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HomeMy WebLinkAboutMiscellaneous - 1278 Osgood Street t � �� (�77-5 �oDzJ t" Farm Family FARM FAMILY Mail to: P.O.Box 22091,Albany,NY 12201-2091 Ship to:344 Route 9W,Glenmont,NY 12077 November 13, 2017 Town Of North Andover Attn: Building Inspector, Fire Dept, Board of health. 120 Main St North Andover, MA 01845-2420 RE: Claim #: 20-G-3K7074 Ensured: Osgood Street Ahf Realty Trust Date of Loss: October 30, 2017 Location of Loss: 1278 Osgood St, N Andover, MA To whom it may concern: Farm Family Casualty Insurance Company writes to provide notice as required by Massachusetts General Laws c. 139, §3B in connection with the matter referenced above that Farm Family has received notice of loss or damage likely in excess of$1,000. You must notifyus b certified mail within 1 da of h f this 0 s the date o f s notice if you intend to initiate Y Y proceedings designed to perfect a lien against our insured otherwise we will proceed with payment. Please contact us at 1-800-948-3276 with any questions. Sincerely, N Delianedis Senior Claims Representative • Farm Family Casualty Insurance Company 800-948-3276 x7666(Direct) (Fax) nick.delianedis@americannational.com 1100278(12/16) THIS PAGE INTENTIONALLY LEFT BLANK Date.... ............1............. RTh�ti TOWN OF NORTH ANDOVER PERMIT FOR WIRING 114MUg t� C .. Inf¢� -Z�7�7L L,L Thiscertifies that ........................,.Q...,..,.....................................................................................s...... has permission to perform ....( r, ..................... wiring in the building of............. �2 .. ..../............................................... 79- at ... .2 .................IC ..........c...�...........................,North Andover,Mass. Fee�, "� ' Lic.No. M�s� � , . ....... ....... .. . ELECTRICAL INSPECT Tt Check* 11-W 11467 Commonwealth of Massachusetts OfficialUse Only / Permit No. ( 1 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank 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)NK OR TYPE ALL INFORMATION) Date: _3 l 447 13 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. Location(Street&Number) 1 Z--? 8- os (,ou i 5 T- Owner or Tenant —<-s, l-t-\A f Telephone No. Owner's Address S C Is this permit in conjunction with a building permit? Yes ❑ Nu- (Check Appropriate]Box) Purpose of Building tk&-5 A4-C_- 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: tj�J S ,,,y S`,yam �Le1b- l�✓ GGc7Z-�([� Completion of the following table may be 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- Elo.o mergency ig ting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 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 Tons KW No.of Self-Contained 3 Totals: "........"" ' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ 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 OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value f Electrical Work: "7 SV (When required by municipal policy.) Work to Start: 3I I Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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 c=BOND m force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . LIC.NO.: (M k , Licensee: ,(��c-�q�-� -tlz ✓�� Signature LTC.NO.: 6Z?kp (If applicable ent "exempt"in the license number line.) Bus.Tel.No.: 644 3� � Address: , -S 6S�.LG d� 1�.-t S r1D N Alt.Tel.No. j-o�b� *Per M.G.L c. 147,s.57-61,se urity 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 ❑owner's agent. Owner/Agent PERMIT FEE:� Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§ 32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the ` notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass[N Failed EN Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: r SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass EN Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECT N: Pass ` Failed 0 Re-Inspection Required($.)❑ Inspectors Comments. J Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industriql Accidents Office of Investigations UT 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): i�Lrq—�, Address: P g j City/State/Zip:_ ivI f QWhone Are you n employer?Check the appropriate box: Type of project(required): 1. I am a employer with fl::::, 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Bu' ' g addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. lectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions 1 myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. (,A:. E- -D J cr-� Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: ►ti-7 � 0 S 6o D_Z) 'S-(, City/State/Zip: AJ V, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failare to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certlif under the pains and penalties ofperjury that the information provided above is true and correct Si ature: Date: 2_1 Phone#: 3 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: I Y 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 ofhire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not producedacceptable 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the r 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 1 town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents offxee of Investigations 600 Washington Street Boston,MA 02111 Tol,#617-7274900 at 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 -www naass,gov1dia `Z Date.�.. ......9. ........... NORT►f TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 8 �,SSACMU This certifies that ..��,� �;�-�,......��'l`y`............................................... has permission to perform wiring in the building of ............................................. at. .7�..... . . . North Andover,Mass. .. ....... ..... ... . ........ ................ Fee ..zJ... Lic.No.-���........... ... d ELECTRICAL INSPE R ? Check 8676 s Commonwealth of Massachusetts Official Use Only �j Department of Fire Services Permit No- - 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(NI 527 CMR 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATION) Date: Z 09 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. Location(Street&Number) f? 7 8S l��0 b SSE Owner or Tenant _ Telephone No. Owner's Address Z 42 6-0 p b �7'/I�—E-7-- Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building_. 11jeU41ah Utility Authorization No. Eidsting Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and.Ampacity n Location and Nature of Proposed Electrical Work: De7t�C7of� O/2— Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed LuminairesNo.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 d• rnd. Batte Units — , No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of � Zone.