Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 119 MARBLEHEAD STREET 4/30/2018
-119 MARBLEHEAD STREET 210/00_g�0-0p�0�0.0 .ate .� - ,;. RECEIVED Butter 10*rt �. '1(00fe.., Inc. SES ADJUSTERS/APPRAISERS TOWN OF NORTH ANDOVER FOR INSURANCE COMPANIES ONLY HEkTH DEPARTMENT P.O.BOX 8294 SALEM,MA 01971-8294 TEL. (978)741-5731 FAX (978)740-9109 claimsna,butterworthotoole.coin 08/31/2017 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Inspector & North Andover Fire & Health Inspector Department 120 Main Street 795 Chickering Road 120 Main Street North Andover, MA 01845 North Andover, MA 01845 North Andover, MA 01845 RE: Insured: David Mushaty Address: 119-121 Marblehead Street North Andover, MA 01845 Policy No.: 5527976 Loss of: 08/17/2017 Fire File or Claim No.: 75-0730 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen.Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec.3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location,policy number, date of loss and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Vicki Gardner Adjuster Member of National Association of Independent Insurance Adjusters 6/29/2016 Date: June 29, 2016 20759 This is an e-permit.To learn more,scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20759 TOWN OF NORTH ANDOVER 0" '0 PERMIT FOR WIRING This certifies that Philip F Zampitella has permission to perform install 14 panels 3.71 kw wiring in the buildings of MUSHATY. DAVID at 119 MARBLEHEAD STREET , North Andover, Mass. Lic. No. 13141 1/1 .+p t 4LmieIPNm2+2U159-s X E ` G' L`h',:.r„(,ratl�andwcrma.vievrpointdoud.mm/k/recorc;';759 .._...... --------- --------- - -._----- - ---- "i BwB M xeveass Town of North Andover,MA 4 Searcr - 20759 -Electrical Permit-IN Conjunction with a Building Permit(Commercial or Residential) TIMELINE loSubmission received Qknow our request is in progress Im 28,2015.935.. We'll let you of any updates via email.Feel free to check the status at any time by coming back to this page. al Electrical Review in progress 0 t r iir.Fee Q ' ,.... 3 /� PeR?iit IyiUantL' - �r'y St PUBS ATM AIN (x.11 .. �cO B Ndlh AnCOver HJwfe Avpll— Katelln Brown 119 MARBLEHEAD STREET,NORTH ANDOVER,MA Dme. MUSHATY,DAVID Attachments -OTLCK71001F Tuejun 28 2016 13:36:.FDF Primary Contractor Search for your contactor using the search bar below.Either the Finn's Name or license 6 is required. - sj N.me •m� i Tuesday,Jun 28,2016 09:38 AM Comnwncue &of Maesachud th Official Use Only c� cc77 1Jepartmert�o�..tire�ervicee Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod C 527 12.00 (PLEASE PRINT IN INK OR L IN ORMATION) Date: City or Town of: �A To the Inspector of fres: By this application the undersigngives notic tlA. /q i r h inten' a to perform the electrical work described below. Location(Street&Nu er) Owner or Tenant ' Telephone No. y G� Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Bog) Purpose of Building &_n a J.Q= �C(m i 1 u ft)'Y e Utility Authorization No. Existing Service a� Amps Vd0 /c34p 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: a* Dag I Virg 01 S- 4W Completion o the ollowin table=be waived bX the Ins for of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.o Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators kVA No.of Luminaires Swimming Pool g d e ❑ d. ❑ Battery UnitsseIICy Lighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o•o election an Initiatin Devices No.of Ranges No.of Air Cond. Total ns No.of Alerting Devices No.of Waste Disposers Heat Pump ....umer _ ons o.oSelf-Contain p Totals: LL Detection/A.lertin Devices No.of Dishwashers Space/Area Heating KW Local❑ pme'pa ❑ Other Connection No.of Dryers Heating Appliances KW eCNo oy f Devices or Equivalent No.o atero.o o.o Data Wiring: Heaters KW signs Ballasts No.of Devices or fauivalent No.Hydromassage Bathtubs No.of Motors Total HP a Wir- No.of Devic ti tionr E uivalent OTHER Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Valu of Electrical Work: C) (When required by municipal policy.) Work to Start: - Inspect ons to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVE E: 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 cover!w in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE-2"'BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penattles of perjury,that the information on this application is d complete. FIRM NAME: V IV1 LIC.NO.,. Licensee: Zolyn ' Signatuir LIC.NO.: 1�) L1 I A- (If upplicabl ,enter empt"in the Lice a number line.) Bus.Tel.No.. Address: Alt.Tel.No.:�i-4-1�1q•5�� *Per M.G.L.c. 147,s.57-6 ,security work requires Department of Public Safety"S"License: Lic.No. --------OWNER'S--iNSURA:NCE WAM-—R-:-I-am-aware-that the-L-icensee-does-not-have-the-liability-insurance-coverage•normally required by law. By my sign a elow,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No.� PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Leeibly Name(Business/Organization/Individual): 1/, ✓r rt't" .5eds e—t 1 n c . Address: -3 -301 Q - N� tn1,r y S N� c- �Q Q City/State/Zip:_Lq��i, t-Ar— g Yy K 3 Phone#: TV ( - 22-1 - G Y S l Are you an employer?Ch he appropriate box: Type of project(required): 1.21am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work tight of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof r 'rs insurance required.]t employees.[No workers' comp.insurance required.] l ,e-tither Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonmation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. [am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: H r cam_ /m err e-Ah J S G4 1.1 11 c L Gd^lin N y Policy#or Self-ins.Lic.