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Miscellaneous - 131 SANDRA LANE 4/30/2018
131 SANDRA LANE 210/09��_0-0000.0 � � \ �_ 10695 lbate..,F/ P/Y.......... 940Rr#, TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING This certifies that................. . has permission to perform........... u�...... plumbing in the buildings of... .............................................................. at..../3 ... ..... .. ..... .............. .... ....... ......................... North Andover, Mass. ro V%-7 Fee.Y7......Lic. No. !�� /j. ................................................................ PLUMBING INSPECTOR Check# :2 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING W?,RK ' CITY } MA DATE PERMIT# h JOBSITE ADDRESS i 3 J OWNER'S NAME P, J POWNER ADDRESS Mir TEL 11FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL�{] PRINT CLEARLY NEW: RENOVATION:D REPLACEMENT:Q PLANS SUBMITTED: YES® NO FIXTURES'l FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB1 ___1 1 _.___f f 1 .____► 1" _-- _I _ # -..____.. l I ` CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEMq- DEDICATED GAS/OIL/SAND SYSTEM ( I 1 P _�.( - _._I I ._ _l f f == Q DEDICATED GREASE SYSTEM _-.1 _ G _.___ --_� f _____� ___ __..____I ._..___� f .__-__f 1 DEDICATED GRAY WATER SYSTEM { . . _ ___ _ I T.-! _.__.__f __- . I ____-._J I �-___ f I DEDICATED WATER RECYCLE SYSTEM 1 _.-._.._..1 f � _ f _._ .1 f _____ I .__._ 1 ------i DISHWASHER ._.__1 --D _—__1 __.. 6 _.._._ __..f ___.._i .__-._f 4 _.___f DRINKING FOUNTAIN f ( 1 FOOD DISPOSER FLOOR/AREADRAIN INTERCEPTOR(INTERIOR) _._f ( _— l 1 .__.._._f f _...._._I __j _____—_I KITCHEN SINK LAVATORY I ___J _.I _._. i 1 __-.___1 _.___1 _ J -.___f ._.._J ___ I _.__...J I 1 ___-._l •� ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK TOILET URINAL W SHING MACHINE CONNECTION _ _—f �! I .__.__._f ___ WA ER HEATER ALL TYPES WATER PIPING OTHER -f I _....... .- --._1 .... _I i ..__..__ —i --I f INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES -.-f NO _ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2-11" OTHER TYPE OF INDEMNITY 1 BOND DI 4 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 JE1 CIT 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 com 'ance Wtk a P ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME i"—&P _ (LICENSE# ._. i SIGNATURE IMP 0 JP D CORPORATION[EI4 PARTNERSHIP # LLC COMPANY NAME u ? ADDRESS CL IV CITY _;STATE ZIP �I TEL FAX s CELL I EMAIL Q I R94UGH PLUMB G INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES hq��,, Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES < r_ J6 �' Y w The Commonwealth of Massachusetts , - Department of Indifstrigl Aeeielents Office of Investigations 600 Washington Street .Boston,MA 02111 wmmassgovIdla Workexs' Compensation Insurance Affidavit::Builders/Contractors/Elect icianslPliimbers Applicant Information Please Print LeaitbXy Name(BusinostOrganization!Individual): 2 c 6aQ P2 um,� W, .Address: , 0�?CAA120- City/State/Zip: _/ l R CAO)L/9 Phone M 6� ...2/ 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 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors 2.E] I am a sole proprietor or partner listed on the attached sheet. 7• F1 Remodeling ship aud`have no employees These sub-contractors have S. ❑Demolition working for mein any capacity. workers'comp.insurance. 9. ❑Building addition INo workers' comp.insurance 5. ❑ We area corporation and its 10.❑Electrical repairs or additions required.] officers have exercised.their 3.❑ 1 am a homeowner doing all work right of exemption per MGL IL❑Plumbing repairs or additions myself[No workers'comp. c.152,§1(4),and wehave no 12.❑Roofrepairs insurancerequired.]; employees.- workers' 13.❑Other comp.insurance required.] XAny applicant that checks box#1 must also fill out the section below showing their workers'compensationpolicy information. i-Homeowners who submit this affidavit indicatingthey tie doing all work and then hire outside contractors must submit a new affidavit indioathig such. tContractors that check this box must attached an additional sheet showing the name of the sub-coufractors and their workers'comp.policy infomaation. -ttim an employer that b vroviding workers'compensation insurance for my employees .Bellow is the policy and joh site information. Insurance Company Name:- Policy#or Self-ins.Lic.