Loading...
HomeMy WebLinkAboutMiscellaneous - 127 PRESCOTT STREET 4/30/2018 rctsw i i a i rctt i 210//0992.0-0005-0000.0 �I I Date..... �a. ' .....��................. +, °F NOR7F�,� �o?' " , TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �,gsACMU�t�9 This certifies that .........1...P�''a`'.. ............... ...............5........................................ has permission for gas i stallation ............... in the buildin s of............. ;a �SC�=T� North Andover, Mass. ��" Lic. No. .'. .1".!. ................................................ Fee.(,0.(Q _ GASINSPECTOR Check# � b �•`� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY:. -:NoRz�=/aNDo -MA DATE_ ��.;: PERMIT# JOBSITE ADDRESSa — PQ ESC o ST OWNER'S NAME �, a GOWNER ADDRESS TEl�� _]FAX TYPE OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINTT CLEARLY NEW:E3 RENOVATION: REPLACEMENT:®'' PLANS SUBMITTED: YES© NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER �— CONVERSION BURNER COOK STOVE [-- DIRECT VENT HEATER �- DRYER FIREPLACE FRYOLATOR ` FURNACE GENERATORS — GRILLE _ . INFRARED HEATER LABORATORY COCKS MAKEUPAIR UNIT C)VffN POOL HEATER K OM./SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHERve 00 INSURANCE COVERAGE I have a current liablilly nsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES W0 El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Eg--* OTHER TYPE INDEMNITY ® BOND F 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 0 AGENT. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and aocur4tp to the bes my edge . and that all plumbing work and installations performed under the permit issued for this application will be in com Perti As the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME LICENSE#1 1 S6 Y SI ATURE MP[3,MGF ED JP® JGF Q( LPGI® CORPORATION .36( PARTNERSHIP®# LLC® = COMPANY NAME: ee 8r Se2v t e ADDRESS — CITYlamas-fir � STATE' /1'I TEL G/ -ag7= Odq 11 FAX CELL s° rJa6-IgQ4 EMAILe�ar ���li� � �� COMMONWEj y • • • H OF MASSIC � ' • HIISE�-S• PLUMBERS. ISSUES THE. SFITTERS -- LICENSED AS FA LLOWI N�` LSa:CENSE MASTER PLUMBER.: DAVID W GARF I ELD ,. 21 WILLOW STuj BROCKT _a ,�fi y ON MA 02 — �;. 15645 0. 3 O l 1451 5101/16 . 226442 COMMONWEALTH OF MASSACHUSETTS BOARD OF. t PLUMBERS<1AN6 GASF.ITTERS"_ ISSUES THE FOLLOWING'tICENSE.;_ j REGISTERED AS A .PL.UMB I >SOR�:� �` r DAVID W GARFIELD FEENEY BROTHERS SERVICE, �il �. _ 21 WILLOW ST BROCK70N MA 02301 3619 05/01/.16 221413 EEENBRO.01 SMORAN CERTIFICATE OF LIABILITY INSURANCE DATD,YYYY}-- ---- .- 1!130123012015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the poltcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers S Gray Insurance Agency,Inc. PHONE FAX (877)816-2156 434 Rte 134 (A/C.No Exti: ac No South Dennis,MA 02660 ADDRESS: INSURERS AFFORDING COVERAGE MAIC @ INSURERA:OId Republic General Insurance Corp. 24139 INSURED INSURER B Feeney Brothers Services LLC INSURERC• 103 Clayton St • PO BOX 220801 INSURER D: Dorchester,MA 02122 INSURER E: INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !LTR TYPE OF INSURANCE D B POLICY NUMBER M&VDDPOLIC� SM1 MIDD EXP LIMITS A X COMMERCIALGEN£RALLIABILITY EACH OCCURRENCE $ 1,000,00 CWMS-MADE a OCCUR A2CGO750160i 02101/2015 02/01/2016pREM1SISEs Ea occurrence S 300,00 MED EXP(Any one person) S .10,00 PERSONAL&ADV INJURY S 1,000,00 GEN'LAGGREGATELIMITAPPLIES PER: GENERALAGGREGATE S 2,000,00 POLICY[1]ECT M LOC PRODUCTS1 COMPIOPAGG S 2,000,00 OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $. ALLO"NED SCHEDULED AUTOS AUTOS t30DiLYINJURY(Per sccdenl) $ HIRED AUrOS