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Miscellaneous - 1320 OSGOOD STREET 4/30/2018
/ 1320 OSGOOD STREET J 210/034.0-0030-0000.0 Date12- . . . . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . a T'v . . . . . . . . . . . . . . w wiring in the building of . . . . . . . . . . . . . . . . . . at . 5.?`: . . . . . . . . . . .0jorth Andover, Mass. Feel��77771, ic. No. .Mg.-PZ . . . . . . . . Chi I ck 9 c� 01-2z ELECTRICAL INSPECTOI4 11233 I 4 Commonwealth of Massachusetts OfflcialU'se�Onlly y� Permit No. �- Department of Fire Services Occo p BOARD OF FIRE PREVENTION REGULATIONS [Rev.l�yandFeeChecked (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT MHK OR TYPE ALL)NFORMATION) Date: `i ( -z-- City _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) � � S Owner or Tenant Telephone(�.( l�1/ ? ,L, �c� Telephone No. 16 S:�-20 Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building d Fft C-t'i 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 i Location and Nature of Proposed Electrical Work: LJ-) Completion of thefollowing table may be waived by the Inspector of Wires. S f No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.oTotal Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o mergency ig ting rnd. rnd. El Batter Units No.of Receptacle Outlets 2-V 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 Totals: Detection/Alerting Devices " No.of Dishwashers Space/Area Heating KW Local El Connection El Other Connection No.of Dryers Heating Appliances KW Securi t3'Systems:* No.of Devices or Equivalent 4 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 WYres. c7CS Estimated Value o Electrical Work. Fj E ow (When required by municipal policy.) Work to Start: L `'t 7, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE POND ❑ OTHER ❑ (Specify:) I certify,tinder the Gins and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . '[_jA,t- [ LIC.NO.: /Li k, Licensee: �� C�L� t�D��-N ignature LIC.NO.: —Z (If applicable enter "exempt"in the license number line) Bus.Tel.No.: Z' 7 Address: tom,S J•- ti k--Le I,�, �L.ti(, , A) AAf Alt.Tel.No.•��� 3 7,C'`��F rd Z *Per M.G.L c. 147,s.57-61,sect ity work requires Department of Public Safety" ''Lich- 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 t permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the i notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall-be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass n Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: t Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: F ) Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com r ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 s� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): P� L&_AA A-f_ 4L- Address: LAddress: t,u-s 8 J City/State/Zip: 03-61k— Phone#: Are y 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(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. [_J Remodeling ship and have no employees These sub-contractors have 8. ❑De lition 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.❑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.]i employees. [No workers' comp.insurance required.] 13.❑Other Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Dontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site zformation. isurance.CompanyName: (,-Q_,Asvp\10v%_ L-5 olicy#or Self-ins.Lic.#: Expiration Date: 1 )b Site Address:_ 3 T-cz) o S 64� 511 - City/State/Zip: /l/b_ ,q�n�l�dcc-t�C It- Itach 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 ne 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 C up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigations of the DIA for insurance coverage verification. do hereby cert under the pains andpenalties ofperjury that the information provided above is true and correct. i nature:�AA =AA Date: t 'to Z_- zone#: �� �j 7 b c7 ?L— 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#: ' r 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." i Applicants t 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 of 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. #617-7274900 ext 406 or 1.877-MASSAFE Fax#617-727-7749 evised 5-26-05 www.mass,govldia - Date . .?�:. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . .. .. . . . . . has permission to perform . . .c9Q�-?!`7. .S x/14? c--r.... . . . . . . . . . . . wiring in the buildin of . . . .774A . . . . . . . at . . . . .� North Andover, Mass. Fee . .�?2 /. . . . . . . . ..�,5�'-Lie. No. ELECTRICALINSPECT4R Check 10997 - _ - 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 ElectricalCode(ME ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 3 ( Z-- City ' --.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) 3 -LO Owner or Tenant M,°rA� (,,t15�"�-4.�c,L'- Telephone No. (-5-7C?o Owner's Address ^^ Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building 04[L L` 5 Ji C�b &(=Y— Utility Authorization No. I Z� 0 ZZ Existing Service_L0 Amps ( / C Volts Overhead Undgrd❑ No.of Meters New Service 200 Amps 110- /LYOLVolts Overhead Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 66;ULVI C.c Completion o the ollowin table maybe waivedby the Ins ector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: """"'"""'""'""""".'"""""" Detection/Alerting Devices . No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No,of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 31cQp J` (When required by municipal policy.) Work to Start: 2-- Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such c,�o� v,�er a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE LY BOND ❑ OTHER ❑ (Specify:) I certify,under thepains s and penalties o er'ur,that the application information on this a lic ' fP J y .f on is true and complete. FIRM NAME: 9V,t 't LLQ (e I LIC.NO.: M Licensee: M(CA,(,q E(-- J►1 t I Signature LIC.NO.: 162 (If applicable,enr`exempt"in the license umber line.) \ Bus.Tel.No.• Z`ZrJY 5/ Address: 3 YS lRj�t�--/ 5 '�` f J �C(�ti 5 i � (Alt.Tel.No.: 9 fr 37,S=v Z— Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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 - EILECTMA.L PERM NO. )USPECTTON'REPOR ELEC�.'MAL IN'SPECT'OR- .Ro, . _ . �CTroN Passed _ �lT7SPE L 7 Failed--[ ] fie-inspection xequiurecT($50.00)�[ I ikspectors'coxmareAts: (Cnspectoxs7 Signature no rnitiaTs) — Date passed',[, Failed—[ ] - Re-inspection required($50.00)•-[ � lhppectors en . 4. (Inspectors'Signature-.no initials) Jute 3.UNDER GROUND INSPECTION. r Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (fuspectors}Signature•-no initials) Date WINSPECTION-1811EIRMCE: VICE:±O3�7A r,C! i failed—[ ] te-inspectionrequired($50.00)-[ (Iuspecto s'SigaRturA 7io int 'als) Date P.MBPECTxON- OTHER:Passed-[ J Tailed--[ )- Re-inspection repixed($50.00)•-[ j Inspectors'cotnm.ents: ( spectors'Signature Ito iititiaTs} Date DOOR TAGS APX TO BE PILED 011T AND LEFT ON SITE IF THE APEA.TO BE INSPECTED IS NOT ACCESSIBLE AND A.RE WSPECTION OF$50.00 IS TO BE CHARGED. ti 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 Legibly Name(Business/Organization/Individual): (A,(atk-t` fid=Ct L4-(b� Address: I 5 13 0 Y�Z+ S LG . City/State/Zip: KI Akq61pn=J 6..H 03 4s y-t- Phone#: °l 3 Are yo y an employer?Check the appropriate box: Type of project(required): 1. 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 E]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 11.0 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Ro pairs insurance required.]t employees. [No workers' comp.insurance required.] 13. ther ✓t cL' c>�6• ( *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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. 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.Lic.#: Expiration Date: Job Site Address: 3 (�6&op City/State/Zip: A.-Or .4-ti r O—z",A4- 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 g q P 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 certif under the pains and penalties of perjury that the information provided above is true and correct. Signature: ` Date: Phone#: 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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r 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 I-877-MASSAFE Revised 5-26-05 Fax#617.727-7749 www.mass.govldia Date.... ... � �aORTN 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACMUS� PJB � v T Thiscertifies that ... ......................................