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Miscellaneous - 129 MAIN STREET 4/30/2018 (4)
129 MAIN STREET 1 2101030.0-0001-0 .0 ---------------- c��-,rn vjo � ....... .... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ....F .. ........................................................................... has permission to perform ............................... wiring in the building at... ...... North Andover,Mass. Fee.��, .. .. .. ... ....... ..........A-iLECYR_1SAL INSPECTOR Check # 0739 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 Commonweglth,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, firmM.G.L.r corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in Mc.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be.deemed-by the 7nspector_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 puipose 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. ❑ le 8—Permit/Date Closed: Z 1 ***Note:Reapply for new per it 0 Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusetts Official/Use Only � Department of Fire Services Permit No. ((/ ! 3!2 Occupancy BOARD OF FIRE PREVENTION REGULATIONS ev1and Fee Checked /07 � j leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3 7 City or Town of: NORTH ANDOVER To the Inspector of ices: By this application the undersigned gives notice of his or her intention to perform the electrical work describ d below. Location(Street&Number) �'/1797' 197POP Owner or Tenant .114, %y,davt sem- Dh u f C' -41,v kiiy Telephon No. 97? 79Y y4_6 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ,� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:A07- 2* 10T2* cfllpi let„t' `7�i- —a.�„► Completion of the followingtable ma be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o Total 1 Transformers ansformers KVA No.of Luminaire Outl No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting nd. nd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I 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 g Totals: ' .. ..'" Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local[:JMumcipal ❑ 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 I No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: e4.4,944 2_J Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectri 1 Work: 7zyr, 0 © (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify,under the pain ndpenalties of perjury,that the nformation on this application is true and complete. FIRM NAME: .@ �ia C; LIC.NO.: Licensee: Signature LIC.NO.: 7CI (Ifapplicable,enter"exempt"ip th lice�nnse tuber liyy��) Bus.Tel.No. e1 �y3 Address: 37/ G�� t JfgCD� /l//� �.��/0� Alt.Tel.No. ©7Q *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent PERMIT FEE. $ Signature Telephone No. The Commonwealth of Massachusetts Y Department of IndustrWAccidents Offwe of Investigations 600 Washington Street Boston,MA 02111 wi www.nm&govldia Workers' Compensation Insurance Affidavit:BuildersJContractors/Electricians/Plambers Applicant Information Please Print Leaibiy PJ , Name(Businesstomanization/Individnal): Address: -3-?/ 6/l z 6 4-7 l/ y� City/State/Zip: 7�4 ILW Phone#: KOv3 • Are you an employer?Check the appropriate box: Type of project(required): j 1.❑ I am a employer with 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.t 7. E]Remodeling ship and have no employees These subcontractors have S. ❑Demolition working for me in any capacity. workers'comp-insurance_ 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10,t'Electrical repairs or additions rte.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑Plumbing repairs or additions 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 tin out the section below slowing their workers'compensation policy information. t Ho Wn li rs who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. *Contractors that check this box mast attacbod an additional sheet showing the name ofthe subconinictors 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: Policy#or Self-ins-Lie.#: � fl ' j 7�D3or l Expiration Date: Job Site Address: ra 9 111;lla /1p/,i d,0 Ak ©lro— { Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the ' and penalties ofperjury that the information provided above is true and correct Si afore: �/ Date: a Phone#: 6-03 �� o'Z�7 3 Official use only. Do not write in this area to be completed by city or town gf Mat 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 i Date . .4�-Z/-. l Z-- r lub TOWN OF NORTH ANDOVER , PERMIT FOR WIRING This certifies that . . . . has permission to perform . . . . . .: . . . o . . . . wiring in the building of . ..P V``J`�.