#: VV L S-0 cl G U / Y U Expiration Date: I ( / 1 / 2 a/G Job Site Address: City/State/Zip:- Aja(ha 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 11 Phone#: Official use only. Do not write in this area,to be completed by city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f . EcolibriumSolar Customer Info Name: Email: Phone: Project Info Identifier: 4967026 Street Address Line 1: Street Address Line 2: City: State: Zip: Country: System Info Module Manufacturer: Jinko Solar Module Model: JKM265P-60 Module Quantity: 14 Array Size (DC wafts): 3710.0 Mounting System Manufacturer: Ecolibrium Solar Mounting System Product: EcoX Inverter Manufacturer: SolarEdge Technologies Inverter Model: v.SE3800A-US (240V) Project Design Variables Module Weight: 41.88778 lbs Module Length: 64.960665 in Module Width: 39.0551392 in Basic Wind Speed: 100.0 mph Ground Snow Load: 50.0 psf Seismic: 1.5 Exposure Category: B Importance Factor: I Exposure on Roof: Partially Exposed Topographic Factor: 1.0 Wind Directionality Factor: 0.85 Thermal Factor for Snow Load: 1.2 Lag Bolt Design Load- Upward: 820 IV Lag Bolt Design Load - Lateral: 288 Ibf Module Design Moment— Upward: 3655 in-Ib Module Design Moment—Downward: 3655 in-Ib Effective Wind Area: 20 ft2 Min Nominal Framing Depth: 2.5 in . Min Top Chord Specific Gravity: 0.42 EcolibriumSolar Plane Calculations (ASCE 7-10): West Roof ' Roof Shape: Edge and Corner Dimension: 3.882857552789975 ft Attachment Type: Stagger Attachments: Yes Average Roof Height: 25.0 ft Include Snow Guards: No Least Horizontal Dimension: 38.8285755278998 ft Include North Row Extensions: No Roof Slope: 36.0 deg Truss Spacing: 16.0 in Snow Load Calculations Description Interior Edge Corner Unit Flat Roof Snow Load 33.6 33.6 33.6 psf Slope Factor 0.62 0.62 0.62 Roof Snow Load 20.8 20.8 20.8 psf Wind Pressure Calculations Description Interior Edge Corner Unit Net Design Wind Pressure Uplift -20.7 -24.3 -24.3 psf Net Design Wind Pressure Downforce 19.4 19.4 19.4 psf Adjustment Factor for Height and Exposure Category 1.0 1.0 1.0 Design Wind Pressure Uplift -20.7 -24.3 -24.3 psf Design Wind Pressure Downforce 19.4 19.4 19.4 psf ASD Load Combinations Description Interior Edge Corner Unit Dead Load 2.4 2.4 2.4 psf Snow Load 20.8 20.8 20.8 psf Downslope: Load Combination 3 11.3 11.3 11.3 psf Down: Load Combination 3 15.6 15.6 15.6 psf Down: Load Combination 5 13.6 13.6 13.6 psf Down: Load Combination 6a 20.9 20.9 20.9 psf Up: Load Combination 7 -11.3 -13.4 -13.4 psf Down Max 20.9 20.9 20.9 psf Spacing Results(Landscape) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 71.9 71.9 71.9 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 64.0 64.0 64.0 in Max Cantilever from Attachment to Perimeter of PV Array 24.0 24.0 24.0 in Spacing Results(Portrait) Description Interior Edge Corner Unit Max Allowable Spacing Between Attachments 55.7 55.7 55.7 in Max Spacing Between Attachments With Rafter/Truss Spacing of 16.0 in 48.0 48.0 48.0 in Max Cantilever from Attachment to Perimeter of PV Array 18.6 . 18.6 18.6 in EcolibriumSolar Layout Skirt M Coupling ® End Coupling Clamp End Clamp Note: If the total width of a continuous array exceeds 35 ft; break array to allow for thermal expansion and contraction. See Installation Guide for details. • North Row Extension Warning: PV Modules may need to be shifted with respect to roof trusses to comply with 0 Bonding Jumper maximum allowable overhang. EcolibriumSolar Roof Weights -in Conformance with Solar ABC's Expedited Permit Process Module Quantity: 14 Weight of Modules: 586 lbs Weight of Mounting System: 50 lbs Total Plane Weight: 636 lbs Total Plane Array Area: 247 ft2 Distributed Weight: 2.58 psf Number of Attachments: 25 Weight per Attachment Point: 25 lbs Roof Design Variables Design Load - Downward: 918 Ibf Design Load- Upward: 720 Ibf Design Load - Downslope: 460 Ibf Design Load - Lateral: 252 Ibf EcolibriumSolar Bill Of Materials Part Name Quantity ES10260 EcoX Row-to-Row Bonding Clip 3 ES10121 EcoX Coupling Assembly 11 ES10146 EcoX End Coupling 2 ES10103 EcoX Clamp Assembly 20 ES10136 EcoX End Clamp Assembly 5 ES10144 EcoX Junction Box Bracket 1 (Optional) ES10132 EcoX Power Accessory Bracket 14 ES10184 PV Cable Clip 70 ES10195 EcoX Base, Comp Shingle 25 ES10197 EcoX Flashing, Comp Shingle 25 . v � O � C� Cn < --i om - - ------- - - n N N F z � . . to I I01 O O Z ZN I pO N 0 I ov f m0 00 O IZo c m� I O O ❑ I A N W N I � I I C CO I I I - - - - - - - - O Z G G C-':�mZ1 A F=CD �m D0i m2>0 zz (A m n'- z n < 7 D A 2 m 1 � o� � ��-u m Zco 5(D 00 C') (/) �Uz zn ry oG)O 0ZF m z m x =o ED 0 ! 00 p c mm m 0;0 T rn T O r D z 121 Marblehead St Apt H, North Andover MA 02149 C m D i INSTALLER:VIVINTSOLAR Mushaty Residence m SITE m INSTALLER NUMBER:1.877.404.4129 �/���/���� P PV 1.0 m MA LICENSE:MAHIC 170848 v v O ( 121 M rblehead St Apt H North Andover,MA 02149 PLAN DRAWN BY:JRP AR 4967026 Last Modified:6/9/2016 UTILITY ACCOUNT NUMBER:2871001028 A� 0 X C m 0o0 �� 3 or 0 r w m# z _ w3U) 50 m z CO U) O 3 U) S 2 G) r m O O U) T = D m z N� Zi m m m r � < rnz m ;0 0 W U) m m p) m m II � o � O O m r Z Cx D= INSTALLER:VIVINT SOLAR Mushaty Residence m INSTALLER NUMBER:1.877.404.4129 ��(�/���� C P P�/ O m R ROOF n m MA LICENSE:MAHtC 170848 v O J ((( 121 M rblehead St Apt H V North Andover,MA 02149 PLAN DRAWN BY:JRP IAR 4967026 Last Modified:6/9/2016 UTILITY ACCOUNT NUMBER:2871001028 U a C s N 1 MOUNTING CANTILEVER L/3 OR LESS nN CN PV&0DETAIL fnaow dv� L=MAX 64" d o z z COUPLING CLAMP a CID PV MODULES,TYP.MOUNT z°a OF COMP SHINGLE ROOF, PARALLEL TO ROOF PLANE MODULE t77 C � RAFTER PV ARRAY TYP. ELEVATION PV SYSTEM MOUNTING DETAIL O NOT TO SCALE NOT TO SCALE O N o0 CLAMP+ CLAMPASSEMBLY d ATTACHMENT (INCLUDES GLIDER) LEAF SPRING OD o COUPLING GLIDER J ECO COMPATIBLE N MODULE c v � PERMITTED STRUT NUT n m CLAMP+ CLAMP ECOX BASE ^ m m ATTACHMENT SPACING SEALING WASHER o m o COUPLING FLASHING COMP SHINGLES a V Q s rte. In a z ui .. IY � w > z w w z m N 5/16'x41/2" J J U Z SS LAG SCREW H J TORQUE=13x2 FT-LBS _ Q L=PORTRAIT CLAMP SPACING SHEET NAME: Eco CLAMP ATTACHMENT z � COMPATIBLE Z) Q L=LANDSCAPEF- CLAMP SPACING MODULE NOT TO SCALE O LLI MODULES IN PORTRAIT/LANDSCAPE SHEET NUMBER: NOT TO SCALE . M Photovoltaic System Conduit Conductor Schedule(ALL CONDUCTORS MUST BE COPPER) DC System Size 3710 Tag it Description Wire Gauge if of Conductors/Color Conduit Type Conduit Size AC System Size 3800 1 PV Wire 10 AWG 2(V+,V-) N/A-free Air N/A-Free Air = a o Total Module Count 14 1 Bare Copper Ground(EGC/GEC) 6 AWG 1 BARE N/A-Free Air N/A-Free Air 2 THWN-2 10 AWG 2(1L1,11-2) PVC 1" o 2 THWN-2-Ground 8 AWG 1(GRN) PVC 1" 3 THWN-2 - 10 AWG 3(11.1,1L2,1N) PVC 1., t v o ` 3THWN-2-Ground 8AWG 1(GRN) PVC 1" • Q` � 4 ry O — Z 0 v 0 e 5 Solar Edge Z m mo 5E3800A-US `Conforms to