�. ............................................... .Suti �"02� has permission to perform ............. 1 ......................... .............................. wiring in the building of.......... ....py�L�2.L..................................... at..� �?... /.. ...... ........... ,North Andover ass. Fee 3 .. Lic.No. 1= .......... .. . .... ALkEenucAL INSPgCTO.. Check 1/ 07 10896 Commonwealth-of Massachusetts Official Use Only Department of Fire Services - Permit N°'- J - �--- r' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] ' (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 12.00 (PLEASE PRW NINK OR TYPE ALL INFORMATION Date: /2 City or Town of: NORTH ANDOVER To.the Inspect r of Wires: By this application the undersigned gives notice of his or her*in tenfon to perfoim the electrical work described below. Location(Street&Number) Owner or Tenant j Telephone No. Owner's Address Is this permit in conjunction with a buildin permit? Yes No ❑ (Check Appropriate Box) Purpose of Building L ' Utility Authorization No. ExisEing Service Amps / Vol Overhead❑ rd Und g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number-of Feeders and.Ampacity % Location and Nature of Proposed Electrical Work: 69)G Com letion of the.following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool Above ❑ In- ❑ o.o mergency Lighting d. rnd. Batte Units -—� No.of Receptacle Outlets . , *F,C1. igners S No.of Zones IIIIIII� No.of Switches No.of Gas Burners No..of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total nsl No.of Alerting Devices 1 No.of Waste Disposers eat PSP Number Tons KWNo.of Self-Contained Totals: .-_........................._._.__. 1 �...... _.: Detection/' ertin Devices x 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 Devices or E uivalent Heaters KW No.of Data Wiring: Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Batb'tubs No.of Motors Total HPTelecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Ilecyical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COL 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 c verage is in force,and has exhibited proof Asao the rmit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)I certify,under thepain d e alti s pe ' ,that he in ation oni"ca ' n is true and complete. FIRM NAME: EJ LIC.NO.: Licensee: (J Si a tireLIC.NO.: (If applicable, enter wee 111111 i ense n tuber line Address: J Bus.Tel.No.: ^Per M.G.L c. 147,s.57-61,security work requirDepartment of Pub is Safety"S"License: Alt.Lie.No. -:�a 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: $ 0- ij�,_ ., ` I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations �' ' 600 Arashing ton Street Boston, MA 02111 www-mass gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Atipiiicant Information Please Print Legibly Name(Business/Organization/individual): Address: City/State/Zip: Phone#: . Are you an employer?Cheek.the appropriate box: 1.❑ 11 am a employer with 4, ❑ 1 am a general contractor and I [7. Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6' ❑New construction 2.El am.a.sole proprietor.or partner- listed on the attached sheet x ❑Remodeling ship and have no employees These sub-contractors have $. El Demolition.working for me.in any capacity, workers' comp.insurance. [No workers'comp.insurance 5. 9• ❑Building addition p El $corporation and its required] officers'have dxercised their 10.El 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•❑.Other *Any applicant that checks boz#t must also fill out the section below showing their workers'oompensation.poHey information• Homeowners who submit this affidavit indjeating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box mustattached an additional sheet showing.the name of the subcontractors and their workem'comp,pori J i; „nation. I am an errPloyer that is providing:warhers'compensation insurance for my employees: Below is the policy and jab site information ' Insurance Company Name:_' Policy#or Self-ins.Lie.#: 4 • Expiration Date: • Job Site Address: City/StaWZip: 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$250.00 a day against-the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature: Date: Phone#: Offcial use only, Do not write ut this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector 6.Other Contact Person: Phone#: e. Date..-$A�*/—" . . .... . HORTM TOWN OF NORTH ANDOVER 0 PERMIT FOR GAS INSTALLATION This certifies that . . �e has permission for gas installation . tp in the buildings of . . . . . . . . . . . . . at t7. . . . . . . . . . . . . . . . . .. . .4. ., No r t h d ver,/M' s. Fee. Lic. No.. 72d. . . . . . . . . . . . . . . . . GAS INSPECTOR Check# 8098 fkA C) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY I NORTH ANDOVER MA DATE MARCH 12 2012 PERMIT# JOBSITE ADDRESS 1320 OSGOOD ST. OWNER'S NAME I MTM INSURANCE ASSOCIATES LLC GOWNER ADDRESS f MTM INSURANCE ASSOCIATES LLC TE 978-681-5700 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL E] PRINT CLEARLY NEW:Ej RENOVATION:® REPLACEMENT:© PLANS SUBMITTED: YES[j NO APPLIANCES 1 FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER . -- CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _- FURNACE GENERATOR mm.n.. GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ------ -- ---- --- - ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I CONNECT ToAPLUMBERS INSPECTED LINE TEMPORARY UNTIL THE CUSTOMER GETS NATURAL GAS —J _-_._ -_..__ __ - INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E]NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [7,1 OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 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 co lance with all Pertine pro ' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I JOHN MARSHALL LICENSE# 778 SIGNATURE MP® MGF Ej JPE] JGF® LPGI CORPORATION Ej# PARTNERSHIP E]# LLC E]# COMPANY NAME: EASTERN PROPANE GAS ADDRESS jj3j WATER ST. CITY DANVERS STATE MA ZIP 01923 TEL 1-800-322-6628 FAX ; CELL EMAIL If ;� A ,2 2()1, 9 36Niv 7-he Commonwealth ofMassa huserz Department o{lndustrial Accidence office oj �nvesiigations 600 Washington Stree: Boston_�� 02I11 Workers' Compensation Insurance AMd2-j7it: ]Bund::s/Con�a�io:sl�le�ieisnsf�lz�be� ; Applicant Information Please PriIIt L,e�"abl�' Namt (Business/Dtgeaizauor,1hdiviGual): r� Address: City/Statc,Zip; -- Are you an-employer.' Gbech.:tin appropriate-bum: Type of project.(requlred): 1_ I am.a employer with 4. I am 2 general contzaatDr andl 6. ❑N---%v construction employee=:(full and/orpart-time)." have hired the sul-- -ontracwrs . . . - i 2. 1 am a sole proprietor Dr partner listed on the attached sheeC $ T ❑Remnd-ling ship and have no employees These sub-contractors heve 8. 7 Demolition working for me in any capacity. workers' comp.insurance. 9, []BuDding addition [No work=rs'comp.insurance 5. :[1 We are a corporation and its .] ofncer have exercised their Ele, -- l.repairs cr additions required 3.0 I am a homeowner doing all work- Tight 0r exemption per MGL I l.Q Plumbinc.rcpays or actditioms e. 15 1 4 .and we have no myself, [No workers comp: Z )> 12.[j F.vof reparrs �l insurance required.]t elnploye-_.s. [No work=s 13. Other i S ;�rI�, comp.insurance required_] ,, 'AMYanplimactaat eae 3�s box#1 roust also$tl t tae=ct=below sbuMvZ tamwad='mon poli��'.it tea - 1 Rmneovm=woo submit c==c=ta=sabmt m ww affidavit sm-i 'Caut m=rs thu rhes this baz tangy aiizrhau.en a6di=1221 ab=:t sh—ing fte of ta-s& wd ftsir raiess'aomF Pov j'ecu I aa,ar,employer that is prm,&i g workers'wmpeatsa rr irwv=n e;for any employem pelon 1s the pohcy and job.si#e Insurance Comaany Name L fJ � j ' PaIicy "pirationDat-. Jot;Site Addrew- �3�® s goag.j SY. City/5tat iv: ✓1 O.� 1�►C.�Uvev Attach.$ colpy.of the workers'.compen=tinnlid clam- tion Damber end a t's0on_date,. Failure to ncure cov;age as required under Section 25A ofMGL-a.IS2.can lead to the imposition of crimiaal.penelties,of e fin,^up to S 1,500.00 and/or one-ye$r imprisonment,as well as civil penalties in the f=of a STOP WORl�OF.DLR ani E.fne of up to;250.00 a day aga.iret the viola. Be advised that a copy of this statement may be farwa d to the 0fncc of Investigafious of the DIA for imst>iavcc coverage vm fimbou I do hereby.certift under-the pains and p perJur�he frcfv anaiiort provt ed aagve Is.true and cnrtec� 1 067x a1 use only. Do.Rat write in this area;to be completed by city Br town ofyu•lal � 9 > 9 City or T.oRzt: l'errn�r/Lleense Issuing Authority (circle one)' 1.