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Miscellaneous - 123 BONNY LANE 4/30/2018 (2)
/ 3 BONNY LANE 2101062.0-0050-0000-0 Date. . `1:1114 . ... .... NORTH Of 0 4L TOWN OF NORTH ANDOVER 10 PERMIT FOR GAS INSTALLATION �` �9SSAC MUSEt 'F -ffi This certifies that . . ,�!?'jr� ! '. . f.!a�i . . . . . . . . . . has permission for gas installation . .o4� 4 . . . . . .. 1 in the buildings of . . xwe�,..Ak,,Ll. . . . . . . . . . . . . . . . . at . . .+� �-. . . �q!►¢"... . . . . . ., North ndovez, Mass. Fee. ?5,.0°. . Lic. No.4P. //4!! r. . . . . � �GASINSPECTO Check# Z L r 7993 � l7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CityfTown:_ � . , -` - Fermt t#1eI } Building Locatic3 : Owners Name: ?0— Educational Type of Occupancy: Commercial Educational Industrial _ Institutional� Residential New: ► Alteration:L, Renovation: Replacement:l.J Plans Submitted: YesC3 No FIXTURES C ly uta LU to Cn tri � A (n rn rn u., m � � � � � � � [n � W W t7 � in > U Z as ® Q 0 < � x U a M O B W Cl) O W ® uL O W n B 12 W W q > O O tail z � B Q SUB BSMT. BASEMENT 1 FLOOR s 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR.. 8 FLOOR _ Check One Only Certificate.# Installing Company Name:. Y_2l*,.(A@-<-D 0aN---e— i r Corporation Address:. CityfTown: Stater Partnership Zip_...Code:i Business Tel: ell: Fax:.. Firm/Company'.., Name of Licensed Plumber/Gas Fitted.. rv)�' a INSURANCE COVERAGE: --� l have a current liabili ,Insurance policy or its substantial equivalentwhich meets the requirements of MGL: Ch. 142 Yes 'Nz If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ii 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 LiAgent Signature of Owner or Owner's Agent By checking this box 0;1 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 permit issued for this a'ppli.cation will be in compliance with ail Pertinent provision of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. _...... . ..........._.........................._........._........__ Type of License.- By icense.By' ....... ..................._ .. _.: as Fitter - Si iaturn of Licensed Plumber/Gas Fitter Title: . . Master City/Town i Journeyman :; License Number: APPROVED OFFICE USE ONLY LP Installer , �{ Date.................................. NORTN - tOeO TOWN OF NORTH ANDOVER PERMIT FOR WIRING �1 �O+.rao���•h �SSAcNUsf This certifies that ................................ .................."�.. has permission to perform .............................................................. .......,. wiring in the building of...... ./.V.............................................. r 12:� ���! / _ , at.....,. ................................. ........p�-! ......:......)..A.'�oAndover,Mass. Fee.. `` P..."... Lic.No...90 2?0�...... f ECTOR.,. Check # .©_ 1048,8 Common-wealth of Massachusetts Official Use Only - 460 Department ®f Fire Services Permit No. lb Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS I[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 PPMT•IN 1NK OR TYPE ALL MFORALI TJOA9 Date: &—,Z-/Z/ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Nt Location(Street&Number) I)- J &,jj� (,,pj ti Owner or Tenant F)D(21L--P- Telephone No. Owner's Address C Is this permit in conjunction with a building permit? Yes E] No El (Check Appropriate Box) 'Purpose of Building e- Utility Authorization No. Existing Service Amps Volts OverheadEl lJndgrdF] No.of Meters New Service Amps Volts OverheadF] Undgrd❑ No.of Meters Njimbe'r of Feeders'and.Ampacity Location and Nature of Proposed Electrical Work: Z 0 J/,ti 4 e-J bI Completion ofthe following table may he waived by the Inspector Of Wires. No.of Recessed Lumin-aires No.of Cefl.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above EfIn- No.of Emergency Lighting gynd. rad. 'D Battery Units No.of ReceDtacle OutletsUrners FFPMALARMSTNo.of Zones No.of Oil B No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained Totals: P... ...........................................I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local E] Municipal M other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent f 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: 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 ance including"completed operation"coverage or its substantial equivalent The undersigned certifies that such cove ge is in and has'exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE n OTHER El (Specify:) I certify, under thepains andpenalties 9fperjury,that the information on i ap lication i�s6ue and complete. FIRM Q ' L� W-5 r LIC.NO.:D001yf-A T License,---? A Signatari r', LTC.NO.: (If applicable,enter"exempt"in the license number line.) Tel.No.- Address: e.0 . 73o)c /i < Ar1aov-r— At A/r" Alt.Tel.No.: '64 14 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: 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 EI owner's agent. Owner/Agent , , •r-1--t___,.,_ The Commonwealth of Massachusetts ( Department of Industrial Accidents ' 4 i Office of Investigations JA 600 Washington Street Bosto,re, MA 02111 . www.riruss.gov/dia . Workers' Compensation Inshrance Affidavit: Builders/Contractorsxleotricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: . Are you an employer?Checlt.the appropriate-box: Type of project(required): I.❑ I am'a employer with 4, n 1 am a general contractor and I employees(full and/or part-time),* have hired the sub-contractors . ❑New construction 2.❑ I am.a.sole proprietor.or partner- listed on.fine attached sheet,t ❑Remodeling ship and,have no employees These sub-contractors have J[.7 . n Demolition working for me.in any capacity, workers' comp.insurance. 9, n,Building addition � [No workers'comp.insurance 5. ❑ We are a corporation and its required_] officers have exercised their 10-n.Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL I I-n Plumbing repairs or additions myself [No•workers'comp, c. 1.52, §1(4),'and we have no 12•❑ Roof repairs insurance-required.]t employees. [No workers' comp. insurance required.] 13.n.Other °Any applicant that checks bo)'#I must also fill out the section below showing their workers'bompensation policy information, t homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that checic this'box mustattached an additiora)t;hyet showin-t_he rpme of the subcontractor and their vmrka s'cemp.policy info,�.atcn, I tarn uss empfUyeP that ES.PYC?Vidll-ig:worhers l eompens a on laasurai2ce fo,r w en ployees. Below is the policy'and job site informatfom Insurance Company Name- Policy ame "Policy#or Self-ins.Lie..#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'•compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 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 • I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature:. Date: Phone#: f3f�cial use only, do not %�itis area,to b2 ao�;,plet ed by r'u`V or tpwis.official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: .;..:..—mss,.--�,«�....�.^ � ,;,,,,.�_.._•.-...�..,..,"... .�...:..,, Dater?..O ... �.... a �. �aORTH TOWN OF NORTH ANDOVER C? e ° O�. PERMIT FOR WIRING r` �sswCHU i; b tp This certifies that ...��...../.�...?� a.�u.l .............................................. F has permission to perform w....�a'�5.... ...�..-�.n ........................ wiring in the building of .. � . .... . k.. .... ... .......... .:......................................... �d�j� is i` at..� .................`. ........................:.......... ,North Andover,Mass. Fee&................ Lic.No........1 . ......... ...... ...... ............. r ELECTRicAL IN; R Check # � t 8010 "all 115011� ►r�s:a wash a ®"dna c ^ �s, 9 , mlrn sa4' `� 1.Via. 'c�c�a� ,�,'►- ,s�,° .� �n� � ;e a es`�a .n rli`►'� $e`� -..�e =a@ �a •� M e °u sys� MPria,- c®n M@ p �nY u r:e a N Official Use Only Commonwealth of Massachusetts Department of Fire Services Permit No. Fo 10 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 PRINT IN INK OR TYPE ALL INFORMATION) Date: c;17 C� a.R City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice o his or her intention to perform the electrical work described below. Location(Street&Number) IC 37 Owner or Tenant ��� �f�� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the olloMn 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 Swimming Pool Above ❑ In- ❑ o.o mergency ig g nd. rnd. BatteEy Units I.Z No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Tones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. TotTons No,of Alerting Devices No.of Waste Disposers .Heat Pump Number Tons KW No.of self-Contained Totals: -* Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [I Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent Heaters ICS' Signs Ballasts . Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications iring: No.of Devices or Equivalent OTHER: I 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: 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 ❑ OND [IOTHER ❑ (Specify:) I certify,under 7th�Xea7n4dla�itiles of perjury f the i#yrma�on this app[icati n is true and complete. FIRM NAME: v LIC.NO.:%. T Licensee: G'' S' e ignature LIC.NO.: (If applicable, enter"exem "in the license number 1' e.) Bus.Tel.No.: 3—O� Address: Fel *Per M.G.L c. 147,s.57-6,r, cu ty work requires Department of P lic Alt.Tel.No.: O P Safety S License: 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: $ ///� 1 i. ��((// h, *f s. �. �f The Commonwealth of Massachusetts ki ' f Department of Industrial Accidents �)Ji Office of Investigations 640 Washington Street Boston, MA 02111 www.nzass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers Applicant Information Please Print Leeibl Name(Business/Organization/Individual): f /9l/ Address: City/State/Zip- /� , ����G�� Phone 2�/ -3—J,-� Are yo employer?Check the,,appropriate box: Type of project(required): 1. i am a employer with �9 4. ❑ 1 am a general contractor and I 6. ❑New construction 93wyees(full and/or part-time).* have hired the sub-contractors 2. I am asole proprietor or partner- listed on the attached sheet 1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for mein any capacity, workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No-worke'rs'comp. c. 152, §1(4),and we have no 12.[] Roof repairs insurance required.]t employees. [No workers' comp, insurance required.] 1311 Other *Any applicant that checks bo)t#I must also fill out the section below showing their workers'compensation policy information ,- I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. i I am an employer that.is.providing workers'compensation insurance for my employees: Below is the policy and job site information. Insurance Company Name:' /;z C Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required g e9 under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor 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 Siianature: Date: Phone#: LEee�r only. Do not write in this area,to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son: Phone#• I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. 'However the owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not-the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self.-insured companies should enter their Self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for firtture permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-115 Fax# 617-727-7744 www.mass.gov/dia Date: . . . .. c 0 ' f NOQTM TOWN OF NORTH A VER 01 ♦ - PERMIT FOR GAS INSTALLATION •�`th �9SSACNUSEA G' 6)4-i' This certifies that . .1.,1. . . . . . . . . . . . . . :. . . . . . has permission for gas installation . . ?. . in the buildings of . . . . . . . . . . . . . . . G. . . . . . . . .. . . . . . . . . at '� - '� . . .ir...