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HomeMy WebLinkAboutMiscellaneous - 1160 GREAT POND ROAD 4/30/2018 (26) NG FILE
Date... .........
t NpRTM 1
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
♦ r
♦ oma+ ����•
7SgACMUSEt
This certifies that ............................. fes.. .��............................................
has permission to perform ,� ..,.. ................ ter...' .....-.........................
wiring in the building of �`� 4 ,&
at................ .............................................................. .North Andover,Mass.
r n � \
Fee.l............ Lic.No/71;��. .......... � .....` .. ."':..
ELECTRICAL INSPECTO ��
Check #
84 / /
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checkedr
kv [Rev. 11/991 leave blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE A L INFORMATION) Date:
City or Town of: d ri�'r To the Inspector of Wires:
By this application the undersigned gives notice of hi or her intention to perform the electrical work described below.
Location(Street&Number) O � Qh
Owner or Tenant /�j/���! S CA Gt9'z Telephone No.
Owner's Address
Is this permit in conjunction with a building pe mit? Yes ,W No ❑ (Check Appropriate Box)
Purpose of Building 7 � � Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Li: ` � ` 151��Go
a�O4 2
Completion 6fthef&,7vvYing table may 5e waived by th-m!"r ector of Wires.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans — No.of
Transformers KV.L
l o.of Lighting Outlets No.of Hot Tubs — Generators kvA
No.of Lighting Fixtures Swimming Pool Above ❑ In- El No.—OT Emergency ig mg —
rnd. arnd. Battery Units
No.of Receptacle Outlets Z No.of Oil Burners % FIRE ALAR:.iS No.of Zones
No.of Switches �$' No.of Gas Burners — No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. -3 TotTons D•� No.of Alerting Devices
No.of Waste Disposers Heat Pum Number Tons No.of elf- ontained
Totals .__.... ......._..........._...._._._..............._............. Detection/Alerting Devi"s .
No.of Dishwashers Space/Area Heating KW — Local ❑ Municipal ❑ Other
Connection
No.of Dryers f Heating Appliances _ KW _ Security Systems:
No.of Devices or Equivalent
No.of Water — KW _ o.o _ o.o _ Data Wiring:
Heaters Signs Ballasts
No.of Devices or E uivalent
No.Hydromassage Bathtubs — No.of Motors Total HP i Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
' Attach additional detail if desired, or as required by the Inspector of Wires.
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 ® OND ElOTHER ❑ (Specify:)
Estimated Value of Electrical Wor (When required by municipal policy.) (Expiration Date)
Work to Start: //JZ— Of Inspections to be requested in accordance with MEC Rule 10,and upon completion.
I certify,under the pains and penalties ofperjury,that the information on this application is true and complete.
FERM NAME• ( LIC.NO.: j
Licensee: � ��/ /9, �IlyGlil/ �(� Signature LIC.NO.:r O�
(Ijapplicable,enter"exem t"in the license number line.) Bus.Tel.No.•.5-ak-J';12-?360
Address: f Arc,lM 6 Alt.Tel.No.:-,?'J7—
- OWNER'S INSURANCE WAIVER: I am aYwe 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. $7&
e,
f ��
s The Commonwealth of Massachusetts
Department of Industrial Accidents
l e
Office of Investigations
L 600 Wash�` °'`•%' ington Street
Boston MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leo_ibiy
Name (Business/Organization/Individual):
Address: 9- -7'
City/State/Zip: /6 Z Phone 2-
Are you an employer?Check the appropriate box:
� Type of project(required):
I am a employer with.- !� — 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7•)a Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance.
[No workers' comp. insurance 5. El We are a corporation and its 9. Building addition
required.] officers have exercised.their 10:❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.7 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.] 13.0 Other
+Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submii.khis afiidavii indicating trey are duiEte Ell Stark azid iben hire outside ecntraciors muni submit a new atndavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for ny,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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify un&er ains pen 'es of perjury that the information provided above is true and correct
Sisnature: Date: (J
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. Plumbin]]Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined.as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit:to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit compl eteiy,by checking the boxes that apply to your situation and, if
necessary,supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office oF Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/ficense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum 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 G2111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26=05
Fax#617-727-7749
v^m-mass.gov/dia
Date.