�.'L, .oAA)1-5 ( .T. D fir dt�� . . . T. . . . . . . . . . ,No Andover, Mass. oe� Fee . .V,-! .`. L'ic. No. . . 7q. . . . . . 21CAL ELEC INSPECTOR` 1 Check# 3 3 76 10906 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.01 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.E.c.143,§3L. Permits shall-be limited as to the time ofongoing 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 puipose 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. ule 8—PermitMate Closed: ***Note:Reapply for new per 0 Permit Extension Act—Permit/Date Closed: Commonwealth of Massachusetts official Use Only Permit No._ f' 10 ' _ Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS rRev.9/051 fleave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIOA9 Date: y'(2- City or Town of: N To the Inspector of Wires: By this application the undersigned gives notice of his or her intention toto perform� the N ed cal work described Location(Street&Number) L� !�A JPJ AP �il �C,l" QCA1 O" Owner or Tenant �©G ��1W� Telephone No. Ck Owner's Address 1)7A ltv � T.31uTS Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) }rte'�y � Utility Authorization No. Purpose of Building QL1V V J" 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: ZTJ4 It Com letion o the ollawin table maybe wanted by the I Total o Wires. No.of No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets - No.of Hot Tubs Generators KVA Above In- o.o mergency ig g No.of Luminaires Swimming Pool d. ❑ d, ❑ Battery Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.o -taction and No.of Switches No.of Gas Burners Initiatin Devices Total No.of Alerting Devices Na of Air Cond. g No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Con * No.of Waste Disposers Tota Detection/Alerting Devices Local❑ Municipal ❑ Other No.of Dishwashers Space/Area Heating KW Connection Heating Appliances �y Security stems: He No.of Dryers g pp Na of Devices or E uivalent No.of Water No.o No.of Data Wiring: Heaters KW Signs Ballasts No.of Devi ees or E uivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP Na of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires e� . Estimated Value of Electrical Work: AY 0,0J (When required by municipal policy.) Work to Start: 1-4-117, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of sameto the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) Lf bbl t � Et��nd co 1et� I cet�ify,under thLgamumms nd penalties of perjury,t&hat the information on this p mpFIRM NAME: J� 't ; ' OEIA LIC.NO.:n� Signature LIC.NO.:Licensee: Bus.Tel.No. (If applicable,ent in the license r, her line.+ Alt.Tel.No.: Address: *Security System Contractor License required for this work;if applicable,enter the license member here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owne_ r0 owner's agent., Owner/Agent PERMIT FEE: $ (ZS,60 Signature Telephone No. N° 9700 Date.6*7z_ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACNU 7 A)' J\ This certifies thatA71e. ! 5 . . . . . . . . . . . . . . . . . . . . has permission to perform . .. ..�: .,n-1 —. .��!�+-.!1� .. . . plumbing in the buildings o�f !f� +�•�4. . fi���,.. . . . . . . . . . . . . at . . . . . . . . . .. North Andover,Mass. Fee.7tY . . .Lic. No. 3!;.45 M�.62 PLUMBING INSPECTOR X Check # /79' v WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY iN I MA DATE t t _ u �—�PERMIT# I v V JOBSITE ADDRESS /'� �� j OWNER'S NAME POWNER ADDRESS -� L _ I TEL J AX { TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL Q PRINT CLEARLY NEW: [a' RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES NO© FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ------------ DISHWASHER -._.- _DISHWASHER __1 .._...__J ___._._J --------I f. DRINKING FOUNTAIN __.__..J _ _l FOOD DISPOSER _ _J FLOOR/AREA DRAIN 1 _........._( _.___! __-____1 ___--_._1 i ---------1 _.._.__.J .__.__i INTERCEPTOR(INTERIOR) KITCHEN SINK —I -.1 - ! - LAVATORY I _-..__....J J I { i ._._.._......I 1 __._.__1 _____.1 .--..___-{ _--__._.J _E-Al I ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 __..._.._i J 1 .._-- _1 J ._._-__J .._...___-i URINAL _1 . .....-.? --1 .....- I ----_.1 _....._.J ._...._...( .......-.._i _._....-1 -- ! ........---( ___._t :......