- No. onesNo,of Switches No.of Gas Burners o.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. TotTons No.of Alerting Devices No.of Waste Disposers Heat Pump Totals: Number Tons KW__ No.of Self-Contained "'........ ... Detection/Alertin Devices r No.of Dishwashers Space/Area Heating KW Local Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or E uivalent No.of . Heaters �' o.of Data Wiring: 5i�-M�s Balla�HP . No.of Devices or E uivalent No.Hydromassage Bathtubs No.of TotaTelecommunications Wiring: No.of Devices or Equivalent OTHER: Estimated Value 9f E Attach additional detail tf desired,or as required by the Inspector of Wires. ctrical Work: (When required by municipal policy.) Work to Start: Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O RAGE: 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 cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) ! I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 1361L7- /i?j,-j r 1t- J Tit l L LIC.NO.: I-jzqa`_ Licensee: f3ElL7— Mli-leL Signature_ , ��; LIC.NO.: (If applicable, enter"exempt"in the license number line) Address: 7?oI 70ci Bus.Tel.No.:1`kK *Per M.G.L c. 147,s. 57-61,security work re uires Department of Public Safety"S"License: Alt.L cl.No. ��pL3�-I tJ 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 11 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $—�f t The Commonwealth of Massachusetts k� ( Department of.industrial Accidents Ogee of Investigations 4 600 Washington Street UM ` Boston, MA 02111 www.nzass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print Le�bly Nain.e(Business/Orgmizafion/Individual):_ 1?,�7")W l pe/ / ` Address: P--O, 7c Ci City/State/Zip:_/2r4 y D,✓d itJf>t Dao 7 7 Phone#: . 60 L 2q 1= O 6 F � Are you an employer?Cheek.the appropriate box: 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I Type of project(reyuiretQ: employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.( I am.a.sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity, workers' comp.insurance. [No workers'comp, insurance 5. [:1 We are a corporation and its 9 ❑Building addition required.] 10. Electrical reg ] officers have exercised their ❑ repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No-workers'comp. c. 1.52, §1(4),and we have no 12. Roof repairsinsurance required.]t employees.ees. [`oworkers' comp. insurance required.] t3.❑Other *Any applicant that checks bo-Z#1 must also flit out the section below showing their workers'compensation policy information t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must anached an additional sheet showing the frame of the sub-contractors and their". rkars'camp.policy inSrmation. � 1 am an employer that is prouidingworkers'compensation m1'ation insurance or e information. �+p f mpinyees: Below is the policy and job site Insurance Company Name: Policy#or Self-iris.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 do hereby certify Uflder the pains and penalties of perjury that the information provided above is true and correct Si Lure: Date: Z Phone 0 [[6.Other cial use only. Do not write in this area,to he completed by city or town official or Town: Permit/License# ng Authority(circle one):ard of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector act Person: 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 a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance'coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the numberlisted 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 permittlicense number which will be used as a reference number. in addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-8.77-MASSAFE Revised 5-26-I15 Fax#617-727-774 www.mass.gov/dia Of NOFTM ,� 3j �` TOWN OF NORTH ANDOVER p A ' PERMIT FOR GAS INSTALLATION �9SSACHUSE� 1 . This certifies that r ... .Z ? �� . . . . . . ''. . . . . . . � U has permission for g�a-s installation . . . in the buildings of -. . . . . . . . . . . . . . . . at e?.7_ fr3&' 1P . . . . . k�-��-A , North Andover, Mass. Fe��o. ::. . Lic. o '. . . . _ - -?fi�.�.L. .. . GAS INrS�PE�TOR Check# O a 3 A2;1 6746 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: North Andover _ -- Date: 04/02/2009 Permit# Building Locatio-1278 Osgood Street -- - - - - pyre Name: Arthur Fogetta Type of Occupancy: Commercial Educational Industrial lnstit Aonal Residential New:, Alteration: Renovation: Replacement,',-,( Plans Submitted: Yes No' *. FIXTURES W W Y = N aCr x 0 40 H m x OF LU O W V W ~ vt O W w z I- QQ z O x W M W p I- M N W W W g m O Q d FW-- 0 2 W X lz N 0 W c3 W to O r 0 XU. I- W z = WCA) tr Z W W N 'r Q a m W O z OOz -Jow ~ H W z W v � �+W+ y 9 z = o A u=, tag (�? z a� O a 1W— > > ?r O SUB BSMT. BASEMENT -i37 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR WH FLOOR 7 -FLOOR V FLOOR Check One Only Certificate# Installing Company Name: J•Michael Thurber Plumbibg&Heating - - -- - - Corporation Address: 81 Hilldale Ave. rCityITown: South Hampton -State: NH_ - ---—- - --- --—-_ — Partnership Business Tel: 603-235-4936— Fac — • 1( Firm/Company Name of Licensed PlumbedGas Fitter FSame - INSURANCE COVERAGE: --; I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No If you have checked Yes.please indicate the type of coverage by checking the appropriate box below. A liability insurance policy L�/ Other type of indemnity;_ } Bond . a OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement Check One Only Owner ! Agent Signature of Owner or Owner's Agent By checking this box[ ,I hereby certify that all of the details and Information 1 have submitted(or entered)regarding this application are trim and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By _Plumber Title" Gas Filter ; atu orLIVinied umber/Gas Fitter !!Raster c4frown Journeyman 'cense Number: 12393 APPROVED OFFICE USE ONLY) LP Installer i t oy Mfl eTN A 32.da; +.,•tido` 4g 4CHUSE . CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number `1 Date 1c;1_ A1-d V 6 Q, [ JJTHIS CERTIFIES THAT THE BUILDING LOCATED ON MAYBE OCCUPIED AS S iron tr- Paw -Dw el Molal IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO A(240- -FU T,� ��A i an s vsG om -D S-- c Building Inspector T0VM of Andover 0 LA h ' Mass.,O d I� COC MIC KE WICK over� 4 "?A TE D P'Pa,`�� S G �i BOARD OF HEALTH PERMIT T D Food/Kitchen I l Septic Syste - / /� --�-- / BUILDING INSPECTOR THIS CERTIFIES THAT.....liv/.. /. .....� ...rPe.7�.../ �7Td .....•.••..•.•.•.• Foundation ,AN(!��._ p .................................... buildings on ,1... o . has permission to erect.... ./a. .... .. .� .�.f3�...m�5.�o0.�.....