�... . . t'1North Andover, Mass. Fee. . � . . Lic. No.. . . .1th 1 . GAS It SPE *'OR Check# k 633 f. MASSACHUSETTS UNIFORM APPUCATON FOR PERMrr TO DO GAS7G,/, (Type or print) Date r-- NORTH ANDOVER, MASSACHUSETTS Building Locations ri 1 .lam Permit# l�\je.� Owner's Name \mount . KOkV New;—,k ew Renovation D Replacement Plans Submitted x w w Z a' F O�d Z .Fr SJ y W W Q S; OL 0: W OC w q E. � 1�' Z , d > Q a H F > m Z O z W O uFi O a o x 3 0 ° W > a a H o SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type _5 Check one: Certificate Installing Company Name_ ©)1719 `a\ate'ilytie� �V►'h $�'1Q��1q D Corp. Address Opal —R j 0'-�Ro J R'�Y) Partner. Business Telephone ® Firm/Co. Name of Licensed Plumber or Gas Fitter 1pni6UN \�� 17QAQik e, INSURANCE COVERAGE Che o e: I have a current liability insurance,pol icy or it's substantial equivalent. Yes No � If you have checked Les,please'indicate the type coverage by checking the appropriate b Liability insurance policy9k Other type of indemnity 13 Bond 13 Owner's Insurance Waiver: l,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 13 Agent hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and ins ations ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massac setts ode and Chapter 142 of the General Laws. By: Signature of Licensed Plumberr Fitter Title 1 Plumber 4 o City/Town, D Gas Fitter License Number DMaster APPROVED(OFFICE USE ONLY) Journeyman Date..Z ... A �ORTM„1+OOL TOWN OF NORTH ANDOVER 0 16 PERMIT FOR WIRING 'tSACHUS This ... ........`'`.'`t"¢ - .- - ..............certifies that . ......................... has permission to perform . .. -a :rf�`���'........................................ wiring in the building of... ..................................................... ........... ........... at.,./. ......... .................. North Andover,Mass. V 7� FFee!?`'.............. Lic.N 0./*4 ............... ECTR* &,—** EL R r4 Check # 7102 Lommonweann or massaernusetts utticial Use Unly Department of Fire Services Permit No. /6,-,-Z. Occupan BOARD OF FIRE PREVENTION REGULATIONS Rev.9//05cy and Fee Checked `~ � 1 (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 PRINT IN INK OR TYPE ALL INFORMATION) Date: / 1,2 — � City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice f his or her int tion to perform the electrical work described below. Location(Street& Number) 0� � ,a/ r Owner or Tenant , l Telephone No. Owner's Address C54-- Is this permit in conjunction with a building pperm`it? Yes No ❑ (Check Appropriate Box) Purpose of Buildings, % ��/` f �/f� Utility Authorization No. Existing Service d Amps 1� /,;��/aolts 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: Completion of the ollowin table ma be waived bv the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ n- ❑ o.o mergency Lighting _ rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection an Total - Initiating Devices No. of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat Pump I Number. ons o.of SeIU-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection i No.of Dryers Heating AppliancesKW Security Systems: No.of Devices or Equivalent No.of Water Heaters KW o.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP a ecommunications firing: OTHER: No.of Devices or Equivalent 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: 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 coveroge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE V BOND ❑ OTHER ❑ (Specify:) I certify,under th Pis;7-0-5:Z enof ury,th I thf,''formation on this appliestion is true and complete. FIRM NAME: O4C�L�'l��l/G._ LIC. NO.: Licensee: Signature LIC. NO.;}�%� 5 A applicab/e, r " empt"in the lice sen er ne. / Bus.Tel. No.: Address: ,',/' l� ��� �� d Alt.Tel. No.:. *Security System Co racto License required for this work; ' applicable,enter the license number here: 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. $ 1 f 4 :. Date . , .., HORTM - f 2,Oyt''..o ,•1tio F p TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SACMUSEt r v v a-c �f { 4 . . . . . . . . . . . . . .This certifies thatC4.r)�I�a . . . has permission for gas installation : . .14i. . . . . . . . . . . . . �Y in the buildings of ,/� �f''� '. . . . .. . . .J. .. .. . . . . . . . . . . . . . . . . at f tze.. . . . . . . . . . . , North Andover, `Mass. Fee.50:':. . . Lic. N0�4; . . . . . . . . . . . . . . . . . . . . . .. . . P GAS INSPECTOR f'. Check# I I � 5837 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FMING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations M Permit# Y 1J Z�0\ —C M 1I S� Owner's Name Amount$ ! New❑ Renovation V Replacement ❑ Plans Submitted ❑ x w w z C) a E✓ Z Z, a rx m w d s z °" ce > Q Gw w � z ¢ x � a w a w � z d w z �� w C7 p w x m z o z a x o x w � 3 a ° z > SUB -BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4T Ii . FLOOR 5TH . FLOOR 6 T H . F L O O R 7 T H . F L O O R 8TH . FLOOR (Print or type Chec 'one: Certificate Installing Company Name EI�nu � Rt9�0�ri� Li Corp. Address 1. ❑ Partner. Business Telephork 6j o Cl Is ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter &.Jyqu, O Jp l\CIXQ.f INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checkedrimes,please'indicate the 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 ❑ I hereby certify that all of the details and information I have sub e0eer d)in above application are true and accurate to the best of my knowledge and that all plumbing work and installat' nspeder Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse Stated Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber City/Town ❑ Gas Fitter (cense Number Master APPROVED(OFFICE USE ONLY) Journeyman v TOWN OF NORTH ANDOVER =_ PERMIT FOR PLUMBING . �,SSACMUSE� . . _ This certifies that �o YNA V k 6.4 e'er'' has permission to perform plumbing in the buildings of /. I . . . . . . . . at.. . . . . . . . . . . . . North Andover, Mass. Fee 0.5t S .Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check #` 21 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ' ) 1 _ _ / Date /Q � Building Location / �flntrjkl LArye,Owners Name 1�1 Fes/ D)U Permit# Amount rl/ (1 (4v� J�A ��}11�� Type of Occupancy New 0 Renovation U Replacement Plans Submitted Yes No """� FIXTURES A I SuRa l>c 0 R4SR W SL H M FLaR 4M FLOM slH lz,oat. 6M 1U 7M FUM gay FLOM (Print or type) � n f Check one: Certificate Installing Company Nameg0yJA1� (\'S®�IL'Y OA �Ur,IJ<}l'1 e 6 Corp. rY , Address —QGe Je— Partner. l'I3c�3 ❑ Business Telephone 03- r Q-- Firm/Co. Name of Licensed Plumber i QgVgLx*-� P\ 10 ve no r\p\2 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy � Other type of indemnity ❑ Bond ❑ insurance Waiver. I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent El I hereby certify that all of the details and information I have itted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and i latioed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa usetts tubing Code and Chapter 142 of the General Laws. By: �gna 401" nstrLiumDer Type 4qPlu bing License Title City/Town icense Numoer Master Journeyman APPROVED(OFFICE USE ONLY 4220 Date.. ........................... .• "a TOWN OF NORTH ANDOVER F p PERMIT FOR WIRING $3 CHUS This certifies ..` has permission to ........... wiring in the building of...:. .. &............................................................. ,North Andover,Mass. at........ ........ .. ...... . . Fee..�t .......... Lic.No:.Li E. ................�./a�1...... .:............... 1� ELECTRICAL INSPECTOR Check # j THEC0AW0AWEALTHOFN�gSS4CHUSEM Office Use only DEPARTMF VNT OFPUX1CSAFETY BOARD OFFIREPREVEIVnoN Permit No. IiEGUlA770NS527CNIRI2:OrI Occupancy&Fees Checked —�A APPLICAHONFOR PERMIT TO PERFORM EMOWCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date p Town of North Andover t or of Wires: To the Inspect The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) j 6) 3 QQtWV LAW, Owner or Tenant O Owner's Address S A Yr 27 Is this permit in conjunction with a building permit: Yes ® No � (Check Appropriate Box) Purpose of Building Qw Utility Authorization No. -- Existing Service a66 Amps ac, /0)4L Volts Overhead M Underground g No. of Meters t New Service 4W Amps jac3qu Volts Overhead M Under found g No. of Meters Number of Feeders and Ampacity U k S-A N 00 Q im J,,, /hyl d Co „�, 7}7 L160A na�u Location and Nature of Proposed Electrical Work Q A e"A c mac c;� EX S-A, u,A —F, P.an b No.of Lighting Outlets 11;6=a No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Swimming Pool Above Below KVA Generators d KVA Burners round roun No.of Receptacle Outlets No.of Oil Bu No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No-of Ranges No.of Air Cond, Total FIRE ALARMS Tons 9 Cud No.of Zones��� No.of Disposals No.of Heat Total Total No.of Detection and Pum-- Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained No.of Dryers Detection/Sounding Devices Heating Devices KW Local Municipal Other -- M Connections No.of Water HEaters KW No.of No.of Signs Bailasis No.Hydro MaAage Tubs No.of Motors Total HP OTHER- C 9AD11 h O Flo,-1&,0 i, ;;rani CIS/ o ri cl -:P In a friSstlranoeCove[ae-Rouarittothe re#emaltsofM%sada>CtsQnffalLaws rn m K d I�o4 [hawaamltLiabiltlyKmnuoepblicymdudngCoWCo orits&kstantia mpvalag Y [ha�sutxnif�dvandpfoofofsametotheOffice YES NO ED thebox rM ca ffytu have dledod YES,please indicate the type of ooverage by NSURANCE� BOND OTS R�ran�rs p s,�` oaExpiratimDate volktOStatt h D*R4esW Rough Estitr*dvalueofDectdcalwoiic$ ignedur der-t ePamlhes pajtuy T— — Final IRMNAME Nl iQ /I-Q P . `t'UV1aA- IkaseN0. iarisee �.A;zln��. Q ,,, Sigrrahue 7'Yt (� r.kQ -- LimreNo n BusirmTel.No. 9'7k- fnY 5- U/) 0A ddre� t' [5 �t>X ��i �'�n n� �.�z r'cl �lA�l .r� ,i�-� 2 �'- I �S•.3 3 Cee�� WNIIZ'S INSURANCE W Al Tel.No. `` ANFR;lain aware that the Lie does not have the mstuxm oow raoc or its substantial dthatmysgnahueonthispmrritapphcaltmwaivesthisroquia-ot egutvale<nasregunedbYM 11t>s�lsGeneralLaws 'lease check one) Owner Agent M / Telephone No. PERMIT.FEEr�- rgna ure o caner or gen Location i o3 IAA)<--- No. a DateOQ NORTIy TOWN OF NORTH ANDOVER f �,r • O 0 A D # , # � Certificate of Occupancy $ Building/Frame Permit Fee $ � cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ v U o Check #16039 Building Inspector ISI TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: / ,� X ic ACo SIGNATURE: Building Commissioner/1for of Buildings Date t� SECTION 1-SITE INFORMATION I 5� O N 1.1 Property Ad ess: 1.2 Assessors Map and Parcel Number: / 3 &A1,1' Y LA l O/e 77-/� 2� ��� nn /j Map Number Parcel Number /� 1.3 Zoning Information: jf /�`T 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf.) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided -Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record �Y sx,Y1� �. 1��3 &AIVY Z-A �� jr*,brfZ1'C1;14Name(Pri P) Address for Service: l�,- Sign Telephone 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 ❑ Licensed Constnwtion Supervisor: O f License Number Address Expiration Date ic Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number r Address r Expiration Date z^^ Signature Telephone YI i a _ , 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 0' Repair(s) V Alterations(s) 01 Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: b/F r e s c, P414T �- w e b i-nv Z>oo2 u.,,/-ry S pz-�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USk ONLY ` Completed by permit applicant 1. Building (a) Building Permit Fee J� Od 0 Multiplier 2 Electrical (b) Estimated Total Cost of �0 QdC� Construction 3 Plumbing Building Permit fee(e) X(b) 4 Mechanical(HVAC).,, © �'- 5 Fire Protection 6 Total 1+2+3+4+5) 600 :17heck 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 OWNE``R,,/��AUTHORIZED AGENT DECLARATION 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 N e a. G✓l� �-r /cn N dU Q� �. Si Owner/Agent Date „ SEE A 1111111111111 IN, NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS fiEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �j 1 r.