$card of Healtb 2.Building Department 3,Ctryll own Clerk .d.Electrical inspector S.Pluwib no inspartor III 6. Other Contact Person: Phone ft. j Location 19-149 v No. 9�'/1/ ' SO l Y-'Z O Z Date e - TOWN OF NORTH ANDOVER o . Certificate of Occupancy $ k ..,e . . . Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee ' tIT,n'Nv TOTAL $ Check#ZHl 25079 Building Inspector SIGN PERMIT APPLICATION 1600 Osgood Street Building 20, Suite 2-36 TOWN OF NORTH ANDOVER Site Owner Gv y f iK Applicant Nt-r �1r�S�011�r✓G-K Tel —� ,(✓ Site Address o 0 Size of Proposed Sign Map Parcel Def� Illumination: inated -/ How attached: a)Against the wall V b) Internally illuminated C,/pLjGj b)Roof c Externally illuminated �e c) Ground d) Other Materials: G�11.Jz[> 1 Proposed Colors: Background (aT Lettering Border Cost of Si n Required Attachments: Note: No permanent/temporary sign shall be erected,or enlarged until an Photographs of building application on the appropriate form furnished by the Sign Office has been filed Material sample with the Sign Officer containing such information including photographs,plans Color sample and scale drawings,as he may require,and a permit for such erection,alteration, Site or Plot Plan(Required for all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of.the Drawings of proposed sign Sign Officer determines that the sign complies or will comply with all Other, specify applicable provisions of the By-Law. Will sign overhang any public road or walkway Yes O No If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: . Receipt# Check# Revised 10.31.200617orm Sign Permit Application SIGNATURE OF APPLICANT APPROVED BY �i� clfl %10 R TI-( O��TLED f �-r 2 4oE res, t....6,6 O. TOWN OF NORTH ANDOVER 4 coc Mlcwl wlcw -- _ - '°�R�rEn pPp'yc5 SIGN P E R IVI I T �SSgeaus�� DATE: March 7, 2012 PERMIT: S01$-2012 THIS CERTIFIES THAT MTM Insurance Association has permission to erect. "MTM Insurance Associaties LLC" The sign will be 3 Feet Deep by 5 Feet Wide Fabric Canopy. on 1320 Osgood Street provide 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 of Sign Regulations, Section #6 , Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED Inspector of Buildings Amount Paid: $30.00 Receipt#25079 Q a .�r�r+g„�qt x: r t ;Ay x� t. Qon ' s uj 14 Location No.�C) ICo DaA Zl 112— TOWN OF NORTH ANDOVER 0 Certificate of Occupancy $ y> Building/Frame Permit Fee $ `' Foundation Permit Fee $ Other Permit Fee. $ 94 r0,�'"t t TOTAL $ Check# 25052 Building Inspector 14ORTH ©�4t68m 16t9�O �. h4o f;� t_..k.. 4 Q to TOWN OF NORTH ANDOVER SIGN PERMIT DATE: February23, 2012 PERMIT: S016-2012 THIS CERTIFIES THAT MTM Insurance Association has permission to erect. "MTM Insurance Associaties LLC" The sign will be 8x4x2 Feet, With Granite Posts and High Density Foam, Externally Lighted. on 1320 Osgood Street provide 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. 4 Violation of the Zoning of Sign Regulations, Section #6 , Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED y � nspector of Buildings Amount Paid: $54.00 Recceipt#25052 %40RTF{ t4¢D 16 ® 6 TOWN OF NORTH ANDOVER b : A°RATCD � SIGN PERMIT C DATE: February 23, 2012 PERMIT: 5016-2012 THIS CERTIFIES THAT MTM Insurance Association has permission to erect. "MTM Insurance Associaties LLC" The sign will be 8x4x2 Feet, With Granite Posts and High Density Foam, Externally Lighted. on 1320 Osgood Street provide 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 of Sign Regulations, Section #6 , Voids this Permit. INTERNALLY ILLUMINATED SIGNS ARE PROHIBITED nspector of Buildings Amount Paid: $54.00 Receipt# 25052 SIGN DeSIGNS 67 Main Street Plaistow, NH 03865 cuENr (603) 382-5856 ADDRESS Fax (603) 382-2548 PHONE TO: DATE ORDERED, COMPLETION DATE l3'�-di �� S ❑PICK-UP LIVER N4STALLATION _ DELIVER TO o.._l a(1e r �?cSls,�� QTY SIZE SIGN TYPE MATERIAL LETTERS AMOUNT W. H D (SINGLE SIDED-SS DOUBLE SIDED-DS) SIZE. STYLE r � � x ,Y x ,b%9 -- ,5 N -,us r 1 i xPiix z i �� JbZ s,de,4 S! tV f-U4 x x , x x DESCRIPTION: �� r N Tcc6f C X « X 2__ ' - of rcc, WE PROPOSE hereby to furnish signage-complete in accordance with the above.specifications,for the sum of: dollars $ Payment to be made as follows: �ecnts&C'ons�itionf� SKETCH DEPOSIT:The sketch deposit covers minimal costs involved in developing SPECIAL conditions on client's purchase orders in no way negate the above a concept.It does not cover the actual purchase of a custom design,which would be Conditions of Sale.In ordering the work described above,the client accepts all of figured at an hourly rate,with a quoted minimum price.The sketch remains the these conditions whether noted on his purchase order or not. property of the designer. IF UNUSUAL DIGGING conditions(i.e.ledge,water,etc.)are encountered in ground PRICE QUOTATION GOOD FOR DAYS. installation,this contract is binding;however,an additional cost based on our labor, PRICES as Indicated above,are minimum estimates for art or sign work only. plus %on sub-contract labor and materials,will be added to the above Photostats,typography,photographs,overtime,changes and/or time additions, price. delays caused by the client,special consultations and all other work expenses that cannot be estimated accurately in advance will be billed extra unless otherwise THE CLIENT agrees to pay all costs of collection in the event of default of payment by specified herein. the client,including a reasonable attorneys fee.In the event of delinquent payments, the client will be charged a rate of %interest for every month after the first FINISHED art,mechanicals,and signs will be released for use by the client only. 30 days. Mechanicals,original art,sketches and materials other than signs originated by the designer are the property of the designer,and will be held for the client,unless otherwise shown. Quoted by —/ i Dat `�tartce°�fcor"a The above prices,specifications,and conditions are satisfactory and are hereby accepted.You are authorized to do the work above as specified.Payment will be made as outlined above. Signature Date PRODUCT 5520 ptex^vv\.t� A- Zn t'Z- SIGN PERMIT APPLICATION 1600 Osgood Street Building 20, Suite 2-36 TOWN OF NORTH ANDOVER Site Owner W 0 056 d d d elitz - �— Applicant 14-Of azz Site Address DyGi ooh d e� Size of Proposed Sign Map Parcel Illumination: a)Not illuminated How attached: a)Against the wall b)Internally illuminated b)Roofxternally i lummate c) Ground p L d) Other Materials: P/✓h✓� � Proposed Colors: Background LU t+c' Lettering Border Cost of Sian Required Attachments: Note: No permanent/temporary sign shall be erected,or enlarged until an Photographs of building t/"" application on the appropriate form furnished by the Sign Office has been filed Material sample 'i/ with the Sign Officer containing such information including photographs, plans Color sample v and scale drawings,as he may require,and a permit for such erection, alteration, Site or Plot Plan(Required for all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of the Drawings of proposed sign ✓ Sign Officer determines that the sign complies or will comply with all Other, specify applicable provisions of the By-Law. Will sign overhang any public road or walkway Yes( ) No (>� If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: �7 Receipt# Check# n Revised 10.31.2006Form Sign Permit Application SIGNATURE OF APPLICANT APPROVED BY Y . lJ • S G • • • ;e INSURANCE ASSOCIATES , LLC 00 � .y rtR a p da Je 1r MMI i k { k eM+R z Parking Plan SaeDJnw lFOFSPA CES' IMOO' ––_– – B£QMff2 REGt0RD0WNER: USE.D7,1 Haus 4p A/erp.ero xxe FLLgP AREA CfA I°a°°�?� fr t GSA:Jon SF. eD r SPACFS PLAN/NTENT.' Lourie Moncinelli T NAADK.- SPACE 1,320 Osgood Street 2,�SP . I HAAD/CAPPEDa> APRt.�Mml AB North Andover MA 01845 - �Y PIAN 6 AUH.De� —152- NOTES' _ ''• >7 1).97E.NYO4MA7XN TAKEN FRGW LlosxLM LOCUS - ';� Zf PRa"FRTYLNE x FOR-IXN LS fROYI RECORD PLAN A6 M \ AND DOES NOT IIA TOY AERNL#WVMY TOM fRCMI 4ovGM LEGEAD `\ a GIBING M.111�LD F rim k �„-) SCALE LDGE dr LAw 7'�/DDD"3 eL.ON9 PARKING SPACE DETAILS. �`� I—� .acre 1320 Osgood Street o �t � ® ��1 �� •\ ��� �� North Andover MA ` xm1N,2nlDle-wq:Dn(TXp-BA 9411[nur o s� 4n.Mn. A.mE.mere sv wrgE vxmoc m� a ->onW- v TT ear-wn -a-- Z MNM.W s[TeAar EMc4 LOT rwir vAmsm 5 Aas-.I rT Osee Re/- Aea..owa Rnl.enca w _ -- _MraKW O.wD Rnaxts-,s E[P Bast 11913 Pogx 35 AAv:J! for 30 rT � /� -�- -� �amt � ,,/a•en-colt w...a,G tvwsE � o ` / oeass a.xA[R i � f '�9 Y 4L cne Beu[n cnxa'E E� I � i,� DNF TING BLD^ T YCIxw III_ T70Pr 9 ��'�- -t71' >2.6 FOOD TRPARKING PA VEMENT DETAIL.