OF HORDTH 14'
n
a 3� ° �4 TOWN OF NORTH, NDOVER
41
,
p PERMIT FOR.GAS INSTALLATION
t
'1s,9SS,C NUSEt
This certifies that .� : `'"''�. . <?. . . . . .
has permission for gas installation
. .��` --
in the buildings of ! -� %g- �. . . . . . . . . . . . . . . . . . . .
at �!l�'. �:/ %� -. �-North Andover, Mass.
Feeh� . : . . Lic. No. �! -'� . . �., Ale,e7p .. . . . . . . . . . .
/ GAS INSPE&OR
L v rr
Check# -.
6664
MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FTTTI NG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Locations /,Pox,
2j
Permit#
Owner's Name ?koo k G!! °6 Amount
New Renovation Replacement �o
D Plans Submitted ❑
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a
V y W s OF UO m rA
F S
CK 02
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W += w W
W zw v, z E c a > w
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SEMENT
T. FLOORD . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . FLOOR
7T H . .FLOOR
8TH .' FLOOR
(Print or type)
Name �I x Check one: Certificate Installing Company
Address
Zb �i-i73 13 Corp
IDD �� ,y �
Partner.
Business Telephone, 77
inn/Co.
♦ Name of Licensed Plumber or Gas Fitter_ SP
FINSURANCECOVERAGEk oger
t liability Insurance'policy or it's substantial equivalent. Checcked desplease in ' to the type coverage by checking the appropriate box.Yes No0nce policy Other type of indemnity D
Bond 13
Owner's Insurance Waiver: I rn 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.
Signature of Owner or Owner's Agent Check one:
Owner 13 Agent 13tted(or entered)in above application are true and accurate to the
t hereby certify that all of the details and information 1 have submitted
best of my knowledge and that all plumbing work and install o s performed and
compliance with all pertinent provisions of the Massachuse tate Gas Cod Cha rm�t Issued for this application will be in
te' 42 of the General Laws.
By: ignatur of Licensed Plumber Or Gas Fitter
TitlerVI
Plumber
City/Town, [3 Gas Fitter License Number
E3Master
APPROVED(OFFICE USE ONLY) Journeyman
Torun of North Andover HORTN
'OFFICE OF 3?o�ss1�OG
COMMUNITY DEVELOPMENT AND SERVICES i. .-
27
.27 Charles Street
North Andover, Massachusetts 01845 �9ssacNus���y
WILLIAM J. SCOTT
Director
(978)688-9531 Fax(978)688-9542
_ s
CHIMNEY APPLICATION AND PERMIT
DATE_ PERMIT #��,���
LOCATION ( Q G, I
OWNER'S NAME �/Zaa is 560
BUILDER'S NAME /%�U12.oA U �x,)sY- (� -� • '
MASON'S NAMESD>(/l-zV
MASON'S ADDRESS
MASON'S TELEPHONE Z 3 3 pd ZZ
MATERIAL OF CHIMNEY Cj9'1 L/
i
INTERIOR CHIMNEY EXTERIOR CHIMNEY 5z
NUMBER AND SIZE OF FLUES 7—
THICKNESS OF HEARTH ]�F
Will chimney or fireplace conform to requirements of t e code and
have rules and regulations been received:
DATE
SIGNATURE OF MASON r CONTR. LIC. # 3
EST. CONSTRUCTION COST/CONTRACT PRICE
PERMIT GRANTED a `1 0 FEE -'�
ROBERT NICETTA, BUILDING INSPECTOR,
INSPECTED
REMARKS RECEIVED
li` to 6 2001
SOLID BRICK REQUIRED BUILDING DEPT.