AUTOS INFO Peracdde DAMAGE $ g UMBRELLA LIAROCCUR EACH OCCURRENCE $ REXCESS LIAR HCLAJMS-MADE AGGREGATE E $ DEO I I RETENTION$ S WORKERS COMPENSATION X PER DTH- ANDEMPLOYERS'LIABILITY STATUTE ER - A ANY PROPRIETORIPARTNERIEXECUTtVE YIN 2CW07501601 02/01/2015 02/01112016 E.L-EACH ACCIDENT $ 1,000,00 OFFICER110.1SER EXCLUI NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 II es descnbe under DS(RIPTION OF OPERATIONS been E.1_DISEASE-POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, North Andover,MA 01845 AUTHORIZED REPRESENTATIVE i' i Ih. A 'FA ©1988-2014 ACORD CORPORATION. All rights reserved. D ACORD 26(2014101) The ACORD name and logo dre'registbred marks of ACORD Location r �= ` No. � � Date �`4 f NORTH TOWN OF NORTH ANDOVER 3?0'�„•D'•,Moc 0 + Certificate of Occupancy $ / () 0 Building/Frame/Frame Permit Fee $ s�cMusa 9 Foundation Permit Fee $ .Other Permit Fee $ TOTAL $ 1 D Check # i_ g 17248 � ---- u Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING e BUILDING PERMIT NUMBER: DATE ISSUED: 3_ M ic SIGNATURE: ` Building Commissioner/inspector of Buildings Date SECTION 1-SITE INFORMATION I z Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: / 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 Required Provided ReqWred 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 ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT istoric District: Yes NO rn 2.1 Owner of Record �f / �ppGhhG � 1;04 to are Tint) I Address Signature Telephone 2.2 Owner of Record: .a O N nine Print Address for Service: 0 rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ LtcenserConstru ion upervtsor: C, Q O 3 r License Number Address � '-o-��C�j��•/�!/.� f �J Date S��/ 8 Exp ray tiooif / k�ig—natnre Telephone '... 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration rnon Number r Addr— e S T, 7 ar 11v Zd� / z� y z nature Tele one Expi on D e ^ � f 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 0 Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � � ~� OFFICL, ESE ?N�y Completed by permit applicant 1. B ' ding (a) Building Permit Fee eve 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 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 &Lttt� tJ • Lt ) to act on My beh*1 in,hall ma s relative to work auth Led by this building permit application /0 Signature of r Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject it property s Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print arae i i ature of Owner/A ent Dat NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS w SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUII DING CONNECTED TO NATURAL GAS LINE i 9 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: (Location of Facility) Signatur 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 a The Commonwealth of Massachusetts G Department of Industrial Accidents . -I d P Office of Investigations w= Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: CitV Phone # am a ho eowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City: Phone#: Insurance.Co. Policy# `'7z r/":;2 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'imprisonment as w.ell_as_civ.il..penatties in.the form of a-STO-P WORK ORDFR..and.a.fine_of.(.$1D0-00)_aiday.against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do hereby certify under a sins and pen es of perjury that the information provided above is true and correct. Signature Date 3 Gy Print name Phone.# ,7,0elf Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department ❑ Other NORTH Town of 41`y i adover, Mass., T 0 - L K COCMICHEWICK AORATr: S U BOARD OF HEALTH PER11M. IT T D 11 Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........ 