• BITUMINOUS CAPE COD BERM ----------- v v � - �'-► / Lasz t - S 1 0.'N7RAC7O4 SMALL COVTACT pLSATC AT I-BBB-J4I-7273 FOR UMFR(RLY/M UIX/7Y MANORS.AT LEAST J BUSNESS DAYS PRIOR TO ANY COV M C'T.CW. Z LOG 7ION OF EXI.S'T MO LNOER 0MtM7 UIN7ES AS-W W ON PLAN ARE .%41176 APPRO174A7E 7NfRE MAY B£ADCY7AAWL L"V%S' TR WRES NOT SADHN ON PLAN CLN67RAC7M-WU BE Rf,9'CNSME FOR LOCARAO AND l'RDIfC1NG ALL UNDERGRa/A'D II-Sw Ew=Wr N n AC I� tp sae Com}' U7k/7@S�S7RUCRMC$BOW MOM 9NMN CN PLAN AND INOSE NOT SNOMM J ALL NEW UIk/7E5 SNAfL BE LOCA7M UAMOROUND.LLNEESS STA7FD UTNERMRff. NEW SWCNy[LE H030 M17I'(5'F i COV7RACILW SNALL B£RESPOWS,HE FOR ANY DAMAGE 7D EX/S'TNG JYP WMEN15 NOT LdM LPSMIGL NN O107J __L- / TN' ✓ ee Ho TO 302 PROPOSED M BE REMON"D OR DfmOL15 KD. ANY DAMAGE SNMLL BE REPAJRED TO WE ® E SARSCAC7100V OP WE O.Vl..BY INE MIRACIO¢ SC00WRAC7001?V"AS REOVlRfD BY REM" Y f AND tTTCS ALL NECESSARY PCBM'IS fLW ONSIRLICIKW SbvJm ErgNea h¢LLC 6 AS REDUM ANLL BF TORY VW V SAFETY MEASMES CLNSIRLCRLN MEMODS AND 0-90—M�BM `® O�GOOD ----/ --'--/-'--- 7DAS MIXRMf�MD�/�ACT2 5,4SW MAL ELE D INa AA N $VHSLMFACE[MANAGE TO PREVENT NZVZW fLOMDIC SEE ARaVrCRAPAL AND/DP c y M pw��p..�lyl�µyly.µuot[a�w.lwlaaawne•o (ROUTE 72$ – PUBO/C WAY — // // �IIJR,� ,, l //A Y - B RrOL M EN MAKE IMEMSLL ks AWARE OP ANr AAD ALL L'LN57RCICIXN n5' 1 VAR-W/DTHJ I � i1^�ttlA'7AIKN5 LMP M BY PERM75 AMD APPRO✓ALS/5.9/fD BY Ili R£d/LAIAPr AUINON7£$PRKN ID LYN57RLA:IXN Psmrif 9l,Pbr Poor GbfunAraxnW 9 CONIMAC7O7 SrLxLL NNF PRLYES_OLNLAL LAND SURKMR M STAKE PROPOSED V7r _ / dPROWMEN75 AND URX/T OP PRO97.AD AO%IOM[ ,may-Y b ID PROPOSED W7DEKN lXiI11NG b'7D RLIGN LOCATED CW DAE SUC Cr TNf BLAIdNG AND SNALL IIfET Aq%N AAAOIER ZCWXTC REOC4.AIXN H,..N/f 1LGN7NG O�PARKM.0 ARL1.S'R£PVNEMFNTS • 97 IFNNEr 5 ,r GrOR"70-4A %H7.7 �•...0®1.,,� / 11 ANY NIFNOFO R£NSKNS a Di£IKi%ZCNTAL AAD Y£RIICAL LOGIXN LE NPROLFMfNIS C r 1■ T x,509)Jg�-��ZI { ^�••�.•,"�•_•,•SL.:p-L�'L'iL's"'�"-"I`• 14 S AL OV PLAAS SJMLL Bf BENCHED ANO WD BY INF EACbVEER AAD APPRLWMAIf Y '' {a(SO7J l5l-C1i41 MI/NK7PAL DEPARTMENT PMEM roMP[FMfNTA IDYL O f1 INC FXL57IA'G SEPTIC SYSTEM BRAT BC LO PROPOSED AND RC-LOG HD AS REOrRR[D BY AaP1N ANDOY£R BOARD LY HEALTIL M E rMOCR THE T RZOSE'O PAl£MCNI. m iot 13 Dlb PLAN SHALL RfONIPE A IXMB LUT RfIX/EST/APPLKA7XN ro Of F1LFD MIN D/f 4awDOT f �A' ,y1�°'�rey� 9313 Date. "oM °TAtip TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ACMUS� This certifies that !Ae^�� �a�er . . . . . . . . has permission to perform . . l. . �,!/?. . . . . . . . . . plumbing in the buildings of . .P/4UL , /7 e-alq . , . . . , , at . ./3?-U. . . . . . . d _ , North Andover, Mass. Fee. 1r6. . . .Lic. No.���5-3 �2. . �. . . . . . . PLUMBING�TOR Check # - 1q0, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK. - CITY I yDk�T`l- �N�)V eR_ _- - - - MA DATE. o'Z Jur' /02 PERMIT JOBSiTEADDRESS / �-Q ODS �' OWNER'S NAME V OWNER ADDRESS _1�/c�el>!H _ TEL JFAXJ . TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL _ RESIDENTIAL. PRINT CLEARLY NEW_( _1 RENOVATION:(r/< REPLACEMENT: ,t PLANS SUBMITTED: YES . NO( FIXFURES Z FLOOR— nT2, 3 4 5 6 7 a 9 10 it 12 13 t4 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEMDEDICATED GAS/OIUSAND SYSTEMDEDICATED'GREASE SYSTEM DEDICATED GRAYWATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM I DISHWASHER DRINKING'FOUNTAIN FOOD DISPOSER 1 } FLOOR E AREA DRAIN I 1 INTERCEPTOR INTERK) -=d -- KITCHEN SINK LAVATORY ' ROOF DRAIN SHOWER STALL " SERVICE/MOP SINK a TOILET URINAL WASHING MACHINE CONNECTION - WATER HEATER ALL TYPES WATER PIPING f'� OTHER -- -- - - � �, INSURANCE COVERAGE: / 1 have a curreflt.Nabilit insurance policy or its substantial equivalent which meets the requirements of MGL C1t.142. YES NO IF YOU CHECKEDYES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY[NSURANCEMICY[✓_J OTHER TYPE OF INDEMNITY BOND ..- OWNER'S INSURANCE WAIVER:I antaware Mat the licensee does not have the Insurance coverage requiredby Chapter 142 of the M'assaclttisetts General Laws,atW that.tuy signature on this pemtit application waives this regtilreinent. CHECK ONE ONLY: OWNER : } AGENT { I SIGNATURE OF OWNER OR AGENT I hereby eerlitytlial 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 plumbhrrg work and Installations performed under the permit issued for this application will be in co a{f Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ILICENSE#��b�,�jj SIGNATURE MP) I JP � CORPORATION1 I#i iPARTNERSHIP`J 011 I LLC I 01 COMPANY NAME �{ ADDRESS 407 0 Gbh �gtJ J>R#e CITY 17�14'G U 't aL STATE 1� ZIP O 02{o' I TEL f97�-Aga-927g _ I FAX - _ CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW EQR 0M. . CE USL ONLYMONNOTES Yes`' No THIS APPLICATION SERVES AS THE'PERMIT `❑: ❑ - �S le7 Z FEE::$ PCRIVIIT PLAN MV EW.NOTES 4 t f F . �; fh���tititiaiittqTritlllti,�'1l2trss[rctttfs�tt$ De�r7i�ta,*erc�o�'IitriiisLifialEiec•€rt�eilis )OAAM s"f 4flous �j tf(!Q�Ytesl,!�ngtQn�Pe��E BoMew,MA.021 tvit?lV.fif[fss�►Qt`/�ff� f '�+r4rf ets Gt►ttttt�itsntkou 1Eli ttl'(tticdirt O gititcladOcin m to tit i�tc�ttttsf lt�t�xei �•ttT1lictiftf Iitfortttutiiit � Pjetis��'tr�if'Y.ceft'i�tt i �'tittt��Rtisur��0ighiii>;itio'atluai4iduaij�. +•. t � Otltttfefi � l�hotie �:: �y+ott,ntt entitTril et 2 Gfrcctr the t+pin op rtnle boys 7'Ypb;bf POW ret stet t<Ti'eity: ArE � l. t ant it etnpto cr iei(Ti .4.Q t ant n gciterai coittrdctortnit$I G ciE t6iisiticc�ion talrio}:ees ts+lTtutcttortt�ui.tituo} lavee 1tred 111e'snlf:conlractors. MMatnetsofepropifetorarpartiteiL listed O'lltit ittaettedAicet.�I 7 �ctnotroling j sTITp nnafiave no ctupk ccs `yci osub•coiitmstors t►at' 81. Q Dentolttion xeotRtng Corine to r+n1�capacTtys �vot�er�'coln}r,iasitraitee. F � []'13tt1tttntgxecTditiott; � ioico�cis"cQmp�rnsumttco lVe eacorpgatiollaniiits l si iRTrLtF ttI aI'Iei[rLcal rre mAmoriddi€ions: j qllicersdltti�cti�ercTsecFtTielt 3.®I;bntaltauieoteriertloTi�attWOO, rialitofewelliptioitpckWOL fl E111(ifilmugn�itr;ortrctcti[iont to self.[NO1 orh-cre contlt. G.tS2',1(�1) tiudti�ltetectto _ t2: j ttoofrepa[rs j iiisuranccmgniredj.fi ctiipFayccs.[Nt tsotl-ers` Otltcr t comp.itisui-Ancctzgnticdj l ��gr.}iplicr4tth�t<fI:dA'mIIIiIrtrtsofittc21%V;citcillcat,rtottsttoulnbtkcIm-cibms,compt;ItoIIf,licpLIrvtmiIiox �tfotn aalFastrtiasatvuifthiseticsuFtfnOtctotalrcytr<<aewolhsilkfrdthen Lice dnGiFkfudrattusImpt u$yiitnhhtpfrltt�rittSicaIm�sFFt6, tCtsur, iri<tUutdi;titfi tn�r.ar;t..riley?.12nr.-tdiltogslsteel SU111ngtt_.trmtt M116911. ..'A. lriira+etrretli[�J�i�c*rlltrrl.'ls[iaot�lrl[itgtr+otkers'ccrnl�s'rtscrltnrrksurancefirtp eiratntrc�s.BelnsrJsfl«E�vl[ci�ntufoGs�le��~ !r(Jarrtrttflvtl. - � { IpsarattccCamisan�.l��r'ite : _ � �: f Potici.It-orSelrlirls.Ulm 8 I;�pi ittionUate`•. Jbb Site A&cess; 1it(acltncopy;bftttCRaClterS�EalllrC)15R1iottpbltcylip darn(Fol 1tcage(sjtRivtingW lialtei,ttarltbg r(it[tloSliTf IlivalLtte}e ! raitarcto'set ore t ocerliges iegrcitect tnlderSeition 25�i ofaT;c.tSenti.ieaci to talc iniTlosUiottpFcrpuTrinikataTtics Ql a flim tip tq'91,5004 andlQcotte earialprisonntelli,as itch as civ.it penAllicsin elle form ofit STOPAWORIC Ol(DER'anti a fila € t ofupfo52S.o0 iota;+.againstficoviottr[oY. tTcaffidsiiT'titatn.c �goft[Iisstatentc� i►ta}r be font%ar<Tedla theOffieeaE t tltvestigatioy►s of the DIA for fustimuce>coyerage eet•'iGeatibu. telolieer&j�cerf' i•ffrttlpa��r[rfitesokJ`�reifrrrt�t[i2P![rr=1q("ornttrlid�cprtr)�irrifleLote�sfiaaxiiritl�drrec! •' .STetiCarc� �'�?/L l)Ate• (1 irJ orrti�Po not il1Ff?cIt6Gl�flfc'!t�[d[ISCO11111t+[L'IJL}+ct or.farvrr.gjftcTrrJ.' . . ci(S•ar`iuei?t . . t'crnctt[L}eciiseIt fs�.ulft�AMtoil( (ciircteoite).- � t I.ttoadtt'of t-leattli 2.Wilding Department 3.Cify/Touit&Cric .4.G(fefrldtinspetot'&:1'lnurblttg llcsjle�tot- 6.Other• Cotifttci,t'ei .oiE Nto),IC4. I Wad It'Iassstchusetts.GenerzclLntvschapterX52re�i►iiesmlkelttplb�rerstoy�ravideIvor here cQinicia teioiyfoFtltelcentpTo ees:. L'tmsttatt to titlsstafufa,an eiilproye3gleitectas':,, eiyrpersolt IrFilre service o€auotitci tiQtlerWconEract ofLire. $spm�s ornitplied.Qmloriti�itten�'k . cilJJpto}erist`'e iitetias"ng iniiigiclzta>lypaiiitessliipi,g sa iatioh�cppAr lionorother-,egdl-clitiCyjotrau}ihtaor�iioia aflTtei`ai�gortageng+gedntia�joiitfeuterprise,aruritiZlitd'mgtTielegal 6presentalii sbFafleseaseal'eiriplo}rer,orate ieoen >rQrftttste ofatrGldii:Id sal patt�ter,trip„astociatian or other-Iegal entityTct>iTi oa'ul Ho ernTrinyces; tvetestFie otinerofR ciiveliiitghobse•Tiavittg nofinaig•fbait tlu et^apatiute}tts and *ilio rosidestlierch olr the oompaut ofthe tllset(ipg flouseofanoflternttto entp�oyspeasons to 8oanainlenauce,coilstittcfion o7-rCpair►vor%on such dtEtltiugltoiise tbt�op'tttLgrointcTsor•Uttitdittgoppt►rtenTntthereto.