#: Q LU C- yf1W 13 D Expiration Date: �`'�� & Job Site Address: —Pity/State/Zip: .v 0,� Attach a copy of the workers'compensationpolley declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MOL 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 STOR WORD 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 o£ Investigations of the DIA for insurance coverage verification. I do hereby certljy u . er the . ins nd nalties ofperjury that the information provided above is true and correct, - Si afore• Date• —� Phone#• �J2 221 ZIY3 C> , 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/'Down Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone M 4� • 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 defrned as"...every person in the service of another under any contract ofbire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two ormoxe of the foregoki engaged in a joint enterprise,and including the legal representatives of a:deceased employer ,or the receiver or trustee of'aa individual,partnership,association or other legal entity,employing employees. however the owner of a dwelling house havingnotmore 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 employes." MGL chapter 152,§25C(6)also states that"every state or local Iie-ening agency shall withhold the issuance or renewal of a:license or permit to operate a business or to construct buildings M 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapterhavebeenpresentedtothe 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 numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members orpartners,arenotrequiredto canyworkers'compensation insurance. If au LLCorLLP doeshave employees,apolicyisrequired. Be advised that this affidavit maybe submitted tothe Department of Industrial Accidents for coniir nation 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 obtak 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 pe�:it/7icense number whichwill.be used as a reference number. In addition,an applicant thatmust submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if nocessary)and under"Job Site Address"the applicant should-write"all locations in (city or town):'A:copy of the affidavit that has been officially stamp ed or marked by the city or town may be providedto the applicant as proof that a valid affidavit-is on file for future permits or Ecenses. .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 Q.e.a dog license orpermit 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 ciuesffons, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Com- oawealtIx o assa.,chusP s Aeparbe tQfhtdwWal,accidents Of Roe QUA VOSugatiom 6.0G Was V' oa Sb:ml Boston,MA 0.21 It Tel#61M-27,4.9-00 a 406 Qx 1-877-YMSSAM _ Revised 5-26-05 FaX 0 617"727-7749 _WWW-Mass,gov/dia f >00MM0NWEALTH OF MASSA° HUSETT^, ' • o . ® o . BOAR©t)F PLUMBE#tS AND GASF I T;TES:::.;:` ! ISSUES THE FOL LOWII:G` RFI. ST AS AUMB I ' NG'CORP€:7 ... MICREAL J DIS ANiO ORCHARD PLUMBING + Jr Y 16 01864-243]> 33 <>> `; 05`701.x:;1:6:;:::: 204170 , %c4:COMMONW&&H OF MASSACHUSETTS o • � o e BOARDaF `�� PLUMBEA.S. ANI GASF I,TTERS . S S U E S THE F O L L OW IN !`I`C E N'S E;:. ::: L I CI±NSE AS A JO-URN EX.MAN P,L."-UMBER J DISANI`0'......... 4i M IC..HAf L 16 ORCHARD RD € 0.1864-24 j 'R ADI N G::. 37 r. q. 1 O ''/0::.1;:/:1::6.:> 204171 ... 7 3.15"'':: 5 ;.C(�i1VIMONWEALTH OF iSSACHI#SETTS .I BOAR©f)F PLUMBERS 'ADGA LOWINGTICENSE : ISSUES THE FOL L.a CEN `Efl AS A MASTER P.L'UMBER` MI6 CHAEL J D I SANTO y a` 16 ORCHARD =M —247'`:.. k REA[3'I NG 01'864 204172 8786 05 01116 , Date....... ........... O 40ATh TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS,CHU This certifies that ... ............ 1-t. ... ....... ............................................................................... ..... . has permission to perform ............. ............a........................................ wiring in the building of.......... ........................................................... jat ..........1-31 ..................PO�rth Andover,Mass. ................................. ............................................. Fee 6.........Lic. No. ......... 5-.......7. ........... ........ . .......... ELECTRICAL****- * - R, Check# 1-3-3r? 3 ` Commonwealth of Massachusetts Official Use Only Permit No. 2's o Department of Fire Services Occupancy and Fee Checked p Y i BOARD OF FIRE PREVENTION N REGULATIONS [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code QV14Q,5;7 CMR 12.