ANSI > C12.1-2008 SQUARE FUSED N1RB .. Z 240V/30A FUSED NEMA3 Poi n[of Interconnection,Load w w Z OR EQUIVALENT WITH 75" Side 705.12(D)(2),Conforms to tj ry Existing Disconnect Service p C TERMINATIONS NEC 2014 Main Disconnect Service Panel Single Phase Z Z 2 ij�• — �� SHEET MNAME: i 14PV MODULES PER INVERTER 3710 WATTS STC 2", _.A--_—R. 0A STRING 1:14 PV tZ, 14 � MODULES (3) OA SHEET NUMBER: MI NI MUM GEC SIZE AWG COPPER VISIBLE/LOCKABLE'KNIFE'A/C ri DISCONNECT W Conductor Calculations PV Module Rating @ STC -Wire Gauge Calculated from NEC code 310.15(8)(16)with ambient temperature calculations from NEC w Module Make/Model JKM265P 330.15(2)(a)using the 90C column(On the Roof)or 75C column(Offthe Roof),310.15(B)(3)(c)for•1/2 v Y off roof,and raceway fill adjustment 310.15 B 16 Ratin of conductor after adjustments MUST be Max Power-Point Current(Imp) 8.44 Amps Y 1 l Il 1 g 1 a v N DC Safety Switch Max Power-Point Voltage(Vmp) 31.4 Volts Greater than output current v w On Roof-Calculation-Wire Rating(90C)x Ambient('+22C)x Conduit Fill Derate N a 'o Open-Circuit Voltage(Voc) 38.6 Volts -0 0 Rated for max operating condition of inverter (On Roof):10 gauge wire rated for 40 A, 40A x 0.76 x 1(2 Conductors)=30.4>16 Short-Circuit Current Isc 9.03 Amsa NEC 690.35 compliant ( ) P (Off Roof):10 aquae wire rate rated for 40 A, 40 A x 1(6 x 1(2 dors)tors)=20 v 'opens all ungrounded conductors Max Series Fuse(OCPD) 15 Amps o Nom.Maximum Power at STC(Pmax) 265 Watts '" Z j Maximum System Voltage 1000VDC(IEC) Optimizer Solar Edge P300 Voc Temperature Coefficient -0.31 %/C DC Input Power 300 Watts DC Max Input Voltage 48 Volts 1. OC Max Input Current 12.5 Amps AC Output Current According to NEC 690.5(8)(1). 20 Amps DC Max Output Current 15 Amps - Nominal AC Voltage 240 Volts 0 Max String Rating 5250 Watts THIS PANEL IS FED BY MULTIPLE SOURCES(UTILITY AND SOLAR) Inverter Make/Model SE380OA-US • CEC Efficiency 98 % titi - AC Operating Voltage 240 Volts Continuous Max Output Current 16 Amps ROOFTOP CONDUCTOR AMPACITIES DESIGNED IN COMPLIANCE • DC Maximum Input Current 13 Amps WITH NEC 690.8,TABLES 310.15(B)(2)(a),310.15(B)(3)(a), Short Circuit Current 17.5 Amps 310.15(B)(3)(c),310.15(B)(16),CHAPTER 9 TABLE 4,5,&9. • LOCATION SPECIFIC TEMPERATURE OBTAINED FROM ASHRAE 2013 w Max Output Fault Current 17.5 A/20ms DATA TABLES. v ASHRAE 2013- Highest Monthly 2%DB Design Temp:32.3 Celsius Lowest Min.Mean Extreme DB:-21.5 Celsius N OCPD Calculations a 0 Q Breakers dependent upon the Continuous Maximum Output.PV circuit nominal current 5 based off ff of modules per Circuit X(1.25(NEC code 210.19(A)(1)(a)X(.9 Max AC current per micro-inverter) m � o Inverter 1:SE3800.A-US-U Max Output=15.83 A x 1.25(NEC code 210.19(A)(1)(a)) > Z L;i =19.79 A<20 A(OCPD) w W z system output current w/continuous duty=19.79<20A(System OCPD) a a " o Other Notes z z g SHEET All ampacity calculations are made in compliance with NEC 220.58 NAME: N d a O m 2 a SHEET NUMBER: N LJ c w . ND 8 G 0 nM C/) O O (j) A Z --I C m ip D X A (n o > c m � m O A -n o O CnA..T m C N m -� Z�� O-.� O A w 414 { 'A Pr � A A- t t .� _k_� w .�• a� i 13 W un m 00 - — om x N mm �O ZCo O Z M m x O-i mC TO Zn mo o� O 1 0C �m C) cn m m 00 Zc mm m U5 C/)3 mz 0� ZZ c i D m INSTALLER:VMBEROLAR Mushaty Residence K DESIGN m INSTALLER NUMBER:1.877.404.4129 V O V D n� 121 M blehead St Apt H PV 4.0 A LOGIC MA LICENSE:MAHIC 170848 v v C North Andover,MA 02149 DRAWN BY:JRP AR 4967026 Last Modified:6/9/2016 jr UTILITY ACCOUNT NUMBER:2871001028 II `�' . R 1 �I 1 �� � # �. 0051 Date.......41-...2,.Z...... ...... ... ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 'SA US This certifies that .................f.. .............. .......... .......... ........Cay ............. has permission to perform ...... .................................................................. wiring in the building of..........M.Y. AV-17�............................................ at...... ...... North Andover,Mass. . Fee... ................. Lic.No......... ........... ............. ......... .... ELECTRICAL INSPECTOR Check # Commonwealth Of Massachusetts Official Use Only ffifflml Department ®f�1 re Services Perm""To.— �Fi 67 S—/ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINTMINK OR TYPEALL INFO TION) Date: City or Town of: To the Insp ctq�of Wires: By this application the undersi#edgives nW' e ofAfts intention to perform the electrical work described below. Location(Street�i Number) � Owner or Tenant yV( S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ BLDG PERMIT# Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters A New Service Amps / Volts Overhead❑ Und rd g ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ' r � Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total. Transformers KVA, No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires L. Swimming Pool Above ❑ In- ❑ o.o mergency ig ting rnd. rnd. Bane Units No.of Receptacle Outlets -13 No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection and ` Initiatin Devices No. of Ranges No.of Air Cond. l'otaTons No.of Alerting Devices No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No. of Dryers Heating Appliances KW Security Systems:* No. of WaterKW No.of No.of No.of Devices or E uivalent Si Heaters Data Wiring:s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 14 (1-LV Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under the p insnd p�lues of erjury, the information on this application is true and complete, FIRM NAME: LIC.NO.: ( f Licensee: F Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) s Address: Bus.Tel.No.:: C1 *Per M.G.L. c.147,s.57-61,security work requires Department of Public Safety"S"Licen Alt.LIC.NO.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ELECTRICAL PERART NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-]DOUG SMALL 1.ROUGH INSPECTION: Passed Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no tials) 3 Date [2.FINAL INSPECTION; assed—, " Failed—[ ] Re-inspection required($50.00)-nspectors'comments: (Inspectors'Signatur - o x Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: EEE� (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME; Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. '81977 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s o � •'a ,SSACMUS� This certifies that . . ././a V.