7M.C.V A4 0. WAA R .......................... ... ......... . . . . . .................................. ' "" '.:: Foundation has permission to erect.,.St R ... ....... buildings on a r C0 A� Rough ...... ....... .... ......... .......... to be occupied as 1 40.N..t y . r � R provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inon, Alteration and Construction of Buildings in the Town of North Andover. y ;k/57 /� spe '/av PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS 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 I FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or typal NORTH ANDOVER, . Mass. Oats _...10 Bunding Permit 216 3 2 Location7-.1(,& ST Owners Name ( w New ❑ Renovation Replacement ❑ Plans Submitted: Yes❑ No.❑ FIXTURES s! in wZ 19 s » ra Is w a w 4 at R ~ s o _ 2 w L a » sr w M 7~C s t� q M M to •t w 16 It sFi at J o st V 30 1.- O A w • o s Q Q 0 _ s 9 Q V ~F w i as o i s i o •Ail aNIIINT IST FLOOR l IND FLOOR SRO FLOOR 4TH FLOOR aTH FLOOR OTH FLOOR. iTH FLOOR •TH FLOOR - Check one: Certificate Installing Company Name ( vim- ❑Com,_ Address ,aSEa�.� t—S ❑Partnership Irm/Co. Business Telephone .Sz - � .Name ct Licensed Plumber INSURANCE COVERAGE: e- e I have a current liability insurance policy or Its substantial equWenL Yes? No ❑ It you have checked yn, please Indicate the type coverage by checking the appropriate box A itabllty Insurance policy Cther type d kxiemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insuranca coverage required by Chapter 142 of the Mass. General Laws. and that my signattrs on this permlt application waives this requirement. Check one: NgnOwner ❑ Agent ❑ star•o Owner a Owner a ent 1 hereby cerilty that alt of the delaAs and Information I have submitted kx enter in abi�twaHance Uon us trw and a ale the best of my knowledge and that sB plumbing rrak and installations performed undat the Q m�1t I pertinent provislons of the Massachusetts State Plumblrq Code endCuptar 142 of with ail l 8Y nat sac ter CRyRorm i TitleUcenae Numt��Q��D/ _ APPr1CMD(OFFICE USE ONLY) Type of Plumbing tksnse: Journe yman 0 h i { Date. . . . . . . . . . . . . "0°T:'�a TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . has permission to perform . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee.. . . . . . . .Lic. No.. . . . . . . . . . . . . .... , . . . . . PLUMBING INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File Location—MI -?izoSC0tT "�'7 ' No. Date 'PS17 TOWN OF NORTH ANDOVER 3?0�t,�•o I•,M�t Certificate of Occupancy $ = x • • � ; ' Building/Frame Permit Fee $ cNus"cm e� Foundation Permit Fee $ � s� < f Other Permit Fee $ t Sewer Connection Fee $ jt Water Connection Fee $ TOTAL $ q fa — �� z3o9 R 09l�W�:54 Building Inspector 460.40 PAID k 8757 Div. Public Works APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. I.LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK :PAGE - ZANE p'Y SUB DIV. LOT NO. F- - LOCATION �n /� Pres c c�S C PURPOSE OF BUILDING J- 1 A�1 0 � J civ a' OWNER'S NAME R usS'err + Tl�a� 1 N o ui atV d. NO. OF STORIES �_ SIZE /j a� n , a� OWNER'S ADDRESS / P res 6� .r ST' BASEMENT OR SLAB p_ _ +� CO � ' d' ARCHITECT'S NAME SIZE OF FLOOR TIMBERS` ISST �I4 X�Jj 2ND 3RD `' BUILDER'S NAME G!`�`JAS, 17C:: -7-�r SPAN DISTANCE TO NEAREST('BUILDING /T/1 7r�6e Cc. DIMENSIONS OF STILLS V DISTANCE FROM STREET POSTS xU�l Ae DISTANCE FROM LOT LINES-SIDES �s-/,�, REAR L/_4`U fi GIRDERS ,�/Que• AREA OF LOT i{ ,Q. f AC`,CS 't FRONTAGE �ry/1 / HEIGHT OF FOUNDATION '/�V G V THICKNESS IS BUILDING NEWCS 7" , d T SIZE OF FOOTING 0 << X /(- /c IS BUILDING ADDITION �GS MATERIAL OF CHIMNEY t o`,I.- / IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Sa W8 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �5. IS BUILDING CONNECTED TO TOWN WATER yes BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE CS INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH BIDES EST. BLDG. COST Wr 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. E'ECTRIC 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 oll- kad�Z;2 DATE FILED re YILDING INSP[CTOR SIGNATURE OF O NER 1OR AUTHORIZED AGENT (� F E E 6 C� OWNER TEL.# �/� �f PEP.,MIT GRANTED CONTR.TEL.a w+' yC - q! z/7 Z7 19 CONTR.LIC.U 6W O 9 H.I.C.# o -3 c&L Al 62 91995 BUILDING RECORD 1 OCCUPANCY 12 , SINGLE FAMILY STORIES I I 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 / _ 3 11 2 I3_ CONCRETE BL'K. PINE PLASTER BRICK OR STONE HARDW'D _ _ PIERS _ DRY WALL _ UNFIN. ✓ 3 BASEMENT ' AREA FULL FIN. B'M'T' AREA _ 1/1 '/r 3/, FIN. ATTIC AREA _ NO 8 M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 _-2..f 3 DROP SIDING CONCRETE —I_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MASONRY ATTIC STIRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR ✓ POOR ADEQUATE I� -NO-NEC 5 ROOF 10 PLUMBING GABIE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT I SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK ✓ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST ✓ PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM _ r STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR f WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS r OIL ABL'M'T_Ii2nd _ ELECTRIC lsr 3rd NO HEATING e a� ORT Town of 4:7. - over No. 4 2 r3 Z ort dover, Mass., A o1� 31 19`iS Q � LAKE •w/,,,. COC HIC HE WIC/( � I AERATED E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System ' I BUILDING INSPECTOR THIS CERTIFIES THAT�S,?��hk....k7p4� ... .. tv4m%. ............................................................................ Foundation has permission to emt... �..A�?�........ buildings on ... ...�R co-T—T...2;r.................................... Rough �0.. uo.X:zz...T-A,t�l. . . . .. ..... :l.k ......4AQ....QA.Rl��.......��........... Chimney to be occupied as .... i?I,�C?�(1... provided that the person accepting this permit s&ll in every spect 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. ePLUMBING INSPECTOR '� ea C'��.�Ftca-ho►�� �Q VIOLATION of the Zoning or Building Regulations Voids this Permit. �"OLARough Final cad �a3Z3"1 PERMIT EXP 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS L TI T Rough ................. Service BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh s No Lathingor Dr Wall To Be Done y Until Inspected and Approved by the Building Inspector. Burner FIRE DEPARTMENT PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT w gap i (.PHASED UPW-1 PLAbUG RECOW>SAUD L-VfDekCE ONf'fK�Cr �.1NQ, ool O ��wwr w, w ■ �r� iwa.er•.■�eyr 50u�2.GE f�,NPoV�R� �at�11L po R.