�7 SIJ / ' y � ;k r ?V +� ��t 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 c11, S150A. The debris will be disposed of in: L. t_ 2� (Location Facility) ��y�N Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of g the Building Inspector I Town of North Andover Building Department 27 Charles Street .�.- _- North Andover, AVIA. D. Robert Niceaa 4845 Building.Commissioner ' essi' (978) 688-9545 978 688-9542 Fax HOMEOWNER UCENSE EXErirtPl7pN Please print _g r DATE 106 LOCATIONZ)4/-I L Number Street Address/ - �� ' (�r- Map/ fOMEOWNEF2 �/vt Ivt�7S Nam Home Fhon.e w0 p'hone ESENT MAILING ADDRESS _ej City Town U State / Zip Code The current exemption on for" of two units or less homeowners"was Qxtended to i and allow such homeoWners to en nciude e►+mer-oc�cup�d dweltirigs not possess a license, 9 9e aR individuat'for hwe Y*.does Provided that the owner acts as stipendsor (S8wlcGng Code Section 108.3.5.1) .DEFINITION OF HOMEWOWNER: Person(s)who awns a parcel of land on which he/she resides or intends to there is, or is intended to be, a one or two reside,on which c essory to such use a»dlor tafcrr 'dwelling. torched or d es ac- t�+"o-year penott s4611 not be n coF►srdereo d a her . horine in a The undersigned"homeowner"assumes r ons, comp ility for Applicable codes, b mo �c.e Witt+the State y-laws, rues and regulatior� Building Code and other The undersigned "homeowner"certifies BuildPIY with said proceing Department minimum ins mat h61she understands the Town d No.Andover Pectlon P►ncedures and requirements "mum and r irenents_ and that he/she wild ' i OMEOWNER'S SIGN ATUR ; 'PROVAL OF BUILDING OFFICIAL IA®RTPI Town of - . Andover 0 jbs X47 o� oC ,� dower, Mass., ADRATED � S � BOARD OF HEALTH PERMIT TFood/Kitchen e Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT � �� ,� �� �s .................. ........................ g..................... ........................................ .................................. Foundation • has permission to erecto?.....64. Ml Auildin s on .....I.. 3........ . .... /! ... , Rough to be occupied as 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 he Inspection, Alteration and Construction of Buildings in the Town of North.Andover. & lea I SP I& O pop 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 -010104041400416050 .flo . ....... ....... ......... ................................................................ 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. SEE REVERSE SIDE smoke Det. Location /o-23 i3g,'v^' �4A-J �- No. �� Date ' MORTN TOWN OR NORTH ANDOVER o?o•�...o w ` Certificate of Occupancy $ car • ; ; Building/Frame Permit Fee $ / CMuSEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �.... Building Inspector 10 f2 99 812:13 98.00 PAID Div. Public Works 1' ,RN'1T'1' r� NO. . PPLTCATTON FOR PERMITTO I3UYT��*^******1' 01ZTH ANDOVER, NIA AL\PZ'O. LOT NO. ' in 2. RECIRDOFOWNERSIIIP DATE BOOK PAGE zoN.E SUB DIV. LOT NO. LOCA I ION i, A.) r{ C q ry PURPOSE OF BUILDING � .� g., �.p� -cl\NNl;ll'S N:1nIE 'le p �A l\jC L j. No.of STORIESL SIZE: x � OWNER'S ADDRESS BASEMENTOR SLAB 13 g.fL/I g;vr ulcnrrLc'r's NAME SIZE oOFFLooll'nn1 ulLRs I A 2ND 3RD� l0 BUILDER'S NAME.', ry SPAN ° DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM S'IREET .S"GJ ._` /,j DISTANCE: DIMENSIONS OF POSTS DISTANCE:FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS �1REA OF LOT' � � ,,® FRONTAGE HEIGHT OF FOUNDATION CiL`� 'T'1I1C1:NESS ! rt IS BUILDING NEW N0 SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHMINEN' ✓ � IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BLIIL.DING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TOTOWN NVATER �S BOARD OF APPEALS ACTION, IF ANN' IS BUILDING CONNECTEDTO TOWN SEWER Yes { IS BUILDING CONNECTED TO NATURAL GAS LINE /v 0 1NST IJC"LIONS 3. PROPERTY INFORMATION LAND COST -- - - - -- EST. BLDG.COST </ PACE I FILL OUT SECTIONS 1-3 EST.BLDG.COSTPER SQ. FT. EST. BLDG. COST PER ROOM FI E(TTlIC AI LEERS MUST IIE ON OUTSIDE OF IIIIILDING SEPTIC PBRMLE NO. \'I`I':\C'llEll GARAGES MUST CONFORM TO STATE 1'IRL REGIII_AT'IONS 4. APPROVED BY: e PLANS NIUSTRE FILED AND APPROVED BN'I)UIIJ)ING INSPECTOR BUILDING INSPECTOR DA I E FILED OWNERS TEL# 0 CONT'R.TE.I../I (,179 . cl L J OF OR All SI ✓ CONTIZAAC9 1-7 Q C:NAIURF: 1)VI'NI?R TfoilFEE AGENT (� (JSP ILLCA 1'iaiAIITC-R:1N'I-E:D Revised 5/5/99 .INI NORTH Town of dover No. ya Y� T Z h 0.S� �0CJNq dower, Mass., / A0RATED P? C) S 5� BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT...... 48.r. BUILDING INSPECTOR .y...�.�u.............. r .. e...s.......... ...................................................... Foundation has permission to erect.0 Q..."10 ...r")**uildings on .........IA.3........B.-10-NOV- 0y......)AAJ V, Rough to be occupied as...............l................:.......... op.N..... v .............................................................. chimney provided that the person accepting this permit shall 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 PERMIT EXPIRES IN 6 MONTHS Final PUNLESS CONSTRUCTIO ST S ELECTRICAL INSPECTOR ®"� 13$41. 4 � Rough 1� .. ...... .. .............. ........................