$ f . Roug t0 be Occupied as a )ZOO h!..!.,a 13 h+4 , a 5+41t r4-PA C.4 0CP 61 N I e D lit+Q'r( iij Chimney ...................... ............,..................................................................................... J ............................... 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 andy-Laws rel ting.to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 3 y 3 9►�r3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. a R gh L( 9-0; - PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRIC PE C Rou ........................ .... ................................................ BUILDING INSPECTOR inal Occupancy Permit Required t0 Occupy Building GAS INSPECTOR c/ tgh.,Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To BeDone FIRE DEPARTME T Until Inspected and Approved by the Building Inspector. Burner E� Street No. � SEE REVERSE SIDE Smoke Det. Date. f 40RTH 1 . TOWN OF o NO .ZHANDOVER PERMIT FOR PLUMBING ,SSACMUSE� � � � (- �+ This certifies tha/t'--��. . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . has permission�to perform plumbing in the buildings of . . . � at . .7 . . . . . . . , . . '` . . . . . ... . . . . . .;North Andover, Mass. Fee. . . : ." .. .Lic. 'tVo./ .31`,, . . . . . . . P�M41NG INSPECTOR Check # 06 ' 8033 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING CityITown: North Andover 4 MA. Date: 04/02/2009 Permit# Building Locatiom_1278 Osgood Street = Owners man*: Arthur Fogetta Type of Occupancy: Commercial Educational i i Industrial; Institutional Residential f New: Alteration: Renovation:, Replacement: f' Plans Submitted: Yes No w. �. FIXTURES z z rn O Y to z } J = W W n. 2 FQ- Z N N Q Q z Z F a m i 4a a w WF' w z O v a X 3 W 0 z N QD Y = p LU ir 0 I- 9 x z a u. 3: a x Z = w to W It Q Q N N Q O Q O x Q W Q Q Q 1- Q O 0 x X 4rn 05O SUB BSMT. BASEMENT 1 FLOOR 2 WFLOOR 3 FLOOR 4 FLOOR S FLOOR 6 FLOOR 7 FLOOR 8 FLOOR 1_� Check One Only Certificate# Installing Company Name:'J.Michael Thurber Plumbing 8 Heating - _ Corporation Address:;81 Hilidale Ave. _ - �CgyiTownHampton T_- State:.NH — Partnership Business Tel: j_03-2_ 5-4 39�__--'1 Fax: + - -- Finn/Company Name of Licensed Plumber: same INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes' J No If you have checked Yes.phase indicate the type of coverage by checking the appropriate box below. t A liability insurance policy f Other type of indemnity F { Bond y OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and information i 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 application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws, By _ Type of License: Title J Plumber nPAM gof Licensed Plumber yrrown journeyman� License Number: '12393 APPROVED OFFICE USE ONLY) 1 �f TO Y D�/ /, DATE TIME AM �1 FROM PHONE( ) PM H OF CELL'( ) O l , FAX ( ) N E M E M s `JA E � ' M E O E-MAILADDRESS SIGNED PHONEDn .nKsTURNEDnW�N �TOLLCALLnWASIN 7 URGENTn, RnW NORTH Of A s^� X 4 '°•••.°•�•`�5 TOWN OF NORTH ANDOVER 9SSACHUStit APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY : 1 17 9 ©saQc2 1-_ DATE REQUESTED FILED/READY FOR INSPECTION JI `© /1 CLOSING DATE ON PROPERTY: I I FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND PERMIT SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTION FEE OF TWENTY DOLLARD $20..00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES'- SIGNED c ROUTING CONSERVATION // 2 PLANNING v S/6 DPW -WATER METER NOTE: DPW MUST INDICATE THAT WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST . DPW Signature SAINT JOHN PLANT: 101 Ashbum Road•P.O.Dox 31$7 rSTUaw �BC N Saint John,1�D,Canada•M3S3 Fcix Phone: (506)633-8877 *Ww.strescon.com TO: FROM: Bob Moore Chris Caehatt COM17ANY: 111-ION1 NUMDEI William Bat±ett Hotnes (506) 633-8877 NA_X N UMI3EIL- PAX NUM.8813; (978) 682-2397 (506) 632-7576 CC: DATU Doug C1Yng= 04--Nov-02 Rg: 'COtAL NO.OP PAGNS INCLUDING COVER: Calcuktions&Engineei Stamp 9 EJ tACILN't' X FFR REVIEW D PLEASE COMMENT ❑PLEASE REPLY d PL)+;ASt,Rt,CYCLE PROJECT: FQRGE'ITA HOUSE (CUT-LIST) -0 1278 Bob.- Please ob:Please find acconapahying this coversheet calculations stamped by out Etigineet as pet your ir-quest. Should you have arty questions please contact the undersigned. Youts truly, S:MSCQN IMITW Claris Carhatt Project Manager If you do not receive the complete nutabct of pages, Please contact the sradet itninedlately 6/Z'cd EGO'ow NOOS3KS WdZO:E 2002*V 'AON { CCwCISIB V 3.5a Preaaat Praetfeaaed Beam Design gARR�'f1.CON 11/04/02 Page! 1 - -------------------------—------------------------------------- ----------------- ------ Compaty ! ,Otrescan Limited Project: Daaignar: Gary Fillmore ID: --------------------------------------------- CONCRETE MATLRIAL PROPLRtIES ---------------------------------------- ---------------------------......--- ---------- -------- PRECAST ------------------ Unit Weight Wt ■ ISO Pdf ComprtdaiYe Strength 7 k$i Elaaticity ModAiUE4 B 5072.2 kai Initial Strength fici 3,5 kei Initial Modullia kai .............................................. --------------„-..................----------- SECTION 09OM9TAY ---------------------------- --------------- ------------------------------ --------------------------- szr=ft - it QVVSET - inSECTION INDENTIFICATION No Froin $b 2 Y molder Label Section Label --- -------- -------�- ------- ------- ---------------- ------------I-- 1 0.00 27.00 0.00 0.00 Hollowcore HC4 XB ------------------------------------------------- PAMSm Sk]=OX JMOtEkTigg ----------------- ----- ------------------------------------------------------------------------- Top -------------------Top BOTTOM lop BOTTOM No A - iA2 I - izi4 Bb - in3 yb - 1.x3 v/S by - in hf - is hf - in bf - is bf - in -.. .... ..� �- --- ------------ --- -- ------- ------- - ----- _. ------- 212-68 ------ 212 6B i653 5 413.36 4.00 1.92 11.35 1.00 1.00. 47.25 47,25 -- ------- -------------------------------------------------------------------I--------------- MISCMA99005 DES= PAf2AMETERS -------`----------------------------------------------------- -------------------------------------- -- Slutp = 0 111 Curitg Type ■ ACCelerated Minimum Depth of Cover Cement Content bio pay Preatretlairig sEeel - ow Relaxation Top - 1.5b in Age at Erection = 40 dayo Conmtruation type Unahormd Bottom ■ 1.50 in Air Cont®nt = 4 9 Dedi_gn Code + VSA (ACS 218 99) Humidity ■ 70 % Left Support tl 0.13 ft Fine/Total Agr. 0.4 Total Beam Length 27.00 ft Right Stippo:rt 26.97 ft ---- -------------------------- ---------------------- ----- -------------------- PRESTRESS3NG 9TUL ------------------------ ----- -- ----------------------------------------.