__1 .._.._--I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES M"*NO IF YOU CHECKED YES,PLEASE INDICATE TH YPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND �I 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 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 compliatrice with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME j�.J�I?I� LJ()A,' LICENSE# F SIGNATOR MP _' JP Q CORPORATION Fi# j PARTNERSHIP O# i LLC ___1 COMPANY NAME I ADDRESS 'Z CITY STATE = ZIP TEL FAX ; CELL�� EMAIL IIV I- v�. ._�� w `c- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# _ 7 PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leffibly Name (Business/Organization/Individual): 4 AM S ly 6 k y Address: I City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I �mployees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2.LVJ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical 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. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are 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. tam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site %reformation. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: `ob Site Address: City/State/Zip: kttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. iznature: - Date < < � �° L (2— hone#: Zhone#• 0 ( 1 — � �� a �(L0 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#: f Y Id —+fr 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 number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for 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 burn 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 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www,mass.gov/dia :. .COMMONWEALTH OF MASSACHUSETTS. �i I PLUMBERS E ND GASI ITTERS `LICENSED AS E MASTER PLUMBER:::: f ISSUES THE ABOVE LICENSE TO I uARRIS :F WONG 23: PCRK::INS ST � I t QUINCYMA 02169 1532 1.35_Gb 05/01/1- 161tSG2 �.. _. l CONTROL,# H 3 7 0 ? 3 IMPORTANT If this license is lost or destroyed, notify II Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100. If your na'rrte or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended.It is a personal privilege,and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. i f f j - r 9448 Date...-O':.fl,......... f N°R7M� 3:;•_t:�``° "°oma TOWN OF NORTH ANDOVER 0 -Swift ' PERMIT FOR WIRING 'o*,,,o ��Ss�cHUU This certifies that ............J................................ ............................................. has permission to perform ...SAL�� � ? K 1?A wiring in the building of.......... iv�'�!.`v4' ?S ...... ........ ........................ at....................................................... North Andover,Mass. b... Lic.No.c�.G 3.yY.9 ELECTRICikl! R Check # Z 216 Commonwealth of Massachusetts official use only 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(MECI 527 CMR 12.00 (PLEASE PRINT LV INK OR TYPE ALL WFORAL4TJOA9 Date: 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) Owner or Tenanty �� - Telephone No. Owner's Address Is this permit in conjunction with a building pe mi . Yes No Purpose of Building CG ��� f d� � (Check Appropriate Box) 7` Utility uthorizaiion No. Existing Service Y� AmpsVolts Overhead �Und rd l g ❑ No.of Meters New Service Amps. / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: L Completion o t�ollowin table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No,of Ceil.-Susp.(Paddle)Fano.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires �� Swimming Pool Above ❑ In_ 140.o mergencyfig g d• d• Batte Units No.of Receptacle Outlets 3� No.of Oil Burners FIRE AL ARM No• S _ of Zones No.of Switches No.of Gas Burners o.of Detection and InitiatingDevices No.of Ranges No.of Air ConcL Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number Tons p Totals: - __.._ o.of Self-Contained 11 Detection/Alertin Devices FNo.of ishwashers Space/Area Heating KW Local❑ Municipal ryers Heating A Connection ❑ Other Appliances KW Security Systems: atero.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts . No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Tom Hp elecommunications firing: OTHER: No.of Devices or E uivalent /� Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule Io,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove;age is in force,and has exited proof of spme to the permit issuing office. CHECK ONE: INSURANCE (Bexhibited OND ❑ OTHER ❑ (Specify:) G � / I certify,under the-vidns andpPienaltresthe-vans of er�u v, at the information on app[icakon fs true and complete FIRM NAME: � C �l e L ��� � LIC.NO.:Licensee: LIC.