TenantJ;�?-/�yS' Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of No ❑ BLDG PERMIT# P g- Utility Authorization No. Existing Service fUr/ Ams � - P �/ _Z�/vVolts _ Overhead � Undgrd❑ No.of-Meters, New Service Amps / � Volts Overhead _ �� _ ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity _�- &2 Z6±4 e Location and Nature of Proposed Electrical Work: /G Completion of thefiollowing table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total. No.of Luminaire OutletsTransformers KVA No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- o 1 o mergency ig ing rnd. rnd. EJBatte Units No.of Receptacle Outlets ✓c No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection and No. of No.of Air Cond. Total Ranges Initiatin Devices Tons No.of Alerting Devices No. of Waste Disposers Heat Pump 1`Tumber,..Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Water No.of No.of Devices or Equivalent Bal Heaters ' Data Wiring: Si s Ballasts No,of Devices or E uivalent No.Hydromassage Bathtubs No,of Motors Total HP Telecommunications Wiring; OTHER: No.of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. �Q - —�(When required by municipal policy.) Work to Start: /-/1;� Inspections to be requested in accordance with AMC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under Phe aim and penalties ofperjury,thq the information on this application is true and complete: FIRM NAME: �r � �i�E.G7��/ L, Licensee:�,,'y.c//eo.�,�/S,cG�f�lofc /%-dSignature LIC.NO.: �o y (If applicable, enterLIC exempt the fiEense number line.) .NO y yptre„Z Address: /-5- �,� fr•T A �9 Bus.Tel.No.*3 9-6 ice- 7rosi *Per M.G.L c 147,s 57 61,security work requires Department of Public Safe "S"Licen fit'Tel.No.:_9 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability ins LIC. a coverage normally required by law. 13y my signature below,I hereby waive this requirement. I am the(check one)❑owner El owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: p/ (Inspectors'Signature-no initials) Date 2.FINAL INSPECTION: Passed—K Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: y cam-✓ (Inspectors'Sig ture-no initials) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- [ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 4 5.INSPECTION-OTHER: Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial'.Accicients Office of Investigations 600 Washington Street Boston,MA 02111 �,h s�• www.mass.gov1dia Workers' Compensation Insurance Affidavit: Duildelrs/Contractors/JElectricians/Pluanbers Applicant Information Please Print Legibly Name(B.usiness/Organization/:individual): Address: f,� 3d L�'O s City/State/Zip: Phone#: 7- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. FJ Now construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling . ship and have no employees These sub- ontractors have 8. ❑Demolition working for me in any capacity. w rs'comp.insurance. 9. ❑Building addition 5 [No workers'comp.insurance 5. LJIVe are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other !Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T HomeoWners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA_for insurance coverage verification. I do hereby cerci er t pains andpenald s o e ' _ aat the information provided above is true and corre'c't. Si ature: Date: Phone#: 49- E 9' Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): X.Board of Health 2.Building Department 3.CitylTown CIerk 4.Electrical Inspector 5.Pluanbing Inspector 6.Other C ontactPerson: Phone#: Daniel J.Parker,A.I.A. A R C H I T E C T 158 Gale Avenue Bradford,MA 01835 Architechire ♦ Planning ♦ Project Development Voice/Fax:978-373-2446 January 14,2011 Doug Legare TWOMEY &LEGARE CONTRACTING P. O. Box 366 North Andover, MA 01845 Re: O' Ii 1 ion -- 116 Massachusetts