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Miscellaneous - 118 BROOKVIEW DRIVE 4/30/2018 (2)
/r 118 BROOKVIE-- W� DRiVr� ! 210/090.A-0067.0000.0 Location 110 Y. i e-kI Y/ �LL- 0 No. 137 Date I?-13—0� NORTH TOWN OF NORTH ANDOVER 0 F s Certificate of Occupancy $ Building/Frame Permit Fee $ 4CHU5 Foundation Permit Fee $ Other Permit Fee top( $ OD TOTAL $ jLf d'00 Check # -i—'-=— 5855 Building Inspector 19 TOWN OF NORTH ANDOVER ` BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING T�1S SQOH SOFIjsC OHI BUILDING PERAIT NUMBER. DATE ISSUED: far9-/ o-2 OZ S_IGNATURE: Building Comrrissioner/I for of Buildin Date •�, SECTION 1-SITE INFORMATION z 1.1 Property.Address: 1.2 Assessors Map and Parcel Number: O DejVe )q 0 00b Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: -67, J Zoning District Proposed Use Lot Areas Fronts aft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red I Provi ed R r Provided P 10 J 1 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: k .7 Water S}�tv M.G.L.C.40. S4) / �8 7° Ys 'ltc I � Private 0 � Zone . Outside Flood Zone 9� Municipal 0 On Site Disposal System CTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Tay u*f VOJ4 i 1 q�, erccevfew e- NO, Namt Ia N&Ae6, Address for Service: � 01 � �1 Signe Telep one 2.2(Owner of Record: Name Print Address for Service: O z rn Signature Telephone SECTION 3 CONSTRUCTION SERVICES 3.1 sed Construction Supervisor. Not Applicable 0 PMEV P AWNW-5 Licens Constru tion Supervisor: 02„ q O License Number Addre Expiration Date iignature Telephone 1.2 Registered Home Improvement Contractor Not Applicable ❑ v GLW-e Co 10C- ;ompanv Name , ! � I 1 wo 61, KRV Registration Number,dd ny Expiration Date ianature Telephone LI/ e 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' permit. Si ned affidavit Attached Yes....:.. No.......0 SECTION 5 DescriptijA of Proposed Work check all applicable) New Cotrue ion Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � -4 O f�?�"u-SE !NL.Y} Completed by permit applicant gam, N� s ` 1. Building (a)� Building Permit Fee ./� V Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee X (b) 4 Mechanical HVAC 5 Fire Protection V 6 Total (1+2+3+4+5) Check Number SECTION 7a-OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, �� O,f S t , s Owner zub ject A J property Perp Hereby autho a to act on My behalf, in 1 m tte la to#ork rized by this building permit application. 0-2-7 Q2 Signature of Owne Date SECTION 7b O NERKfa(V, /AUTHORIZED AGENT DECLARATION I, 04(rLO, as OwneAuthorized Agent f subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belr f Pr nt -OZ ent Date NO- OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 2 3 RD SPAN DIMENSIONS OF SILLS DIIv1ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CITNINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 4 FORM - U - LOT RELEASE FORM INSTRUCTIONS: .This form is used to verify that allnecessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. n)l/ ,wung ESSMUMMEN APPLICANT� S .�•� l�C................PHON ...... 2�MEME..am E MEN N T`I"�O ASSESSORS MAP NUMBER 10'90 LOT NUMBER / 00, SUBDIVISION 'l LOT NUMBER �� STREET m,`eyy De1Ve STREET NUMBER ............................................................................ OFFICIAL USE ONLY ............................................................................ RECOMMENDATIONS OF TOWN AGENTS DATE APPROVED Oa CONSERVATION ADDS R DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED F INSPECTO� TH DATE REJECTED DATE APPROVED SEP IC INSPECTOR-I3EALTH {- i DATE REJECTED COMMENTSke Q 1 STIp�.G PUBLIC WORKS-SEWER/WATER CONNECTIONS F DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Y The Commonwealth ofl'las Massachusetts i Department of Industrial Accidents Office of Investigation j Boston, Mass. 02111 Wor'ers'Compensation Insurance Affidavit F - I Please Print IV C, PVC Name: 0 ( 7777777 Location: City Phon n / `� am a homeowner perfomtmg all work 7 (O 7" . � 1 ►nyself. =i am a.sole proprietor and have no one working in any capacity ! am an employer providing workers'com y employees g per►sation for m em 1 ees working on this job. compa' ny,name- 4.o �1i1/S' Cc tri_ �• /,ISG Address Mo. �27-2- 79 rne: Add r- . City„ Phones#- Irtsttrona:C.O. _ Otic+v >'a+ture hi swum coverage Psrequkr d undar Section 2M or MrN L 102 cm-lwd t&tf)&kAOo5Mm d eftinai and/or one Yeas'imprisonment as iNeit as dvN R .daFfine Wsto S—500 OQ understand that a c penafties in the fOn.D of a STOP WOW ORDM and afire MOQOo)a day against rro- t this statement may be forwarded to the Otl�te of�of they MA for�verNica0m. /do herby certi/y u Pains. perjuw VW the kAxmat!bnDFO ded above:is bue aril!cornet Signature BateA�__ print name Phone# rf lcial use only do not write in this area to be completed by city or town oifieiar OCheck Yimmed ate msponse is0 Building Dept- ' building Dept p Licensing Board zrtact person: ❑ selectman's ice Pho 1e# Q Health Depart'ntent Ofher 'r2 MAWS COMPENSATION MAR 04 2002 2:40 PM FR KITTREDGE INSURANCE 393 4518 TO 919785710165 P.02/02 Acj ! CERTIFICATE OF LIABILITY INSURANC ID 3`/,19' PRxuCat 4/02 THIs 7E is MOUED AEA MATTER OF INFORMATION ONLY AND CONFERS NO RIGH UPON THE ClRITICATE Xi ttradga ln$Urassoa Agraoy SAC HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR lis Ii.DLaia St., P.O. Boa 2519 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NaOnO,3 o DLA -774 I INSURERS AFFORDING COVERAGE Dhoss�e308-393-7744 INSURED (MUM-RA: American Caau&JV Cc/Reading {wuRER2: Transportation :nsuraaaa Co. � eit Andrews ti nitee Co., The. mwmc. valleyBo a 1"wance Cc. North of lerica Xh 01862 i rauRnec N6uR6R G: COVERAGE3 THE POLIC1E3 01-IN8UAAHCt NAMED AOCvE FOR TME POL:CY PERICO tN=ATM.40r IT46TANCIN6 ANY RFpLNIlyEN7.TEgM ORCCNCtTipN OC ANYp;NTnACT OR OTNSR CCCL&AENT WRH RESP[CT'0'IYHICH THIS ce"VICATE MAY Be ISSUED OR .RAY PSRTAW,THE INSURANCE ANFOA mRYTkG7==DLSC.^.IGGA a.R..h IS SUa1GCTT0 ALL TFCTT.RMS.MIUS10NS AND=01-1040F SUCH i POLICIES.AGM%'GA,To UMtTE SMCWN MAY HAVE""WILICED EY PAID C—US. TYPE OF INiI RJ{NCS pcuCr nulreETtNA�IMevot�%rj e: GATE ANN001"POLICY N; Wr-3 OEsveRAL LualLm EACH 0=.eUNM !31000000 i a X coLQAg;=Lc.NGAALLtAGG1TY 2048691231 03/01/02 03/0./03 FMQUAAGE fre) !350000 .r.._ :Lsx+sMADE X CC^ Uric W(my vwowwn) :S5000 -- ---•--._...- _.... :PSMULBADViNJL'RY !