-- -- --- - - ----- OFFSET DebondiDg - Et Qt y material Label 6eCtioxi Label X - ft Y - in LEFT RSrsirt Area - in2 FpU - kai `----- - ---------------;I ••- ------- - ------ ._-- 7 7 Wire (270) 1 Wits (270) 0.00 1.75 0.00 0.00 0.153 270 f u-270 kai Sias#1/� 27.00 1.75 0.654 * Immediately After cracking Ole'Mq� CAkY I. pr CL3V FIL OR , )CTU ! N .41006 � s �0 Ilii ..� A 6/21d E60'ON NOOS3NIS WdZO:E 2002'b 'AON CONCISE V 3.5a Precast Preatreeeed Hearn Deign AARRsTI.CON ll/o4/02 Page: 2 ------------------------------------ ------------------------------------`----------------------------- company : Strew;= Limited pro�eot. Degigriar: Gary Fillmore YD: ---------------------------------------------------------------------------------------------- `-----------------------------------`--------------------------- ------------------------------- BEtF WEIGHT Ilb/ft) No From _--To-_- I S --- -------- II ------------ 1 0.00 27.00 221.54 --.-........................................ —----------------------------------------- ---`----__------- APPLIED LOAD .......................................... -------`-`---------- _.-....... _---`---------- INTENSITY - (*) QV 999 ft Load Caae Load Label Load Type LSVT RS= LEFT RIGNT --------- ------ -- ------------ .. ......... ............ --` `--------.- DEAD r--- ..topping Line Load 100 loo 0 27 DEAD edl Lan® Load 40 40 0 27 LXV>3 wl Une Load 400 400 0 27 (*) lb point loads ib/tt line loads lb-ft point torsion/moment lb-fE/ft line torsion Load fetctoru: Self Load = 1.4, k)ead 13T - 1.4, Topping Lard d 1,4, Dead Load 1.4, Live Load . 1.7 BHEAR/TORBT014 DATA ------------------------------------------------------------------------------------------------------- No Material Label ty - k6i I - Aoh- in2 Ph in. 1EY060 kai 60 0 0 I 6/E'd EGO ow NOOS3NiS WdZO:E ZOOZ'b 'AON CONCISE V 3.5a Precast Preetregsed Beam Design BAkRETI.CON 11/04/02 Page: 3 ---------------------------------------------------"---------------------- Company : Sttaddon Limited Project, Degigner: Gary Fillmore ID: ------- ----------------------------- ---------------------------------------- AkAL140xS RESULTS --------------------------------------------------------------- -`------------------------------------ LWYACTORED SUPPORT REACTIONS FACTORLD SUPPORT REACTIONS Load Cage LEFT - kips RIGHT - kips Load Case LZVT - kips Rt9AT - kipv ........... ------------ ------------ ----------- ------------ ---- ---- SELF 2.9909 2.9909 SELF 4.1872 4.1972 MAX) BT 0 0 DEAD BT 0 0 TOPPING 0 0 TOPPI140 0 0 DEAD 1.85 1.69 DEAD 2.646 2.646 LIVE 5.4 5.4 LIVE 9.18 9.1e SUSTAINED 0 0 9USTMMED 0 0 COMBINW T 10.281 10.281 COMBINED 1' 16.013 Y6.OX3 COA114ED a 4.0809 4.6609 COMBINED S 6.8332 6.6332 BT before Topping T Total Load AT After 'topping S = SUOtdined Load ............................---------------------------------- -------------------------------------- MOMENT RESULze (kips-it) -------------------------------------------------------------------------------------------- ------- LOCATION ---------------------- --------- __.----------,.- LOCATION X tt Mit omn Mcr 7 2Mcr 1.3314u Mod -------------- ------- ------------ ----- ----- ------------ ---------- ---------- ------------ Max k Fddtored 13.50 106.01 120.66 76.6$7 91.988 140.99 $2.311 Mali - Factored 0.19 -0.010023 -1.2856 21.354 25.661 -0.013331 -0.0030551 Max. 4, Resist 13.50 106.01 120,66 76.657 91.998 140.99 32.311 Maio - Regiat 0.13 -0.010023 -1.2856 21.394 25.661 -0.013331 -0.0030551 SrRVSS %21sULTS (kai) ---------..------------------------------------------------------------------- ------------------- ----- RELEASE MAXIMUM (4-) RLLA#SB MINIMUM (-) X - ft f X - ft f ----------- ------- ------------ ------- Top 09 amain 13.50 0.444 0.13 -0.008 Bottom of Seem 2.16 1.611 0.00 0.000 -Y+ -y TOTAL TOTAL SUSTAINED SU5TAINED SERVICE MAXIMUM (k) SERVICE MINIMUM (1) SERVICE' MA7tIMOM (4) SERVICE NIMMUN (-) X - kt i X - ft f X - ft f X - ft f _- -------- ------ -- ----- ------------ -:-- -- -- ------------ Tap of Beam 13.50 1.559 0.13 -0.007 13-50 0.007 26.97 -0.007 Bottom of Seam 2.16 0.993 13.50 -0.378 24.94 1.285 0.00 0.000 Top of Topping 0.00 0.000 0.00 0.000 - - - - Transfar length dOed - 2.04 it Development length used 6.77 ft STRESS AT TRANSFER L$NGTX X - ft Wb) ft(b) -------- -..---------- ------------ At Lt from Left 2.04 1.619 0.023 At Lt from Right 24.96 1.619 0.023 PERMISSTBLE STRESSES AT RELEASE PERMISSIELE STV"SB5 AT SERVICE Minimtm Release Strongth (Before Losses) (After Losses) vici tj 2.69 Compreanion Totai 2110 CoMpkt9dion 'rotai 4.20 Sustained 2.10 5u6tainod 3.15 T:n:ion (except at ends) -0.18 Bilitsee.r -1.00 Concrete hUpture Strmed Tension (at ands) -0.35 Grogo gee -0.50 gr = -0.6275 AUXILIARY REINFORCEMENT R£QUIR= AT TOP AUXILIARY RE1kVO1ZC9MENT R£QUIYIED AT BOTTOM At X 0.00 ft A9 = 0 int At X 0.00 9t As = 0 int 6/t?'d 660'ON NOOS3diS Wd20:6 ZaOZ'b WN 4033 �y Date.....`..���`�...�.. NORTry 0 TOWN OF NORTH ANDOVER sot PERMIT FOR WIRING �SSusf� f rr AJ d IQ GK This certifies that .... ......`.'..t Va"� A has permission to perform ..... .............................. ......................... wiring in the building of a � " r(re'q M�, ... �.I... ...... ................................................. a.. at.../4?. ......�� �.�.............................. .Noah Andover,Mass. ��,,,(( �1 Fee.....J. ........ Lic.No..P?R.Y, ................... )6 ✓� In.......................... �ff ELECTRIC INSPECTOR Check # `Ia0 Officia U �r0_�I Permit No. _ ?��ed�ZnLfllZlf/��4.C'?�f� SS�4L'�fZtS�7'TS � Vopt-ea°6 PaR&S-#4 Occupancy&Fee Checked_ . BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR//12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number la—2 JP - d `S Owner or Tenant /r �y Zu��'s Ownel's Address Is this permit in conjunction with a building permit Yesc9K No ❑ (Check Appropriate Box) Purpose of Building S7��� �i ^ Utility Authorization No, E)osting Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work V i Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ � No.of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sat No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection, No.of No.of Low Voltage No.of Water Heaters KW Si ns Ballases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: sfclr INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a curr&nt Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitte ooid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSUFV4 NCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimai I Value o EI q'cal W $ F-75—(0-fl Work' Siart —ay Inspection Date Resquested Rough Final Signe under the Pe hies o r)ury: � / ��� y s FIRM NAME V h A -f LIC.NO. Lkensee /'r' kr.