Avenu I�a�tL�.ndAver;-� Framing Inspection Dear Doug, Per your request, I visited the Project on Friday,January 14, 2011 to review the framing of the addition&modifications of portions of the existing space for the Project noted above. During the visit I reviewed all new framing members of the portions of the Project executed, specifically the framing including the LVL's, beams, rafters and joist, the connections including hangers, bolts and anchors and observed that the materials and connections installed to be consistent with the Project specifications and the installation to be in compliance with the details shown on the construction drawings dated 10/19/2010 that were submitted for the building permit. It is my professional opinion that the framing, specifically the new framing members appear complete and the work was performed in a manner consistent with the construction drawings, which were approved for the Building Permit, and that it meets the applicable specifications and details. If you should have any questions, please feel free to give me a call and I'll be glad to discuss them with you. Y rs ly, Da arker I.A. ��E©AR�y Architect %-3 p yo�R�, ® No. 5958 ��> HAVERHILL, w 0 MASS. MA registration#5958 Date. . . . -. . . . . . 8852 NORTH °��o TOWN OF N01T ANDOVER ''° PERMIT FOR PLUMBING r This certifies that . . . . . . . .::5. . .60 . . . . . . . . . . . . . . . has permission to plumbing in the buildings of . . . . . .� G!eeIt . . . . . . . . . . . . at . . . .0 � . ���5 . /�GG :. . . . . . . . . ., N AWoass. .aFee. .Y7... .Lic. No.. � 366 . . . . . . . . . . . PLUMBING INSPECTOR Check v .� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: st?f MA. Date: �'��' '/ __ Permit# Building Location:- � �ss �'YE _ Owners Name:H in Type of Occupancy: Commercial ❑ Educational,❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: 10 Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES z z U) 0 Y U W z U) J 2 Fes- W' rn �a Z Fa- Y 0 Q . Q Z n Z :;: LU rn Q cn z I— w z I N n 0 a I- 0 = rn w o °' z z vi 0 v a X W z "- w v x a O v� v z a cc 0 0 0 Y z uzi lw- iw- w a a N °. .a 0 Q Q 'O = _5 Q a . a a tx- a m ca o 0 u_ 0 x Y J -j W N W I- x 3 0 SUB BSMT. BASEMENT -isT FLOOR ' 2 FLOOR 3Ru FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR IN Check One Only Certificate# Installing Company Name: /'e &Re-f9rw4 ❑Corporation Address: /Z 6N LG.r!D JrT Ci /Town: Eyd-iy State: ^1' ty /`! I7Y ❑Partnership BusinessTel: ?7; -&T-3134 Fax: 97J Zty A& Firm/Company _ Name of Licensed Plumber: ,j�L4yr/'j eA INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yesx No If you have checked Yes,please indicate the type of coverage by checking the'appropriate box below. A liability insurance policy U9 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)r arding this application are true and accurate to the best of my G z Knowledge and that all plumbing work and installations performed under the per i ssued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1 o he General Laws. By Type of License: Title _ ❑Plumber Si ature of Licensed.Plumber Ci /Town Master License Number: I'� APPROVED OFFICE USE ONLY Journeyman �— 7556 Date.. ./.—./`?-n •:�,; OF NORTH ,4' 3? °` O 9 TOWN OF NORTH ANDOVER P. � .; a • PERMIT FOR GAS INSTALLATION s i h SAC HUSEt•( . This certifies that . . . . v€. ��. . . . . . . . . . . . . . . . . . . . . has permission for gas installation �/����t.�f!lTl� in the buildings of . . . . . ? 