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. FORM U, LOT RELEASE FORM ,I 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 PT- f4oS 4-1 C7TV --_4CNe. PHONE � bi¢ /I/E- LOCATION: Assessor's Map Number 179 PARCEL SUBDIVISION LOT (S) STREET/;P.-) tV T ZotgE- ST. NUMBERZ,23 ` r *****************************************OFFlC1AL USE ONLY****************************** **** RECOMMENDATIONS OF TOWN AGENTS: 1Af AA-t tc_t . F a �o2rut�2S CONSERVATION ADMINISTRATOR DATE APPROVED N t-2 D, knoF ; DATE REJECTED N O Conn' (� !.v 8/Z x COMMENTS O PLANNER DATE APPROVED / DATE REJECTED COMMENTS filgIvn&d . )s A(- &rMiuz av�� FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED bsti;= DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT�1 ` �c,� �&1� ac, 4 � y RECEIVED BY BUILDING !NSPECTCR DATE Revised 9197 jm Town of North Andover NpR7F{� OFFICE OF 3� ° °e.0 COMMUNITY DEVELOPMENT AND SERVICES ° . x K 1 27 Charles Street North Andover, Massachusetts 01845 WILLIAM J. SCOTT �SSACHUS Director (978)688-9531 Fax (978) 688-954? In accordance with the provisions of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: a, H . (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project threuab the Office of the Building Inspector i 'J BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNI ING 688-9535 EiJ.ei €tk„«�c' ��.- {3' � 7• �,F +: (. u: e t r�h ��nsi '},'ERx+�'^ x. I y t �}� ,t J r �y, ` i;. t .s �. '. I -. h, i �,� {�J° t•�r., }3f '� { I �.s'�,�WA'••9�.. t t4 �I^'t dR, Ye I”'a�r�} 1 ^, t i-;t '�'� � k' ',t+ (. , f Y� I �4i� 1 � _a. f s �F �ir` 5�+.7� ..t^j I y4; '� +• 't., i y 4: I f `..; , a'.1. '1�_e, .. f, { t� `' ,. >„'a d t ,a ��'.p,es',a ly ,}tt ,' +?«x' ¢ � 1 i c �•.g to s ,a +�` �4 7 ,'"F t +.; x� E�'�• t F .,. i ,r M�.* Pa.t«: •53 a;+ �'q � ' #:1 e�� if ` +•:!.- � �;v�!�¢ i.ii 'J - + f{ t.. /. it e, ��;.• :S fz; h f}; r .�t„+{ c !�{ ,P,� - 7 'i:t� a•rk- �,{•,: L� w. �. %• i� ^">2oA.a'„t lie j.. 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A yes C rS)( P-aa ,F sfif - G C b 1 sHEm-HXIVG- Ss *-t 6 - Noeo4 z .bVic-1 c —tw o` ' SETA A l t -------------------- b SCC wz-TH Location No - Date 07';,,tio TOWN OF NORTH ANDOVER o? 0 „ Certificate of Occupancy $ Building/Frame Permit Fee $ <� Foundation Permit Fee $ ss�cnust • .SJ#Jaer Permit Fee $ 7�_ Sewer Connection Fee $ F. m Water Connection Fee $ TOTAL $ Building Inspector 10092 Div. Public Works PER'.= No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP� LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE - ZONE I SUB DIV. LOT NO. LOCATIONi. PURPOSE OF BUILDING OWNER'S NAME , �O NO. OF STORIES SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME �nA©� SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X { IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION u-e- Q IS BUILDING ON SOLID OR FI fLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO ITOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE 2 FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED `� ' ! 6 - 4�1- _. BUILDING INSPtCT011 SIGNATURE OF OWNER OR AUTHORItfED AGENT F E E OWNERTEL.# PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# i H.I.C.# -- /()o - t BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY SroRIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI, FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJAII UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ 114 1/2 1/1 FIN, ATTIC AREA _ N_O B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD�N'D ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASUN'RY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY -1 WOOD SHINGES KITCHEN'SINK SLATE NO PLUMBING. ' TAR & GRAVEL STALL SHOWER _ f ROLL ROOFING MODERN FIXTURES _ r TILE FLOOR I TILE DADO • r, 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G l UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING N�ATN KAREN H.P. NELSON o Director °. Town Of 120 Main Street, 01845 NORTH ANDOVER (508) 682-6483 s ate, BUILDING A CONSERVATION ss'°" '�� DIVISION OF PLANNING PLANNING & COMMUNITY DEVELOPMENT CHIMNEY APPLICATION AND PERMIT DATE 7— ) 3 ' Q � PERM T'1 # / LOCATION/Z3 Q)LyZOS44 OWNER'S NAME e lk )�9 VA Co; BUILDER'S NAME Rte-yk'�, { 'T-7—,, MASON'S NAMEV 19, f fh loo ►� o MASON'S ADDRESS U � �+ . � 5� � 0 {� � � 1 VJ }� l9 C {'�1 MASON'S TELEPHONE J o e 6 96 p-) I MATERIAL OF CHIMNEY INTERIOR CHIMNEY EXTERIOR CHIMNEY X NUMBER AND SIZE OF FLUES 1 f� 1 �V THICKNESS OF HEARTH �Q Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE 7' _� 6 SIGNATURE OF MASON CONTR. LIC. # mO 6 EST. CONSTRUCTION COST/CONTRACT PRICE (O O PERMIT GRANTED ^�- FEE �6 a ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES I I I I ale �Canvnaoar+aeatl� o�✓��t�tiac�u.,;elG: 1j, A NoRTH ovwmn of t R over No-3y6 - _ T O � dower Mass19 LAKE GOCKiCH CK V 2'Q \ 7 AD'QATED '9S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System p BUILDING INSPECTOR THIS CERTIFIES THAT................................. .. .f � �"� �'. ................................�... ............. .. Foundation has permission to erect......��...t! (.!l IK�. ....'�ttilttiRg�dT1 ..........�..Z. .........4?...b.........J.1•........... ...........1z.... Rough tobe occupied as.....................................................C',f .(. - .......:..........:.............:................................................ Chimney provided that the person accepting this permit shall in every respecf conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of - Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST Rough 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. Smoke Det. / �j 2 *v.�.. LocationY Z,A No. Date` N°RTh TOWN OF NORTH ANDOVER F „ Certificate of Occupancy $ + r Building/Frame Permit Fee < Foundation Permit Fee $ .a ss�cMust M Other Permit Fee $ a Sewer Connection Fee $ g Water Connection Fee $ TOTAL C�. (A?Uilding Inspector 1_i2 10051 Div. Public Works PERr3fIT NO / / APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP K40. 