THIS PERMIT MUST BE DISPLAYED ON THE PREMISES
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Town of North Andover NORTk
OFFICE OF
��Oy ttLO e''1�'OOL
COMMUNITY DEVELOPMENT AND SERVICES p
27 Charles Street "
North Andover,Massachusetts 01845 "ssq�H�s���y
WILLIAM J. SCOTT
Director
(978)688-9531 Fax(978)688-9542
CHIMNEY APPLICATION AND PERMIT
DATE /d/ I PERMIT #-/c/Y31
LOCATION //(ted �i2e1�1G
OWNER'S NAME 117-21 a is U6/00
BUILDER'S NAME �y �XJSY �!9VC
a
MASON'S NAME
MASON'S ADDRESS 1)
MASON'S TELEPHONE 7e/ 233 oz,-,77,/ f Il j
MATERIAL OF CHIMNEY J'1'j J —S//�y /J ✓'GK
INTERIOR CHIMNEY EXTERIOR CHIMNEY
i
NUMBER AND SIZE OF FLUES X h
THICKNESS OF HEARTH ' -- 8
I
Will chimney or fireplace conform to requirements of Ithe code and
have rules and regulations been received:
DATE D f
SIGNATURE OF MASON CONTR. LIC.
EST. CONSTRUCTION COST/CONTRACT PRICE
PERMIT GRANTED FEE
I i
,ROBERT NICETTA, BUILDING INSPECTOR
INSPECTED
REMARKS
SOLID BRICK REQUIRED
THIS PERMIT MUST BE DISPLAYED ON THE PREMISES
BOARD OF APPEALS 688-9541 BUILDINGLT
688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
I
• • ' Town of North Andover %AORTN
OFFICE OF Olt 11,1,�aD
COMMUNITY DEVELOPMENT AND SERVICES
9
# -
27 Charles Street
North Andover, Massachusetts 01845
WILLIAM J. SCOTT 9SSgCHUSe�
Director
(978)688-9531 Fax(978)688-9542
CHIMNEY APPLICATION AND PERMIT
DATE_/zz1le -8 PERMIT # ! IS
LOCATION //Gd
OWNER'S NAME &',
BUILDER'S NAME
MASON'S NAME &Xsa jxx q-��
MASON'S ADDRESS
MASON'S TELEPHONE_x 79-/ 233 ©UZ7.—
MATERIAL OF CHIMNEY
INTERIOR CHIMNEY EXTERIOR CHIMNEY
e.
NUMBER AND SIZE OF FLUES -Z, g2 A
THICKNESS OF HEARTH ✓
Will chimney or fireplace conform to requirements of the code and
have rules and regulations been received: .k
DATE G1
SIGNATURE OF MASON CONTR. LIC. # 32-0
EST. CONSTRUCTION COST/CONTRACT PRICE
PERMIT GRANTED FEE j ,�--
ROBERT NICETTA, BUILDING INSPECTOR
INSPECTED
REMARKS
SOLID BRICK REQUIRED
THIS PERMIT MUST BE DISPLAYED ON THE PREMISES
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
LJ'W�u1J�iJU�
Construction Company, Inc.
May 31, 2002
North Andover Building Dept.
Mr. Robert Nicetta
120 Main Street
North Andover, MA 01845
Re: Brooks School
Dear Sir,
This letter is regarding the (4)Faculty Housing units located at Brooks School.
We have contacted our mason contractor, Colella Masonry of Saugus,g MA, and have
scheduled the parging of the fireboxes for Monday June 3, 2002.
I apologize for this oversight and I will assure you this will be corrected
immediately and prior to occupancy. Thank you for your cooperation with this project.
Sincerely,
Brett Murphy
Vice President
J i
otary
Commission Expires: 11-Xa-M
State of: Massachusetts County of. Essex
P. O. Box 1510 ■ Newburyport, Massachusetts 01950 (978) 465-0381
Date. . . .. /K. .rF . ./ .. ..
MORTM
p TOWN OF NORTH ANDOVER
• - PERMIT FOR GAS INSTALLATION
1
h
gs,SSAf MUSE�t
This certifies that . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
permission for gas installation . . . . . . . . . . . .
in the buildings of . . . ... •<.. . . . . . . . . . . . . . . . . . .
at//�(. . . . . . :`. . . . . . . . .. . . , North Andover, Mass.
Feed%. . . . . . Lic. No.. .�. ... . . .. ... . �U f . . . . . . . . . .