$1000000 GEKERALAGGREGA-E S 2000000 c:a t AGGRGGATL LOA APP!Ie"5 P6a PROOUC 5•COMNOP AG6;s 10 0 0 00 0 I PotrcY; IIP I 1 CMODILz L/1p1LriY CCMOR40,SMIX OMIT S 10 0 0 00 0 ' C _ANY AUTO �csle2Qas: cs;v=;oa 01/01/03 ;F�xaertl ALL OWNED Aur^-S o.scHmuLM AUTOS (aa S X. WI REO AUT=$ EMILY S X... tICNGthNEDaUTOS coerat:a:arr GAiIAGi LIADILt'Y ONL"•EA AC=oe4T S AMY AUTO EA ACC 3 AU70 OMLY: AGG:j S i '""U"LITY_.. EACMLIC=RRENa °.5 2000000 9 OCCUR — ;LAWS a=:72 3/01/03 AGGP*0ATE s 2000000 b I _'DEDUCTIBLE S X FSTe ICN s 1 10000 WOWIRS COMPEN-UrION AND EMALOYR �LAsluTY :043661.276�6 -aKY Llae�("• s, ER s I 03/C 1!02 03/01/03 ELGAC19--IDGUT fs1000000 EL.CISFASE-EAF.YPLOYEE$1000000 F-L.wwte-Pout-.P,r,s 1000000 f � 1 i:ESCSUI'T1Ch Ot CFAj UtC'SY tVU^RSEYENT.SPEC.AL PROVMONS CERTIFICATH MOLDER ;I AOO nom*,Lr..q$mr-D;INSURER LETTER: CANCELLATION SSD LlIC U#OUI2 ANY OF Twfi Aecvc 17WRISM POUCIBS GE CANCFIIED BEFORE THE 0UlIRATro TATE TMEREOF.TM'.SWRO INSURER TALL ENDEAVOR TO HAIL 20 DAYS WR TE4 `QTICE TO THE C191TINCATt HOLDIA NAMED TO THE LEFT.BUT FSILURF TO DO SO SMALL 3AD21,21 CSR':ZD TC1TY 04003%NO COUGATION OR LIAIMLI7Y Cr AMY ww0 UPON TIT,INSUAKA ITS AOBITN opt �aRE3 :,ACORD CORZOIRATION 198a 4* TOT4L PAGE .07- 4- .:fie &artzma,�uuea`tX c , wtzckaeffj Board of Building Ret�ulations �y One Ashburton Place, fpm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: OJ1411934 Number. CS 027999 Expires:031142004 Restricted To: 00 RODNEY P ANDREWS 1647 LOWELL RD CONCORD. NIA 0174_ 7r. no: 17,C 6 7 / 1 Seen:oo for,eceiotanal:-arse of address notific=tion. ✓/tt c�an•iRcn�.zf/� •L. r���rnuiai% -" BOARD CF?UIL:)ING RE UL4 i V4S License: CCNS7RUC7CN Si;= V;SCR Number. CS -=729_3 Birthdate: 021W19-14 ! Expires:OJ1dr.LCa -r.❑o: .7 Restricted: 00 RODNEY P ANCREJVS 1647 LOVVE.1 RD CONCORD. UTA ot7.,2 ammsummr �r + 'ylZ•/��.�/JCL-a�>/� C:/ L' G✓twci'.v�/IiLL�Ci>!,/ ':eL:C =. ,N =1L! U puate.address and return cru.Ylars:mon for ct:: Audrms — Rme+•ai _ Employment _ La: -' -I�• Ba.r4 at Buddlnq Regauuaae,ao Stannams Laccase or rt-psmaou valid for indindni use anty F HOME IMPROVEAEMT C..^HTRACTMR before the expirauou date. if found remM to: r;) Board ai Building Reguianons=4 Sisnaaras _ Y, Regtavauon: 11:—' _ one,%soburton Place Rm 1301 Exauanon: 0711V=a2 lloston.11a.0:108 Type. Pmate C.xoorsuon ANORE'JVS GUN17E CO..INC. ROONEY ANOReVVS / i REPUSL'C RD N 131LLRICa.MA 0ttl6C wanrowr+nr mot vai without Siollum g No 2203 Date......I. .....`X... ...71 t f NORTH� 3?;.<„`'�.:•�."�,� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMUS� This certifies that {.C...� 0�?r�.�`�'".....�. C U..: .............. ..... ............... has permission to perform ..... i.................................... wiring in the building of......!:A JJ h... ,`ew....l i �!!!�'�...................... St....Lit... .... �!�.a . .�. tiJ.. I�.:.......... .. .North Andra ,M Fee' C)..0...... Lic.No...� . SOV . ............. ..................... ................... ... ELECTRICAL IN CTOR 01112 14:43 300.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer THECOMMONWEALTHOFMAISSA Office Use only DEPARTMEWOMBUCS9FM Permit No. BOARD OFFMPREVEM70NREGRATIOA S S CMR 1200 ' Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 L %! (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. �f Location(Street&Number) /(j ��a < (jar /,,i/ Owner or Tenant C31?00 l tom✓ �iv� f Owner's Address Is this permit in conjunction with a building permit: Yes[LJ-ifo (Check Appropriate Box) Purpose of Building AJ-(-w �) Utility Authorization No. G `lff z Existing Service Amps / Volts Overhead Underground No.of Meters New Service o2 Gy Amps /otv/any;Volts Overhead Underground ©— No.of Meters l;umber of Feeders and Ampacity Location and Nature of Proposed Electrical Work ?Uo.of Lighting Outlets No.of Rot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local a Municipal a Other Connections -N,).of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• hnwceCbRisa"iDtheWzunaitdMwmdusdisGaiaWLaws Ihaw aametlLrbtkIraml ePblcyurhuditgCo 4*k Co critss a#vala�t YES � NO Ihmesubmftdvdidprm(bfsanelothe0(im YES NOa If}cuhawdrdcedYES,platssetrdt*the"xof cnaaWbydadngthe INSLJRANICEo BOND o OTHER o q1wse ) W��S� ��i�� EstirrtakdVahtet�7ecuical Wak$ .r� .� Inp actimDaleRe4icsted Ra# Fatal Sigttad unda$ie Patalties ofpetjtay. � FIRM NAME �A7/C dt c•.•C. ' T 2 lr r. la cps�_ LioaIseNa 1 Lioa>9ee Sign&= moi% � L-l' (Lt.� 'L"_ I ioertseNo Business Tel Na Adds., l _���S � AIL Tel.Na 'Z-12L 3R 1 Co OWNER'SINSURANCEWAIVER;IamawatethattheLxeme lheitmaanecotei orilss lecg lat�tt�tmedbyMa GataalLaws and fmtmysigl�cnthspernitaptrtratimwaik4estltisM4Sim tt (Please check one) Owner Agent ® '1 Telephone No. PERMIT FEE 4096 Date..... ......................... TOWN OF NORTH ANDOVER 0 0.. � A PERMIT FOR WIRING �,SSACMUSEt ZQ This certifies that ..—�P ....e..��... ............................................... . .. io has permission to perform ....... .................................................... wiring in the building of......... n &X_-4t ................. at..... ......................... ......,North Andover,Mass. Fee/7 Lic.No&'5s',�::3............... ..................... ELEcmcAL INSP EMR Check # 9 9 9-5 .- _ l om wnwea114 of Madeachueelb Official Sc Only Permit No. �/(? 94. a1JeRarintenl o`,J`ire �erviced Occupancy Fee Checked — BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(iNIEC),527 CMR 12.00 (PI,E.ISE PRINT IN INK OR TYP1i:ILL hVt'ORjLL 17YON) Mile: ��_a ov,- City or Tolvil of: A alyd 0 U/.9 To the Inspector of iYires: By this application the undersigned gives notice of itis or her intention to perform the electrical work described below. Location (Street S, Number) //b- L// Owner or Tenant ,T� S/ a!2 U TT-e a n a 7 Telephone No. Owner's Address 74 m r Is this permit in conjunction with a building permit'' Yes No ❑ (Check Appropriate Bos) Purpose of Building Utility Authorization No. Existing Service A(9--, Amps //O /oZ,�-OVolts Overhead ❑ Undgrd No.ori-Meters New Service Amps / Vol(s Overhead ❑ Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical!York: � wGy� � tfy� �l 47 U L Completion of the following table may be u-aived be the Ins)ccro,-of wi,-es. No. of Recessed Fixtures No.of Ccil.-Susp.(Paddle)Falls No.of Total Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool a bone ❑ Ill- o.o mergenc}• tg tang rod. rod. Batte Units No.of Receptacle Outlets No.of Oil Burners FIR-E, ALAR1,1S INo. of Zones r No.of Switches No.of Gas Burners No.of Detection and TotalInitiating Devices No. of Ranges No.of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers !-feat Pump Number "Tons KNV No. of Sclf-Contained Totals: Detection/Alerting Devices No, of Dishwashers Space/Area Heating KW Local 0 t'Ylunicipa! ❑ Other Connection No. of Dryers Heating Appliances KWSecurity Systems: No.of Devices or Equivalent r No. of!Vater No,of No, of Lata �r'iriu� Heatersn w Sins Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of MotorsTotal hi I' 3 1'elecommunications NViring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, oras required by the Inspector of!Vires. INSURANCE COVEIUIGE: 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 E- BOND ❑ 0-11 IER ❑ (Specify:) � Estimated Value of Electrical Work: d G v (When required by municipal policy.) (E. piration Date) Work to Start: Inspections to be requested in accordance with iVIEC Rule 10, and upon completion. I certify, under the Iradrrs anti pe nalties of petjury,that the information ort this application is tare and complete. FI RIINAr1IE:/��v nt� /� n.o � 172 Itz o.v-7 LIC.N0.:/¢S 1 J 3 Licensee: /2c.