( /�' JJ�� v c✓� signature —LIC.NO. Bus.Tel No.f7ef 4e2-4e2 Address-)7 / �y�/411(/4 ,S la Iti, �� AR Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE L (Signature of Owner or Agent) 4 Q 8 J Date....q.-1 ..-0.z....... t NOFTM 1 ° t"`° '• "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� k c This certifies that �. `� C , ............ .............................................. a has permission to perform ...... ... � `<' !..1......... ....................................... wiring in the building off tp. .l.Q......�.Q P�. .... . .................................... 8 �s "' .. N rth Andover Mass. at...... ....... ...........................�.Q.................. , Fee..................... Lic.No. �`�"� 023 ���.... .............�?.:��.... ��........................ ELECTRI AFiaCTOR Check # — Z� I3 Official Use Only ' Permit No. _ Is aetxe«t o6�" Sf Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 2:00 (Please Print in ink or type all information) Date I G To the I nspecf#6r of ires: Town of North Andover The undersigned applies for a permit to perform the electrical /w�orrk,rdescribed below. Location(Street&Number �p2 ��1 V W L37— Owner or Tenant 1-f Gia Owner's Address (Vw C Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building �� �'L V� l�-� 1 � W 46 Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service &DD Amps f Volts Overhead ❑ Undgmd ;['j� No.of Meters- 54 7 Number of Feeders and Ampaciity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers S ce/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heatinq Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER =, (Please Specify) (Expiration Date) Ecltimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penpities of erjury: ,p 7-IRM NAME SITooL LIC.NO. Lkensee i l�'�/y/f,l Y ri 7JL!2 Signature LIC.NO.�; f %AVO Bus.Tel No. 6 Address_ L C� z J Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have.the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that mysignature on this permit application waives this requirement Owner Agent (Please Check one) 17 Telephone No. PERMITTEE $ (Signature of Owner or Agent) I - �ooD � L�cztl�n.� a � 080s _ No. '� �J Date NORTiy TOWN OF NORTH ANDOVER 3:0:t .So ,�,h•GOL F . D /1 # PMw # l J Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 5 Check # 3�°1 Alm( 15522 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO �+CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAc^MILY DWELLING rz C b4 ^5,✓�: 6f, _ ,Y '9�.,etS.. n 'i'°,,. ..,w _.,_.._ LNl 1' ' gyV¢ `P� i"'}a F r"3 m`nTr } Hd3BS 17 Nil rn BUILDING PERMIT NUMBER: S�Q DATE ISSUED: a� SIGNATURE: Com, Building Comn-dssioner/121=tor of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 13 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: ( ).1 9 i 0 O 51V14 —gym, / 4cl, '3Y7 Zoning District Proposed Use LotreeaAr sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided o �' L Z v 1.7 Water.Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: �y 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone l'' Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHW/AUTHORIZED AGENT 2.1 Owner of/Record Name(Print) Address for Service ? -,/ 6 Signature rTelephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Ltcensed Construction Supervisor `�� Z ' License Number Add ess Z Expiration Date ignature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address mom Expiration Date AOft Signature Telephone 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........a No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction >?V Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be s OFFICIAL QNLY Completed by permit applicant 1. Building (a) Building Permit Fee o K -fA0 0 p �b v D�� Multiplier 2 Electrical / ©� (b) Estimated Total Cost of C� Construction 3 Plumbing 7 Building Permit fee(a)X (b). 4 Mechanical HVAC 5 Fire Protection �tJ� 6 Total 1+2+3+4+5 / G / Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, / / �/l //l� Ems%�1� as Owner/Authorized Agent of subject property Hereby authorize G�'i////�ys� ✓/�}^/'Pi to act on My behalf,in all matters rela 've to work authorized by this building permit application. Signature 'of Owner I Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Own er/A ent Date r NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3 SPAN DIMENSIONS OF SILLS DM ENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 J FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained.This does not relieve the applicant and or landowner from compliance with any applicablo requirements. .■■■.■r■■..■■.............■rrrrrrr,/rrr.■...■.■■...........r.........r..a..■ APPLICANT !y�/y r 60 ryc' 1.9 PHONE 6c6a Z —Z 3 ZZ) ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION FP-2 M LOT NUMBER 13 7— STREET STREET ,S STREET NUMBER I V if �........... .............................................................. OFFICIAL USE ONLY B■none..r..■.................■............................................... RECOMMENDATIONS OF TOWN AGENTS I.............. ■r..■■.....own.■■rown NONE.r■■...r...r.soon.r......r..r.r.on (( DATE APPROVED Z 2-62 CONSERVATION AD TOR DATE REJECTED COMMENTS DATE APPROVED T PLANNER DATE REJECTED COMIvMiih'N TS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTEDA11r� DATE APPROVED vI SEPTIC INSPECTOR-HEALTH DATE REJECTED CONMIENTS 0/<_225 �o►J gEPT�G PUBLIC WORKS-SEWER/WATER CONNECTIONS D AY P !J DATE APPROVED F :DEP DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR. DATE 1 � i MAS �HIG�H �A, Jane Swift Kevin J. Sullivan MatthewJ. Amorello , AY Governor Secretari Commissioner January 15, 2002 Marchionda & Associates, L.P. 62 Montvale Avenue, Suite 1 Stoneham, MA 02180 Re: North Andover — Route 125 (Osgood Street) Access Permit Application for Parcels B2 & B3 Atui.: John A. Barrows Dear Mr. Barrows: This letter is written in response to your submittal of a plan with a permit application for the subject project. The District Permits Engineer has reviewed your submittal and determined that your proposal for the driveway does not involve work on State property. Therefore, your check is being returned and an access permit from the Massachusetts Highway Department (.'IY1assHiuhway) will not be required (provided all the work remains on private property). A permit for the water line con=nection will be required and is being processed. If you have any questions concerning this correspondence, please contact the District Four Permits Engineer. Kenneth Ravioli at (781) 641-8451. Sincerely, Stephen T. O'Donnell District Highway Director I Y1Hi mh cc: Arthur F'orgetta Enclosure Massachusetts Highway Department•District 4 .519 Appleton Street. Arlington, MA 02476 • (781) 641-8300 EXIS7IN Z0' WIDE EAS EMEN7 �,�- o 1000* PARCEL 62 / f i 66,347 S.F. ` ! / F < 1.38 Ac. PR. _ _ _ MAP 34 PARCEL 43 BLDG / / E — — N/F DANIEL & JOANNE FORGETTA / DB 1153 PG 570 PR. WATER ! SERVICE- MAP ERVICEMAP 34 PARCEL 49 I X62 / / / PARCEL 63 / N / _o / 25000 S.F. EX. _ FORGETT / / Z__ / / � � 0.57 Ac. - - � 1 e%2 ST � � - - - - - - - FAMILY T T /� �, r�'5A/ � / / � � W.FD r - - - ` — V% OF D B �5 P G 134 PAI�.A�s,�°ti I / LU / o X. TREE MARC.