5��4!v� . . . . . ... . . . . . . . . . . . . . at . J f b M#-C! .. . . . . . . . . . . . . . . . . .. North A ver, Fee. Lic. No../.S'3.11, 3b. CPO_ GAS INSPECTOR Check# /0 e.,5' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:_AJiA 1/_— MA. Date:--/- _f___- Permit#------- __- Building Location:���11 ��yE --_--_ Owners Name:_1_�ct12� gF Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential kff New: ❑ Alteration: ❑ Renovation: ; Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES to WW Y n W O to x H W m x 0 J LLIU a' z to W W 0 Q' O z z 0 W x W O Q O Z l=_ W W LLI m. O Q n F- W J d X > z W Q x V O. LL W I. Q, Q CnL) W W W Z x W O� W 0 Lu > U WLU 5, Z O -� f- F- O Z J C9 LL N F- �_ W w w W o a w w co > o° a o 'w z W Q a a U 0 0 u. 0 O x z _j O a .� > > O SUB BSMT. BASEMENT 1 FLOOR / —eu--FLOOR - 3 FLOOR 4 FLOOR gA H FLOOR FLOOR 7. FLOOR V FLOOR Check One Only Certificate# Installing Company Name: [G___ a� /iNG �R?7'NG ❑ Corporation _ Address: 46i✓4040 f'7_ City/Town:— ET �'E/�J State:�� _ --- ❑Partnership Business Tel: p79 PSS- 3 f 3e. Fax:—J971=Za -- Wirm/Company Name of Licensed Plumber/Gas Fitter: 44 P e4f?. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes�No El If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. I A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information/have itted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installatirmed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing CChapter 142 of the General Laws. Type of License: By-- ---------- jPlumber Title as Fitter Sig ure of Licensed Plumber/Gas Fitter ------------�- Fmcurneyman aster City/Town _—___—__ License Number: APPROVED OFFICE USE ONLY ❑ LP Installer — ----- The Commonwealth of Massachusetts Department of Industrial Accidents y Office of Investigations ° °rq i° 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Legibly Name (Business/Organization/Individual): /� ' C /�yUI�//1ING 114&T)`AJC� Address: to ri 10 City/State/Zip: /7 f ZW v4-s0 Phone#: 97 76 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I.am a general contractor and I 6. ❑New construction employees(full and/or part-time)`* have hired the sub-contractors 2.K I am a sole proprietor or partner- listed on the attached sheet. # Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9_ ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4) and we have no 12.❑ Roof repairs insurance required.]i employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as,well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day agait t leviolator. Be advised that a copy, of this statement maybe forwarded to the Office of Investigations of the DI r' surance-coverage verification. I do hereby certifyludelrl e pains andpenalties of perjury that the information provided above is true and correct.' Si nature: r Date: S�z Phone# Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having.not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or-on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfonnance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confinnation 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 pen-nit or license is being requested,not the Department of Industrial Accidents. Should you have any.questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit multiple•pennit/license applications in-any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future pen-nits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 4.06 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia 8/9/2009 3:09 PM FROM: Fax TO: 9786889592 PAGE: 061 OF 001 rasa [North Andover Building dept. Concerned neighbor Attn: Building inspector L raoreaE owrE 08/09/2009 Please be advise that ovw days a athroom is being renovated and a shed dormer being erected over the week-enss Ave The contractor is from N2'2!mits or worker compensation. �N� J�� �� _ c,.,.��� � ark•��� � ►1 I � � i i Date....- .. A 2161 NORTH TOWN OF NORTH ANDOVER Q' OL p PERMIT FOR WIRING S SSAC14us This certifies that ...... t...`.t r, , .,,r :1 r has permission to perform ' r. wiring in the building of.....,�/Al..... r..'4 rte' t—r/I...