(//3 1 Signature (If applicable, [ r ',mem t"in the lice nu a lin ) LIC.NO.: Address: $ / /7 C�-���v 1 20,us.Tel.No.:_1i'7Y- *Per M.G.L c. 147,s. 57-61,security work requires Departrnent of Public Safety"S"License: Alt L cl No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑ owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: S T'he Comrrmonwealth of Massachusetts Department o f rndustrial Accidents ` D ce o .� f investigations 600 Washington Street BoStorz, X4 02111 www-mass-ovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers An ficant Information Please Print LeQibiv Name(Busines s/Organization/Individualn ` Address: or > if City/S fate/Zip: a �'C_ ��/x Phone#: / Are y an employer?Check the appropriate box: I.2Ll 1 am a employer with�_ 4. ❑ I am a o 77. L77 f project(required): general contractor and I employees,(full and/or part-time).* have hired the sub-contractors New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet $ Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' comp.insurance. 8. Demolition [No workers' comp. mance 5. ❑ We are a corporation and its 9. Building addition • required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right Of-exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. C. 152,§1(4).and we have no insurance required.] t employees. [No workers' 12.0 Roof repairs comp.mstsr'ance reouired.] 13•❑ Other y fiery -3Iicant that checL�bo:A l t ase .. n1LS f tYll Un?'I.ne 3erT^n be.^P.•c-n��unre�r Flotneownees who submit this affidavit indicating they a.e do"—g all work and 'Contractors that the cic this box must attached an additional sheet showing Vie°hire outside coni cto s fvs submit a new aindavit indicating such, the name of the sub-contractors and their workets'coma.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below,is the oli information /� /� ploy P �J and job site Insurance Company Name: ��r-1 L Policy#or Self-ins.Lic.P. All( X) ZIV Expiration Date: S — Sob Site Address: � City/State/Zip: Attach a copy of the workers'compensation policy declaration pa (showing sho g Page the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the ' osition of fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form off a STOP WO criminal penalties hand a of 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 c er the pat .and penalties o er fP jury thrtt the information provided above is true and correct Sismatur : Date.:_- Phone#: / / Official use only. Do not write in this area, to be completed by cam,or town official City or Town: PermitUcense# Issuin b Authority(circle one): 1. Board of Health 2.Builaiaa Department 3. City/Town 6. Other Clerk4. Eiectri:aI Inspector a Plumbing Inspector Contact Person: Phone : Date. G1/ TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING SSACHUS��9 a This certifies that . . . ! 4. �.�. . . . . . . . . .( . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . plumbing in the buildings of . '. .M . . . .4! .C.+.. . . . . . . . . at , North Andover, Mass. Fee. /'(,/U,. Lic. No.ll . . . . . . . Ct'z� ..zr�.. . �.-. . . . . . PLUMBING INSPECTOR Check # O L 86 � � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City1Town:_ ti7d(Zr!4 A"VU Zjy i i C-Q , MA. Date: ZI U Permit# C>j' Building Location: t 11 H A f k) ST Owners Name: C_A F;Cc -A M G 1 Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional ❑ Residential❑ New: ❑ Alteration: Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES z z N O W .Z y J S H W Z a W z H Y cn i Q w o w W � Q z rn z z ag t- w — Q p = Q Lu Q a Q w o w z W N z v a LL J w w 0 I a. o i 3 0 M s a o o z z n P � _ s !r Q Q J Q O0 2 J Q Q Q Q t— a m m o a u. O s Y W rn I-- M 3 3 0 Ca SUB BSMT. BASEMENT [IIF LOOR FLOOR FLOOR FLOOR 5 FLOOR 6 FLOOR 7 FLOOR . 8 FLOOR Check One Only Certificate# Installing Company Name: -t V-Q P ti P L-4 H 19 61�)-is ❑Corporation Address: [►� CitylTown: State:. PI=Partnership Business Tel: 351 'L tgys�* Fax: ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the.requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑. Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner .Agent 1:1 1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this 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 ❑Plumber Signature of Licensed Plumber City/Town 01master APPROVED OFFICE USE ONLY) Journeyman License Number: FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER LICENSE NUMBER: PERMIT GRANTED❑ DATE: PLUMBING INSPECTIOR '`w►. Location No. f ~� Date j�U A No r►, TOWN OF NORTH ANDOVER t „ Certificate of Occupancy $ # Building/Frame Permit Fee $ l = �? ��s Et�ff Foundation Permit Fee $ it Fee $ Sewer Connection Fee $ Wer Connection Fee $ `L�Building Inspector � J J Div. Public Works PERMIT DjO. 00 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE 1 MAP 4-40. LOT NO. 12 RECORD OF OWNERSHIP iDATE BOOK PAGE ZONE I SUB DIV. LOT NO. LOCATION 12� Nl1t�(�$f j� PURPOSE OF BUILDING Co tm a c p 1 'ryc:o OWNER'S NAME '/2q Ktd(N 5-[j¢�EI'[' -�a(,� NO. OF STORIES 40&je �� SIZE -LIQYLA Ir���O OWNER'S ADDRESS �+ v. 1� +e O�e .p BASEMENT OR SLAB ARCHITECT'S NAMEC)L m v /'��(�.JJ�CC� I`�y''•Y SIZE OF FLOOR TIMBERS IST � �.. 