�IIONDA' 0 NOL z / / ° EX. TREE `SS/ NAL a BLDG 17 EX. _ � , — _ l: -��`` 1 1/2 STORY W.F.D. — ` / 1284 DRIVE _ ��� `Z- / Ngo I 0 1 EX. _ �172-- SHOP FLOWER PROPOSED COMMON DRIVEWAY PR. DRIVE R F (TYP.> - PLAN � EXIST. AOGE�S & kllRIVE I � "�'q`� qs � \ - ' EXIST. UCTION '�� F / LOTS B-2 + B-3 EASEMENT //P ��16 �pNp6�40' 16' (MIN.) ^�o -_ — ` PROPOSED / ) Fi�j 1 b _ OSCO©D STREET IN DRIVEWAY — I _'//'EX. TREE p EX. — — _ 0 �A� w vEM�N� PARKING NORTH ANDOVER, MA PR i y 0 X PP MSN LOT ! I ACCESS EX pJ 00 Q P� l PREPARED FOR: EASEMENT c PPROX. �C FRO A R DRIVE 86.61' / / ARTHUR H. FORGETTA ' _,ROM INFO) MHBdh iFND 176x7(ex 1284 OSGOOD STREET qtz— 21. RD INFO) Q EX. E.O.P. X. PAVEMENT m — -"- �X_8_G� IvA1L 0 ' // / EX NORTH ANDOVER, MASSACHUSETTS 01845 + APPROX. LOC. FROM RECORD INFO) 4. _� l H:\PR0JECTS\620-04\CURBCUT2.DWG T r7 / —C— DRIVE MA. HIGH WA YREV. DATE o / 176 ex. u N � _ _N _ _ _ _ �Marchionda LAYOUT BASELINE _ _ // �ti OSGOOD STREET �,�R*. GAS MAIN x0 & Associates, L.P. (A+'F'ROX.LOC.FROM RECORD INFO) — —' �' (PUBLIC - VARIABLE WID�f�i� _ xE O.a. (ROUTE 125) Z (1961 ALTERATION - DB 933 PG 170 - PLAN #4250) / 40 20 0 40 Engineering s ons and EXISTING / 62 MONTVALEAVE.,SUITE I DRIVEWAY -EX1.S-DNG STONEHAM,MA 02180 DATE: 12/10/01 DRIVEWAY (781)438-6121 FAX:(781)438-9654 SCALE: 1"=40' I Town; of North Andover NORTH Building Department ` = 27 Charles Street 70 North Andover,Massachusetts 01845 (978) 688-9545 Fax(978) 688-9542 °� ��w:..:-• �9SSAGHUs���y I i - I I DEBRIS DISPOSAL FORM i In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. I The debris will be disposed of in/at: ks 4 Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. .I I I i I i I GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUII.DING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. j 1-gotl1al- 6 Ig I �� 5K Permit Applicant Property address Map/Parcel 97 -/96 3 10;� Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the ENEMPTION section 8.7.6 of the Growth Management Bylaw.I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit.Further I understand that my interpretation of the exemption status is subject to review by the Building Department and is only officially accepted when the building permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot,in the building permit application and associated attachments,complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement,restoration or reconstruction of a dwelling in existence as of the effective date of this bylaw,provided that no additional residential unit is created. The lot(s)was/were created prior to May 6,1996 and are exempt from the provisions of section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and or moderate income families or individuals,where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents,where occupancy of the units is restricted to senior citizens through a properly executed and recorded deed restriction running with the land.For purposes of this section"senior"shall mean persons over the age of 55. This application is part of a development project which voluntarily agreed to a minimum 40%pemanent reduction in density(buildable lots)below the density permitted under zoning and feasible given the environmental conditions of the tract,with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland.The land to be preserved shall be protected from development by an Agricultural Preservation Restriction,Conservation Restriction,dedication to the Town,or other similar mechanism approved bythe planning board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 and shall receive a onetime exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for a building pemit(all other permits from all other boards and commissions have been received and the project is in compliance with those permits),and the Development Schedule does not accommodate issuing a building permit in that year.One building permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits.Applicant must submit an approved FORM U with this EXEMPTION. PLEASE PROVIDE ANY AND ALL INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS APPLICATION IS ALLOWED UNDER ONE OR MORE OF THE ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATE INFORMATION OR THE CHECKING OFF OF A ABOVE ENEMPTION WHICH DOES NOT COMPLY,WHETHER DONE TO MY KNOWLEDGE OR NOT IS GROUNDS FOR REFUSAL BY THE BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. APPL S SIGNATURE U DATE THIS FORM TO BE ATTACHED TO THE BUILDING PERMIT APPLICATION Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print ;1:114 P1311,11 Name: Location: Ci Phone am a homeowner performing all Work myself. Ol am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. Company name• GD o r i a. L i l(e a e- Oe v. Corn 0609— Abbe.# n P Address City' PVD A n dpu rr• Phone Insurance Co ICY eN IanA t^ Sla y C,0fAA4 ✓)/ Polio# WC 95$M. 9leg Com n name: Address Ci Phone Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine of($100.00)a day against me_ I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. f do herby cerfdy under the pains and penalties of perjury that the information provided above is true and correct Signature Print name �J i r a w► I ct r/t Phone Official use only do not write in this area to be completed by city or town official- � Building Dept ❑Check if immediate response is required Building Dept E] Licensing Board p Selectman's Office Contact person'_ Phone#: Health Department Other FORM WORKMAN'S COMPENSATION ✓die �iynvmoozurea�fi �yy.�7'Laaracfulile�d BOARD OF BUILDING REGULATIONS i License: CONSTRUCTION SUPERVISOR Number: CS 052241 Birthdate: 10/10/1952 Expires: 10/10/2003 Tr.no: 9092 Restricted: 00 WILLIAM K BARRETT 1049 TURNPIKE STe t, N ANDOVER, MA 01845 Administrator REQUIREMENTS FOR BULDING PERMIT SIGNOFFS BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Building Permit application 1. What is the proposed project? Deck pool addition new house other 2. Are plans attached? Yes No (Fpr additions and new houses on septic systems, complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is mui nicipal sewer available at this location? Ye No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes No 5. Is thelocation served by private well? Yes No 6. If this project is an addition and the house is served by a septic,system, has there been a Title 5 inspection done recently on the septic system? Yes No 7. If, yes, is the inspection report on file at the BOH? Yes No I I I f . TOWN OF NORTH ANDOVER, MASSACHUSETTS DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 J.WILLIAM HMURCIAK, P.E. Telephone(978)685-0950 DIRECTOR Fax(978)688-9573 � HORT{q 9 O O 4. 