0 °)._. I LOT NO. 2 RECORD OF OWNERSHIP IDATE (BOOK ;PAGE - ZONE SUB DIV. LOT NO. �- a� R-N f! � � t / LOCATION _ PURP SE OF BUILDINGIVR ` V 'S NAME _P- NO. OF STORIES A SIZE 41 W ER'S ADDRESSug BASEMENT OR SLAB siffi�Kp� ARCHITECT'S NAME f-.. p�/',wE�/1i` � SIZE OF FLOOR TIMBERS IST A�lx"`,o 2ND 2)(10 3RD BUILDER'S NAME ®` J 1 / `(J�Y rE� � SPAN V' DISTANCE TO NEAREST BUILDING l� �i DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS � L,7 1h, ���1l x4 C DISTANCE FROM LOT LINES-SIDES REAR GIRDERS v AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION -� I. �` THICKNESS IS BUILDING NEW /V A0 SIZE OF FOOTING /a"' X IS BUILDING ADDITION MATERIAL OF CHIMNEY L4 &S'a�✓!a�! IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND (1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER M BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER M o� IS BUILDING CONNECTED TO NATURAL GAS LINE No INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST s-04 PAGE 1 FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FFIILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ! — O / WILDING INGP[CTOR SIGNATURE OF VNER OR AUTHORIZED AGENT F E E '� OWNERTEL.1/ PERMIT GRANTED �� CONTR.TEL.k 7-- CONTR. LIC.# H.I.C.# Ja � BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ SiORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION - 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D — PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA _ 1/1 V? l/, FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD",/'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR 1. I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 8 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR i WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GASOI L B'M'T2nd _ ELECTRIC lft 13rd NO HEATING FORTH F Town of 0 d 0 No. 31y .� =-r- T- L 1 `or dover, Mass., 7 - 19V coc��c�ew�cn � ADRATED 5 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......................................... .. .. ... /�.�.:........� ..� : ' ........................................... Y Foundation C g . ..... ..... �. ...... Rough has permission to erect....... (........�. ..... .... .. ... ...... buildings on ........./... ,..z...........,. a... � .. / .. Chimney to be occupied as...................................................... ... �.. ... .. .��.........�...�.��I.L..�/.................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough :: ........ ........................................... Service UI ING 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. JOB CoL-CS COLLOPY SHEET NO. / OF / • ENGINEERING CONSULTANTS F / 65 Ayer Street CALCULATED BY DATE M, METHUEN, MASSACHUSETTS 01844 TEL/FAX (508) 685-8069 CHECKED BY DATE SCALE & n� //0 n f- ...................... ... ............... I xSEc.T' ...: . . i .... .. .. ... L. l,.5 / :. . .. ............. i ...... ......... -i `. '`�N a� ..... ..............i4 �It'edr�.... zx . .. Ztin ....................... ...... ........... .......................... ............... .............. ...... ...... .. ...... ...... ...... ...... .. ...... ...... ..... ...... ...... n .............I�rrG.. ...;............. ......._.... is c R�DQ 3 p.. ...._...... :.......................... .........<........ 0...X Z �. , ..... .. :.... i .. . ..._W f>t15�'r�v G . ,.. -VIA op- ............ ... .... ... .;� FRANCIS w; w i .. .... v ....... 201 12 l . N�19 w e ap. :... STS :...� .... ... ONALE� ............ ..... . ' .... . ... ..:.... .::. ' �;u�sTiNrr.,.... .............. 3!�z L.G . . -04 X ..........:.. .. . . ... .... �f � LOAD 5 .. . .... ...::.... ....>.... .... ...... .. ..... i ....:..... is ?)............................ ..... . 7-Jr ....:.:... ..... F' . . �i... ......... ..... .. .. ... IIS .... a .. _�, la ....: 11 .. `- ,�... Iq 7 : U..,..... .. . . " .. _!r.�.. p Vic.. L........ 19-5 r ... L.i J .: ..: .: ............... ... ..—1— m �..... ......._ \.._.- - ._....... ...... .. .......... ... f ! .. .._ .. . ut 31 .. . r � �.. .: +... .,...... I ............ ... F.. ... .vN..T� 5 5 " _... PRODUCT 204-1(Single Sheets(205-1(Padded)®®Inc.,Groton,Mass.01411.To Order PHONE TOLL FREE 1.800-225-M Location � 2 � d^tn! y AV 4-7 No. ` Dateof TOWN OF NORTH ANDOVER AL Certificate of Occupancy $ 41 0 Building/Frame Permit Fee $ �- Z <� Foundation Permit Fee $ LMUSt . Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ F=` TOTAL $ ; � Building Inspector 03/14/96 11:59 57.20 PAID -9589 Div. Public Works PF,;R3irr xO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO. S"0 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE I SUB DIV.-LOT NO. I LOCATION E b /J/IJ y L PURPOSE OF BUILDING d/�,� �! /� OWNER'S NAME ;el../ 1� g7 NO. OF STORIES X SIZE OWNER'S ADDRESS � �� BASEMENT OR SLAB Jt,-4,- .,,pf- ARCHITECT'S NAME �g SIZE OF FLOOR TIMBERS iST¢}�, 2NND[X/g 3RD Aj BUILDER'S NAMEd��""��f tI / SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION ,.,`a rl THICKNESS ! �� IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION ,y �, IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODEX�y IS BUILDING CONNECTED TO TOWN WATERC BOARD OF APPEALS ACTION. IF ANY `! / IS BUILDING CONNECTED TO TOWN SEWER lylo IS BUILDING CONNECTED TO NATURAL GAS LINE Q INSTRUCTIONS - J� /--/� 3 PROPERTY INFORMATION � t O l� �( LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. • ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ,ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED ezat 13 BUILDING INfP[CTOII SIGNATURE bF OWNE V R AUTHORIZED AGENT FEE Z.d OWNERTELJ PERMIT GRANTED CONTR.TEL.# ®9 19 / CONTR.LIC.