`6"l o►� O� Lo LP AeACf- .. UND�� t . • • f'Y6 ,05 P E �---- — —• -— • n. • i ■i ri l r r. f f FORM U - IAT RELEASE FORM 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 w landowner from compliance with any applicable local or state law, s regulations or requirements. *** ************Applicant fills out this section***************** APPLICANT: ��v ss tel/ %V�c v �6 war d Phone Tq 3cl -LOCATION: Assessor's Map Number Parcel . F Subdivision Lot(s) Street JJ ' Fres c o (( Sr(, `—S`t--Number /A Z ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Date Amzroved Conservation Administrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department eEe� /76��,� G✓-vie f r� ti�� �(eTc C T�r'1 �v t�-� j/ �Zy GJ -Received, by Building Inspector Date AUG 291995 ! ' i. �� Office Use Only 01 4z v:ommanl imfth If Musu4mifts Pemtit No. 7-961 ltvar!iriL Of 1ILthiit occupancy 6 Fee Checked Z671 BOARD OF FIRE PREVENTION REGULATIONS 527 MIR 12:00 30 peave blank) ELECTRICAL WOR RM K APPLICATION FOR PERMIT TO PERFORM All work to be performed in accordance with the Massacnusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date `t-z5-- T& 5=T& or Town of NORTH A -R To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Numbers / Z 7 Owner or Tenant (),- s /�YJc�Ct I"Cl� Owner's Address Sop" 'e Is :his permit in conjunction with a building permit: Yes No C (Check Appropriate Box) Purpose of Building ility Authorization No. Existing Service _146 Amps /-?4/—,i1—LL0V0itS Overhead `!I\ Undgrnd C No. of Meters New Service Amps Volts Overhead Undgrnd L! No. of Meters Number of Feeders and Ampacity n ,/ did I,,/ Location and Nature of Proposed Eiec*ncat `.vera 1 #2 FAD `' ` i / rl eo h — C;:aza -<" -L4 Total No. :f Hct�cs No. of Lighting Cutlets I I No. of-ransformers KVA 7-7 No. of Lighting Fixtures ISwimming =°, Acve— tn- yrnc. — crnc. _ Generators KVA A i I No. of Emergency Lighting No. of Receotac:e Cutlets / No. of Cil Burners Battery Units No. of Switcn Cutlets ( No. at Gas Surners FIRE ALARMS No. of Zones otai Noof Ranges I tons NInit ao. ft ngtDevicesection nd . No. ci Air Conc. V No. of Disoosais I Nc.cf P"eat 'boas 7otat i u:ros Tcons K'.V No. of Sounding Devices No. at Sant Contained No. of Dishwashers I i ScacerArea =esacg Ktv Detac::cn/Soundng Devices Municipal No. of Dryers Heating Cevices KVV Local _ Connection l iOther i No. of No. at I Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs j No. cf `.totcrs T a HP I I C7HER: INSURANCE COVERAGE. Pursuant to the recuiremens zt `.tassacnusetts general Laws I have a current Liaetiity Insurance Polio in inc!ucCzr.` a Ccerao:cns Coverage or its sucs:antial ecuivaient. YES = NO = I have suomttted valid of of same to the Ctfics. YES = if you have checked YES, aiease ineicata the type of coverage by cnecxng the aD r:ate box. INSURANCE — BOND = OTHER = (Please Scec:!-f) (Expiration Oate/l Estimated Value of Electrical Work S D , , ! - 2 �^ Fnai Worx to Start 12' yL,'r Inscec::cn ate =ecuestec: Rough Signed under the P!raities of perjury: FIRM NAME l/ L/ / �, LIC. NO. L censee i/7 t �0S;g ature LIC. NO. r Bus. 7e Acdress 7� -C[.1�6L �'r �/"'1V/,i/fLG �C Alt. Tei. No. CWNEa'S INSURANCE WAIVER: I am aware that :he Licensee does not have the insurance coverage or its substantial eQuivalent as re- cuired by Massachusetts General Laws. and that ntv signature On :his permit application waves this reewrement. Owner Agent ;P!ease cnecx one) -eteonone No. PERMIT FEE 5 ,Signature of Owner or Agent) x 565 Date.Q'-Z.::�-.9„�t�.......... 256 WORTH °�<«`° :•�"o TOWN OF NORTH ANDOVER PERMIT FOR WIRING �SSACMUS� i pp ` This certifies that ... .. .N..L?................. ....... � .................................. has permission to perform . tT..... .�.. ? .. .. !:.../ 3 � wiring in the building of.•• .•QSSELL.•••• at..1. I.......V . .... ......................... .North Andover,Mass. F .Q. ..... Lic.No.. .fi,L ............Cy .................... ....... ......... E CTRICAL INSPECTOR CU k 0—' 11:21 0.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File