�P T—IV& v1,t/U Signature Ll C.NO.: (If applicable, enter i„the license numbe)-line.) / Bus.Tel. Address: 2fC ? /... P /3 S%/? sem- i(/e P Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coyera-e normally required by law. By lily si!,mature below, I hereby waive this requirement. I atm the (check one) ❑ owner ❑ o hers a ent. O�yncr/Agent Signature 'Telephone No. PERMIT FEE: ii ,i 1 Q • , a « Location l rU !L�rt��l i�U)!� Dr . ro AL Date ? 24 NORTH TOWN OF NORTH ANDOVER I % Certificate'of Occupancy $ 0, "'Building/Frame P6rmit Fee $ AcHFoundation Permit Fee $sus Other Permit Fee $ Sewer Connection Fee $ Z Water Connection Fee $ TOTAL $ c� 33y, C r U '1r Buiidi g Inspec r T) 1(1l14/98�+10:c`'S 1,248.00 pq�1�" s v Div. P lic orks t IC Location ? P���L r1,0,t) - % 1 __ _ Date Z l `" I "ORT" TOWN OF NORTH ANDOVER Ota+'■° "x,10 a Certificate of Occupancy $ - � Building/Frame Permit Fee $ ' O7 3�° � • E Foundation Permit Fee $ � s�cNus t a Other Permit Fee $ Sewer Connection Fee $ a i Z Water Connection Fee $ a d TOTAL $ If I-, Building Inspec r 10/14/98 10:26 1,248.04--�A%3 , )� ' n r Dr3 `rel l . E a "" _ Div. Public Works :4 s PER311T NO. � APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. 10. a 2 RECORD OF OWNERSHIP (DATE BOOK iPAGE ZONE I I SUB DIV. LOT NO. �� C00 ,,eW 1p e. Home.$ 6 � (�10 ' v LOCATIO CoovIevi De,t/ PURPOSE OF BUILDING re'yj'1 OWNER'S NAWIf 6euoUev) Coo A)TC !(orAt 5 NO. OF STORIES � SIZE OWNER'S ADDRESS f ,o 6O X 5.1 1 Y BASEMENT OR SLAB Q se,K c v r ARCHITECT'S NAME W w S J tc� �N SIZE OF FLOOR TIMBERS IST 2,K )o 2ND zX)b 3RD z K BUILDER'S NAME f00 Ulew e0yiy)eJ one S SPAN / DISTANCE TO NEAREST BUILDING oO DIMENSIONS OF SILLS DISTANCE FROM STREET / IF POSTS DISTANCE FROM LOT LINES- SIDESO�I ' yo I REAR GIRDERS AREA OF LOT ? r O3 O f` FRONTAGE /� z HEIGHT OF FOUNDATION 7! /O A THICKNESS /o IS BUILDING NEW J O yeG SIZE OF FOOTING /0 % 30 ' V IS BUILDING ADDITION vTJ MATERIAL OF CHIMNEY -Zee p /?lC'eeye e S IS BUILDING ALTERATION 0 IS BUILDING ON SOLID OR FILLED LAND C•�0 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE e IS BUILDING CONNECTED TO TOWN WATER S BOARD OF APPEALS ACTION. IF ANY A/0 IS BUILDING CONNECTED TO TOWN SEWER N� IS BUILDING CONNECTED TO NATURAL GAS LINE e 5 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST O1 0 O SEE BOTH SIDES _ v EST. BLDG. COST /✓C O / Q 00 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PERSQ. 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REG ATI NS t PLANS MUST BE FILED AND APPR 7pVEAD BY BUILDING INSPECT R DATE FILED BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENTopzr F E E t OWNER TEL.Al J SsY�` PERMIT GRANTED CONTR.TEL X 690 - 6 55 0 ` » 9O BO`S 9',3 CONTR.LIC.X H.I.C.l 1✓�ie %�a»rzzza�zroeaG�IL O����JJIICIldJeflJ I; DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number:;. Expires: Birthdate: CS 905693";'01/13/2000 01/13/1954 Restrlfted Tot_.„ 60 DAVID A; KINDRED 30 MILL POND POB% 531 1 N ANDOVER, MA 01845 15 6� cc Restricted To: 0@ I 00 - 35,000 cf enclosed space (MGL C.112 S.66L) j IA - Masonry.only A - 1,6 2 Family Homes ( ! Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. f FORM U - IAT RELEASE FORK 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: �f'OdiGw h'v�t/�C`. d,qt S Phone O 4 5 � LOCATION: s A__assor' s Map Number / Parce; Subdivision �Oa�U�CS/ Sl.��f5 Lot(s) /® Stree} - C DOyC� /�Cjy St. Nu:.�er Use XRECOATIONS OF TOWNAGENTS: Date Arcroved 1�'�_cn Ad-_nis tr( z--r Dame Rejected �C Date Approved T wn Planner Date Rej ec:ad Com:^er. Date Anmroved Fcc,d _ns6-451. th Date Rej ecmad A (� Date Aptrcve•d % ins -:E--r-H e-al t Date Re-iec:__ r Wcr�:s - se:•;er/waz=_r ccnnect_ons - drive= ay pe=41-- 7 z F_re De=art-e_n-- -2 - 0���90 Recsi�ied by Building Inszector Data NO 823 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. �' Z 1Q09 Application by the undersigned is hereby made to connect with the town water main in Bf"o L,� Street, subject to the rules and regulations of the Division of Public Works. \\ The premises are known as No. �� ('[� U L eW �!'l Ue' Street or subdivision lot no. l� –�5 -8 /1 E Owner Address Contractor Addres �- p I i nYs S i g nahr6e 4 PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to rack U to make a connection with the water main at 13(-x`-tl Ute-L ) �f t J Street subject to the rules and regulations of the Division of Public Works. ,Bo rd o Public Works By Inspected by Date See back for rules and regulations RULES AND REGULATIONS GOVERNING THE INSTALLATION OF WATER SERVICES 1: No persons shall tap or in any way tamper with water mains which are part of the distribution system of the Town of North Andover without a valid permit from the Division of Public Works. + 2. All water services shall be installed a minimum of five feet below the finish grade. 3. No water services shall be backfilled without inspection by a representative of the D.P.W.—Telephone 687-7964. 4. Service connections shall be 1" type k copper tubing. 5. All fittings shall be brass flange type Mueller or equal H 15202 Corporations H 15212 Curb stops H 15402 Three part unions H 8185 stop and waste valves 6. Curb boxes shall be installed at the property line and shall be of the Erie Type with 4�/z foot rod and brass plug type cover. TOWN OF NORTH ANDOVER. MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. Telephone(978)685-0950 DIRECTOR Fax(978)688-9573 N0 R'r ? a O 0n,�r. ii+4�Yt%i� R Y r s �9SSACFHUSE�Sc. DRIVEWAY PERMIT DATE u 61 LOCATION F BUILDER phone OWNER 9 �cN2T( ttort hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. MAScheck COMPLIANCE REPORT Massachusetts Energy Code ; Permit # MAScheck Software Version 2 . 0 Checked by/Date i ' CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 10-5-1998 DATE OF PLANS: 10/4/98 TITLE: Lot Brookview Dr , PROJECT INFORMATION: Brookview Estates North Andover , Mass . COMPANY INFORMATION: Brookview Country Homes COMPLIANCE: PASSES Required UA = 720 Your Home = 509 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 1768 38 .0 0 . 0 53 WALLS: Wood Frame, 16" O.C. 1381 13 . 0 3 . 0 98 WALLS: Wood Frame, 16" O.C. 2184 13 . 0 3 . 0 156 GLAZING: Windows or Doors 246 0 . 350 86 DOORS 78 0 . 350 27 FLOORS: Over Unconditioned Space 1872 19 . 0 89 HVAC EFFICIENCY: Furnace, 90 . 0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans , specifications , and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code . The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC eq Tent selected to heat or cool the building shall be no greater t 12 % of the esign load as specified in sections 780CMR 1310 Builder/Designer Date Q � MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 ` Lot Brookview Dr, DATE: 10-5-1998 Bldg. ; Dept . ; Use CEILINGS: [ } ; 1 . R-38 Comments/Location WALLS: [ ] ; 1 . Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location [ ] ; 2 . Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ J ; 1 . U-value: 0 . 35 For windows without labeled U-values , describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] ; 1 . U-value: 0 . 35 Comments/Location FLOORS: [ ] ; 1 . Over Unconditioned Space, R-19 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] ; 1 . Furnace, 90 . 0 AFUE or higher Make and Model Number THERMOSTATS: [ ] ; Adjustable thermostats required for each HVAC system. AIR LEAKAGE: [ J ; Joints , penetrations , and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] ; Required on the warm-in-winter side of all non-vented framed ceilings , walls , and floors . MATERIALS IDENTIFICATION: [ ] ; Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values , glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] ; Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ] ; All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS: [ ] ; Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] ; Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 . 4 . MISC REQUIREMENTS: [ ] ; Refer to 780 CMR, Appendix J for requirements relating to swimming pools , HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems . ----NOTES TO FIELD (Building Department Use Only) ------------------------- � r10RT . Town of �__- - over * dover, Mass., 191 a Q s LAKE A 94:c0CNJC" WIC 1 1 �S Oq4 E o-►PP` '� �G BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... QQ.. ....V.i. ......�Q..V N..... ......... ........Q Y�!�.�.�..g.................... Foundation has permission to erect..............I ............. buildings on � ..�o..( �I.a.� 13t;!Q1eU1*w Do. Rough to be occupied as....�, .N.. .�.' ... .�!!141.. .....R!! �.l.I�+Ict......a.... �1 ...... Ili1. ... Chimney .to .. . . provided that the person acc4ting this permit sha I in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings In the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough R cCW4 1 Oa b a Final PERMIT EXPIRES IN 6 MONTHS � ELECTRICAL INSPECTOR UNLESS CONSTRUCWU S T � Ilij Rough ........... ....... ...................... ............ ... . Service .. .. .. ..... ...................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. INV END TRENCH 1.2 .$.0 }y . . . . ` INV 6GN TRf=NCHZ. 128.50 .. '� T . ,: r' .. 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A r 7±.' �11 Y'," a •.,i' 4'� ; MY„1. - '; a . f ern r :s tk�t'r` i, s.4 r y<.'t 1 3Qs 5 t fes' a lis r �} "41,1e L , . , . r 1' .* 3 ' }s Rrt' ":. f k4.N.r t.fir, I 11 'j , OCT - -30 -3# 8 FFZ I OPEN SPACE w. 40�'. C g* 100 FT, WETLAND BUFFER LINE 200 FT. RIVER ZONE )IN BUFFER LINE to n 10 37,830 S,F. 0.87 Ac. Z NSFEkISnNc; LOT 11 1 f FOUNOArION N/F LOT 9 e4. Pit 4,702 24 L i 7 P 11> BROOKVIE Nps, 5rIj Ij 9/99 DRIVE 8 TEELE EN No. 3048 ps!as% llq lvosu� WE HEREBY CERTIFY ':'HAT WE HAVE EXAMINED THE PREMISES AND 'THAT ALL APPARENT EASEMENTS AND ENCROACHMENTS ARE LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS QVIRPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED, ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, SY AN INSTRUMENT SURVEY, THIS PLAN COMMUNITY .1-1 -- ^ �PA�NJELNO, --- 2500J8 0009 0 ,1 :. ... ' - t : f.1 ....... ... _ - .. 3 .._t- bq A, .. A , s. ZT CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number Date TH/IS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS t AIM P4 SAN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. o1 "°"'",ti CERTIFICATE ISSUED TO —Boo OOL 1,rt J roy4WOMP Is ADDRESS / ,NOwot - . o Building Inspector t Town ofoVe r No. s, Al * - dover, Mass., D 191 � z LA E �O'9A_C OCHICH E WI CK '9 SAA T E D APPS `J BOARD OF HEALTH Food/Kitchen Septic System . , , PERMIT T : � N. BUILDING INSI�ECTO �92 THIS CERTIFIES THAT...3raoKuie.w,. . . ....... Q. ...... .�......... ........o.l .��..g. Foun ation has permission to erect..............I......................... buildingg on ..�Q..� �I. .�.... .f`go 911W...Dp. Rough",14/?l to be occupied as....5.1 lPIC! a �� r9 h Chimney .N. . ... ! �� c .d..... .. ' ...... ......4 .......................... provided that the person ac c4 sting this permit shaa i in every respect..conform......... ....t.o the terms of the application on file in Final oZ J Sgt this office, and to the provisions of the Codes and By-Laws relating to 'he Inspection, Alteration and Construction of l Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOL4TION of the Zoning or Building Regulations Vrds this Permit. Rough •�� Sl!►�,•,~� PERMIT EXPIRES IN 6 MONTHS iECTitic ` E UNLESS CONSTRUCTI S JT C ou / � GGGi ............. .. .... Se ............. ........................ ............................................ j BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Conspicuous Place on the Premises — Do Not Remolr� Rough Display p Y in a Cons P No Lathing or Dry Wall To Be Done Until Inspected and Ap"Proved by the Building Inspector. RE DEPARTMENT ;�A4 4 /w Burner C� Street No. '� ♦ w"�/ Smoke Det. 3 0 u 8 Qw. ie ter?• /.�. .. QIHd 00.5E � .. c NORTH TOWN OF NORTH ANDOVER a r PERMIT FOR GAS INSTALLATION � D 1 SSACMUSEt �n Cll This certifies that . . t �f; ? �. . . . .C� .`. . :. . . . . . has permission for gas installation . . A-.e. . in the buildings of . . . . . . . ��.�..�. ►. . `. . . . • . • • . . . . . . . . . • G C!�� l C ,at . .� . .�. :.��.l'z . �. . . . . . . . . . . . .. North Andover, Mass. Fee. . Lic. No. . . . . . . . . . . . . . . . . .. . . . . . . .. . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer f+�.ASSACHUSETTS UNIFORM APPLICATtOM FOR PERMIT +O O GASFITTING s (Print or Type) NORTH ANDOVER Mass. Date f3uiidin9 ovation \ 1('7_ ���' V� Permit Owners Name New Renovation Replacement Plans Submitted FIXTUo_c rn as W � :y es .o 0 w y -A 0tu m to uar u�t Q a s w 4 y to tts W 0 ut < = � � "' Q to t" to w w o T U- 0 td O O d to > C w .r Q G < ¢ O O t W O tet - tc v v t: a ca c� c{I a• c� o.t ►- o j) • '• Soft--SS•.tT. i ! 1 � i � t � t t � � . . [2A—SEMEMT { IST FLOOR ZHO FLOOR 3RM FLOOR 4TH FLOOR aTfi FLOOR GTH FLOOR 7TK FLOOR srif FL OR (Print or Type) �^ Check one: Certificate # Installing Company Name � � ,SV Q Corp. Address Partner. Firm/Co. Business Telephone: i3 -3:g�eyq:7 \ Name of Licensed Plumber or Cas Fitter iUAt�c� In.surance Coverage: Indicate the type of insurance coverage by checking the. appropriate box: Liability insurance policy Other type of indemnity 0 Bond Insurance Waiver: I , the undersicned, have been made aware that the licensee of • this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent i hereby certify that iii of the details 2nd WormUion f hale submitted (or entered)in above application are true:rd accurate to the best of lay k.