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: �I City or Town of. NORTH ANDOVER To the Inspecto of Wires: By this application the undersigned gives notice of his or herintent'on to perform the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjuMW�r ' ' permit? Yes No ❑ (Check Ap rop fate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service i Amps 1 Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity �s b Est Location and Nature of Proposed Electrical Work: (34*_C4111-7 Completion of thefollowing 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 Swimmin Above In- Elo.o Emergency Lighting g Pool ❑rnd. rnd. Batter Units r 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 g No.of Waste Disposers HeatPumpNumber Tons KW No.of Self-Contained Totals: - " ' " " *''--J-*""''" 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 No.of No.of Data Wiring: KW Heaters Signs Ballasts No.of Devices or Equivalent 1 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of 97res. Estimated Value o Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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. j CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and pe alties ofperju ,that the information on this application is true and complete. FIRM NAME: _AAOA) 6a� G LIC.NO.: ,46771 Licensee: A74457 Signature6_ 96mht� LIC.NO.:6ju4o (If applicable,e "i-. Iic n ber line.) � r ' us.Tel.No.• � Address: '(G( !� Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security w rk 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 du 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.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 M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass F?] Failed IN Re-Inspection Required($.) ❑ Inspectors Co ments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed M Re-Inspection Required($.) ❑ Inspectors Comments: r Inspectors Signature: Date: r ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: Date: FINAL INSPECTIO . Pass M Failed 0 Re-Inspection Required($.) ❑ 1K Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts t Department of1ndustr1alAcc16nts Office of Investigations 600 Washington,Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lee bly Name(Business/Orgmization/Individual): Address: /00 " City/State/Zip: �% G Phone#: 6(0 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I a employer to er with 4. F1 am a general contractor and T * have hired the sub-contractors 6. FJ Now construction mployees(fall and/or part-time). 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. F1 Building addition [No workers'comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No 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. 7 Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. s $Contractors that check this box must attached an additional sheet showingthe name of the sub-contractors and their workers'comp.policy information. PP Y lam 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.Lic.#: Expiration Date: i 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 requiredunder Section 25A of MGL o. 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. X do hereby cert and the pains d enalties of perjury that the information provided above is rue and correct. Signature: Date: C.(J Phone 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.PIumbing Inspector 6.Other - - Contact Person: Phone#: ar 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,r,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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should R 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' r 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 Comm. onwealthofMassachusetts Department of ladusWa1.Accidents Office of Investigations 600 Washington Street Boston,MA.02111 TO,#617-727-4900 ext 406 or 1-877:MASS.AFB Revised 5-26-05 Fax#617-727-7749 _WWW-Mass,govldia .. 1wOMMO�IWEJ�TH,OF MASSAC;I.1t3SET�'� BOARD O nE ,CTl 1 I ANS _ 1 SSUES TH;E FOLLOW 1 NG L E CENSE AS A I�EG1 STE tf: ,MASTER E ftI CTR 1,,C-I AN �--DVANCED ELECTRICAL SCRVItE COk t .{VSD PIKE ASHLA�II ST .PO BOX '7612;07 " 1`11.RgS MA 0217 b 0019 15771 A a7/31/16� $13og +C011A11AON1IVE/�LTN".4F,M�S�S.�ti�Hl3SE"T'T�a. x.; } . • • ' • • 1♦i� CTR 1C iANS :. ,E � � ISSUES THE .FOLLOWIM. I:ICENS r w AS A REG bURN;EYMAt- ELC ,TfI;A � t�A1flD R PIKE ¢ 98 EASHLANU ST L >I P� ;Box .76120.7 -' tE1ROSE MA 02176-0019 ,I j 3340.9; E. 07/;31/1b>> 81308 ) f r Date. ........ ... ............ t NOR T/1 TOWN OF NORTH ANDOVER oma WV . , PERMIT FOR WIRING • ° ;: ;7 °•ciao '� '� t `4$�CHUSE This certifies that' �(//q -"y� U PCa .y ,� .................................................................:.......... . .......................................... has permission to perform ..,� f�(-,<,....,. u .... ...... ................................................... wiring in the building of..............t.7-1.45...................................................................... at .. .�... et........�.N.t................................Aorth Andover,Mass. I"ee.< .........Lic.No.;5 ,` �. �� - ................ ... ...... ELECTRICAL INSPECTOR Check# �� ` 1 Official Use Only Commonwealth of Massachusetts n/ Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code Q4Q,5;7 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: Z09 City or Town of: NORTH ANDOVER To the insfiectdr of Wires: By this application the undersigned ives notice of his or her inters on to perform the electrical work described below. Location(Street&Number) �� Owner or Tenant t Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of BuildingA&AW, 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: 6�0 AWXz—, YAI) Aqmw Completion of the following 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 Lighting rnd. grnd. Battery Units i 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 g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: "'' Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW Security Systems:* 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 97res. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 4M1 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 cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify,tinder the pains and pe Ities of perjury,t�haattthe information on this application is true anti complete. FIRM NAME: . C P (J LIC.NO.: �l �� Licensee: 1?6F Signature LIC.NO.:4�5, (If applicable,ent,�r,"e a "'in icense n Timber line.) Bus.Tel.No.: Address: rU/) 1 � j� Alt.Tel.No.: *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 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 frlgd 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 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed '❑ Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH PECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Y' Inspectors Comments: Inspectors Signature- Date: FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comm Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com >� The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Investigations IN 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): Address: �Coz City/State/Zip: /rll�Qf CX( Phone#: ,�� Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I 6. [-1Nowconstruction _,employees(full and/or part-time).* have hired the sub-contractors 2.0�:am a sole proprietor or partner- listed on the attached sheet. remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. El We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 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.] employees.[No workers' 13.[i Other comp.insurance required.] J 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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.#: 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 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 Vf 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 DTA.for insurance coverage verification. X do hereby cert.and Chep enalties ofperjury that the information provided above is t ue and correct. SiMature: / Date: Phone#: 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#: �1 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 ofhvre,express or implied,oral or witten." - An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged g gin 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 an of its 'c y political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy 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 Iegibly. 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 F 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 j (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 Comy4onwalth of MassachusPtts Department of Industrial Accidents Office ofInvestigat ons 600 Washington Street Boston,MA.0.2111 Tel,#617-727-4900 ext 406 or 1-877,TMASSAk'B Revised 5-26-05 FaX,#617-727-7749 wvs�w.m�ass,gov�dia �� `� I �� �����`o _-- 'iil)a I1i11;1i� tea' I GOMM'ONWEALTH OF M S A HUSE`Ji'T� LOU s ME E Utf-Tt1 b ' FANS' ISSUES THE FOLLOWING LECEPfSE AS A 12EC 1 S16ktED, MASTER E Lf CTR 1-6 I AN ApV11NCED ELECTRI Ct�L 5ERV1.CE'S G;O KE " X98. ASHLANIl;`ST Po soxbr2o7 ELtgSE MA02176 0o 19':::: I• t'577t` A �7I31�;16 '___w �t430 9 , co ONIMONWEALTH OF MASSACHUSETTS ' • • ' • • a ELECTRDCfANS , THE' FOLL;OWINO„��fC'ENSE J0URNEYMAN1 CEC�TRI<C�I A 1)Au!p R P-1 KE 98 ASHCAf�ID ST 6 i 20 MfLROSE <:MA 02176 001q � -07%31/1£� --813o8 6()72 Date.................................. NORTH °`,"`° A"".. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING U This certifies that ................. ........ .......................... has permission to perform ......... .............................................. wiring in the building of......... /.. ....... .............. at......1.)/..... ........ ............. .North Andover,Mass. f pd Fee,5 ............ Lic.No 9.. ......... ELECTRICAL INSPECTOR V Check # FO WT-e-ve- Commonwealth of Massachusetts Official.Use Only Department of Fire Se ices Permit No. i� 7 Z Occupancy and Fee Checked ' �- BOARD OF FIRE PREVENTION EGULATIONS [Rev. 11/99] leave blank) APPLICATION FOR PE IT TO PERFORM ELECTRICAL WORK All work to be performed in accords with the Massachusetts Electrical Code( C),527 CMR 12.00 (PLEASE PRINT IN INK OR TI LL ORM TION) Date: Q Cit or Town of: Y G To the Inspector of res: By this application the undersigned gives notice of his c r herin ention top form the electrical work described below. Location (Street& N ber) Owner or Tenant U F { ') Telephone No. Owner's Address Is this permit in conjunction with a buildin ermit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building sx t l` Utility Authorization No. 3_7W 222 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: Jy e x-- &Ler, LA l Cont letion o the ollowin table may be waived by the Inspector of Wires. No. of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. grnd. BattM 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 TotaInitiatin Devices No. of Ranges No.of Air Cond. Tons l No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Water No.of No.of No.of Devices or Equivalent � P KW Data Wiring Heaters Signs Ballasts No.of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent r OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability' surance including"completed operation"coverage or its substantial equivalent. Th undersigned certifies that such cover ge is in force,and has exhibited proof of le to the ermit issuing office. CHECK ONE: INSURANCE BOND El OTHER [I (Specify: (� Z (Expitlationi te) Estimated Value of 7lectric al Work: (When required by municipal policy.) Work to Start: .S Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under tl pains and penalties o perjury,th t the in ation on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: zli Signature LIC.NO:, �,• (I.fapplicable,s "exen}� in the 1' nse number li .)' / Address: (,% 1G Gcn, Bus.Tel. 40 Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I aware that the Licensee does not ave 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: $ �_,) �� �'Xn911 �� Z6y, F�1� Generators Residential& c) each additional meter ..$10.00 TOWN OF ANDOVER Commercial: Sewer Ejection Pump: $25.00-.. ELECTRICAL PERMIT FEES a) including photovoltaic& Signs: $25.00 each ballast (Effective March 12, 2003) generating Equip Per KVA $1.00 Smoke& Heat Detectors & MINIMUM PERMIT FEES: b)un-interruptible power systems, Initiating Devices: RESIDENTIAL $25.00 per KVA$1.00 Residential: $1.00 each COMMERCIAL $50.00 c) batteries over 100 amp. hours, per Commercial: $60.00 up to 10 .NO SE CABLE O N cell $1.00 devices over 10 - $1.00 each QLA'S.IDB DI' .BUILDING Heat Devices: $1.00 each Space Heaters: Air Conditioners: $40.00 each Heat Pumps: $40.00 each area heating $1.00 each Alarm Systems Security: (for fire Hydro-Massage Bathtubs/Hot Sub-Panel: $25.00 systems see smoke/heat detectors) Tubs: $20.00 each Swimming Pools: Residential: $40.00 Lighting Fixtures $1.00 each Residential: Commercial: up to 10 Devices Lighting Outlets: $1.00 each Above Ground: $25.00 $60.00 additional devices over 10- Major Appliances: (not listed) Inground: $50.00 $1.00 each $20 each Commercial Pool: $100.00 Carnival Equipment: $50.00 each Motors: (per hp or fractional part Switches: $1.00 each Ceiling Fans: $1.00 each thereof) $2.00 Temporary Service: Oil/Gas Burners: IN9ust have Utility Authorizalion Number Commercial New Construction or Alterations: Residential $20.00 each Residential $25.00 $100.00 per 1,000 Sq. Ft. of Commercial$20.00 each Commercial $100.00 Construction Space Office Furnishings: per circuit$10 Transformers: Commercial Service Change/ (Relocatable Partitions/Cubicles) a) capacitors, Per KVA $1.00 