GAS INSPt=
Check#
37
MASSACHUSETTS UNIFORM APPUCATON FOR PERNM TO DO GAS FITTING
(Type or print) Date
NORTH ANDOVER,MASSACHUSETT
Building Locations Permit#
o $
ve_�oly, v Owner's Name U
NewE]FZ Renovation ❑ Replacement ❑ Plans Submitted ❑
z o
a
x
U
Od A L7 OV oc > 0 00
SUB-BASEM ENT
BASEMENT
1ST. FLOOR
2ND. FLOOR
3RD. FLOOR
4TH. FLOOR
5TH. FLOOR
6TH. FLOOR
7TH. FLOOR
8TH. FLOOR /
(Print or type) ( t on • ertificate Installing Company
Name oro.
Address I I r� J J ❑ Partner.
Business Telephone — ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter LLU
INSURANCE COVERAGE Check one:
I have a Furrent liability Insurance policy or it's substantial equivalent. Yes ❑ No❑
If you have checked M,please indica a type coverage by checking the appropriate box.
Liabi.. —insurance policy Other type of indemnity ❑ Bond ❑
M
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 ❑
I hereby certify that all ofthe details and information I have submitted(or entered)in above a ' tion are true and accurate to the
best of my knowledge and that all plumbing work and installat pe under Perm ssu fo i application will be in
compliance with all pertinent provisions of the Massachuse State a of a neral Laws.
By: Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber
City/Town ❑ Gas Fitter License um er
APPROVED(OFFICE USE ONLY) ❑ Journeyman
31
' Date . . ...... ........
40RTN TOWN OF NORTH ANDOVER
o �
PERMIT FOR GAS INSTALLATION
f 9
,SSACMUSEt
This certifies that/. . .. . . . . . .! . .'. . . . . . . . . . . . . . .
o
has permission for gas installation .: ��.�ri-?'.- � r %. . . . .
in the buildings of . . . . . . .
at ��l:� ?�4.r% ��. . . . . . . . . .. North Andover, Mass.
�J
Feer r.'. Lic. NoA0 InI . . . .
GAS INSPEC Re
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
z
t o
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
ype or print) Date `L19
—
NORTH ANDOVER, MASSACHUSETTS �9rvdlcS SGtJOol
Building Locations /<< z°n QS Ply -IOU S Q- Permit# 2//0
!!G0 Gr e07 pond Amounts
NO nt-h jq/'1 iya VP/" , ')til Q'- Owner's Name
New❑ Renovation ❑ Replacement ❑ Plans Submitted ❑
_ c _ L
zc w z z c w v
c z
n C =� z � C x w d
cn
Z n
SU B -BASE VI ENT tz
B A S E M EN '17
I S T. F L 00 R 2
2IND . FLOOR
3RD . FLOOR
4T H . F L O G R
5'r H . FLO G R
6T [I FLOOR
7T 11 FLOOR
, 8TH . FLOOR
(Print or type) 1 �o Check one: Certificate Install' g Company
Name ILA, �e f2o c� PIQ t Aber�c 11/e0'l'!/7! (201-P � Corp. l���C
Address Box 72 g
❑ Partner.
Business Telephone 9
74 97 4-2-99 ❑ Firm/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check n :
I have a current liability Insurance policy or it's substantial equivalent. Yes r-" Nom
If Leal
you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy (�hk Other type of indemnity ❑ Bond ❑
Owner's Insurance Waiver: t 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 ❑
I hereby certify that all of the details and information I have submitted(or entered) in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Cha r 142 fthe General Laws.