-towtedse and that ati p(urnbing wort[ ind tnstatlatiotts Jaformcd under Permit issced Co: this apPHution will be to ootoplianee wittt an pesifueat Provisions of the lvtatsachusetts State Cas Cade stud Qapter 142 Of L Cer:erat Lava. By YPE LICvNSE: —C��OadlF Plumber TivIeGasritter Signature of Li nsea City/Town: Master PZumbez or Gasfitter Journeyman APPROVED (OFFICE USE ONLY] License iiumber i .�+►��/'9s�.,l"i/+....--.1(ra--.`r•'7�`r..YK'i'"'..�. ..- - - �-� � .. ..�.'r�Yom'. .�r.r•....�.-..�-.. ,-�- --�.`.--�. Date.,/! .`� . . 3874 // ` 1 NOR71y } a',«�� •�"o TOWN OF NORTH ANDOVERY 3? saw ...• •� C� ti p PERMIT FOR PLUMBING SSACMUS� This certifies that . . . . . . . has permission to perform . . . Y'� . .t-A�w' . . . . . . . . . . . . . . . . plumbing in the buildings of . . .0' `— at. .�,/. . ./. �.u. 9.A.-.U.11 ! . . . . . . . . . .. North Andover, Mass. Feed?.j, -. .Lic. No..,�3.0. ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 11/30/98 14:59 225.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer L MASSACHUSETTS @� IXFOVIM APPILQCA1 tOt�.E-08t ��o����� .'� O 0 l'[,•t.lM131N a (Type or Print) NORTH ANDOVER ,Mass. ' Gate: �1 ,g' • � � �_. Permit Building LfiCa�iQC4m��d - ) 7 Owners Name � New Renovation Replacement Pians Submitted `'`ova•.. �-<_ • of X Y_ __-- :4' Z w w tJ _t k^ d v l Z ® g V- 03 $� i o cmlt Imo- u�c ai Imo- t» x rn x .j as — m m x o m a to a rn ? a °' w C& Q tri Q o .z a a cc W 7C d �. O a. z X Y n v H Q = w M lid tsr > f C7 } f- o (a � v7 0 z v Q of Z - w @- O v x ac -s m oz a es -t ' r,- LZ C1 C cc to 0 / S 1t S"S S M T. BASEMENT QST FLOOR I I 1 2tin FLOt�R IM 3R FLOOR 4TH FLOOR t HT STH FLOOR 6TH FLOOR 7TRFLOOR STH FLOOR] _ (Print or Type) Cl-ieck one: Certificate Installing Company Name Sa S � � Corp. Address l �� �/ ,•.� �'j Partner. Firm/Co. Business Telephone 66--j3agsmqj�ky_T\_ Name of Licensed Plumber: a i) � - _- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [--] Other type of indemnity 1l Bond 0 Insurance Waiver: 1 , the undersigned, have been made aware that the licensee of ' This application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent I bereby certify that Al of the details and information r Marc submitted(or entered)in above 2pplivlion ace true snd accurate to the best ct uty krtawtedgc and that all piunlbing work and installations l.errormcd under t,crmi(itsuc<i for!iris application Will be in wmpliance With 211 pertinent pro- of lim Mazsadwtetts state riumbin(l:Code and Clupter 142 of(lie Ccncral La-1. Titlib- . Signature of- L i�:ezn:�ed�- Iuinber Y Tvpe of PIiunlYlastar License APPROVED (or-rrcr use cittt_y) T.i.celise Number D :7ou5rneyalarl 31 1 1 Date.f 2 / ... r NORTH TOWN OF NORTH ANDOVER 3?p,`41�ao L O PERMIT FOR GAS INSTALLATION f D s i, • ♦ "a ,SSACMUSEt This certifies that . .. ... .. . .. . . . . . • • . • has permission for gas installation . `. . . . . . . . . . • . T� in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at ��'� : `' `` ` `� . ., North Andover, Mass. Fee ?. . . . . . Lic. No. 319 . . G `, } 03/01/99 09:15 15.00 PAID/ GAS INSPECTOR PAID/ , ,/77 Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) V 61 Mass. Date 5/ 19 g s Permit # Building Location fI4 ,8 ut v/Fw S r Owner's NameC j05RXL LS14 /`C Z'R X Type of Occupancy k New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ m I c to W N Y Z ¢ N GN N N Q N Q O N S f- W J N W O U m ►� S n z o u a ¢ ¢ o M o z ►- y W O d c �+ q G N C7 W < = z ~ C W W y Q D Z < W C7 ¢ > LL !- V J h W Y < W J Q C ~> LU Q t O O W G O rJ M' a¢ '= O C7 2 LL 3 G C J U c > a a. O BASEMENT f 1STFLOOR l 2ND FLOOR 3RD FLOOR _ I J 4TH FLOOR f STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR , l Installing Company Name �O> t Check one: Certificate Address b-*? M o R t L yIV ie n ❑ Corporation RP tqG V ly�, p2 S S a�d�' ® Partnership Business Telephone S� 3 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter U S Iz Pd t:,` ° INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes & No Ll If you have checked Les, please indicate the type coverage by checking the appropriate box. 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 Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owners 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 the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. -Q 7)' By T of License: �� �'^ �/✓e�+�+' � Plumber &gnaturtAbf Licensed Plumber or Gas Fitter Title Gasfitter f 3 Master License Number e City/Town Journeyman APPROVED(OFFICE USE-ONLY) I Location t No. Date TOWN OF NORTH ANDOVER • i Certificate of Occupancy $ �'�s'•^°'tl�' Building/Frame Permit Fee $ ncMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3�� Check # /aC 1643 �- Building Inspect TOWN OF NOR' "EI ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. �J-91/ DATE ISSUED. _ _ 003 SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: (� Map Number Parcel Number (h 1.3 Zoning Information: 1.4 Property Dimensions: pp--D �s C30 Q i o 0 P -i- 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 SupplyMG.LC.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record r 1 Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone M SECTION 3-CONSTRUCTION SERVICES 70 3.4 Licensed Construction Supervisor: Not Applicable ❑ D�K C nu-c i)o n ✓�-1 Qensed Construction Supervisor: Z0 � O 16 E on ey S a r� (1 License Number aan A ss D — 2. -7 -' -2- 00 C- L Expiration Date ica to Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name 17- t9 `T rn Registration Number r Address '] o4 z Expiration Date Signature Telephone !1/ s SECTION 4-WORKERS COMPENSATION(IVLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. —Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg.' ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be Oftlt AL U Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of � �1 Construction !/ 3 Plumbing Building Permit fee(s)x (b) 4 Mechanical HVAC O 5 Fire Protection 6 Total 1+2+3+4+5 a rj d 0 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT r I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 0e/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM Sc W_ N INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT �A� Qa��t '`b°� `�•} PHONE —�Z k-r-- L,6$-(09-l LOCATION: Assessor's Map Number PARCEL_ 1 0 SUBDIVISION r'oo Klr i LOT(S)_ STREET_ kc �r a ST.NUMBER_ l ************************************OFFICIAL USE ONLY*** ** ** **** *** * * REC MENDATIO TOWNAGENTS: CONSERVATION ADMINI ATOR DATE APPROVED Q ' DATE REJECTED COMMENTS .' TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FO INSPECTOR-HEALTH DATE APPROVED L C DATE REJECTED SSE� IC INSPECTOR-HEALTH +� DATE APPROVED 7�ti DATE REJECTED if nn COMMENTS &I / I�a1 sn1 t=� 5 S'CC� r/�e NocD r p -5- PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DA TE____ Revised 9197 jm Alexander MacDonald' -Prop OSd� No. P.O. BOX 2.61 ECIFICATIONS Nutting Lake, MA 01865 AND ESTIMATE 667-8961 Page No. of Pages PROPOSAL-VBMITTEDTO PHONE DATE n STREET JOB NAME CITY,STATE AND IIP CODE JOB LOCATION Q,. VN-"j Ax j e- t--' ARCHITECT DATE OF PLANS JOB PHONE We hereby propose to furnish materials and labor necessary for the completion of: 1 e�. —t �, h 011c.