Repair: Outlets & Fixture: $1.00 each b) ducts, conduit&conductors ltuP have Utility Authorization Number Ovens Built in/Counter Top Units: (Associated n ole$10 Transformers) $25 $100 (first 100 amperes or fraction,one $10.00 each c) each manhole $5.00 meter) Panel Change/Circuit Breaker: d) each handhold$5.00 a) each additional 100 amperes Residential: $20.00 e)per KVA$1.00 capacity or fraction. $30.00 Commercial: $25.00 0 primary feeders, $25.00 each(over b) each additional meter$25.00 Phone Jacks: See 600 volts, non-utility owned) Commercial Temporary Service: data/telecommunications g) vaults and equip. $25.00 each $100.00 Ranges $15.00 each Washers: $15.00 each Must have Utility Authorization Number Receptacle Outlets: $1.00 each Waste Disposals: $5.00 each Commercial Repair and/or Recessed Fixtures: $1.00 each Water Heaters: $30.00 each Maintenance Permit: (Blanket Re-inspection Fee: $25.00 Permit)up to 2 Electricians$150.00 *For .1•' inti-F'amil-v & per pair of Electricians over 2 $50.00 Repair to Service Residential: $20.00 barge Commercial Projc i Data/Telecommunication: Residential New Construction sInspector Residential: $1.00 per port Slu(, ti$�•ii'itl#, �€)r (Dwelling): $220.00 Commercial: $30.00 up to 10 g` [1Cl Ids. , (with service up to 200 amps) devices over 10-$1.00 each11Iusr have Utility Authorization Number Paul I:Cennedy (978) 623-81106 Dishwashers & Disposals: for services over 200 ams see below (Office Hours $ ani to 10 ani) $5.00 Each a) for each 100 amps capacity or Dryers: $15.00 Each fraction add$20.00 Emergency Lighting(Battery Units) b) each additional meter$10.00 *.Inspection SSchedule:. $ 1.00 each unit c) each additional panel/sub panel I ROUGH Feeders or Sub-feeders: $25.00 1 FINAL each 100 amp capacity of fraction ,.; ' Residential Additions/Alterations: I �'l`���C,.1_� (�I ttl}pI1Cable) thereof $220.00 maximum Residential: $5.00 each Commercial: $15.00 each Residential Service Change or ADDITIONAL + Gas/Oil Burners: Underground Service: INSPECTIONS TIONS `S25 00 (ill Residential: $20.00 each $40.00 Must have Utility Authorization Number applicable) Commercial$20.00 each a) one meter, up to 100 amp capacity $40.00 (revised 07/05) b) each additional 100 amp capacity or fraction$20.00 Location )A E,4 No. Date r TOWN OF NORTH ANDOVER { A Certificate of Occupancy $ Building/Frame Permit Fee $ 26 g Hus SS CH'Eta Foundation Permit Fee $ � gill Other Permit Fee $ !4i Sewer Connection Fee $ = Water Connection Fe $ TOTAL $ s Gilding Inspector - 10271\ Div. Public Works PERMIT Nd- ,S`2 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP ijO. LOT NO. 2 RECORD OF OWNERSHIP jDATE (BOOK ;PAGE ZONE SUB DIV. LOT NO. I LOCATION PURPOSE OF BUILDING OWNER'S NAM , NO. OF STORIES `s >l SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR "' GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREME TS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER l IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST r PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR FILED RUILDINO INSPtG'TOR SIGNATURE WNER OR AUTHORIZED AGENT F E E � OWNER TEL.# �'" PERMIT GRANTED CONTR.TEL.# V -fig CONTR.LIC.# H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I AGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY-WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. B M TAREA _ 1/ 1/2 1/ FIN. ATTIC AREA 1 NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARD111'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE r rj ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) _ FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OI l B'M'T2nd _ ELECTRIC 1st 13rd NO HEATING XoRTH - F Town of 0 dOver 390 �- r> o ;r � K K dover, Mass., iY COC HIC HE WICK 19 ADRATED P �`P 1 5 B(PARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..................................................a../...)'1..2.L&..............................................r.... ................... Foundation has permission to erect.... 1dTa!�4........ tuwdiags_on ..........l,�.►.....:.....-& ].�J..c'�..fz..o..... .......... Rough tobe occupied as.....................................................�.�, .t�.S' .....................................:.......................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough Service DI SPECTOR Final Occupancy Permit Required to Occupy B ing GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. Page.No. of Pages I 3 Massachusetts Avenue AUG 1 21996 _-+ NORTH ANDOVER, MASS 01845 (800) 833-9276 PROPOSAL SU MITTED PHONE DATE / P za e r A2 - 01 � %G SITREET, JOB NAME CITY, STATE AND ZIP CODE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Z3-��s��, �e 6 �/zS 7l/g /H G✓,��/�/O in e4 le q or77-_fWIX, 1,l/O 111 07 //OfC✓<+>/,�ro,� /C<.f/ J_,-,/c _5;df�dOs.