§halfnotbzcntrse•ofsuel►.einplo}ntentbd eotect`KiIleAven�plajer:'� 11'lGL cltapie7.132;�?SC(6)also'slntes lll�t'"ei'c1•tsSftttC:4�ioeal licensing ngetrcyslittlf tvltlil'io1'cT fhe�s&ualtce oi^ i:eiteiia€I:oifn Ite�ltsa oa•peraniffa ope.>-:tlea Gtrsrttessor to:eomsfrircElttiildiugs in flte conurioiuvealfh I'oi•srt�t tllpltcalit stL�i?tastlot prptlueetl nccepfatbleeElcleitee of catnpliattcetrith-flieutstiriinceeoter;tge retltueetlf Additionally,kGEeli�ptcr152,.625C(7)slates"Neitherineeomntonivealthnorady-ofifspolitic�lsub*dWsion!Psliatl 0�140.iittoany-Contract for fticperforn)atieeofpublicieori;utttilaccePIATeevide►tceofco7upliauceivifiitiir insurance rz ititEmenisoftliis eltapferllat a beets presenteclto thecorilracting authority.” �#ii(ilIcttttls •-- -- I?TetiseftlCout titg.itiatler ':ra)I) �itsaliout;lfgiai�itt+5ut T ia1 b F teclatt tlteboxesihfappl4-f4yotiisituatioltutid,if E �'' 13 z.3t g 1►$cesYli'-supply iub-confractor s'naiu s ad(Tress cs and Tionentuttbet=(s)aloi6awithiheirceitificate s of n, ppy () eC�, ( )• p (� n t1rance.UniitedVabili Coati aiti o p es.(LI;C)orLitnTfed l tab7[tlj� 'attiie"rs_hrps(LLP)IVIIII ata ens to Te sotlterfhan.iite ` �itentbers of plriners;arenol raquiredfo e p'y I arryivor>;ers coippensattonmsurance. IfanLLCorLLP dots have eipplay=eess apolicp is aequtred.-B itdiised'fiiat this iidaeittuay*6e stillntitteci to iheDepulaitent of Industrial Aecldenlsforconfirnlattonofinstuanczcove>age: A'lsbbesttretosign onddale-tilt nftidavit Thecfudavifshould br;rehinictUtG tile cjVorto.1%,A tlllt(110 APPlibatiou for the Vern4c or license;is beirigg bdUstriel Accidettts. Shotild you Itai.�an ottesligns rc rtt'din .the l' _ rzquestEd,y7o(flte Depaiint€tit a:. .� i tu' 11vftit '0t't" ., '; y.I �to required to tbfaitt a itorkct5 c7?tJ6000tion policy;please call tireD;liattine;tf ajttt'tenuntber fisted t tots.=pelf-litsttred compatties..ttotticl enterilteir ;;elf fiisutanee License numb er07 �theappropriate-Bite Crty of TQjvp0-ffWays I Plettsebv�utefJrat.tIteaffiitaviEi �otlz)tleleantlp tinted.iegibly. 7liebepaabitenthaspraxifledasl3gcealfltbotf011t :o[lfie,a ftidavit foryoittd fillatit'in tileevent the of evol!Investigations has to colithefy-our8g; i iheapplicant, E I?lease be sttr3 to fill in the permit/lice useituntber Which evillbetised as areferenceaitnttbzt:.In addi'Iiot7,an applicIitt triatrtntstSttbtititanultiple pernitt/lice►tse appiicatroi'Tiit anytghreh ywr,iieetl'oniy submitone afhdatif indicatingctnrennt j tlolicy'infoltnation(ifnecessary)andtulder"JobSifaAddress"'theapplicasit:shottictkvrite'�tliecaiionsin - • (city�or lotiii)-Acppy-ofthe.afrtdavl€thatlrasbagiIofficiallystampedorntarkedbythecityortoiutmaSbe-providedtofhe applicantas'proof that avalidii€fadavit sorifile:forAiturepernihorlicenses.Aneinsitlidavitmust-fie filled outeach Year:�i9ierealtonteottnetorcitizertisoCltaittiug.alice77seot=p€rnti'tuott�laiedfonnj-busLtessorcommetciala�aittttie F etog:Iicense or'permit fo burn Ieares etc)said persott is N©Trquirecl to co137plefe ti►Is rffidatint. 'life 0)IiCe ofItlit64afion s leoiild liEie to fits til;}iotrM ad Vance rot yqq coals;rflfioit ititd 916111d ylot0Iftriity quest iolI piq%sedo not hesitate tagi!arts ia:catl: Tate I p< itetit'saddfess,teleAblie ant`s fax nttttiTief; bite f`onttxtnatiYe�ltlt���1�t�s���tt�setfs - . J3eliattatiitit dl`).i><C�ilStltill�ct2lClvlltS .i ill'fice ofItt�'e:�i%��t4oyt� 600AWS11itigtbli Streot fosfoil,MA-02111 Toi it 617-727-4PQQ 09t 406 of 1-877-IVIASSAP-B IZeitis�ti 2G-�S VAX Y1 61-1,72i474 9 �t�thi,ilitassgac�klta Date.... r NpR7M 4 o?°•��``°-; "�o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING , �,SSACHUSE� This certifies that ........... .!4-..�... .i C .......... ...................... ...... .. has permission to perform ......D� Gc nee., ......... wiring in the building of......Mf ..... - ws(/...................................... l,� 2 O ..Zn.1� S at..... ................... .i................ . ..... ,North Andover,Mass. Ob Fee..1 .... Lic.Noll �_1 6........./-�o...... .. . ... ELECTRICALI ECTO$ Check # I ` 0655 r - - Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 2,1 In 1 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) ( 3?A 0 S (m 0 r)� S , Owner or Tenant �"M 5`y �,v� Telephone No. 7O Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building I AUtility Authorization No. Existing Service-j(Z Amps C'W/ ty.2Volts Overhead e Undgrd❑ No.of Meters New Service IZ*- Amps l-W /2. o Volts Overhead❑ Undgrd R No.of Meters a Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire OutletsNo.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In El Battery o Emergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets SD No.of Oil Burners FIRE ALARMS I No.of Zones No.of SwitchesNo.of Gas Burners No.of Detection and '0 v Initiating Devices No.of Ranges No.of Air Cond. Z Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ....••••... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of BNo.al as Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: J7 Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value Electrical Work: 'a (� . (When required by municipal policy.) Work to Start: 7 (L- 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 c�ove�r a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE C' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: 8VIV%.A4 A4-C--- t LIC.NO.: 6d 46- Licensee: /� (1c.[e4� [_ -I/LsQ.t nature LIC.NO.: -Z (Ifapplicab a ent�,+�"exempt"in the licen number line.) Bus.Tel.No.- Z ` "f Address: i1'-'l(MX�� Apt s-1yZ !N� /��-(s g?��'-� ~0 Alt.Tel.No.: 2 r-0 z _ *Per M.G.L c. 147,s.57-61,secirity 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 Signature Telephone No. PERMIT FEE: S E);ECM(CAL PERI6WT X0. INSPEC ION REPORT. _ BLECTMCAL INSPECTOR. ' MXimnspectors, Failed-[ j Re-inspectionrequi�recY($50.00)-X j nts: 2-pectors'sig4atue, o fnitjais) Date I FWAL INSPACTZON, Passed Failed—[ ] Re-inspection required($50.00)•-[ j Inspectors'comments: (trispectors'Signature-•no initials) Date 3. ER GROUND]NSI'FCt'IOJ.Y: Passe - [ ] Failed—[ ) Re-inspection required($50.00) [ ] Inspec ors'comments: (Inspectors}Signature-•no initials) Date 4.fiiSP ON—SERVICE: b o DA +C TTT{~DNATIONALC-R : NA14 •. Passed— Failed—[ ) Re-inspection required($50.00)-[ ] . Inspectbrs'coMmJ1.1 4 Vf WI/ eu (Inspectors'slknatVk 7iio initials) Date 5.INSPECTION•-OTHER: Passed—[ 7 railed•-[ ]. 'Re-inspection required($50.00)-[ ] Inspectors'corbmtents: (Inspeetors'Signature-.no iiutials) bate DOOR TAGS.ARE TO BE FILLED OUT AND LEFT ON RITE IF THE AREA.TO BE INSPECTED IS NOT ACCESSIBLE AND A RE INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name..(Business/Organization/Individual): LkL tA_,t—e _ Address: �Pl.-Use > City/State/Zip: �1,4 'hone#: 7>S- Z Are y an employer?Check the appropriate box: Type of project(required): 1.IFI a employer with 4. ❑ I am a general contractor and I 6. EJ New construction ' employees(full and/or part-time).* have hired the sub-contractors ^� p ) 7. emodelin 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ L g I 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 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.]t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. I LAA..Dy C-- Policy Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 1-3 late S l _ City/State/Zip: Ah_ ,q-, �_ •t�L�E (��5��� 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 certio under the pains andpenalties ofperjury that the information provided above is true and correct. Sian re: Date: L o l Phone#: 2-w- 3 7 s—O4f 67 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#: 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 r 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 Date. . . ..... .. NORT o= TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION SAcMUSEt i This certifies that . . . . . . . . . . . . . . has permission for gas installation . .,T !ry?? '�. . . . . . . . e in the buildings of �) . . . . . . . . . .. North ndo ier, Mass. Fee. K'P . Lic. No./$.?