�. . . . .n4 °� . . . .! . /. .'. . . . . . . has permission to perform . . .K.k. . . . ., 4vll�AP. . . . . . . . plumbing in the buildings of . . . . . . . . . . . . at 11 . . . . . ., North Andover, Mass. Fee Lic. No. PLUMBING INSPECTOR Check # � ]}( MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING lu City/Town. f! MA. Date: / Permit# 1 - - A Building Location.,- LOwners Name: 1 i Educational [-] Reside Residential f Type of Occupancy-- Commercial Industrial❑ Institutional❑ ❑ New: 0 Alteration:❑ Renovation: Replacement:❑ Plans Submitted: Yes No FIXTURES l DEDICATED _I z SYSTEMS O y>j Z J U N W egQ z 0: N C is H Y a Q Ca t�/1 z n fJ H W F Z. A. W �_ Zcc W Z 'ri C O -; y C2: Q z O O W W W DU. F of = W p f. vt .J a = W W I Q y F- a Y x 3 0 C) 3 x z a LL 3 a Y z ►- = c W a W u x a u > > O O O z Q Q ij cc rY a m m c c c'i °x Y g g ° (A � 3 3 3 o a 03 SUB BSMT. BASEMENT 1 ST FLOOR _ 2 FLOOR 3 FLOOR 4 FLOOR S FLOOR _ 6 TH FLOOR _ 7 THFLOOR _ 8 FLOOR l t Check One Only Certificate# installing Company Name: , � J _ oration j Address:& LJLCity/Town: Stater �Partnership �yFax: ❑Firm/Company Business Tel: _n Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ i If you have checked Yes,please indica-* %type of coverage by checking the appropriate box below. A liability insurance policy W Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permItjUued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1 the eneral Laws. By Type of ense: Tide er Signature of Licensed Plumber 3?0 City/Town [tas QJou'ter ter License Number: r APPROVED(OFFICE USE ONLY) _ 0A) s • ar.,t•r••�.av a�cae. v-�--�-. - ��G/V// V L{'Yf 1 ����t''l 56 CENTRAL AVENUE THOMAS,L. OL1vIAnIa tYNN.MASSACHUSETTS 01901 l• — r,ueur.FC T)FMAKIS '1 U. 595-53M llrsiJ rnf rroincel FAX(781) !)yz-47YU n '•,An3 tl flllUQlY LV. c.vv Mr Cttarryinfi Pa_nadonulos ')'7? 7.nwa11 CtrPPt. T:..�....a. rr� ail ;zn LCt11 JL.V.t,-11v� AS you tlivw i Wv,_.11 Ina7c tc fi.r -y---n--in--�Y nnininn letter with • _ - _ regard to Lice PLuiJCL LY U=laL J. - - '.4trPat i h NOrLn F1nauvet . ,I If you would like, j can go Lu ivuL Lh research. However it could save you a few ilulluLcu 11V11Q1.7 i.= icgai fees if you or Elena could get the tollowing maueLiaiS [.LIILII Bui?dinq Department : 1 the current Zoninq By-laws; 2 . ,-ho r-iirrPnt Zoning Map: and 3 . all ..o,mi rc vAri ances and violations in the Building Nom au Ft *- 10 filo fnr thi g nrooerty. nTk ,uthat �nnP the nronerty is in. -'-•- -a _ F L,- -i11 tori tO a l PttPr Savina A1SO, ask LIIC Buildilig ii=oN�.c1,:,. �� --- •-- -- - - ^ - _ : that the property C'CJIILVtttti Lw t__,-= use 'Ind _ -rl-'---n- r=rn,l at-i nnq of the _ --�---- Tnwnts Zoninq urainance. Phage let me know how you wish Lo pLVt.:CCu. Best regards, l Thomas C. Demakis Tf)"rl �ofn-�i�-s2nc-r cn-tn,.�nntir.a�•s,a Cf)T�l}I?IC r1�7:7_f] s-n-cn-c�a-� I ce f,CIL ru ' § 107• 1x7• SEE PLAT NO. 14 ' 6 177• ANNIS STREET - a BI -v F-73I I, -74sv rS° to i 9 t4 101' 11 Ix 55 to 5 8 12 13 - _ 11 42 10 �._.. b' 11,780 S.F. 6,770 S.F. 9,500 S.F. 7,500 S.F. 11,500 S.F. 4.568 S.F. s R' r 6,982 S.F. LOT B 13,700 S.F. 1 23 4,880 S.F. 5,013 S.F. �1 6 56 ` SEE PLAN#13462 y . �. ' 75 11,700 S.F. 14 6,540 S.F. 59 10,695 S.F6,460 S.F. 7,500 S.F. ' 24 �x B 10,000 S.F. LOT A 3,675 S.F. 7 15 15,000 S.F. K � 26 25 22 21 20 19 18 17 W t� 57 58 6,840 S.F. e2 W n y 15,000 S.F. 16,920 S.F. 12,596 S.F. c W A, C 16 ce 10'• 1. 6,208 S.F. 7,000 S.F. 8,250 S.F. 9.500 S.F. 9,500 S.F. 3 nl 7,080 S.F. 7,000 S.F. 8,250 S.F. .'hZ: v2• 5r �,. 4,750 S.F. 50• 51• 10,000 S.F. 10,000 S.F. ' MARBLEHEAD STREET 5x• z 61• ]I' 52• 107' _ m 69 w 52• 50' 102• w• 5l' J7 40 i� 4 60 r 71 39 72 62 oc 28 Z 27 Q 4.954 S.F. 4,963 S.F. Q ,4 G 5,865 S.F. 41 42 44 � 59 63 O o 45 46 W O 5,000 S.F. 76 z x �- 10,450 S.F. 8,990 S.F. 43 Q H i B 38 Q .5,000 S.F. Q 78 58 a 6 I L 175 W '+ r 37 47 lo,000 S.F. 65 48 50 ,q 3"*" 9,500 S.F. 6,004 S.F. 8,11O'S.F. 9,320 S.F. x r� 12,378 SF18,810 S.F. 9,500 S.F. 9,500 S.F. 14,750 S.F 4,750 S.F. B € a:, d 15,000 S.F. '. � . 29 » r 66 36 33 32 79 54 77 53 50 49 $ 3,923S.F. 5,077 S.F. 33 32 13,282 S.F. �' 12,459 S.F. 7,692 S.F. 9,020 S.F. 67 30 70 72 54 5,712 S.F. 34 51 r 3,624 S.F. 35 52 5,330 S.F. 9=S.F. 000 SF O a. 9,373 S.F. .�S.F. 31 64 >o c r 5x 5,135 S.F. lar 4,004 S.F. 3,848 S.F. 73 r� la• '6 103-19,650 S.F. 23,400 S.F. 23,400 S.F. 69 '•,- or lu• 4,000 S.P. 4.170 S.F.•3�SCALE, 80 FEET= 1 INCH BEVERLY STREET err [1 �r'' SEE PLAT NO. 5 7 Town of North Andover I ,LSD Office of the Health Department Community Development and Services Division stF �+fie William J.Scott,Division Director " °q. a:. c • * 27 Charles Street ��ss4cHu5e� Sandra Starr North Andover,Massachusetts 01845 Telephone(978)688-9540 Health Director Fax(978)688-9542 May 11, 2001 Mr. &Mrs. Kenneth Clark 33 North Shore Road Windham, NH 03603 0 Re: 119-121 Marblehead Street North Andover,MA Dear Mr. &Mrs. Clark: This correspondence is in regards to a complaint received at the Health Department about your property listed above. The complaint was that there was a health concern because of the condition of the property, specifically the accumulation of articles on the right side of the home including but not limited to; hot water tanks,trash,garbage, furniture,car parts etc. As you are aware this complaint is similar to one filed in November of 2000. According to the file, last fall the Building Commissioner arraigned for the removal of water heaters and a refrigerator from your property for safety concerns. All other debris in question was left for you as the owner to dispose of. As a follow-up to the commissioner's investigation, an inspection by the Health Director found"no violations of the Sanitary Code"because there "was no trash on the ground...that might entice animals". In response to the recent complaint an inspection of the property was conducted by Health Department personnel on April 19,2001. An almost identical situation was found as compared to last year. There again seems to be.an old hot water heater along with other miscellaneous items, but no unsanitary condition was observed. The hot water heater,as was found before, could potentially be a safety hazard. We would advise you to properly dispose of any such items properly before an accident can occur. The DPW may be able to advise you of disposal options. You can contact them at 978 685-0950. If by the time this correspondence is received,you have already disposed of this item,thank you for addressing the problem without notice. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 NURSE 688-9543 PLANNING 688-9535 Please feel free to contact the Health Department if you have any questions. Be advised that this is not an order letter and does not require any response from you, rather it is a notice that conditions at your rental property, although not a health hazard,may be a safety hazard. Thank you for your cooperation. Sincerely, �usan Ford,R.S. Health Inspector Cc: file complaintant Location 119-121 AA RhlellIdW S-� No. ' �' Date 3—1 ?, D 3 NORTq TOWN OF NORTH ANDOVER x Certificate of Occupancy $ �'�s'•„°°'<�' Building/Frame Permit Fee $ sACMusb Foundation Permit Fee $ t t Other Permit Fee $ TOTAL $ ��D Check # 162 7 9 l Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 'y ._ ......:.- s .'�•��' `5-��-" '`"a' ,= ��'S�l�fOlrt1�"KI��S�Q!� ,..a: ds;�.s r, �,� .; �"" ,'.. BUILDING PERMIT NUMBER. 7 DATE ISSUED: SIGNATURE: l v� Building Commissioner/IIIT4ctor of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Ad ess: 1.2 Assessors Map and Parcel Number: f- o 1 00W Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: lol Zoning District Proposed Use Lot Areas Fronta e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record oIMeN �} y �y t- X17-i �r mavbl�ellQu�s Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Lice ed Construction Supesor: Not Applicable ❑ g (� G JT tv� C Licensed Construction Su• rvisor: al I 0 License Number mn Address o� Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ D Il 2.4 ��� Company Name rn Registration Number r Address I/ c L r Z Expiration Date ^ Signature Telephone YI 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 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: ` Noface 3 I 1160-00 (V'Tce— ldwe5 I' r) i/�8' 00, t�(ql'Q �Kywo# Y1 of �I� U>7 L4NI15 u V' ��►� . $ Y LJi SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAtiSEONLY Completed by permit applicant 1. Building I Q v G (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 • 60 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH.DING PERMIT 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/QQAUTHORIZ,fED AGENT DECLARATION 1, �✓U 1 U �' 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 D U(4 c� �J��.�"Cl'I Print Name dff '^�a� Signature of ON er/A ent Date marc F_. � : NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T VIBERS 1 2ND 3 ! 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 North Andover Building Department 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 c 11, S.1 50 A.. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Md rc� Date • NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector { Date. .. _tX t NORTH'1 ° <"`°:°_•"� TOWN OF NORTH ANDOVER A PERMIT FOR WIRING •�;AT- This certifies that .......5// �Z..l�.;....... .�, .�.r............................ has permission to perform ......... a ... ...... ..0.. ........................... T wiring in the building of..... P. /.!'...�s�.l.��. .................................. at /./*.`.�../?.: ......E-�?�19!?.f.l...f...� ... ......... ,North Andover,Mass. Fee..... ' :......... Lic.No...>._.5a c_7 f_.......... .. ......................... ELE RICALINSPECTOR f Check # 3 5094 Commonwealth of Massachu etts Oftici,ll Uw Only --- h..t Pci t No. Department of F' e Servi es i oo .`l Occupancy and -cc Checked BOARD OF FIRE PREVENTI N R ULATIONS [Rev. I 1/�/t)) Ilctn,c bI; Ihi APPLICATION FOR PER I TO PERFORM ELECTRICAL WORK All work to he pertitrinccl in accordtutcc twi the MJSs:IChll-wItS I'.Icclrirrl Curly WE('),527 UNM 12.00 (PLE.?S'11 PRINT IN INK OR T)PlE.ALL INFOR ',''1 TION) tDate: .yo C�/Q cel Cif or Town of': VR-- �6Q � To the In?ector of Wires: By this application the Lill(IL'I:C1gncd gives notice of Ills or her II11e111101) 10Ilel"101'111 the electrical work described bclrnv. Location (Street & Number) l`�-/,2 IL,04BLEff �}D Owner or Tenant5 IDS ��1 p D UL bs Telephone No,? d 6 Is this peral.il in Conjunction with a building permit? Yes ❑ No (Check;Appropriate Box) PUI'h1191'111 BUiIfllllg Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrcl ❑ No. of Nlctcrs New Service Amps / Volts Overhead❑ Undgrd ❑ No. i f Meters — b Number of Fecclers and Ampacity Location and Nature of P►•oposed Electrical Work: Ai5mw-r tR�PL.Aer� `I C A0P 50-PPL E 1-I r4 L bP-Q vN Q Ro LIcg L 16«TiN 6' �jTu - S Cntn deli-,Ill the lhllnrrin�/abler mut he►ruircrl hl the lu.c ter/nr u/li'irr.c. a` No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No. of• Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA ❑ o. o .mcrbency "No. ofLighing Fixtures 1 Above mgSwinnin 00rrnd. d. _ Battery Units No. of Receptacle Outlets No. of Oil Biurners FIRE ALARMS No.of'lones No. of Switches No. of Cas Burners No. of Defection ,u►d Initiating Devices No. o1'Ranges No. of Air Cond. Total Pons No. of Alerting Devices No.of Waste: Disposers klcirt 1'unlp Number 'runs KW No. of Self-Contained totals: Detection/Alertinrr Devices No. of Dishwashe►-s Space/Arca Heating KW Local ❑ Municipal Connection ❑ Other No. o1'Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent i Na oi'Water No. of Na of Heaters KW Sirrns Ballasts Data Wiring: No.of Devices or rc uivaleut No. Hydromassage Bathtubs No.of•Nlotors Total Hl' Telecommunications Wiring: No.of Devices or Equivalent OTHER: Alluch nrlrliliurrvd r/cluil i/dc'.eirc'rl,oras r eqt invl hr lhv hr pr•cvor ul tt•iw-,. INSURANCE COVERAGE: Unless waived by the owner, no pernlit.for the Performance OfclectricaI wort: may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial cquivelcnt. '['hr undersigned certifies thatsuch cove tge is in force,and has exhibited proof of sante to the perlrlit issuing office. C. ONE: INSURANC EBOND ❑ OTHER ❑ (Specify:) POG1C J4C6.SSe030 /3 OS" (Expiratum IJatc) I-stinlaled Value of Electrical Work: (When required by municipal policy.) Wort: to Start: .) Illspecliolls to be requested 111 accordance with MEC Rule IO,and upon completion. I c•ertr&, under the pains anll pen!l/tres!