//✓" dl /�P/ Wh0` YY1G P -r�/> G.<U<•� �� �-�t�%u/!�/LL�ie do/i/P5� C,i'�/d/�.3000 �'X�1ttF,sid<. 7�<r,,,� �,�F/,.,, /i�_ �-ldY,e;A<rSL<•/ /!/n y// /r4v�/f/�✓l� /1__)'F-1iV 5-, <(�y /r/<.y/!. 2 f!°v��w< r'441vayuetS�u �S� ( j d 1: o? yin r/ 4 41e, 1y � qn 05 /<,�-DHS a/7/, � �QbOr �{„���r, ,`f Ind �Gµ��f� 71�1� .; S�<,��G�d i • t. 144�.�✓• %+ i/1�'.0�l/ , .iPl.�An•.//rC G1A/e 1P, uDtC G[OPSImli lie Cn �7n lFl 7h 6i<srlC r o « 191, jjtjT#d9i hereby to furnish, mat rial and labor —complete in accordance with above specifications, for the sum of: h f? l r�r dollars ($ / W, Payme to be ade as follows: Z li h : Y CG� cz_�- C4. L\,Z2 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica- Authorized tions involving extra costs will be executed only upon written orders,and will become an Signature ;&?,�_ extra charge over and above the estimate.All agreements contingent upon strikes,accidents may Note:This proposal be or delays beyond our control:Owner to carry fire,tornado and other necessary insurance. p p y Our workers are fully covered by Workmen's Compensation Insuranceswithdrawn by us if not accepted within- days. ,�1rrptt�Mltrp of YD► DSFtI—The above prices, specifications Y � ?' Signaturei� and conditions are satisfactory and are hereby accepted:' You are authorized to do the work as specified.Payrpent will be made as outlined above. Date of Acceptance:,. y �I� � Signature PRODUCT1183EeS_im,Croton,Man 01471.To Oren PHONE TOLL FREE 1+300.225-6380 m. mzz-, \0'• '-9 'a ` , raf�a� Ilea Q 71 S ti C r L �e se V;P The Commonwealth of Massachusettso: . 0oniy d i Perrit Noe Department of Public SafetyOccupancy & Fee CheckedBOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12003/90 heave blank)) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachuserts Electrical Code, 527 CMR 12:00 n (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date f y Co City or Town of� rl� rIhDLOd 'y- To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -!;,*" H y� owner or Tenant P r e�e 22 is Owner's Address *'n t Is this permit in conjunction with a building permit: Yes ❑ No E9- (Check Appropriate Box) Purpose of Building Sr Q (_ 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 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures SwimmingAbove In- Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency LightingBattery Units No, of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heats Total Total No, of Sounding Devices Tons KW No. of Dishwashers Space/Area Heating KW No. Detection/Sounding eDevices No. of Dryers Heating Devices KW Local❑ Municipal [—]Other Connection No. of Water Heaters KW No, of No, o Low Voltage Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: ®a ✓e�� oVl� ��'/�C� Cy( C I ��S/��/�� 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❑ NO ❑ J have submitted valid proof of same to this 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 Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: / �/� FIRM NAME _ L1C. NO. ` 57 71J Licensee AOp /�% ./_./ F/Q } Signature, :�_I (pV,p��L(� LIC. NO. Address 6d w001) /), 5 T' L �7 G✓ �, Bus. Tel. No. �$^q / Z Alt. Tel. No. `Z C/ 2 O -_ 014NERIS INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit a cation waives this pequirement. Ow')Telephone Agent (Please check one) 7)1r/D lt+ No f�('p t7 PERMIT FEE S Signatu a of Owner Agen rn Do Not Write In Here 3 D N For Electrical Inspector Only w -C M r m n M Street and No. n DName ........................................................... Z Electrician .................................................... PermitNo. .................................................... Comments .................................................... 4 K V Date..c -.7 i 345 NORTH F. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACMus� , y i This certifies that ....... . ............... r has permission to perform ................. ................................................. wiring in the building of........ ............................... at.......... ...... ... ,, ""`........................ry...�................. ,North Andover,Mass. Fee.....�� .(.t Lic.No./37.41,/k`P .................................................... ELECTRICAL INSPECTOR W HOWnAAp9crst CANARY: Building Dept. PINK:Treasurer