6. A �y °9,.En•E° ,�9 SA US DRIVEWAY PERMIT DATE LOCATION ( Z BUILDER ( Gw phone Z-Z 3ZD OWNER l l` ,� e hone THE NORTH ANDOVER SUPERINTENDENT OF OPERATIONS MUST BE NOTIFIED OF THE GRADE AND SETBACK FROM STREET . CALL THE SUPERINTENDENT'S OFFICE BEFORE FINISH GRADING AND SURFACING FOR APPROVAL OF SUCH ENTRY. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. X A Pr I,1 ca N 1142 APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. f 1 49-- Application by the undersigned is hereby made to connect with the town water main in fy Street, subject to the rules and regulations of the DivisionofPublic Works. The premises are known as No. Z [7 a 19 Street or subdivision lot no. I J (j�Z 7 32 Owner Address Contractor Address X­p plicant�ss i o PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to Ar U(, Fo—re"04 ' to make a connection with the water main at � Street subject to the rules and regulations of the Division of Public Work Board of Public Works By Inspected by Date See back for rules and regulations 1142 APPLICATION FOR WATER SERVICE CONNECTION Zoo North Andover, Mass. �� 1 -}9--o Application by the undersigned is hereby made to connect with the town water main in Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. I -27,5?_ (fStreet or subdivision lot no. Owner Address Contractor Address _UAA L Applicant's Signatu l� o PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to U" 0 r<,04� to make a connection with the water main at �'G� Street subject to the rules and regulations of the Division of Public WorksO Board of Public Works By Inspected by Date See back for rules and regulations DPW 584 Date .... .......................... TOWN OF NORTH ANDOVER RECEIPT CHU This certifies that C-7 Dryll-.4 ............. e9 has paid ................. .. e? ......... .........................I............... Z%40....4�% ...... .............Z7 ........ for ...tw. 4 n-- . .. ...........I ....... .................. Received by .... ............. ..................I................. ...................... Department ...................../:�-(/ ...... WHITE: Applicant CANARY:Department PINK Treasurer ORTIy Town o rn No. SR 8 0 :: ;_�, Andover �. 10 ndover, Mass., O LAKE - COCHICHEWICK ADRATED A-'p AC US IT FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ...5�/..11.�a •••-- a� �� �-0/Z ,�/� `�"�'CUe ml� ....................................... ... ................... has permission to excavate and pour foundation at # S 7� �5.�........./a�8.....os .o.m.a.................. for the purpose of...e..2�M a 02 c I P P ..........................�..........s,.�...a ........ ..? I!4c ... .�N . - �' lJw�l �t�J The person accepting this permit must return to the office of the Building Inspector a certified plot plan show of building thereon before Foundation will be inspected. 3e l /3 VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. BLDG. PEI WiT FEEE $ /1039 --- LESS Io3.LESS FDA FEE "P s o . - C DILE FRAME PERMIT$ 2: �'�� BUIL,D[NG INSPECTOR NORTFI Town of Andover 0 No. � aoo o dover, Mass., - y COCMICMEW1 K V %p�oRATED P `� 7 V 4 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System --�— BUILDING INSPECTOR THIS CERTIFIES THAT.....1/v� e.T�....��f... /e ��".....r�.!....t7Td.......... Foundation has permission to erect................. ..................... buildings on .,l 07�..�c .... �a S� m<5 � S fRough g )Zoo �, , a �� g�-k a5+4Il a� 4 d SAN ( � 1( to be occupied as.. . . ......................................................1.....................................:A.�...p.................... e w Q . Il1t{ 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 gy-Laws rel ting to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 3 '41 3 c)'6-,3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C 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. SEE REVERSE SIDE Smoke Det. I I ' I I i i r-, I I II I I I I , I I I I it I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I f---1-1 I I I I I 1 - I I I I I I I I I I = � I I O I I I I I I i I I t li I , I I II i ii I I I I I I II I I I ii I I I I I I I I I I I I I I I I ii ii I I ii I I I I I I LJ s i ' i I L 1 i i W0 Ct nnF; SCALA; nAf: Sl etc W I L-L- I AM811.i 1-011 13UIL12F-E? OF INF- I-IOMr-5 s1,�rnn�; IAWNI3Y, A-1 z I i r� ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii ii p ii ii ii ii ii ii LJ ----- LJ PPOICT fltx: 5c&r: nAlt; ffff. wI L-L- I AM MMA M51MWC� 1/811-11-011 4/5/01 13UIL-PF-I, OF FINS HOMF-5 rflnr: MWNPr, A-2 MAl;�I.�VA110N I I r, IL Ir I I ii ii I I ii ii II 7 I I � I I ccs I I D O ! � ii ii c I I II I I II II I I I �N I I � ii ii I ---- LJ t i; C l I r I I � I I I 1 I I � I I I I I I I i I I I I I I � C'R I I � I I cR I I I I Y I I O ii - I I t it � � I I I � I ii LJ t r } Ppo,fct Mr: 5C&V : PAT %af.. W I L — IAM [�Af?���I'�i' Fo�G��frA ff5lmNc� 1/811_11-011 :4/9/01 PULPFW, OF FINS HOMFS 9iff fl1r: MVM A-9 511 �I.�VA110N5 6-211 O r ------------ ----- --------------------- ------------------------------------------------------------------------ r— ---------- ———————————————— ----r r-------- -------------------------------------- ———— -------------r 10" X 8'Concrete WAI Beam Pocket fl 10" x 4'(Min belc w Grade) on 10" x 24" Keyed Frost Wall `. j Caitlnuw Feotlnq I I I I r- —, I •` I O N 31/2" Pla,Cd. on 30" x 30" x 12'' Fi_1 l III Q 31/2" Pia,Cd, 7� 7A T1 7� 13 2 on 30" x " x 30 12" p aZ c i Footing Cp1 1 j L I J a� ayh6� beam pocket (4) 2 X 12 built-ulr\ Beam `D .. i � i .. i I I i •: i y� . I i i .