/I'pel jur)', that the t1tl(Il'1t7!!lIlli/ !l/1 tI7LP!l/)/)II('lltlllll lS t!'1!L'(!llll C'llllllllL'tC'. FIRM NAME: ` L L LIC. NO.: -T-00631E Licensee: 5 Signature LIC. N0.:S"O (j l'ntt r 1,l !1 brut le•, cvllrr "r.rrnl Il"in the lic•en.ee nunlhc,r l — / nc. �fDrl14 � � �Cl .— s. Tel. No.. o Address: fl SFcorvv Sl 9V027Zf &U10-0 iy1l�I—� Dl� Alt. Tel. No.:R'7 6 a3y/y MAINER S INSURANCE, WAIVER: I and aware That the Licensee duds not huger the liability insurance cuvcragc normally rcquircd by laW. By Illy signature below, I hereby waive IIli S requirement. I ani the(check one)❑ owner ❑ owner's aecnl. Owner/Agent Sil�,naturc Telephone No. PERMIT FEE: SJ'0, r� ���,� �� ,1 �; a � ' i r S � t A; ' r<, 11V94/2,06 -94444 19783276517 PAGE 01 AC ��- 1 ;LIABIL INSURANCE 33/add s+s�ssue a TMd Mj;,CA'E_4S.WUW ABA MATTER.OF INFORMATION INTERNET TNSURAL7CE AfF8t1CY INC 1"1` ► I�ft WO WeRTS'UPeON TtWE(M # XWM HOLDER.THIS CERTIFICATE IOFB NOT AMEND,EXTEND OR ~1 522 CHICBCRRING ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH A, IAA OiB�k' INSURERS AFFORDING COVERAGE F3RER� � MGT CN DAA GULH$IAN DBA tNBURER B: NORIPOLK & DRDEIm DAYTP "i3t3ZF i'. 'awalm 1a wimma= m 428 FLE"AT STREET INSURER G' ARSELLA PROTECTION NORTR ANDOVER MA 410415" -- t aN�tRP.Ia t¢. C VERAOF ISSUED TO T!i£.IN UF"NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOiWVt STANDING W(Y trt iRRf`T i,i 1 t Ji�fr2� p�I " '� T S7R O'I it iT i T3 3i a�'Tt91 4 f;»!#3'wc, fT}ffl;A. iAAY$E i SS''7 0R MAY PERTAIN.THE INSURANCE Ai:FpRDEQ$Y$'HE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-AGGREGATE LIMITS SHw. N MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' TYPEOFIMRAodt ' TKIv?!CYNUig14ER — -4ENERAL LIA91Lm' EACH 00CURRENCE ;b 1 R 000 L000 A ; C :. A!?#ka#laf 13 i 87/01;1 lYOA ' 0Dl/i'OflS !+IDA l( pro-_moi s#},-000 CLAIMS MAO2 9CGUR r s MPA EXP k cRa- , s v: � u 5�OOC PER&ONALBADYINJURY, 3 1400,040 GENERAL AGGREGATE Jg -2 1-000 I oo{ I.0£Nl,af nfiSGATELRA4TA�PU6$.a5k:.j 'PRODUCTS-COMPIOPAGO POI.W; Ch LOC AUTCi1 OWLE LIAWLITY f COMBINED SIN"UMI 1,000,ODD ALL OWN'.0 AUTOS B 90151602 06/12/2002 06/12/2003 WVILYiNJURY q -8cK-=-=ovteo AvT jPCt PdSMi MIRED.AUTOS BODILY INJURY INJURY t ICIN"i7 AUTO$ � tPet aeddenl) iq 1 PROPER..{DAMAGE y3 �'��3�iAR4�"EtiA�IL-f1Y � - ,A:i'CO�td:,+t��A•&2,CNT -� 4 EA ACC $ ANY AUTO r; t)TNER THAN 1 AUTO ONLY. AcG`5 6XCE98 LIABILITY J ?EACH O0CURMNCE $ 1,000,00c T j J6-CUR MIT di!#l4RlMADS ! AGGREGATE ?g D 1 $flDt3.'tt13 � j 221113/2901 1 1211C37zuuz i { flEt)t#CTf6L£ i i ..Y.. ..i RETENit�JN 3 '' g WORKERS COMPBNSATit}N AND j urC STA U ►, . E.I,.EACH-ACCOEW 'El,DISEASE•EAEMPLOYEPS 100,00c I L.9!$E{tSE-�'Ot t{�v 4P61tr ,�3�}0.,000 I OTHER ; i (ASCRIPTION OF OP8RAT1ONStLOCATIONSNENLCLESMCLMONS AODEC BY GNt*RS6iWe'N7oIicY.AL AROVIS10N5 COMMCIALL AUTO INCLLWES: 200b f00 &�' '50 t _R=AI. '01-AV2 41133-5471 Aft 2002 FORD P350 (COMRCIAL PLATE #J3111s.) \ CERTIFICATE HOLDER 1 TK3NAl 1 Rear INSURER LETfEE3: CRHI~E1.LATlON -mowDAYoft'tse ADM Vemm ovommEVxwEuxovEFm-TKEExPti mto t3ATf'TfI Og,TwSrBsunuonasvRe►ewstL fflORr*UAIL 010 OAYSWR#iM N0=l IT)THE t RTIFICAXE H/]Lt1&s.NABIED m sR�E lt'r sus.Pmu tRRE m vc19O SHALL "Rm NiiRLIABiLfSYOfAT3i7CLND71PON14fEYNSi#RffR.iTS�SYsii REP TA ACOIRD 25.5(7-197) €�i4CORD W1'FiON 1986 r 1 M l f '�'}4M,+•�+IP.-s+....r mss. • _ •y�, •�r CI t � 1 I f 4: . l � f �. iL z a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance A>>ldavit e o�M Sy Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 0 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 City: 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'imprisonments Htell_as_civil.penakieslnlbelmn-fA.STOP WORK ORDER and-.a fine-of.t$1.01)M).aiday.againstmp— 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Y l do hereby certify under the pains and al" perjury that the information provided above is bye and correct. Signature Date Print name Pbone-# Official use only do not write in this area to be completed by city or town official' City or Town PermitA icensing Building Dept []Check if immediate response is required .0 Licensing Board p Selectman's Office Contact person: Phone#: ❑ Health Department Ei Other T40RTH ED Town of5 r. .r4Andover 0 No. S• L A��? .� cover, Mass., 3- -off o® 3 ORATED PIf VLN H BOARD OF HEALTH M Food/Kitchen EfIMIT T D Septic System THIS CERTIFIES THAT...P.tAMPIA.....?%V4--kt 1-mV4.+- BUILDING INSPECTOR ....***.....****'*.........—'**—**—**--**.... Foundation has permission to emt.FN?1�44...... buildings on ... 1 (1- 141...,JV Rough to be occu pied as.... �► 3!.....IN.�.y.P PAI I" Chimney .............................................................pr%twit.1.1................................ 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-Law relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. aw 44LIS 411,0 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ......I...... ........................ .... Affi..... ............ W..................... Service iiHbING 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. Location H No. Date aoRTM TOWN OF NORTH ANDOVER F 9 i -lot 0s �o Certificate of Occupancy $ J�cNus t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # °1�3 ' X6570 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. / DATE ISSUED: SIGNATURE: A � Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property A ess:) ( 1.2 Assessors Map and Parcel Number: ma f I{6G� L/%, Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R redProvided Req1ired Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes wNo M 2.1 Owner of tR�ecor(d' p4ty o-/ \ 61 m4 Name(Prin) Address for ervice Signature Telephone 2.2 Owner of Record: �J Naqte Print Address for Service: 0 Z M Si ature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 icensed Constructio Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �� O q�L t �� , 1 L License Number Address 0 /� Expiration Date ic Signa re Telephone r 3.2 Registered Home Improvement ntractor Not Applicable ❑ v u 4 6 V leww" Come i '�fRegistration Number Addles Expiration Date ( ( Si /1 nature Tel hone Y SECTION 4-WORKERS COMPENSATION(NLG.