/.e . . C. _ GAS INSPECTOR 4 Check# 6 j 8046 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY NORTH ANDOVER MA DATEI 2/7/12 PERMIT# a JOBSITE ADDRESS1320 OSGOOD ST � OWNER'S NAMEE:::,7 GOWNER ADDRESS TEL[::� FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[4jK EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:E±' RENOVATION: J REPLACEMENT:El PLANS SUBMITTED: YES[] NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER .� BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER _... _. _ . .. ....., I DRYER _ .._..... FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT ====F _-..w OVEN POOL HEATER ROOM/SPACE HEATER m_ f L 1- E ROOF TOP UNIT r __.. 1 1. TEST UNIT HEATERL `I UNVENTED ROOM HEATER ..�€. ..... . WATER HEATER F ._.... " OTHER t r INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESNO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY + OTHER TYPE INDEMNITY BOND , OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 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 tru nd 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 compl'i a with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME riEFF HUTNICK LICENSE# 15212 S19NATURE MPO MGF O JP JGF LPGI CORPORATION E# 2840 PARTNERSHIPS# a LLC # COMPANY NAME: CALLAHAN AC&HTG tt ADDRESS 91 BELMONT ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-689-9233 �� FAX CELLL �EMAIL The Commonwealth of Massachusetts ' Department of Industrial Accidents h �" { Office of Investigations 600 Washington Street r ,Boston,MA 02111 '= wwminass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorslE lee tricians/Plumbers Aoi)licant Information 1''lea//se Print Legibly N ante 13usiriess/Or-,uiizatioiV[ndividual : '� `/ /^ / A Address:- Clt�'/ _ _ G State/Zl • 1��yt Ily7 � r'L f; f� hone #: � ' (�'' � L _ — Are you an employer?Check the appropriate box: Type of project:(required): re 1. 1 azn a employer with ,-,Z 5` '` 4. 0 1 am a general contractor and 1 h ❑ New cortstruction employees (full and/or part-tune).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling, ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity, employees and have workers' 9. Buildingaddition [No workers' comp. insurance comp. insurance.$ ❑_ requu-ed.] 5. ❑ We are a corporation and its lU.[� Electrical reprints or additions J.❑ 1 am a homeowner doing all work officers have exercised their 11.�umbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 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 put icy information. T Flomeowners who submit this affidavit indicatingthey 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 state wltetlter or not those catities have employees, If the sub-contractors have employees,they must provide their workers'comp.policy number. I atti art ejrtployer tiuit is providing workers'compensation insurance for itiy employees. Below is the policy and job site information. Insurance Company Name: Gt^t Gt.r -.----------^- Poticy#or Self-ins. Lic.#: / /� !� e�L� ( �)�? Expiration Date:_ Job Site Address:__B0_ nSG•Ovy � City/State/Zip: /V A,L,0d'IJLm n A-SS Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failttre to secure coverage as required raider 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I du here6lV certify under the pains and penalties ofperjury that the information provided above is true and correct. Date: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License#4 Issuing Authority(circle one): I. board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S.Pluntbill Inspector ti. Other Contact Person: Phone#: 03-19-'04 14:29 FROM- T-049 P01/02 U-189 SHAHEEN" GHERRERA, & O'LEARY, LLC Jefferson Office Park 820A Turnpike Street ( ba North Andover.Massachusetts 01843 70 Telephone; (978)689-0800 Toll free: (866)665-5831 '01 �$ Facsimile: 978)794-0890 E-mail: soleury@sgolavvoffice.com FACSIMILE COVER SHEET V FACSIMILE NO, el•�& _ g g _ S'r�Z FROM: P CK DATE: 3-a 0- 0 y RE: a/ ..mo ©S NO. OF PAGES a (including-cover sheet) r G° f. tA,C1 ` l Z Ol ;W. Lj . THE INFORMATION CONTAINED IN THIS FACSIMILE IS CONFIDENTIAL AND IS INTENDED ONLY FOR THE PERSON NAMED ABOVE. IF THE READER OF THIS MESSAGE IS NOT THE INTENDED RECIPIENT,PLEASE CONTACT THIS OFFICE IMMEDIATELY, THANK YOU. IF YOU EXPERIENCE ANY PROBLEMS WITH THIS TRANSMITTAL, PLEASE CALL THIS OFFICE IMMEDIATELY AT 978.689.0800. _ r pv• rt•vr Kkle VC""hACTMG W. IfAu0� nin i Custom Homes& General _3 � �! ��_ Contracting a (/TTY.— Bedford,New Hampshire 03110 _ °O • 440 Low—L 3 ac N m N TO: i/' AP dAq m 132d osl,�a STR. H2ONE AA 7,e-,de9--3,r12.1. .4 K�ovor- d 1 �T� r+�rucE,�eY 4 rFw.ls 0 it X g �� t -fes � rX i 4r �..�.� � �.�.�� ;�- �;•.G,. b!�� � fA all2 r � X!'01LAAA. _ =(•qtr -.mak r ot ! L'i►*`� ..•n.► Tr�.o•,R�ei 'Cr• , _ ell _ a E LABOR HOURS RATE AMOVNT TOTAL MATERIAL w m TOTAL LAaOR > cr m IMAY ae contu+um ON o.v.corwtxo M aiIQiS1i7E! m �+d4apor�ds+O�OWm) 7AK ® I " Y.,..1 PAY TM•gotJwrt s �'- g7f l-19V D � 90 Location No. l^/ Date ' ~ORTM TOWN OF NORTH AN-DOVER 3? � • OG h A o i Certificate of Occupancy $ �'�S• °''�� Building/Frame Permit Fee $ 117 sACHU ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F Check # V 1� 5 5 5 3 Building Inspector/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. /� DATE ISSUED: SIGNATURE: Buildin ner/I for of Buildings Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: f•��o DS�6c� � 3 13s. Map umber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R firedProvided Required Provided c 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information_ 1.8 Sewerage Disposal System: n Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record 3��; fi j'��-�y �i��r�i� 120 �sgaQ� �✓ NaMe(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 14censed Construction Supervisor: Not Applicable ❑ `7+&wgs fP,t o oA) ��g d 9� Licensed Construction Supervisor: O t P/. LicenseNuumyber Q Mn Address /V 11.2l��r f3Z`lS �� Expiration ate i nm>, ignature _ Telephone r• 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Akr7 'a Company Name Registration Number .Address Expiration Date i nature �CcJ Telephone SECTION 4-WORKERS COMPENSATION(XG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes..... No.......❑ SECTION 5 Description of Pro osed Work check all a hcable New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify N w Brief Description of Pr posed Work: 4 Y , SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be "��� t'OFFIOIAL U ONLY �' Completed by permit a licant 1. Building (a) Building Permit Fee f 7 d' Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC �. 5 Fire Protection J 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION ,as.A,wrer/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print ne atare of Owner/A Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE, ' c CT Reg.#517262 THE R MA Re #100020 fm I EPLACEMENrWiNDOwPEOPLE Federal ID#04-2714773 Corporate Headq uarters:26 Cedar St.,P.O.Box 2696 Woburn,MA 01888 (781)933-4100 1-8000-342-2211 THIS CONTRACT MADE THE. I. J. . . . . . . . day of.��(r.l _ . . . . . 200,,'.). between. . . . . r 1 tome ers) Home Phone) (Bus.P ) of. . ./3 . . Os v": . . f... . . . . .0.,1kC ove.C. . . .D/ . '�/`� . . . (Address) (State) (Zip Code) the "Owner"and NEWPRO, INC., "NEWPRO". NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the following described work at the remises located at _ P (Job Addres rliL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TOTAL NEWPRO Additional TOTAL CASH /� Windows Purchased o�� Work Style- Qty PRICE 17 SV� Window Color Specify e N C SlidingGlass Door DEPOSIT / Capping Color S ecifv Q Steel Secun Door WITH ORDER (� `. Double Hung Leaded Glass Picture Window I ObscureI G assB0 0 BALANCE7� Stationa Casement Screens HALF FULL DUE AT Caseme - el# a_ _ INSTALLATION 2 Lite 3 Lite lider &,VW" NEWPRO' does not do any painting or Ba /� rameL staining. CASH Garden Win ow NEWPRO' Is not responsible for conditions Balance Paid to or circumstances beyond Its control Including Installer at Installation Awning condensation resulting from or due to pre- . Otherexisting conditions. CS Bank Completion GRIDS ) Coloni pjaatdrfd' ed Form Signed at Install tion DESCRIBE WOR ; rq G> (� E+tS fe �r G SG fair f. ;n ©rs�. // t- r?f e I // loe c. ,rG✓Yt G , i - 9 ; All steel security doors will hav4 314'aluminum threshold installed over existing threshold. Customer Initials Est.Start Date: Akow Est.Comp.Date: d2 Security Interest: Yes 0 No It shall be the