• i �— — I I � Up Deam pocket • � I i I I L------------- ----------------------J L----------------7 r------------------ ---- ------------- 1 J ap __ —______________ __ ______________ ___I—____________ ______________ O --'1 r---------------------- — I � I Q I ° 1L ----------� I L P 4 I I V -------------- Is "•it 7 CJ FOUNDATION PIAN Z 1/Y'-I'-0" �\ SOL. r Z V IT-O"I L O 10' 10' 6-011 I I'-I I" T-011 Q a PeCK 20' X(9'-611 c I ul O OI �` M17ROOM#2 \ 01 = 3'-6" 13'I 6'-0X 11' r• - 3'-6" ---- 4 j j nN I 4 o1 ' 2'-6" 7'-6" � 1 ,D � O N T5r--PININ6 ROOM LIVING ROOM C tz00M#1TrTPF = LI' o v LU PORCH 11� O 9'-0" 3'-O" 9'-0" 21-611 26'-0" 5'-7" 5'-5" 5'-O" 5'-0" 5'-5" 12' 7" 1..011 z IT-0 ZZ FIR5f FLOM PLAN � � I z I I I I I i I I I i I-1 C�1 29'-8" I Ji� O I � 1 I O 0 Q N Q r b _ 1 I � e 1 b I O 1 � � I k3h U\ I I - I� Cl I I I Pr?orcrTIIL�: 5CU: VAT: Srfr: WFIL-I_ IA.M 13�pF—rT FOC?G MM51MNC� 1811-1'-0" a�5�01 PUILPF-l2 OF FINF- HOMF-S 5ff-Ern1r: n�Awn,aY: A-6 SECONn FI.00C;PLAN i 2 x 8 Pf deck Jolst @ I6'O.C, 7-�-�—r-r—r—r—T—��--r—r—r T-7-1--�--�--r—r—T-7 ZA6xa&/CA I D N 'p4S ilW hwoifl ° VM9 a R rn � ids r1w I I 2 x 8 Pf Deck Jds+s @ 16"O.C. I i I 2 x 10 flar 6K46 e 16"O.C. � i weak 1 6 x T/�� (Z i ----------- v` i fl 1A9 1Jl -Z I x (4 i a � I I I rRO.fcT W: pAT; SI FT; WILLIAM MMAIsinENaJ i�8 -i -o�� 4/ 501 [3UILPF-p OF FINS HOMF-5 5ufflT U: n�Awt�aY; A-1 ri�srANn s�coNn R�i� 4 C C' R� z %SDS z U019"1011 y 4g"i U0, — — lack pIW 2 K 10 Cetlrq Jdsts @ 16"ox, ------------------ O z c� LU m Q 2 x 10 0-ft ers @ 16"oc. WILL IAM [3Af?pF--�"-�" r'rzo crnn�:�Or?G�TTA SI NCS sc��: PAT: sir; PUIL-I2r::�I,, OF FINF- NOMAS 51frrfl1r: A-8 C�II.ING Mrf;00r Ft?AMING o� N x = Rio -R S1 x = � 0 � �c it N N I 61-0 11 Q Q N N PROICr nn�: : WI I!L_ IAM I�AI�I?��"�1' FOC?G M�51PEU 3V 16" 1'-0" nAr�:�� 5�01 �r: 13UIL12F-12 Or— FINF— HOMF-5 5f�rnn�: ► wNPy.. A-9 13UII.nING SECTIONS Location ko4 $tea A is r)g bSC,00 Sfi- No. 5 D8 Date ~°RTIy TOWN OF NORTH ANDOVER pow { ` Certificate of Occupancy $ �'7s'•••°'ESQ' Building/Frame Permit Fee $ 1,53 1 SAC MUS i Foundation Permit Fee $ Other Permit Fee $ TOTAL $ C153— Check # D O .til -- 15631 r Building Inspector n � o �. � vsa ��� s �z,• F 4L op L? -7 � EXIST. USE �5`O /L ' O,, cnF EASEMENT �o�� ��� 3`S,/O ti ui w 20' W W PARCEL B2 v� 66,347 S.F. Z Qzz 1.38 Ac. l rn w v 34.8' `l 1 i u t3; _ F � EXISTING 2- ri SEwE�ASEMENT \ o o- rn 8 .9' 37.5' 4, F N/F 47 2' DANIEL & JOANNE �N �� Np5.2B 40"W ` FORGETTA 81.66 v zo s� cv bo PARCEL B3 N/F o N ?v 25000 S.F. '.aA' FORGETTA o 0.57 Ac. FAMILY TRUST N Z z � i '-,E=-?HCV :Vi. c pp yMELESCiuc EXIST. USE & GRADING EASEMENT �av A =01'29'24" R=1960.00' I-L=50.97' OSGOOD STREET Z 74.03' (PUBLIC - VARIABLE WIDTH) oD N07'03'00"E (ROUTE 125) i WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND THE DWELLING IS LOCATED THIS PLAN IS INTENDED FOR ZONING AS SHOWN. THE STRUCTURE SHOWN CONFORMS PURPOSES ONLY. IT WAS PREPARED TO THE ZONING LAWS OF THE MUNICIPALITY FROM EXISTING PLANS AND RECORDS WHEN CONSTRUCTED. ALSO, ACCORDING TO THE WITH THE STRUCTURES SHOWN LOCATED F.E.M.A./H.U.D. FLOOD INSURANCE RATE MAP, BY AN INSTRUMENT SURVEY. THIS PLAN COMMUNITY PANEL NO.250098 0005 C SHOULD NOT BE USED FOR PROPERTY DATED JUNE 2,1993, THE STRUCTURE IS NOT LOCATED LINE DETERMINATION. IN AN ESTABLISHED 100 YR.FLOOD HAZARD ZONE. CERTIFIED PLOT PLAN PARCEL S2 MARCHIONDA + ASSOC.,L.P. NORTH ANDOVER, MASSACHUSETTS ENGINEERING AND PLANNING CONSULTANTS DRAWN FOR 62 MONTVALE AVE. SUITE I FORGETTA DEVELOPMENT, LLC STONEHAM, MA. 02180 1049 TURNPIKE (781) 438-6121 NORTH ANDOVER, MASSACHUSETTS 01845 DATE: 6/17/02 SCALE: 1"=80' Date. . ..1. 1. :v.l_. ..... TM TOWN OF NORTH ANDOVER O P • PERMIT FOR GAS INSTALLATION L � y �9SSACHUSES This certifies that .0. . Z�: .,y. .`�� ./`?�. . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . . 2. ?. . . �. . . . . . . ., North Andover, Mass. Lic. No.P,.3. .`1.�. . . . .I'- .:1. 2 ... . . . . . . fAS INSPECTOF� Check# ? ; 4109 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print o Type) ,1 r a yt� , Mass. Date ? 206 Z Permit rx � Building Location 'L2 �600P gb owners Name f-012 G < 1 Type of Occupancy Newg""'Renovation❑ Replacement❑ Pians Submitted: Yes No❑ 0 a (D O m 0O a Cdui C9 = F- > LLI V) t�i z O 0 zz r z p� J I�i u� z ¢ O S w � 0 = C7 2 0 0 U o: o 0. 1 W 10. SUB-BSMT BASEMENT 1ST FLOOR i 2ND FLOOR 3RD FLOOR 4TH FLOOR `t STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name JAS Pc' Check one: Certificate Address_ �n_ )G ? O i MAorporation ^` Business Telephone y c] Partnership_ l ❑ Firnvto. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current ability Insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked yes,please indicate the type of coverage by checking the appropriate box. A liability insurance policy c---- Other type of Indemnity ❑ Bond ❑ OWNER'S INSURNACE 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 is permrf application waives this requirement Check one: signature o Owner or Owners Agent Owner ❑ Agent ❑ I hereby certify that all of the details and Information I have submitted for entered)In above appll tion ar a nd accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued fo is ap It do will be in compliance with all pertinent provisions of the Massachusetts State Cas Code and Chapter 142 of the General La Typ of License: By gKumber lignatuee Wlce e Ib Gas Fetter Title Gas r / — � City/Townter License Number APPROVED(OFFICE USE ONLY) 0 Journeyman Date. NOR7M TOWN OF NORTH ANDOVER Oq �1 '• O .�j ��M • •• OL ° p PERMIT FOR PLUMBING 41 'y �°+„�°.x•'`15 ,SSACMUSE� This certifies that . . . .?'� . . . . . . . . . . . has permission to perform . . .-?l.'. .... . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . � . � ” 7- �'� . . . . . . . . . . . . . at. �. ./. . . ��. . . . . . . . . .. North Andover, Mass. Fee.L' . . .Lic. No.., .. . . �-i. �_ . . . . . . . . . . �JQ� Ptt7M8 G SPECTOR Check # �� 5343 i G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �� 1. (Print or Type) Ch/ �rMass. Date-'R" 22- 20 -t- Permit # Building Location j Z7'1Z dS Owner's Name—'vve�c, ( / A- _Type of Occupancy .� New Renovation 0 Replacement ❑ Plans°Submitted: Yes❑ No❑ FIXTURES B.P. # SEWER # SEPTIC # z Z Y Ln } 0 Q w LU � w 2 N V w In Y z to OW Z a Z a W w p m w Q � W z ¢ W Z W � z a 'D U ~�~ LL W = i- L Q 0 _ -� N �- Q w W LL U o: 2 a Z � Z a 0 z z • O v o = m = o o = Q o u- L o a ° m o 1 0 SUB-BSMT BASEMENT 1ST FLOOR 1 I 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name _ C,.C3v\ � P, Check one: Certificate l� c� Address Ra. .QQ O� Cii�('br p oration CZ p 9 ) Y �� ` � t�� ❑ Partnership Business Telephone `7 '"T a ,,. ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter 'C,► INSURANCE COVERAGE: I have a current 0ability insurance policy or its substantial equivalent, which meets the requirements of MGLCh. 142, Yes No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy ES Other type of indemnity ❑ Bond ❑ OWNER'S INSURNACE 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 9 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 the p rmit s e for this ap lication will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14 f t en rai Laws. By Signature of Licensed PI r Title Cityrrown Type of License: 04aster ❑Journeyman APPROVED(OFFICE USE ONLY) 1 Q 3 tZ� License Number