2ND �� 1, 3RD BUILDER'S NAME D h(J.�,cy=l.�un+r!'>.7 SPAN ./• _— Cy�� PL+(�r+s DISTANCE TO NEAREST BUILDING/67 ff�i�l,wf DIMENSIONS OF SILLS --- DISTANCE FROM STREET ( POSTS DISTANCE FROM LOT LINES-SIDES'ffr 7''r REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ,^� SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION '�Go..-rG/j/n IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS /(/�/�/� o/17 /J 3 PROPERTY INFORMATION /•/�„i//t U/U'�JZ C_ D ZI/79 LAND COST SEE BOTH SIDES 1 EST. BLDG. COST PAGE 1 FILL OUT SECTIONS I - 3 dD6 EST. BLDG. COST PER SQ. FT.Oil I EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 Dc,.y]^,/' ��L di �G' 2 SEPTIC PERMIT NO. 32 2 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 1 �./ P 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DAT -FILED .96w ( ( [ Z a (,I BOARD OF HEALTH SI 7WOF OWNERTHORIZED AGENT FEE 1.76- PLANNING BOARD PERMIT GRANTED n Jil1a • 't� 19 BOARD OF SELECTMEN 1?.• BUILDING INSPECTOR w BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILSTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY • ]--IOFFICES 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 1 2 13 CONCRETE BL K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. 8 TAREA _ '/, 1/1 '/, FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS •• 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY �— STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR _ ADEQUATE I NONE g ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT I SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 17 g FRAMING I 1 1 'HEATIN,G. WOOD JOIST PIPELESS FURNACE _ FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS' HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS OAC B'M'T 2nd ELECTRIC lsf 13rd I NO HEATING 4 1 a �;UERVATNION F VvI G Al L PANNHI Q' 4 NORTH C 'T -v&ve own of 0 Andko r No. 004 Aj C er, Mass., ra tj 19 ofi. 9 SS BOARD OF HEALTH PERMIT T LD THIS CERTIFIES THAT.JAI...kh� %....ST!...re 4 t T .4re".................. BUILDING INSPECTOR has permission to~ 141411M......... buildings on ....... Rough 'M '4' 4. vA.0 A Chimney to be occupied as.. of ..veimom..1�!0e. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on rile in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRU( .. ....ST Service Final .............iUi I ....... . . . ..... ..... ........ .......................... .. . .. BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector ti DEPARTMENT OF PUBUC SAFETY COMMON EtALT c x y` -I 1010 COMMONWEALTH-AVE. ; 1 ;,OF BOSTON,MASS.02215 MASSACHUSETTS ' ENCLOSE CHECK OR MONEY ORDER .q •tir- r ^ ' I LICENSE: EXPIRATION DATE �J CONSTR. SUPERVIS0R FOR REQUIRED FEE, MADE PAYABLE TO 06/30/1991 ,E o EFFECTIVE DATE LIC-NO: RESTRICTIONS "COMMISSIONER OF PUBLIC SAFETY" NONE. 1 .06/30/1989 0207.95 JOHN S DRAPER NOT SEND CASH). 122 CHESTNUT � H (DO `.SS N ',029.!--24-8356 N JINDOYER MA 01$45 PLEASE NOTE FEE . YNCREASE PHOTO(BLASTING OPR ONLY) FEE^ PAID, T . 100.00 i FFECTIVE PA1D, 1989 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY JTAMPEDR-SIGNATURE OF THE COMMISSIONER �,/AYDOB: '1T'A1 ? G haal.IS01 /24/1932 ,�,� 4- THIS DOCUMENT MUST a IM SIGN NAME IN{�{�l-gi�VIGNATURE LINE CARRIED U THE PERSON OF SIG URE OF LICENSEE I L jj,,J THE HOLDER WHEN ENGAG OTHERS-RIGHT THUMB PRINT ED IN THIS OCCUPATIU COMMISSIONER 20OM-2-87-81429 i f — 1 • f DRACO CONSTRUCTION, CO., INC. - - -- GENERAL CONTRACTORS DESIGN/BUILDERS January 4, 1991 TO: Joseph D. LaGrasse & Associates 1 Elm Square Andover, MA 01810 Gentlemen: We are pleased to present our proposal to do the work as shown on the drawings entitled China Wok Restaurant by Joseph LaGrasse & Associates. Our proposal amount is: $15,765.00 Thank you for the opportunity to offer our services. Very truly yours, ohn S. Draper JSD/sw rr �I_�• , Ir r . .r« - .. .. _ .. .. - .. 'zr- T_. •'r,.-^. -u-rY .�,.,;,x�--s*vxar•+. s.... ..^�r .. n - •r .- ..- ^•v. .}a _. .. 333 METHUEN STREET LAWRENCE,MA 01840 • r_ _ 617-685-6069 .. t.{ *."