�-2�l �o M-4-�-� ��CiS�'+�5G �t' � -,+y c � ri7 cs�: t>J f,"� Sy 4\-e Z) -4 `;-- Cc tj ��0&-e C- 0 U ek:s-�-c ts:��, �e�,1� YY-e V,,C L9 v'a1 d� v� t cya 7r N. -2 S ,1_ �'(`i w\ `tyIX G C� 4 't;\, :J f C-",—,k k L!3 Como,r.! c� �'�r� u% A- \i S `r� IL Q1- 4e- 6. C, ;tiv �r� rclS t✓ 1�t n t YY\ r d Z (L�ti'ir\ t�rtiln.p SC-m-.?q\ KOCDV2S Lk r c C-eSS �I Loa V-Y—'(' S Lq -ala \a, a U 2) a 1�1 C, -t'Y,\ t 3 .1 Chi.,e r d:-E c:'� 9 (� a a i tj A k ) 1 111C— V A�P—A U 0 `-e S -A (K A GK AL, o-k 0'a ,--V t4� e �f� WE PROPOSE hereby to furnish labor-complete in accordance with above specifications,for the sum of. Payment to be made as follows: dollars($ ). All work to be completed in a substantial workmanlike manner according to specifications submitted, per standard practices.Any alteration or deviation from Authorized above specifications involving extra costs will be executed only upon written orders,and will become an Signature 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.Our workers are fully Note:This proposal fttay be covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are n satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment will be l made as outlined above. Siff"r re Date of Acceptance: Signature Alexander MacDonald Itop0 1 No. PO. BOX 261 ICATIONS Nutting Lake, MA 01865 0 AND ESTIMATE 667-8961 Page No. of Pages PROPOS4 SUBMITTED TO PHONE DATE STREET -� JOB NAME CITY,STATE AND ZIP CODE ga JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby propose to furnish materials and labor necessary for the completion of: �2d.�� cr`. 10 x�� � K�� sur 14 e'�•�-�ri�c�✓�'� iS,� ; h1'�. � c�l:wt� l�S ^Q v t 4-+ utp pi,% �-w .,v J S i vy\� , r c_h C,� tT�elSuL- a 't--eec� �\ye—\C.,U�v _ ` Q — ars aP� l�ibN � 4-t, ;1� 'i to Eei`;ar l ,���C 1 cvc�f� i►viS� �c� w�T� w c+Ci C', b V-e V- j b z;,-r- o y'- V, l0..1 0 w;n ep- rn e, j rte' 2 r%u t- e>.A .A yJ� w ,A-eh ht �V e o'%►A-.? ty e p u \-J- L-e-S b V--,D -e WE PROPOSE hereby to furnish labor-complete in accordance with above specifications,for the sum of: ). Payment to be made as follows: dollars(S All work to be completed in a substantial workmanlike manner according to specifications submitted, per standard practices.Any alteration or deviation from Authorized above specifications involving extra costs will be executed only upon written orders,and will become an Signature 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.Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are- _ I satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be Signs as outlined above. Date of Acceptance: Signature Alexander MacDonald' •f"O OSd� No. P.O. BOX 261 1SPECIFICATIONS Nutting Lake, MA 01865 AND ESTIMATE 667-8961 Page No. of ages PROPOSAISU\ ITTED TO PHONE DATE STREET JOB NAME 41— CITY,STATE AND IIP CODE ^ (� JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby propose to furnish materials and labor necessary for the completion of: YZ pip u i fJ \L¢S 5 ✓� �t7 2 D N 'Oe— WE PROPOSE hereby to fmmish labor-complete in accordance with above specifications,for the sum of: 4� ✓ 'moi ,�'�'� 1 d. dollars($ � \ ����!�Li�). ayment to be maoVas follows: r?1 ,-1 D© b�eS-�� 410.U u 0 i r--Ve r- (-O v-vt k�l"C 2 S P "1 . it r,O a s N 1 r?S �'S O t-)0 i�,4Z-'C-e-r F%VV All work to be completed in a substantial workmanlike manner according to specifications submitted, per standard practices.Any alteration or deviation from Authorized above specifications involving.extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry Jim tornado and other necessary insurance.Our workers are fully Note:This proposal may be covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are. paw, satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be Signal as outlined above. Date of Acceptance: Signature 4- o ENTEA DATE 6FTRANSACTION NOTICE OF CANCELLATION You may cancel this transaction,without any penalty or obligation,within three business days from the above date. If you cancel,any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be returned within ten business days following receipt by the Contractor of your cancellation notice. And any security interest arising out of the transaction will be cancelled. If you cancel,you must make available to the Contractor at your residence,in substantially as good condition as when received,any goods delivered to you under this agreement;or you may,if you wish,comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expense and risk. If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make goods available to the Contractor,or if you agree to return the goods to the Contractor and fail to do so, then you remain liable for performance of all obligations under the agreement. To cancel this transaction,mail or deliver a signed and dated copy of this Notice of Cancellation or any other written notice,or send a telegram to (NAME OF CONTRACTOR) at (ADDRESS OF OONIRACI'OR'S PLACE OF BUSINESS) NOT LATER THAN MIDNIGHT OF • f4\V r`\ 0 X0 o (DATE) I HEREBY CANCEL THIS TRANSACTION. (DATE) (OWNER'S SIGNATURE) (OWNER'S ADDRESS) [Two copies of this form to be attached to the Residential Contracting Agreement] H-GG 25M 6/92 North Andover BuildingDepartment p ment Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with.the provision 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 c11, S.150A.. The debris will be disposed of in: Jz 114 f�f� ke-w eYl '(6A 4-Ji-w evel,6 (Location of Facility) Signature of Permit Applican Date (COTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector U M The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations w� Boston, Mass. 02111 °+M 5�•''� Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City -NcXt� kL- Phone # I am a homeowner performing all work myself. 1 "I I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City- Phone#. Insurance.Co. Policv# Company name: Address CI . Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonmerntass welLas_civil.penaltiesinfhefomo-fa-STDPWDRKARDERand_afine-of-($IW-DD)sslagr,againstme 1 understand that a copy of this statement may be forwarded to the Office of Investigations cf the DIA for coverage verification. 