# j p H.I.C.# r a BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ S.-ORIt THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a 2 13 CONCRETE BL'K. PINE PLASTER BRICK OR STONE HARDW D PIERS _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/ '/f 1/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD",/'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIORF� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE 1 IP BATH Q FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) v FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK ' SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING i l HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 1-j-,dj NO HEATING T HOME IMPROVEMEMICONTRACTOR . .Registration 100698 Type INDIVIDUAL• Expiration 06/23/96 Peter J. Moschetto `i 12 Texas Ave. MA 01841 ADMINISTRATOR v B pN S i :-M-M.- - 5 - oma/ i o Y Date. . . TOWN 0'F NORTH ANDOVER- 41 PERMIT FOR GAS INSTALLATION o . r '� X0,.,.0.••`,�h ,SSACHUSES r� ! This certifies that . . . . . . . . . . . SJR. . . . . . . . . . . . . . . . . . . . . has permission for,gas installation NP'► A -P YL.., in the buildings of . D 0 Ill,ONI .V! . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . .132 . .6pn h'--t . . ' . . . ., North Andover, Mass. Fee.,30.5� Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . `f GAS INSPECTOR Check# 7�S 7300 MASSACHUSETTS UNUMM APPUCATON FOR PERMrr TO DO GAS FMING (Type or print) Date 1 (A NORTH ANDOVER,MASSACHUSETTS ASSACHUSETTS Building Locations 1,�A 1JVJn'�� Lane Permit# Amount$ Owner's Name 00 r an New Renovation ❑ Replacement ❑ Plans Submitted ❑ ,es1 C e UU a o o U F x z ti F O O O 00 W H W F+ CWh O x w O 0 F z U z > .,L.� --!t Z z 0 z O O pW A ' 0 U rn Eaw�'y 1 W A a F O SUB -BASEM ENT B A S E M E N T ' 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6 T H . F L O G R 7TH . FLOOR 8TH . FLOOR (Print or type) 401 �j Check one: Certificate Installing Company Name Ji Corp i`-!-*L Address "1 �1 h �/.Gl/1 7'f0 ❑ Palmer. Business Telephone — ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �@t Ya,A) RNQ+ 0,(`a INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked yes,please indicate the 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 ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach etts State Gas odekand C apter 142 of the General Laws. By Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber 30 f City/Town ❑ Gas Fitter icense Nifmber ❑ Master APPROVED(OMCE USE ONLY) ❑ Journeyman Tie G', MM 9 wit the o„ ' c achu�se is • �. i� �����iistrfa��lcc�s I we vf'1Ov�es atian� 600.k u fi% glon, DdstonyM4 02.11 s Rio,dot 'iaers3 Cow, e4ariIsucef�idavite Roildeis/Cri�>Fae#�a>hslectrns/'irnnbers .�e�se Print Iae�b�` NOMO 03,usinesshotgar�z tionladru 53 Rt?4 e o ;O emip Aylelr! C lea... apPMOW bpm: Typevf rape (regtiired): 1- I n a empIo3rtr*ith _ 4 1 am azefteML.Contractor and 1, 6, Q New;at�nstruehon empjoyeese'Full i�nd/or pa tune .' have hired:�the eiib-contractors 2.❑ I am a sc le.proprietor or partner- li9ted%Elie attached sheet:t: �% ❑remodeling ship and:have no employees These sdb-contras t`s hs" S. ❑ISeinoht�pn. wrl�ing .fir me Yri ani.y cacpaiarty; Balers'Coittp u�isir�oc . g ❑Btuiing aclton. [NO vVorke�z comp �ilrarice S• ❑ tie-are a..Comorahon and its.. . r 1 Q❑Eleetncal rePA or additions J .egtured] officersl ave exercised their a'.:(] I.am a homcownendoirgall workright of exemption Per MCL 11•[�Plum b repairs or:addtttoris Myself d woxkers'cOmp: 2,§1(4>,and we Kaye rio 4:2::0 I of:repairs insuraitee requited.]t: employees �voikers' GOIdl ;7fi1sl3l ilcEa:Yet LtY e:$.] 13`'0 ocher *Any applicant m�box:#i must auIo.6h put the sPcfizan below showuig jheir werkas compo ation.pol3cy?nf rmatlon. t Hrnriewntmwho gubantthis ai idatht ind�caxang.they ark l mg ail ivdrk arid'the�;hire outside nft ctbrs mustsubm�t a tt�w. idavitoin8i atit .surf► $ContracEncs fhai check t}usbax un�st attached an'a tar al'sheef wing the p rtc of fhe sub�conftaidots on.;; T hm.an entpDyer that rs providkg workers'coi peascf on: nsurance for jVanployaes. <Behw4sAe popsy anal jd si#e information. 40ur**O,1dompatiyName's N ani a nC�1 int:� in- CO 1"NGS v i u rs 1 rXsy���Al .Cb y c plic. #.or pelf= Lis.: R 0-13 a ('2& girationDaie.: Ah-l "I— cab`Site Address:. GylStateip; �ittach ii,.co bf'the P'tivkel!`g'ctim pe s o Aalie3'deelairahoet pale.(show ig the ORO it 0er`and ex�pit�AGA date), s_lure to she coyera e.as�e tiired Wider tioia 25 Y of 1vIf L c..1 2 can lead to th =pos tion of cnming penalties of a. fine up to 1,5Q0 Q0 and er one=tear�mpt isanttierit;aswell as.cat�il penalties in thvlf is o#'a STOPW 6RDBI'.sand a fine: Of`tIp to Sb��a:day�idle violator Be Abed ff*,a p6py of this$tateriietit%ri;ay he f o,two�e to the C�fi ce of: Ingest st eins.of the DTA for uisu anee.,COverage venfeatiom I der hembY.verify u r;th�e sand 106, hathe inormaon prddd a � rs a an&corrvaoperlr phone.# 1 2 q94 t? W&I use,af`4y.,Do.nr t:wrlife in:#his.area;to lie;completet ky:'city:or tin o, CfaL Ci y.°r TO* Pertri t;License ssuing:Ahoriiy;(circle°one): 1• ►al'd of H;aalth Z:;.;S ildiing Depairt�terit ty%T�►wt ia� 4 l twf al >hspecfdr Plttgnb�ng; nspe tb�• 5.:ether ContactPerson: Phone.#; Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Daniel & Eileen Donovan Property Address: 133 Bonney Lane Policy Number: HP1725049 Date/Cause of Loss: 9/13/2010, Lightning Damage/Surge File or Claim Number: 23327-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 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. Ryan Werner On this date, I caused copies of this Notice to be sent to t e persons named above at the addresses indicated above by First Class Mail. Signatur and Date ANDERSON ADJUST ENT CO., INC. 50 Nashua Ro , Suite 303 PO Box 1098 Londonderry, NH 03053