-. �. s - w z-. — _ t'^-. r.c v �-' ,t�•r-;r-s '.a�. •r , -tr c. -' t�._�r }-t x l .. .+ _ ;d .. x _ '" - _ 1' }t-�" .y. :7 ��l i.'�ft. - .•t^ - .:.at 4 ...._... �+:�r 'T�. 191' � - -9".f ... _ ♦ .. st .'1' V• Y F. _ _ . � .A.3 i .'r6. L,.v9J . .f-7 -i.. R- .. �� r 4. '✓'.•..' :..-.n i' -moi. :'r..-".^!! ...Ti '.. '•,Y:. .: `-..-c �- :.rtt• - �_ 4i- ...f A.. ...A. ._ .:. _... .__ _ .a.,._,.. �.. Date 1 i �F f t NORTIy TOWN OF NORTH ANDOVER PERMIT FOR WIRING u ,SSACMUS� This certifies that ............O.n.......4,.t1 t..........Z-- ..l.........f.'i.. r!.... has permission to perform '{.....!��.......... Lu �. ... f...................................... wiring in the building of t at.....4- ..... ........:.: '.:! ....................................... .North Andover,Mass. ' C✓ Fee.. ........ Ltc.No. j ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File v All � The Commonwealth of Massachusetts Perms No. 011ke use Only Department of Public Safety Occupancy a Fee Checked , BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 (leave Munk) 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code,527 CMR 12:00 J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) DATE City or Town of NaRrK ANA 0ue,5Q- To the Inspector of Wires: The undersigned applies for a pemut to perform the electrical work described below. Location(Street&Number) /ate 9 �3 M�9/ 5%7— Owner TOwner or Tenant G A(/Al A• ware Ownees Address SA.,w E Is this permit in conjunction with a building permit: ' ❑ Yes ,No (Check Appropriate Box) Purpose of Building __ Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Mctcrs New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Mctcrs Number of Feeders and Ampacity Location and Nature of proposed Electrical Work_ROLA C ft G A,-'P f /3 AU C FixT�R FS MASS 6Z-Ec 7Rt e- R 67-Ra Fr r No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total No.of Lighting Fixtures Above In. KVA Generators d. KVA Swimming Pool ❑ No,of Receptacle Outlets grnd. ❑ grnNo,of oil Burners No.of Emergency Lighting No.of Switch OutletsBatter Units No.of Gas Burners FIRE ALARMS No.of Zones No.'of Ranges No,of Air Cond. Total No.of Detection and Tons Initiating Devices No.of Disposals No.of Heat Total Total No.of Sounding Devices Pumos Tons KW No,of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices No.of Dryers Local ❑ Municipal ❑ Other Heating Devices Key Connection No.of Water Heaters KW No.of - No.of Si ns =- r Ballasts Low Voltage Wiring No.Hydro Massage Tubs No.of Motors Total HP OTHER: 9 13 A A•s r- INSURANCE COVERAGE:Pursuant to the requirements of Massachusetts General Laws,I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES)l NO ❑ 1 have submitted valid proof of same to this office. YES A NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box. INSURANCE R BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work$ (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury FIRM NAMES 0-' AJ E ELEc /GA L GO r iu L, Licensee VAurD '�rf�r�?0^6 , LIC. T NO /O 6�s Signature LIC, NO,�/J G 9(0 Address /2 .,ALLCc�s �iZ e S,4GFn� /yt} Bus.Tel. No.Sa t 7 l - /S�� All. Tel. Nob Z20 r-/9.AZ OWNERS INSURANCE WAIVER:I am aware that the Licenseedoes n_c ha_v�th0 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) (Signature o wner or gent) Telephone No. PERMIT FEE S <Od — Commonwealth of Massachusetts rRECEIVED City/Town of H6 �Z)e d�- o System Pumping Record 0 2005 Form 4 TOWN OF NGRTH ANDOVER w" I HEALTH DFPac TI,,IENT DEP has provided this form for use by local Boards of Health. Other forms may be used', bu e information must be substantially the same as that provided here. Before using this form, check with your local Board of Health to determine the form they use. The System Pumping Record must be submitted to the local Board of Health or other approving authority. A. Facility Information Important: When filling out 1. System Location: forms on the computer,use 1 2- Mew- S117 only the tab key Address to move your W6 cursor-do not Cityrrown State Zip Code use the return key. 2. System Owner: N -e— Address(if different from location) City[Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2• Quantity Pumped: Gallons 3. Type of system: ❑ Cesspool(s) ElSeptic Tank E] Tight Tank I [ ther(describe): —tt�� 4. Effluent Tee Filter present? ❑ Yes ❑ No If yes, was it cleaned? ❑ Yes ❑ No 5. Condition of System: (�Wd 6. Sys m Pumped By: !q C;-, NamV9Vehicle License Number Company 7. Location where contents were disposed: 1 igna re f auler Date t5form4.doc•06/03 System Pumping Record•Page 1 of 1 6024 Date..... •'.. ..........D'^ ' NORTH "� TOWN OF NORTH ANDOVER 3r moi^• p PERMIT FOR WIRING ;,SSACiIUSE�t� This certifies that ..........!...