ow � � ( L A
By: Signature of Licensed Plumber Or Gas Fitter
Title ❑ Plumber . 8 S 97
City/ own ❑ Gas Fitter -cense umber
Master
APPROVED(OFFICE USE ONLY) Journeyman
Location '
No. Date
NoRT)f TOWN OF NORTH ANDOVER
F „ Certificate of Occupancy $
Building/Frame Permit Fee $
�SJAcHuset Foundation Permit Fee $
Other Permit Fee $
1 _ Sewer Connection Fee $
."-Water Connection Fee $
��,-.OTAL $
y Building Inspector
,4CJ+ e Div. Public Works
s'E�Rat t No. 29 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. /PAGE 1
rnAAP 4,40. LOT NO. 12 RECORD OF OWNERSHIP (DATE BOOK PAGE
NE I SUB DIV. LOT NO. —I
I
LOCATION 0 PURPOSE qS.8 MWWMG f +
OW ER'S NAME No nr STORIES
OWNER'S ADDRESS BASEMENT OR SLAB
ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME �`� � ,.,� I, SPAN --
DISTANCE TO NEAREST BUI.DING `x/i•'•o 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 ,/O IS BUILDING ON SOLID OR FILLED LAND
ILL BUILDING CONFORM TO REQUIREMENTS OF CODE 444f!e IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY 00, 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.
EST. BLDG. COST PER ROOM
PAGE 2 FILL OUT SECTIONS I - 12
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
P S MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
'000
G/�E FILED /161
!% BOARD OF HEALTH
SIGNATURE(:rF-0WIq-EFi-0X AUTHORIZED A ENT
FEE Da
PERMIT GRANZ",
OWNER TEL.
y _C�6 PLANNING BOARD
_
CONTR.TEL.
CONTR.LIC.#moi yv R 5 9
BOARD OF SELECTMEN
&6n,"
BUILDING INSPECTOR
BUILDING RECORD 1 t a
r
1 OCCUPANCY 12
SINGLE FAMILY STORIES 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 8 INTERIOR FINISH
CONCRETE d t 2 13
CONCRETE BL K. PINE
BRICK OR STONE P —_ ——
PIERS PLASTER
_ DRY WALL _
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'T' AREA _
114 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
ASPHALT SIDING D
ASBESTOS SIDING COMMCN _
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY _
STUCCO ON FRAME
BRICK N MASONRY ATTIC STRS. 6 FLOOR I_
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLEHIP BATH 13 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
TILE DADO
6 FRAMING 11 HEATING
WOOD JOIST PIPELESS FURNACE - •-••
FORCED HOT AIR FURN.
r ;
TIMBER BMS. 3 COLS. STEAM
STEEL BMS. 6 COLS. HOT W'T'R OR VAPOR
v
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd 11 NO HEATING
COMMONWEALTH DEPARTMENT OF PUBLIC SAFET'e�
OF 1010 COMMONWEALTH AVE., `
MASSACHUSETTS BOSTON,MA 02215
LICENSE
EXPIRATION DATE CONSTR. SUPERVISOR
07/31/1994 EFFECTIVE DATE LIC-NO. .
i RESTRICTIONS
NONE007/31 /1992 040329
PCHARLES S MIERS
= 6 FERN ST
SS N 020-34-0992 mWINDHAM NH 03087
PHOTO(BLASTING OPR ONLY) FEEo;O.00
1 +i
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY �•
HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER Q
DOB:
12/03/1944 Cl )
THIS DOCUMENT MUST
CARRIED ON THE PERSON CF v SIGNATURE OF LIC NSEE
THE HOLDER WHEN EI•- / n / c-tinq
OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATIOtl. // r �`,2f�LC/J COMMISSIONF
' (c'i ✓�ie"Vamr�nonuie¢Gl�a�✓VLnJA�c��utedJ
�\ HOME IMPROVEMENT CONTRACTOR
Registration 111,613
a Type - PRIVATE CORPORATION
Expiration 04/13/95
C J MIERS 3 SON INC
C STEPHEN MIERc
21 WEST SHORE RD
ADMINISTRATOR WINDHAM Nil 03081
NORTH
o" 0
T f Andover
0
� n dower Mass. 1983
SpA COCHIC 11 > >
DRAT E D P'? ��
�-qs
BOARD OF HEALTH
Food/Kitchen
PERMIT D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.................... . ..... ... ...... . ..... ... ..... ....... ................. Foundation
has permission to.weet-. ie c•ao.. . .... .. .... ......... .. ugh
•
to be occupied as........ .... ... • imney
provided that the person ceptin is permit all in every respect conform to the terms of the application on file in Final
this office, and to the provisions o 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 CONSTRUC ON TS t ELECTRICAL INSPECTOR
Rough
s.......... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Rough
p Y P 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.