� I at.............: '.: :... ..:.............................................. ,North Andover,MassA Fee..,?;.r.00.... Lic.No.............. ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File A office Use Only v 5of Cfam ltD1iimmit4 of sadpwfts permit No. 13I!VMi=11t of Vuhtir £"frtq occul3ancy a Fee Checked y BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:000 (leave blank) APPLICATION FOR PERMIT _TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date OM or Town of NORTH ANDOV -R �'' To the Inspector of Wires: . The udersigned applies for a permit to perform the electrical work described below. . Location (Street & Number) /fG mss 2L, LirwLc�- } Owner or Tenant Owner's Address Is this cermit in conjunction with a building permit: Yes _ No (Check Appropriate BOX) `Y Purocse of Building S,vGL� i•..zy sc�'t� E�%%•oL Utility Authorization No. Existing Service � Amos 2ol2y'0 Vats i Overhead Undgrna r No. of Meters New SerAce d0 Amps Vctts Cvemead Unegrno No. of Meters f Numcer of Feeders and Ampacity Y'_ Lccaticn and Nature of Proposed Eiectrcat 'Ncr.K s� '"i'�`Acd 2 Totai No. o, L'gm.mg Cu,:ets No. o* .Hc* ',cs No. of ransformers KVA j 4�cve•— In- � I No. of L.gnnng F;xtures i Swim-:rc =_o� �c _ grre. _ Generators KVA No. of E:aergency Lighting No. of Recec:ac:e Cu:!es No. of ; = rmers j Sattery Units No. of S.v tam Cutlets No- of Gas =urners I FIRE ALARMS No. of Zones .o-at No. cf Cetecaon aria i No. of Rances No. o. A" tans I :rt::at:nc Devices -e_: .alai .ctai j No. cf -:);sccsatS Nc.o _—cs .cr.s KIN No. at Sourcing Devices No. of Serf Contained No. of Dishwashers ..cacefArea ;eating K1N Derec::onrSouncing Crevices L — Municicai r7Other No. of Orvers Heating ocat ng Cevtces !W I Connec::on Nc. of or Low vcrtage No. of Water Heaters KW Stand = :as:s Wirnc No. Hvcro Massage 7ucs No. of `.talars .c:at HP CT, EF;: INSURANCE INSURANCE %CVE RAGE: Pursuant :o :he recti:reme^.:s ::assacmusers general Laws _ 1 have a current Uaciiity Insurance Panay inc:::c:nc Comc:ete_ erravans Coverage or Its sucs:antiai ecuivaient. YES � NO _ ! have suomttted vatic proof of same to the Cffice. YES — NO �! It you have cnecxee YES. tease indicate the type of coverage �y checKing the aoctrocnate cox. INSURANCE BOND = OTHER = (Please Stsec:`r) ' (Exctratton Dates Esnmatec Value of Electrical WorK S a Worx t0 Start -tiLM�"►�,D — InScec::.^.RZa:e -2ct:es:eo: Rough Finai S gnee uncer the Penames of perjury: tic. No. FIRM NAME �I �censee /.i 9 i T/✓�/ l i .v vo a✓ S;gnat::re 4X UC. NO. r Bus. :ei. No. Alt. Tel. No. Address CWNER'S INSURANCE WAIVER: I am aware that the Lcensee Ices net nave the insurance overage or its suOstanttal equtvatenAt a to :'tat "+y s:gaature an ^ts 2ermrt acoticatton waives ants recurrement. Owner cutrea oy Massacr+usetts General Laws. and 9 lP!ease GU .eieonone No. PERMIT FEE 3 3s. "���' (Signature or Owner or Agents ttja5=� Location T� L Date ,aORTp TOWN OF NORTH ANDOVER ptt.•v „ Certificate of Occupancy $ ` Building/Frame Permit Fee $ s" E<� Foundation Permit Fee � � sAcMus �.c Other Permit •ee $ Y a! (11 C3115,-'j !� Sewer Connection Fee $ Water Connection Fee $ Z 199TTAL $ Building`Inspector 4 i^ 6193 Div. Public Works .,P=-i%flT.N0. , L/ APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE I MAP i4O. LOT NO. 2 RECORD OF OWNERSHIP JDATE (BOOK "PAGE ZONE I SUB DIV. LOT NO. LOCATION / �IQ�SUG' PURPOSE OWNER'S NAME /�N/�,�_,/ `1/!Ji e — NO. OF STORIES SIZE V OWNER'S ADDRESS T I-1A . A Lf "V BASEMENT OR SLAB ARCHITECT'S NAME �A SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �l��ij�iF-�I�} l�71- p, ,�,�a,� SPAN -- DISTANCE TO NEAREST BUILDING c�i' N7"`• 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 ye—,5 IS BUILDING ON SOLID OR FILLED LAND � _ WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 6-5 IS BUILDING CONNECTED TO TOWN WATER VI-BOARD OF APPEALS ACTION. IF ANY �/� IS BUILDING CONNECTED TO TOWN SEWER V IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ST. BLDG. COST PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER f0. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY LSE' ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLA MUST BE FILED AND APPROVED BY BUILDING INSPECTOR � F D I lei e WARD OF HEALTH SIGN E O OWNER OR AUTHORIZED AGENT FEE / PLANNING WARD PERMIT GRANTED OWNER TEC.# ^ -ba2 CONTR.TEL.# - A 19 CONTR.LIC.#� WARD OF fELECTMEN BUILDING INSPECTOR f BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIESTHIS SECTION MUST SHOW EXACT DIMENSIONS OFLOT'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 t 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ 1/1 1/1 1/. FIN. ATTIC AREA _ NO 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\r✓'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR _ ADEQUATE NONE j 5 ROOF 10 PLUMBING t GABLE I HIP BATH (3 FIX.) r 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 TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 6 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 j I i DEPARTMENT OF PUBLIC SAFETY 1010 COMMONWEALTH AVE. BOSTON,MA 02215 L z C:EN:-'� 5 EFFECTIVE DATE LIC-NO. iNrl , N n'r:rl�...tl 1C�, ..'.i�} ;_t 1.I_:_ .�._ m•. I•; b- NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER A� I ' I I GNATURE OF LICENSEE OMMISSIONER Andover Bank 4. 7 °' 3 ,. ANDOVER,MA 01810 .• it f;� R - 53-7047 V��. 2113 I' AndoverB k DATE Pay to the order ofl n/��/(�1[JK w fir, •/M /(i r PURCHASER S SIGNATURE , MEMBER FDIC/DIFM T` PURGHASEF S ADDRESS PERSONAL MONEY ORDER CITY.STATE AND ZIP CUSTOMER'S COPY OFFICES OF: dj Town Of 120 Main Street APPEALS ;'s NORTH ANDOVER North Andover. BUILDING t�• .:� Massachusetts O 1845 . CONSERVATION e � DIVISION OF (617)685=4775 HEALTH PUNNING PLANNING & COMMUNITY DEVELOPMENT I KAREN H.P.NELSON, DIRECTOR In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that .the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, S 150A. Ile debris will be disposed of in: � �4 �') qIPI f� t7 . P-qfyr brly (Location of.Facility) Signat re E` Pcrmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. j Proposal Proposal No. FROM ,may �✓_ Sheet No. ' Date Aul Proposal Submitted To Work To Be Performed At Name ` L��r�� Street Street 114 City State City Date of Plans State Architect Telephone Number z" We hereby propose to furnish all the materials and perform all the labor necessary for the completion of DFMI) AdIZI-Y 017 MAO F � � nr 64 A;41 c urs All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($ with payments to be made as follows 4,11-2 ��j' rt� rn CSar Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by Respectfully submitted Per Note—This proposal may be withdrawn by us if not accepted within aD days ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted Signature Date Signature TOPS FORM 3450 0 LITHO IN U. S. A. - NORTty •� Town ofover 0 f,pri k N. n �o�H� rt dover, Mass.,Sd IfJ �.� / 19 too? ADRATED P4�\ �� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... �.. � ... .. ..0 ...................................... Foundation has permission to erect-ITANWA... buildings on ../ifl.....A4*. ..ef-of a....V.�ra........... Rough • �� Chimney 00 tobe occupied as..... . . ......... ..........�.....AMR... ..�.�. r�.. ... .�............................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS I Ohl ELECTRICAL INSPECTOR Rough ......... . ..... ..... ...... .. .... .. ...... ... . .................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. nrulr-n /IATA--rn nplVPWAV PKITRY PERMIT __ __