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) ❑ I Addition ❑. Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: , n �a boor a d �5;141 pc�er/o5 RI2� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QFICIAL;tJSE Q Y Completed by permit applicant 1. Building 7�oe 00 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC / 5 Fire Protection _ 6 Total- 1+2+3+4+5 "'—1,7 Q Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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, ba-U'c� 6L) 6? -crg t 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 t and belief l Print Name O` Signature of veer/A ent Date ✓`f'Y NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TITVMERS IST 2ND 3RD SPAN DM ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS I-IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE fl7 � 0 3-0,17 197-8327-6517 VILL PAGE 01 -CERTIMATE OF LIA134LITY INSURANCE 0715/2003 PRoovaeR. 978_975-4-044 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION VALL'' IStN 4RANCF_AGENt;.Y.*C ONLY AND CONFERS NO RIGHTS UPON THE CIERTIFICATE $22 CH1C}SERIhIG ROAD L�€R, I'M_ t7^PI d w f D O Noir AM l . •EXTIEND R. ALTER THE COVERAGE APPgRDEl3?3! MH 33.#DffS 9€3 , 1 NORTH ANDOVER,MA 01845 -% FOfW"'CO' RA-GI` N AIC dl tNsutif3o NSustERA: ARBEL_LAPROTECTION 0ONTRACTRiol N11c, NORFOLKA-DEDHAM 428 f LEASANT STREET N€LREac,ARBELLA PROTECT1 3AI -AIGRT?4-AN ?VER,-IIIA DIZ45 INSURERo:AIG INSURANCE COVERAGES Tf7E'r Lt1iYv "Ffia'„i3'45 1GiTED�BEIOWMAVSBE NrV5'U&VTOTHE##Q.�IVAEDWA -0AIMO_VC�f3RT$4=-P.L.�MYFERRIODfA01CATER,A1l,JnVITNSTAN.AtNta i A14Y REQUTArWENT,TERM'tJP..COND)TION OF ANY CONTRACrT OR JTN=k �7CUI4SEN7114'IT7i RE£$ELT fiO W'WfCli T-4S CER T IFtGp.TE-MAY�E'IS-'m t0 C'R MAY PERTAIN,THE!N3URANCe AFFORDED BY tHE POU IES DESCRIBED HERE114 IS 8U8JECT TO ALL THE TERMS.EYCLUStoms AhlR GO14afT)oNS OF&VCN �3Ls 4EE.Af3OR€ ATElI�'T SMOV1tNMAY.HAVEREENREDUCED?YPAIDCLAIMS. PDLlCYNUtABER GENERAL LIABILITY ;EACHtyi'i 0RENCE S I,OQG,CIGI3 3CTfyl cGf1A:_trfi'r '8F7d� 3r0C33 071{$9/120134 atnTl? NT C'Latkl3MACY_ X OCCUR I ;teEs.r'ItP�y o�_,.gerxony 15 . __ 5,t1Ct1 l E P. ADV tr�wRv s 1'.000,000 ANSR !;:11(a1_xCL REGhTQ LIMIT:APPLIES—PER-, ER _ °RODUGTo-t COMPeoP Aao $ 2,000,000 ._ A{fiDMDB[4£I,IR.S1LtYT .._%WSM1t33SINGL.ELIMIT -06/32/a003 -4k3/7$l2 Q4 ll;M-Ident' jf 1:Q00,C100 i ALL aIM.'ED AUTCr,S j Bp17tt.Y frtIJ.ZY 1 ,X HIRED AVIO$ i `--- � ! t4^vN,Ori'td€DAJfOS � IcgrwXirsettty e Tor 94drlentl 7G71RA'�sET:i}181tITY ,} AurOC?NLY>EAACCIDENT t hCaYAi1'O i, .. AGO g C � L aJ ,alar 4800420399 12/3Qf2 0 �21��T'I103 Me .�._ "a 1,D6yD; ?GL4f(r3hueCE o�F3Rt"iATE S x,000,000 RETENTION S _... ` I S 'W*34n"Y�t�!?#Y#SAT�CAt71t� D 1:AtPLOYERB'I,IAHILITT WC333-27-74 �l3131('10�33 037:�1120Q�1 -�cRa � =1 AttvstR9P$(aTCRIPARTttfiFJt:X'cCVTlvB ( :&.L.E+tD71A.s.GIOEtyT 10ol000 p�°_ICPR.'tA>-31AER aN.t:•LIiQEt37 E i -. . . ... .. '' €L.D15E4„E:EAE7,iF1,0•rT'T: baa v�sa16-sdnN'Rt . . _ i�� S Tib%AI PRCVISiON�Pk: E.L.v4mAU;POLICY LIMIT I �{3 qo OTHER 1 t iS7i8.AIF !'N19Fj3RE Gl4t$-fIOfAFt4NSllti?Ht fE6t£Y6L�1StON8-AD000BYZWORSIZIFTIOMCtALPROVISIONS 1 CERTIFICATE HOLDER CANOELLATION SRi0U1,UANT VF TtM ASMS tFESCRIBEL POIXIM W C'AWML'M BEFOR,-THE EXpft4yYCih• DATE TNEREt)T'.TflQ ISt3UiNG RF817RER tiA7i41 8F708FcYGit Y8 Y+1R=L 1' t}AYS t`tRiTTi NOTICE TO THE CERTtn0ATE HOLCMR NAMED TO THE LEFT;SUT FAILURE TO DO$0 SHALL T✓PM 110 010-70AMM 15R II iHit.TTT VF AM 7,M V ON 1MV 1FiWmr,,11'5 At"T'S W RISPREWITAMPA Al1 ffOWEO ACOR0 26(20D9 t0@) Ct7#2Pt}RATIONi 19$8 i SVJ10 F;J "82AOCNVV N mizmnCl d G1AV 6565 :OU`41 CCOWO/Ot ;taw;dxd , ,w t4ep tyy SO .l�t:tr4fd 3;' �_. NOS!A'Lldf2S t4wonW.SNOO :0Cu031-1 SNOUr-inow oNicnine rJO cpjvoB } Building Tt Board of . g ebulations and Standards � r HOME IMPROVEMAT CONTRACTOR- Registration: 120199 Expiration: 11/1/03 Type: Individual DAVID`GULEZIAN DAVID GULEZIAN 1428 N-EASANT ST NORTH ANDOVER,MA 01845 Administrator 'ti NORTH ANDOVER BUILDING DEPARTMENT 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector WORTH E ®ver Town of � 4 0 � opt O 0) A_oC L ! dover, Mass., ORATED PPGt-`C 7 v H 4` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.....© ..�.�..��14.............R� . ..�.�.......................... •• ••••••••••••••• ...... Foundation /� 9' -/d/ /ylAJeble ... e.4 has permission to erect.. ..............5.,...0*640 buildin s on .................................. ......... .............. ........................ ...... Rough t0 be OCCUPIed aS 0'' �0 Z>Pt 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-Lpws relating to he Inspection, Alteration and Construction of Buildings in the Town of North.Andover. yr 140 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ��04C................................ .............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. Date.. . f LL- R Of ,,pRTM , `o� TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SSACMUSE This certifies that : . . . . .... . . . . . . . . . . . . . . . . . . . . . . . r has permission for gas installation . . . . . . . . . . . . . . in the buildings of . . ! . ::' .. . . . . . . . . . . . . . . . . . . . . . T ..at �z�. ' . . . North Andover, Mass. Fee(. ..S c,. . Lic. No. �/. . . . . . . L. . . . . . . . GAS INSPECTOR Check# 4414 MASSACHUSETTS UNN ORM APPUCATON FOR PERM TO DO GAS FMING (Type or print) Date ?z, NORTH ANDOVER,MASSACHUSETTS . V / .1 Building Locations &,9-42Z IPermit# l �,/ Amount �!�/e 131e 1`t�od� Owner's Name D�Y�+P��•4 ,.�- New❑ Renovation �� Replacement .❑ Plans Submitted ❑ w � C y U GO0 a a . d � H 0 co . w a ° a» a > N o x w H a Cwh F z d 0 F a o 3 A 3 Ov a A a H o SUB-BASEM ENT BASEMENT ]ST. FLOO.R 2ND. .FLOOR D . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print ortype) / / CD one: Certificate Installing Company Name '''� r( Corp. ' Address ID X ❑ Partner. Business Telephone .sp 7-- 7 ^-.9-J'-/ Name of Licensed Plumber or Gas Fitter 314/0/1c— INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Nor—] If you have checked L,please indicate e-type coverage by checking the appropriate box 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. % Signature of Owner or Owner's Agent Owner ❑ Agent ❑ j t hereby certify that all of the details and informationra�ves miffed(or entered)in above application are true and acx�vate to the best of my knowledge and that all plumbing work anlat performed under Permit I or his application will be in. compliance with all pertinent provisions of the Mass chusetts tate Gas ode and 142 th General Laws. By. Signature of Licens Plum r Or Gas Fitter Title Plumber City/Town ❑ Gas Fitter LIcense Numher MMaster APPROVED(OFFICE USE ONLY) ❑ Journeyman Location No. Date G TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ s►CHus Foundation Permit Fee $ Other Permit Fee $ C-6 TOTAL $ ' Check # 7 1 653t+ Building Insp�of TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING „.; BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building CommissioneELnspector of Buildings Date --1 —d Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ria r��l�e�� �.� al V(/ Map Number Parcel Number ' W 1.3 Zoning Information: 1.4 Property Dimensions: Ul Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No M 2.1 Owner of Record c�vmpm rqA hAe VVW4 dc,f Name(Print) Address for Service: ri , II� Signature Telephone L� 2.2,Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ lcv),A 6j[� yv Lscen ed Constructs n Supervisor: ������ -j— License Number Address /`Q ��,lll /� > 4�� ✓ Expiration Date Signature Telephone r 3.2 Registered Home Improvementntractor Not Applicable ❑ 'NPAV 'l ,,, Company are ( O q —y yNq Registration Number r Address Expiration Date ^ Signature Telephone Y 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 building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify '%\ .A,. t ` i Brief Description of Proposed Work: p" �C n����5 l��e V)co 1110,„ � _V0a-'-'0 r'*, vvi)l do '5 hv)�rl�w' dcVY'5 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFINTCIAL USE ONLY Completed by permit applicant 1. Building ' O'�© &10 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total-(I4-2+3+4+5)-" '-'" pj.' 00°00 1 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, v�d G ��la� 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 UTHORIZED AGENT DECLARATION ,� /t � � �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 Owner/Agent Date Mae .2 19 NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIlvIBERS 1 2 3 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 xAORTH O ED T® of 6Andover , O •I rr y '4. �..��9. �Z No. P . over Mass. O COC MICM I K ARRATED PP'PL\ItC5 S V 4 BOARD OF HEALTH Food/Kitchen PER D Septic System THIS CERTIFIES THAT.................... ........... ...... BUILDING INSPECTOR�... ............ ......................................................... ...... Foundation has permission to erect......................................... buildings on ..��7.... 44011401014.,,,.. Rough .............. ...................... to be occupied as �ioi Chimney . ................................................... provided that the pes permit shall in every respect conform to the terms of the application on file in Final this office, and to the pins of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough . ..................................................................�` ... .................. Service BUIL G INSPECTOR Final Occupancy Permit Required t0 Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. V North Andover Building Department 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 c 11, S.1 50 A._ The debris will be disposed of in: ` T, (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE 07/16/2003 ' PRODUCER - 978-975-4344 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION WILLOWS INSURANCE AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 522 CHICKERING ROAD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: ARBELLA PROTECTION D.G. CONTRACTING, INC. INSURER B: NORFOLK& DEDHAM 428 PLEASANT STREET JNSURER C: ARBELLA PROTECTION NORTH ANDOVER, MA 01845 INSURER D: AIG INSURANCE INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY EFFECTIVE POLICYEXPIRATION LTR C POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COM MERCIALGENERAL LIABILITY 8500013549 07/01/2003 07/01/2004 PREMISES Eaoccurence $ 100,000 CLAIMS MADE 1XI OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS)COMP/OPAGG $ 2,000,000 POLICY PRO' LOC E CT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 90151692 06/12/2003 06/12/2004 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULEDAUTOS (Per person) $ HIREDAUTOS BODILYINJURY NON>OWNEDAUTOS (Per accident) $ a PROPERTY DAMAGE $ (Per accident) GAR AGE LIABILITY AUTO ONLY)EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 C X OCCUR D CLAIMS MADE 4600020399 12/10/2002 12/10/2003 AGGREGATE $ 1,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITUS TAT ) OER D EMPLOYERS'LIABILITY WC333-27-74 03/31/2003 03/31/2004 E.L.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE>POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN TOWN OF NORTH ANDOVER, MA NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL BUILDING INSPECTOR IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR NORTH ANDOVER, MA 01845 REPRESENTATIV AUTHORIZED R SE A V ACORD 25(2001108) ` ACORD CORPORATION 1988 QAll f I ?3oard of Build�mg Regulations and S nards` Lice ROVEMENT CONTRACTOR use or registration valid for individul use only HOME IMF before the expiration date. If found return to: , Board of Building Regulations and Standards Registrat'on 123715 s ' One Ashburton Place Rm 1301 Expiration '03/31/2003 Boston,Ma.02108 TypeIndividual . i=Rt Lionel LeM'ay Lionel LeMay f43 Lorenzo Cir _ c 4�jethuen,MA 01844 Administrator s Noival w Ivit'. ut s grta r v`Y - 9 r ` t- 43 LflRENZfl C ------ - - - - -- - - _- - - - - �_ - - + V UM AY R M61)ELING � V►t l IRCEL METHUEN MA,01844DATE INVOICE# MA. LIC# 13915 ! 3/23/'03 ' BILL TO t - - i I OLYMPIA 6 REALTY TRUST 277 LOWELL ST ANDOVER MA. 01810 L DESCRIPTION _ CITY RATE AMOUNT THIS IS A ESTIMATE FOR 219-22 f A?ARBLEHEAD ST. 0.00 4 NO ANDOVER 1'31 REPLACEMENT WINDOWS 31 160.00 4,960,00 DRYWALL REPAIR D REPLACE DOORS SLABS .00 4 47.00 188.00 . � i LABOR 60 ! 35.00 ' 2,100.00 ads>,oj,L S�F- 7' pv �'/,�a.�7"/2a Joe. vv s t o � + i { ! i� + `I i Tota I 7J48.00