C09M Smoke Det.
CEMED /MATED FiNIAl ., � _ DRIVFWAY ENTRY PERMIT _._
BROOKS SCHOOL PURCHASE ORDER
1160 GREAT POND ROAD
ALL SHIPMENTS,INVOICES 3
NORTH ANDOVER, MA 01845 AND CORRESPONDENCE MUST • O Oro
TEL: (508) 686-6101 • FAX: (508) 685-4092 SHOW THIS NUMBER.
DATED: 5/26/93
C. J. MIERS & SON, INC. BROOKS SCHOOL
D ROAD
.T O) SHIP NORTH ANDOVER,1160 GREAT MA 011845
21 WEST SHORE ROAD TO
ATTN: F. MARINO
WINDHAM, NH 03087
FOB SHIP VIA DELIVERY DATE DISCOUNT TERMS
I
ITEM NO. ARTICLES
OR SERVICES • •
AS PER YOUR LETTER DATED MAY 18 1993 WE ACCEPT youg
RECOMMENDATIONS FOR LABOR AND MATERIALS FOR REAR ROOF
OF HEADMASTER'S HOUSE
WORK TO BE COMPLETED PRIOR TO JUNE 30 1993.
I
I
MAILING OR DELIVERY CHARGES, IF APPLICABLE, MUST BE SHOWN SEPARATELY. LOCAL, STATE, • $6397.00
FEDERAL TAXES, IF APPLICABLE, MUST BE SHOWN SEPARATELY. SUBMIT SEPARATE INVOICE IN AUTHORIZED SIGNATURE
TRIPLICATE FOR EACH PURCHASE ORDER. DO NOT DATE INVOICE PRIOR TO SHIPPING DATE. NO
INVOICE WILL BE PROCESSED ON PARTIAL DELIVERIES.FULL PAYMENT WILL BE MADE AND DISCOUNT
COMPUTED FROM DATE OF FINAL DELIVERY OR DATE OF RECEIPT,WHICHEVER IS LATER.
FOR INTERNAL USE ONLY
REQ > ACCT
NO. NO.
BROOKS SCHOOL PURCHASE ORDER
1160 GREAT POND ROAD ALL SHIPMENTS,INVOICES ,
NORTH ANDOVER, MA 01845 AND CORRESPONDENCE MUSTa
00351
'
TEL: (508) 686-6101 • FAX: (508) 685-4092 SHOW THIS NUMBER.
DATED: 6/8/93
C. J. MIERS & SON, INC. BROOKS SCHOOL
T1160 GREAT POD ROAD
O SHIP NORTH ANDOV RN MA 011845
21 WEST SHORE ROAD TO
WINDHAM, NH 03087 ATTN: FRANK MARINO
ATTENTION: MR. C. STEPHEN MIERS
FOB SHIP VIA --t--DELIVERY DATE DISCOUNT TERMS
ITEM NO. ARTICLES O.
1. IN KEEPING WITH YOUR PROPOSAL DATED JUNE 1 1993 7 7
I
WE ACCEPT YOUR PRICE OF 2561.50 TO FURNISH LABOR
AND MATERIAL AS NOTED.
WORK TO BE COMPLETED ON OR BEFORE JUNE 30 1993.
I
INN
MAILING OR DELIVERY CHARGES, IF APPLICABLE, MUST BE SHOWN SEPARATELY. LOCAL, STATE, TOTAL il $2561.50
FEDERAL TAXES, IF APPLICABLE, MUST BE SHOWN SEPARATELY. SUBMIT SEPARATE INVOICE IN AUTHORIZED SIGNATURE
TRIPLICATE FOR EACH PURCHASE ORDER. DO NOT DATE INVOICE PRIOR TO SHIPPING DATE. NO
INVOICE WILL BE PROCESSED ON PARTIAL DELIVERIES.FULL PAYMENT WILL BE MADE AND DISCOUNT
COMPUTED FROM DATE OF FINAL DELIVERY OR DATE OF RECEIPT,WHICHEVER IS LATER.
FOR INTERNAL USE ONLY
REQ > ACCT 15050310
NO. NO.