�.. ...... /.w.... ST............................ has permission to perform 40�!�.9. .. i �iTi� '� DUTY TS wiring in the boding of....... !A.� ..... ...�.p �Qt............................. at.................r...... ........ ;North Andover,Mass. Fee �...'......... Lic.N04F.2. .. ^% /�f-�! ....... ` ELECTRICALINSPECTQR Check # — DEAUa1iWOMBUCSUEff l> 2 y� malt Na Ba4RnoFFRBPREvavnfONRBGULAMYS527GRUM occapency .Checked APPUCA71ONFOR PERA RT 70 PERFORMEI ECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WrrH THE MASSACHUSSTS ELECTRIC CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INPORMAITON) Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below Location(Street&Number) AAAl N SF Owner or Tenant 3-41 N 2 c% 12-`i MAA) Sr lQC A7 c 4Y T'r 77 7- OA(Address' a( WCLL i N5 toM Rd• W t ►vc� e,r 4 Cr- MA 0 ►� S o 13 this permit in conjunction with a building penait: Yes 1:3 No [3---(Check Appropriate Boa) purpose of Building Re4ttit Utility Authorization No. �s Existing Service Amps�.V olts Overhead Underground Q No.of Meters New Service Amps..L.Volts Overhead Underground C3 No.of Meters Number of Faders and Ampacity Location and Nature of Proposed Electrical Work X&g4o,11 c�o exit, 6 m e f ge, e-h 1,1j h f vel ittr I- frl o. L,g H t i- io F ct- 0 No.of lighting Outlus Na of Hot Tula Na of tnumbm me TOW KVA Na of Lighting lsium f Swarm hW Pooh Above 0 Below Omrmstom KVA Na of Recepuck Oud is 1 No.of Oil Burnam No.of Emergency Lighting Balury units 2— No. Na of Switch Outlets No.of Or BmamsNo.of Rangy No.of Mr Cond. Totd FIRE ALARMS No.of Zonas Tats No,of Dispoals Na of Hat Tool Total No.of Deacticn mrd pornts Toes KW Initioing Devices No.of Dishwuhan Space Area Headag KW Na of Souod[ft Devicn Na of SOU Conubred No.of Dryers Heating Deviow KW Local rml. wdcipdOther uorrs No.of Weer Heuer KW Na at Na of 31200 silub No.Hydro Mudge Tube Ne,of Motors ToW HP OTHER- YM 0 ' Iheteaf>rrtltledvaidproddsanebthe0�Y$4 r)uuhmecfledtaiYBS,pl'+teeadcalafteg'Pedoot�by MMANCE- 3] �iD t7Ifi0L �leaseSpecd» dY os EstialabdVakxof8m kalWak$ Wodilb pp 11t;pectirnDa�Regrad Raft Fd NAME Pl�latEisdpaji>ry►. ( U Z23 Re6h-"c ticaeerla - L+�tre -99„�ae — [iomaeNo r-z-73 Z`3 I , acid.. BtairmrTtl �}7�' 16Z5Addm � ALTUeL — ° OVYIWSMMANCEWAMR-InnawaedutzLicais fttbeirBmnea mWcritratsnWegiivdwassrgiiWbyMasaac mmGnWLaws ardthrtmyApanori ftpe¢r�applcatimwaiKatita (Please check one) Owns � Agent Telephone No. pl3liyMTr FEE t DERRE t NTOMBUICSUM 2 yC ea�OFFMPM��s�ar�IZI Permit�. Occopncy a Fe=Checked APPUCA77ONFOR PERMIT'TO PERFORM ET CIWCAL WORK ASL WORK To BE PERFORMED IN ACCORDANCE WITH TO MASSACHUSSTS BLECfR1CAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INMRMATION) D Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) pl g A m N s77 Owner or Tenant T01pe- 2^� n14iN sT 1QcRC� y Tr�J Owner's Address oA( (,v2i-LiN5toAj RG(. WtIVC_,Hej4cr- MA 0 ►& � o Is this permit in conjunction with a building permit: Yes Q No [ (Check Appropriate Borr) `J Purpose of Building +atL Utility Authorization No. Existing Service Amps/ olts Overhead Unde%raund No.of Meters New Service Amp. olta Overhead UndeVound No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work _Tt,S4a(I d- exit, me,gevey y,jAf v� tt (- t=1o. L.5ht I- �. Fc;. No.of Usti tg ondo No.of Har Tube No.of Traatbnnn Totd Na of Lighting RMM Swhxming Pool Above Below ammum KVA KVA No.of Receptacle Ondw 1 No.of of Barmy Na of Emergency=Owns Betray Unita No.of Switeh Oudeft No.of Oa BartonNo.of Range Na of Air Cord. Tod FIRE ALARMS No.of Zones Toga No.of Diapoule No.of Heat ToudNo.of Demotion and Ton KW No.of Dishwuhan Space Ara Haft KW ft of SSou Doukas - o�g DeMcaa Na of Seirconubw No.of Dryan Hating Devica KW c*dchii No.of Water Heaton KW Na Of No.of Connecdom Sim Bdleda --- No.Hydro Muaage Tabs No.of Motor Told HP OTHER' hauartaeCb�¢P�tbtberegiar�rafiV�dasdhaOmeollawg Itaneaaaetli�r'lKylrraacel�i�yirridr�Cbmpieb� a�sub�ryYcyirdrt Ih maktrawveidpiod r of romm YM Fymhwdm ddedylig, �g& ''��/ 1�� Ptl'aeitd�letbetypeofameagfby II�bUR�i1 XE `I mo tin= Bipotionl7me ay os Estinr�avalzUFBm t Vkik S warkbStrR )t�edi0nnmeft � Aral 8(aS�os" i � Puzzo Oe�r,c S lAl�.'ND h z 7 J Z-3 /0 Co/��^f S• Ivo.. ,q,��o�k r fit�4 Bud=Ti!lj g7� 31?