4 I do hereby un the pains and penalties of peqiliy that the information provided above is true and correct Signature Print name A, AJ Piet Official use onlydo not write in this area to be completed b or town off�ial' �P Y�Y City or Town PermitAkensing ❑ Building Dept ❑Check if immediate response is required 0 licensing Board ❑ Selectman's Office Contact person: Phone# ❑ Health Department ❑ Other JLC VOO)YI1L077,LGPp/�L �q/Gq,Qap�llC6Q�6 -Board of Building Regulations and Standards ' 'HOME IMFROVEMENT CONTRACTOR Registrations-':121945 Expirations_7/1/2004 =Type:-`Individual JOHN C. MACDONALD JOHN MACDONALD 16 EMERSON RD. � ,, WESTFORD,.MA 01886 A �itaiF* .,r i Wiz_ BOARD OF BUILDINGAREGULATIONS F License: CONSTRUCTION SUPERVISOR Number: CS 012005 i { x Birthdate: 08/27/1947 j I Expires: 08/27/2003 Tr.no: 5749 Restricted: 00 JOHN C MACDONALD 16 EMERSON RD WESTFORD, MA 01886 Administrator I I RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged in home improvement contract- ing,unless specifically exempt from registration by provisions of Chapter 142a of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108. Designated Registrant's Name: Registration Number: Salesperson's Name.- This ame:This agreement is made on 14 r�.\ 11 _ JN,60 between - __So V\^ +L c vv\c { (DATE) (CONTRACTOR) q (ADDRESS) (PHONE NUMBER) hereinafter called"Contractor"and (OWNER) (ADDRESS) (PHONE NUMBER) hereinafter called"Owner". I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: 7-4, +0 l%e,r- 2 A 6T- kxo u ma:6 I fue f X4'4-t tV a u`: tt� 2z.r `S�cLpSQn�` Decd% L�P�-k —�j, aN e+ k SE �. fnso6!� -)-+(-to +0 'rl'1q�' S �TtiS4—,% �tiy5 �Ju.�t�l �Q1t��E�QI wti'*4 �-Cil�}_1�rL�1tl� i DETAILED DESCRIPTION OF MATERIALS TO BE USED Materials to be used in performing the above described work consist of the following: Its ( i_uPnip, r !t•rv�f� C2&ar— c &Xe< . 1 tje_ �VV1 II. PRICE Contractor agrees to.do all work described in Section I for the total price of 0© � Q. III. PAYMENT Payment will be made as follows: f 3 3 1/31 %($ Qt`lb�•° upon signing Contract; elo, h % ($Ugi 0 00s' upon completion of FrvA-V. 5 Kz mgles % ($ t o 0 O &)°upon completion of and the remaining %($ 0 upon verification of the work by Owner and Contractor as having been satisfactorily com- pleted,which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about. �6001(date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by 3'tt�g 3cLA 3date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in Section III(Payment)above for the reason that he deems himself or the payments to be insecure.If,however,he deems himself to be insecure,he may require,as a prerequisite to continuing the work described herein,that the balance of the payments under this contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INS RAN U CE Contractor will be responsible to Owner or any third party for any propertye t damage or bodily injury caused by himself, his employees or his subcontractors in the performance of,or as a result of the work n Pe under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that,notwithstanding any agreement for materials and/or labor between Contractor and a third party,Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. VIII. CONSTRUCTION-RELATED PERMITS The following construction-related permits will be necessary in order to complete the scope of work included in this Agreement: The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies,authorities or individuals. Notice: If the homeowner obtains his own construction-related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment and nonpayment of the contractor,the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A,M.G.L. IX. MODIFICATION This Agreement,including the provisions relating to price(Section II)and payment schedule(Section II1)cannot be changed except by a written statement signed by both Contractor and Owner. However,cancellation by Owner is allowed in accordance with the Notice of Cancellation(annexed). X. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of - u-f-9.;r-- following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remedy,repair, correct, replace, or cause to be remedied, repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment,which shall be and are hereby passed through directly to the Owner. Under such manufacturers'warranties,the Owner may be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation,which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the owner specific legal rights,and owner may also have other rights which vary from state to state. Under Massachusetts law,sales of goods carry an implied warranty of merchantability and fitness for a particular purpose. XI. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void,deleted or not applicable,and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER This Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate,and an original signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the owner of a copy thereof. RIGHTS TO CANCEL The owner may cancel this agreement if it has been signed by the owner at a place other than an address of the contractor which may be his main office or branch thereof, provided that the owner notifies the contractor in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. dwner-'s Signature Date Signed c is Signature Date Signed H-GG 25M 6/92 I � 1 � yr !r t II ' e • �� .._..a.«...,,.....a. .: .,.M�:.,::,,.w..��,:.w,r....,.y,.,,..mow.... y..' .. i 4 C i R � wr•.�..�.r..+� ( �I I� '� tI ' �/1'�^~fij�+/ ' f F,Q"::ii, Y.��d )live- 3/INQ-3✓/ ZxCo 5 { $R�YH RU©M ,/.L �vx 5 _ --- . f - ...�...�..�r.. v....n.•.-nrv..w._w - .,wu.:..nwr..wu,m,ww,u.._,._.•Feu..,.....,...•,..•.�,r.��revewn•+ra wrra� T'y P.I 4 ! r Lot�T `a ---�— 30 y L Rrcfn , S1'��'Ne�teS I Y8 NC 10 /f2- k f LO pC � f T LAquo t3dtra. C stff4;My �W- j- 3? i s' r i v 9 9 1 s 'a to r t 1v6the 12-' A 2-t' Dee, K nTT Nr,4ET> 70 r CCE 9 r f � cZ t+J oause 40 i r s � x _ .. ...- � - q . AS TI Iv On 2 ' X. O G ---------- Ole_ x. }F — _ ire Q f4 000, v a ,, ` � ry I A " G ., ......-..,..,,..,..,.......„..�_._..._.'-__._ ..-....._tel . . ...,.W__......_ _a ...._._..._.,...._� _ yk � ,.. .,.,,......... .. ,fit•3 Ct 9 p 4 a r t/ fop Y .a 00 i 7 , NORTH Town of Andover 0 ti N o. 0 C L A dower, Mass., ` -3 _ 07003 SQA C -C 0"Z?ATED5 H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....;74./.........0. ... ".0`04.................................................................. Foundation I has,permission to erect....)Al�.*4**4'*' buildings on .............................................................................................. Rough to be occupied as.101.C-.Kft... P.4p.ft.k......11P.I.C.11-0....KID1...CA.4.10M Chimney ........... .... ........ . .... ...... .......... .... ... ... ... .. .... .... ... ....... ... ... . .... . .. . ....... ............. ........ .. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 10 340' 4v 1116 #3'&*tK PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 'A Rough U40a .............................................................................................. Service 77 BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date..� ... .. NORTH Of 1 o? °` TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION 9 SAC�MUSEtt This certifies that . . . . . . . . . . . . . . . . has permission for gas installation . . . /.. . . . . . . . . . . . in the buildings of . .13 !? A. . . . . . . . . . . . . . . . . . . . . . . . . . . . at .. . . . . . . . . . . . . North Andover, Mass. Fee. Lic. .GAS INSPECTOR Check# 4392 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ° (Print or Type) • 64 A/464 UCZ , Mass. Date 6--La 1V,2A&_-'1Permit#� 3q L Building Location �1� ,CJ.P�yI/iCU ��t t16 Owner's Name Z1_ ,2�y —�X Type of Occupancy New Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No kg-- U) cc Y W a) U) U) V Z a:CC cn U) W F- m Z g x Ir Z CCI— Q } Z z O W cc m U Lu w w O a O w ~ Cr a W W x w Q Cl)a: > Lu W W Ir Z Q W Q a: F- w v7 Lu O Z O ~ U J � W W it x 0101 2 U_ 5 � o 0 O0 M > o a- H 01 1 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR /1 Installing Company Nam A 14r✓kk[�D1JVE//� A L-6zV, Aj:! Check one: Certificate Address ���9b" /P/AM- �A�k�7_ ration / "d, �L�L'L/Y��/!�7/E�� //�J d�� ❑ Partnership Business Telephone �7p-4,57 18�d ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current iabihty insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy 01_/ Other type of indemnity ❑ Bond ❑ OWNERS 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: Owner ❑ Agent ❑ Si nature of Owner or Owner's Acient 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 PPermit issued for this knowledge and that all plumbing work and installations performed under the P application will be in com lin pace with.all pertinent provisions of the Massachusetts State Plumbing Code Chapter 142 of the General Laws. _ r By Type of License ❑ Plumbers Title p Gasfitter `Sinature of Licen a Plumber or Gas Fitter Master City/Town Journeyman License Number /daa6 APPROVED OFFICE USE ONLY) Date. 7. -.�. Q" ,.ORT/y TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSAC14USEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . 1 Jl r U . . . . . . . . . • . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . If at . . .��. ./�.R°.`. . . .`. ... . .�.�.'. . . . . . . ., North Andover, Mass. Fee. !K. ': <. .Lic. No..? 1.4 .(c.. . . . . . . . . .� . . .1 . >-�"... . . . . . . PLUMBING INSPECTOR Check # / 2 5 r 5643 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 3U Q Building Location \�Qc> t -ou&j I-r vp ba j,�e—Owners Name Chemo k— Permit# s y� CC'j` - ?�»-/0 7�0®t� Amount Type of Occupancy New Renovation ® Replacement ® Plans Submitted Yes E] No FIXTURES A STSI�419C R iS Vi'NT ISS FLOQ2 2M KfM 3M FI OCR 4IH FIOCR SIHFU= 6IH FIDM 7IH FIOQ2 SIH FIOCR (Printor type) r. Check one: Certificate AlInstalling Company Name b/�( 1 1 ( � a /n Corp- AddressEl Partner. Business Telephone ❑ Firm/Co. Name of Licensed Plumber: Atn Insurance Coverage: lndicatethefTTeof insurance coverage by checking the appropriate box: Liability insurance policy ❑ Other type of indemnity D Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above t insurance G .. igna Owner 0--- 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 in ations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac State PbAbing C dter 142 of the General I aws. BY signattWof UZTj Type of PZ bing License Title `Z City/Town License INUMDer Master ® Journeyman APPROVED(OFFICE USE ONLY •rM 1 • O ` G4 Town of ' NORTH ANDOVER BUILDING`P�RMIT INSPECTION REPORT X PERMIT NO.: PROJECT: C-) X14PECTION DATE: 11117 UNIT NO.: FLOOR: WING: BUILDING NO.: REMARKS: i Ylrc OT 0ves�, '� wv�Lh T- �1a e i Cj e� �� dT C2 G, F L3 4 /\ � aStw•eivT �-AF,',i rs ,' v&t h C fc(C P-)y '� T` Cj c f w ci �e 42fk C(4-e��- tu b-e Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# Inspector Inspector Inspector Form#995 Action Press,685-7000 Date..... l�.!.....P..-3.. 10 NORTH TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ACNUSE� This certifies that .........AU.C.A.-.........� /� C . .... ........................................... has permission to perform ..... p ...!" 5..`-"........................... wiring in the building of c//�? /6. L at.......I1...5......6roakLe-rp�.....� ..:... ,North Andover,Mass. Fee....5..�....... Lic.No ALQ 30f. ......... ..... ELECTRICALINSPE. OR Check # 46 ,,L ; Official Use Only / Permit No ae�4rtn�ext°6 pu8!!c Saaet*y I Occupanc &Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 52.7 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. I ib + c � Location(Street&Number --fp'r �kA 3 l-Q-P ._.�.� Owner or Tenant c _� Owner's Address Is this permit in conjunction with a building permit t, Yes ❑ ,(/ p No ❑ (Check Appropriate Box) Purpose of Building L .!IJ 0.' Tom' d O(L C Utility Authorization No. L Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 6,611 aX ©D e- I..>a Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ gmd ❑ 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 C'ond Tons Initiating Devices Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers S ace/Area 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 Sions Bailases Wiring N Aiydro Massage Tuds j 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 = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough /r� Final Signed FIRM NAME rthl Pepal spf perjury �!�� �� [ LIC.NO.__a Lf�ensee Signatures rLIIC.NO. AD �� Bus.Tel No. % O a Address (� 7 O W L td Aft 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) �. . l � V== Telephone No. / 1ybea6pt PERMITfEE ignatu of Ow or Agent) a The Commonwealth of Massachusetts d Department of Industrial Accidents }% Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity UI am an employer providing workers' compensation for my empioyees working on ti-his job. Company name: !�G5 T� lr !moi 6ji1 G S•� 211✓.L� Address 8© f'_70 City. to / L-A j/V W i 0/y Phone# 9� Insurance.Co. Policy# Company name: Address City: Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the W posdion of criminal penalties of.a fine up.to$1,500,00 and/or one years'imprisorxrient_as well_as_s:i M42enartieslr:-thelzm-to-STOPYNK) ORDJEid and_afine�f�$1110 DD)a�ajr�yaiastme 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under the pains and penalties of pequiy that the#Mxmation provided above is true and correct Signature _-_Date _ q Print name Pbone-# Official use only do not write in this area to be completed by city or town official' City or Town Perrnrt/l icensing. Building Dept ElCheck if immediate response is required E] Licensing Board E] Selectman's Office Contact person: Phone# El Health Department ❑ Other j