- 5317 �� AtT�1Na OWt,WSM2AIKEWAM3K-Iamaaae w heLioQre �treiraaaroe orittau a}ivei�tarregi�bTeL ardthemys�tNrteont?ipear��pfciliregaierrtat (Please check one) Owner C3Apo Telephone No, pg� FEE I Location No. 2 10 Date g �� M,60 TOWN OF NORTH ANDOVER n Certificate of Occupancy $ } ; Building/Frame Permit Fee $ °1 "«Sir's. L • Foundation Permit Fee $ s�CHust '%4r ' {jOther P6rm ti Fee $ -2 �- .V jrV t!S J � vctt.rt,C � , nnection Fee $ �f, Water Connection Fee $ `''•� "�� � Building Inspector Div. Public Works NORTH E D 6 �/ p TOWN OF * __ - N 0 R T R ANDOVER Q _ LAKE COCHICHEWICK NORTH ANDOVER, MASS . DATE��r��ti g /4'�/ ".9SS .4 TED P' �C� ACHUS PERMIT # /D• S I G N P E R M I T THIS CERTIFIES THAT. � . . W. - Q . . . 5. `t' . . . . . . . . . . . . . . . . . . . . has permission to erect /4./y. . . .. . . . .. 6.0�. . . . . . . . . . oIl« provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the Town of North Andover . VIOLATION of the Zoning or Sign Regulations , Section 7#6 , Voids this Permit . Building Inspector s c3 w 7`e Q3 I Lo- cA!�-_rev ����, .w �' ll/0 O�L. i''L eT T /�S s� c L.-•-cam �?��G,r�Gt� SIGN PERMIT APPLICATION NORTH ANDOVER BUILDING DEPARTMENT Division -of Planning & Community Development Date Filed: 00'y S - 1. Site Address j j�a�h S jJO�-�� ���a J:e& A 2 . Owner AU/IUf-� C_ LA 3 . Applicant AJZA)1-4 < LA 4 . Number of Signs Oyl2 Size of Sign(s ) 5 . Site of Proposed Sign(s ) k?�o„y 6 . Materials : o , 7 . How attached : (a) Against the wall ( ) (b) Roof ( ) (c) Ground ( ) (d) Other Ma.. c��r See o,\-\ ( ) 8 . Illumination : (a) Not illuminated ( ) (b) Internally illuminated ( ) (c) Illuminated from separate service ( ) 9 . Proposed Colors : Background /Loyal Blue Lettering C-co1 Border 10 . Will sign overhang any public road or walkway: Yes ( ) No (�) 11 . If Yes , Name of Agency who will provide liability insurance : 12 . Attachments : ( ) *Photographs of building ( ) Material sample ( ) Color samples ( x ) Site or Plot Plan (Required for all free-standing signs ) ( 7c ) *Drawings of proposed sign ( ) Other, specify 13 . Is Board of Appeals decision required? Yes ( ) No ( ) Signature of-Applicant } _ �r 1988 n 4. Prior to a Certificate of Occupancy being issued for this proposed use, the applicant/owner shall have received all necessary permits and approvals from the North Andover Board of Health. f 5. The provisions of this conditional approval shall apply to and be binding upon the applicant, it ' s employees and all successors and assigns in interest or control . 6. All lighting found within the site shall be as approved b PP Y � the Town Planner and shall not project into adjacent properties. Prior to a Certificate of Occupancy being issued for the structure, the site shall be reviewed by the Town Planner. Any changes to the approved lighting plan as may be reasonably required by the Town Planner shall be made at the applicant/owners expense. 7 . All signs within the project shall be of wood with uniform lettering and design. The signs shall in no way be interior illuminated. (Neon or other means) The applicant shall be required to apply to the Building Inspector for a sign permit. 8 . No additional mechanical devices (ie: 11VAC, vents, etc. . . ) which may be visible from any surrounding roadways shall be placed on the roof 9 . Prior to the applicant receiving a Certificate of Occupancy the facade of the existing structure shall be upgraded. The xisting brick found around the front of the structure shall e continued around the building to the back as it faces the parking lot located behind the building. The planter located along the side of the building shall be extended to the rear of the building, and planted appropriately. 10. Prior to a Certificate of Occupancy being issued for the j structure, the site shall be reviewed by the Town Planner. Any landscaping as may be reasonably required by the Town Planner shall be added at the applicant/owners expense. 11. Any filters to be used with regard to odor or other discharge shall be approved by both the Department of Public Health and the Planning Department prior to the issuance of a building permit. The Board is concerned with possible odor which may impact the neighborhood. cc: Director of Public Works Board of Public Works !� Highway Surveyor % Building Inspector 4�,,� Board of Health Joseph D. LaGrasse & Associates, Inc. Project Nrn�e Drawn By �I�/,4 look f�E5��1VA�lJ-r Mowed By j��- Ard toots * Enolrws • Land Planers AI AJ 6-r Er-r Date IJEc. /7, /T")0_ 90 Andover.' MaSassactx�tts 01810 AD• A vDoVKt FZ l 4�• Suede =D /1 (508) 470-3675 Project No. /�;5 9 72Q O N fl t. ;Y Ru # MAR C ,fin, : p I