obligation of EWPRO to obtain any and all permits necessary and r this agreement,as the Owner's Agent.The Owners who secure their own construction-related permits, or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston,MA 02108,(617)727-8598. If the Owner is obtaining financing by way of a Retail Installment Sales Agreement,such Agreement shall include a time schedule of payments to be made under said contract and the amount of each payment stated in dollars,including all finance charges.The Retail Installment Sales Agreement shall be incorporated herein by reference.If the Owner is obtaining a revolving credit line to pay,in whole or in part,for the contract-�mount herein, the terms of the revolving line of credit including interest rate and payment terms,shall be clearly set out on the credit application.The portion of the credit application referencing a time schedule of payment,to be made under this contract,and the amount of each payment stated in dollars,including All finance charges,shall be incorporated herein by reference. NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of$100,000-$300,000. If the Owner refuses to permit NEWPRO to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason whatsoever shall cause the owner to pay NEWPRO a sum of money equal to thirty-three and one-third percent of the price agreed to be paid,as fixed, liquidated and ascertained damages,and not as a penalty,without further proof of loss or damage. NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control. Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. This contract represents,that entire agreement between the Owner and NEWPRO and cannot be changed except by a writing signed by both the Owner and NEWPRO. You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights.We,the aforesaid owners,certify that immediately after the signing of the aforesaid agreement,a copy was furnished to us. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office, or branch thereof, provided you notify seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement.(Saturday is a legal businessAaiy). • See the attached notice of cancellation form for an explanation.of this right. .I DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. The Owner has seen'.'sample"warranties that will be provided-by NEWPRO upon installation. Ljk1 Sample warranties provided to Owner. 19 IN WITNESS WHEREOF,tpe parties v hereunto signed their tlaMe this day of�� 'I 200 /� � r Signed arketing resentative Owner -- Accep ed: N WP A INC. By �t a -A Signed Auth ized Si ature Title Owner v AAi The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 2 W 'ers'Compensation Insurance Affidavit Please Print Name: Location: �� City /" ' Phone am a homeowner performing all work myself. �1 am a sole proprietor and have no ons working in any capacity I am an employer providing workers' . p g . compensation for my employees working on this jab. Company name: zr y� �i Address S Phone - 9 -x'300 in su Pol!cv,itW ® ' CoMR9M-name: Address Phone* Instrance:Co. Policy# aittrre to secure coverage as required under Section 26A or MGL 152 can lead to thejatpo ion of criminal pennies.of a fine up to$1',500.00 and/or one years'imprisonment as wen as dw penalties in the form of a STOP VVORK oaF�t and a fine d(3ioo 00)a day against understand that a copy of this statement may be forwarded to the Office of Investigations of.the DIA for curage vent Gabon. I do herby certify under the pains and adzes of perjury Mat the kftmationr provided above is titre ani.correct Signature Date Print name. MSNC f&wwi4s 60W5610• Phone " Official use only do not write in this area to be completed by city or town officiar Building Dept pCheck Yimmediate response is requked Building Dept El Licensing Board Contact person: Phone# p Selectman's Office Q Wealth Department ❑ Qfher TM b}ORKMAN'S COMPENSATION DEVCO PRODUCTS INC. NFRc Letter Code; DEV Humber Code; J93 **man.en label io TernPorary Label Extsnalon Double o��d Double glazed TrlPte Did. Tril,le glazed, ArQon/air filled,Low KrypWnjAfgo Vllr K O^rAr9°nlA1r Ooub6 glued, , e Gcot hg 101Nd.Law•1r3&, n1 ed,Low a#3 d.5, Series d la�tl oOperator Type Munen TArpon�ai.filled .001 -002 ; -003 ootT" rder t:urntxr_ 004 detrr32 I deM�1 -�- Res Non-Res �sev�►3 $.)00 be Hung 393.1C.Cd1 NOn-Rei Non-Res 0.46 tt" Hon Fuse Ron Nen4jes 2 SA'Yj F1otiLon:al SSde• 0.47 0 C.31 �` •- -- 393-ti GC.t 0.46 0.23 0.2 t 0.21 7 0.47 0.31 C.31 U22 1 0.44 5000 Fixe) 393-K-fiJ3 3 021 0.23 0.22 ---- -- 046 0.47 0.3 - --- 303-K-Ow 44 0.45 'OO Coscmcn, _ JG3-K-QC14 04S 0.3 0.?t 0 21 0.?1 -- -- - 0.46 0'2 G 44 Q45 $ 7U3 Awning _ -� 0.31 0.3 0.23 n.21 E 5100 Ca 393 K-OC�S 0.45 0.46 0.31 0.3 -- --0-2J 0.2.2 _..C�.4 z 0.44 t". nt 393 0.22 0.7.1 0 23- _--- �� 0.43 0.21 0.03 0.4.1 7 513711-*UA044 0.2a 0.29 G.21 ___. ------- 393-K•00T 0.43 0.2 021 0.2 ~- a 042 fielded Casement 04< 0.20 0.29 C.21 393-K4� 0< 0.21 C.2 0.41 9 fielded Awning % j C.42 '393-x.009 1C Tech Framersash pF193Ki 03 - -0 _ c 11 Me(*,FremelSesh HS 393-K-011 12 We'ded Dead:te 39--K-012 - r label information _ _ - Line 1 Line 2 Devco Products,Inc. -- •� - Une 3 Series $()Pe Une TYPO ft*n above Line 5 Ptvone tt 608-076-9463 R�dIxY I/em. mode!rnv>�aFradrr.�l�•+s+�rrtfiDr:. . PKdW Glatiq QtwdMbj 'VAy ld6! ; Emaj:wyl' 01w, i HOME IMPROVEMENT CONTRACTOR ' lug. Registration: Expiration: 100020 6/8/02 Type: Private Corporatio NENPRO, INC. _ THOMAS FOKON� �w ar St ADMINISTRATOR Noburn � HA 01801 67, 1. 1 BOARD OF BUILDING REGULATIONS ?' License: CONSTRUCTION SUPERVISOR Number:'CS 029090 ' Birthdate: 1:1/19/1,953 - s f Expires: 1.1/19/2003 Tr.no: 8383 1 Restricted: 00 THOMAS P FOXON 230 WALNUT STS ''r*EADING, MA 01867 I Administrator r • S, 'r • l 1 May-20-02 12 : 39P P.01 CSR JEI wpR-t _ n.1 n,2 PROOUCER THIS CERTIFICATE 18��= - ` i __:._ bS NO RIGHTS UPON THE CERTIFICATE r ..y� AL ::::J '--=:. �aeRTIF1CATE GOES:.0O •..E:n �_-..rte_..._... _ 122 Quincy Shore •Drive TER TME COVERAGE AFFORDED Si- ;C North Quincy MA 02171 lPhcne: 617-770-9000 INSURERS AFFORDING COVERAGE - - -_. INSURED INSl1RER 4• Azbella Protection Ins, Co_ INSuRt'i B: AIM Mutual Ins. Co. Noro, Inc, INSURER C: PO Box 2696 INSIIRFk ft, Woburn MA 01801 _. INSURER E. -..-.. .. . COVERAGES c IOUCIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIIE INSURE)NAMED ABOVE FOR THC POLICY PERIOD INDICA ILD.NOTWITHSTANDING "+','P ,INRFMFNI,)ERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMI_NT WITH RESPFCT TO WHICH THIS CERTIFICATE MAY OF ISSUED UH MAY PERTAIN.TIM INSURANCE Ar FORDED BY THE POLICIES DESCRIRFI)HEREIN!S SUBJECT TO ALL TI IE TFRMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIF$.AGGHEGA IE LIMITS SHOWN MAY HAVE BFFN REDUCE0 BY PAID CLAIM!;. INSRI.. ... -- -- --- _ LTA TYPE OF INSURANCE POLICY NUMBER OA7E MM/DUI YVE i DA7EYMMI Dn GENERAL LIABILITY 'EACH OCCURRENCE $ 11000 1 OOO OOO A X I COMMERCIALOF.NF.kALLIgBILttV 850000010649 01/01/02 i 01/01/03 FIRE DAMAGE(Any me6rc) $50,000 _ Ct.AIMS MADE l OCCUR MED EXP(Any one D9160n) $5,000 PERSONAL 6 ADV INJURY $1,000,000 GENERALAGGREGATF S2,000,000 GEN'L AGGHLGATEPLIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000 000 POLICY J.GT f7 LOC AUTOMOBILE LIABILITY COMBINED SINGI F LIMIT B u ANY AUTO 81037400001 12/31/01 12/31/02 (E'Ans'dent) I$500,OOO ALL OWNED AUTOS BODILY INJURY X SCHEOULEOAUTOS (Pat oersom) I5 X(HIRED AUTOS - --• ' BODILY INJURY X;NON-OWNED AUTOS (PI.,acc,cent) 4 I - PROPERTY DAMAGE S (Per—dent) GARAGE LIABILITY AUTO ONLY-EA ACCIOFNT S ANY AUTO OTHFR THAN CA ACC S ( AUTO ONLY: AGC 15 EXCESS LIABILITY EACH OCCURRENCE. S 5 000,000 A X j OCCUR LJ CLAIMS MAOF 4600010709 01/01/02 01/01/03 AGGREGATE S5000,000 _. r I i OFOUC I IDLE RETENTION 5 B IWORKERS COMPENSATION AND X TORY I.IMI I$ ER EMPLOYERS'LIA8ILITY WI`1Z8003031 - '- 05/01/02 05/01/03 E.L.EACHACCIUENf 5500,000 F.L.DIS ASE-EA EMPLOYEE S 500,000 iOTHER E.L.DISEASE•POI ICY LIMIT S 500,000 I I 'F 5..71PTION OF OPERATIONSILOCATIONSAIEHICLESIEXCLUSIONS ADDEO BY ENOL RSEMENTISPECIAL PROVISIONS (OPERATIONS OF INSURED I• a•—---n-- 'E HOLDER N -- ONAL INSURED:INSURER LETTER: CANCELLATION SPECIMB SHOULD ANY OF THE ABOVE DESCRWEG O.Lmonza ME%,ANn;uLLEy OEFUKE THE EXPIRATION v DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1,Q_DAIS WRITTEN 1 SPECIMEN No=& TME CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO BLIGATION IABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESE ATIVES. �AUTRO REPRE9 TA E /-yJ F LYS Y s,& ACORD 25-S(7197) dr an CACORD CORPORATION 1988 a / • � P , i North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) scz_e��� zzQ=x2--d-7-r- Signature of Permit Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector e h i 140K TH O Nrn . O ®ver No. J[ 0 0 over, Mass., 1---". L A 'JS COCHICHEWICK 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT....... ........... . .... ......... . ......................................... ..................... BUILDING INSPECTOR Foundation has permission to erect........................................ ;l1dings on...../ Rough 6............ ......... .................................................... W6P Ell& Chimney to be Occupied ............ ......... .......blooffol 4.0 ..... ..............................................................I...... provided that the ceip'ting*t�ii*p�r�*m***R'**s*"halI In every respect conform to the terms of the application on file in Final I iia I this office, and to the pr isions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION .. 0 Rough Service ................................................................................................................ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 1[7SEE REVERSE SIDE Smoke Det. . • .. • • ' � J i �� 3819 .... ........... b f NORTH 1 TOWN OF NORTH ANDOVER to p PERMIT FOR WIRING SS US This certifies that ....... ...... .... ...... i'�J1..�. '.............. has permission to perform ....... ........ .......... ..................: k wiring in the building of... v(!�P, c f f ... ............................................. at... . .... �......0Sy. r................. North .... Lic.Noelt � � Fee ..�........ 9............ .:fir. ?...... g. .. LECTRICALINSP Check # ; ' office Use only D PARTA10VTOFPUBUCS4F= Pcxmit No. BOARD OFIT?EPREVF MONREGUL9TTONS 527CYIR I2:LiI Occupancy&Fees Checked APFLLCA TTONFOR PERAlflT TO PERFORMELE=CAL YORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 C,mR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wirer The undersigned applies for a permit to perform the electrical work.,described below. INIAP PARCEL Location(Street&Number) .__.__. Owner or Tenant g Owner's Address � 7 E- J 7 Is this permit.in conjunction with a building permit:= /= Yes No (Check Appropriate Box) Purpose of Building " � Utility Authorization No. Existing Service L-Oa Amps Zp Volts OverheadE:runderground No. of Meters _f New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity -- - - Location and Nature of Proposed Electrical Work A No.of�ighting Outlets No.of Hot Tubs No.of Transformers Total KV A No.of Lighting Fixtures Swimming Pool Above: Below Generators KVA -- ground and No. ofkeceptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Bumem No.of Ranges No.of Air Cond. Total FIlZE ALARMS No.of Zones - Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal- Other_ Connccuom No.oflWater Heatera KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER. QI A c sL �yaS a S,"I } - ln�ecot�Rast�mthet�ana�ofl�dB.�elLsCx�alIaws IlnwaalQartLiabLyhnl>tanceRchLYarhldrjgC e CmaaWaitsRisb>baleqma'a1 YES NO Iba,e&b,>EdvalidptoofcfsametotheOfCeYESNo F7 Ifyoulazdrc�YFS,plearemicutdre peofw�uaWbyd-,2dagthe appcpiafebcx Waymstatt a hspccbmDatRRaigh LIJIM e4 I sigoed,ur3a-Tel(�jofpajtuy i I'tcz 0-'CA �eGe 0'can V 1 C IxerseNo tt__,___ FIRIVINA,ME ( i tJ Licanee /' ��h/L4.I / ,A rbl� si,== L.im=lb 'F V amiessme b W-sip -9 13 Alt Tel.Na 2 2 OWf�R'S 1NS[JRANCE WAIVER;Iamawdte thattheLiar;ce ttt�es rottrave theit�st.>rmx�m�a'di�ea>fs su�iar>ti��le�ala4astyMa-�cht.�ls C�alLaws and thatmy s�ahue a1 this peQrvt applir<>r�t waives tlns r�uar�rt. (Please check one) Owner Agent 1 5� CfLt7 Telephone No. PERMIT FEE$ SianaLlre of Owner or ,(!cnt t 3821 3 8 2 Date.... f NORTI♦, TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �,SSACNUS� Thiscertifies that ........................f w.:.:....f.................................................. has permission to perform ., .. .. . -� � ..... ................................................................. wiring in the building of........................:... .................................... at.:.:�.,1............! ` 'w — North Andover Mass. FeeLic.No. ............. ..... ..;�:...................:...--..................... ELECTRICAL INSPECTOR Check # Official Use Only Permit No. VO4Vae4 4;va&s Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK j All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:0 (Please Print in ink or type all information) Date To then ector q#Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work ork described below. Location(Street&Number PA66OCK / r//"' i�- Owner or Tenant L 3�rJ5 S) V t/ l7 C-A J `AAZ gJ' I A-9C'TDR Owner's Address Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building 5-ml bL 6' iFAm i i—iJ Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and AmpacityISI&K a U j Z-h S (AI i-VIS)�Jy l TCH OAS 1- ✓`' il�L 1STj Location and Nature of Proposed Electrical Work ! L C 1 R OSS 1 9V /N6 Total r No.of Lighting Outlets No.of Hot fuse No.of Transformers INA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles OutletLO L r No.of Oil Burners BattUnits No.of Switch Outlets xwkx& No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Spacelkea Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiri ng No.H ro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO If you have checked YES please indicate a type of age by checking the appropriate box INSURANCE = BOND = OTHER = (Please SpeciM.4,9 160 j I �>1')7t/th (Expirati ate Estimated Value of Electrical Work Work to Start Inspection Date Resquested Rough Final Signed under the Pe es of pe' ry _ r FIRM NAME �// L5,p �! /V LIC.NO. Lkensee Signature r LIC.NO. , 2(& BJ/e1 No. Address-! - ' '/ A05 5" 6 1' Alt Tel.No. OWNER'S INSURANCE WAIVER. I am aware that the Lice of havp.the insurance c verage or it"s substan ial equivalent as required by Massachusetts General Laws.And that my:signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT-fEE b (Signature of Owner or Agent) Location U No. Date MORTIy TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $ s� Foundation Permit Fee $ CHun % © er�fpit Fe - $ Q � A�, �'5ewer Connection Fee $ --'''�' Water Connection Fee $ TOTAL $ Y Building Inspector 9 6(j 5 S Div. Public Works PEI-VTIT NO. /Y, APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. /PAGE 1 MAP 4J0. LOT NO. 2 RECORD OF OWNERSHIP (DATE BOOK�-1 PAGE ZONE SUB DIV. LOT NO. LOCATION / PURPOSE OF BUILDING OWNER'S NAME f NO. OF STORIES Mzi OWNER'S ADDRESS �S/ 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 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 60 PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. p PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ,* ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY 1 8 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED/AND APPROVED BY BUILDING INSPECTOR DATE FILED ( L BOARD OF HEALTH S AUTO.&17,00,AGENT FEE U PERMIT GRANTED OWNER TEC.# PLANNING BOARD � } CONTR.TEL.#AKR3R04 19 CONTR.LIC.# ® Q exBOARD OF SELECTMEN BUILDING INSPECTOR 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 RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D —_ i —PIERS PLASTER DRY WAII _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B'M'TAREA _ '/. '/t l/. FIN. ATTIC AREA _ N_O 8 M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDl!J'D ASBESTOS SIDING _ COMM—ON VERT. SIDING ASPH.TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. d FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ a SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING 11 MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. d COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T _ ELECTRIC 1st 1 2nd 3rd I NO HEATING I Castricone Roofing & Siding g � REPAIRS FREE ESTIMATES Telephone: (508) 682-4266 MARIO CASTRICONE 61 Water Street, No. Andover, Massachusetts 01845 1 I/we, the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship,to install,construct and place the improvements according to the following specifications, terms and c ndition on premise elow described: Owner's Name .... .... . ...... . ... ............ ..................................... ................... ........... Job Address .. ....................................City State .. SPECIFICATIONS c i2 �. .. P.. �..Q. -. .. . .... . . ........ . .. . .�............ . .. . .. ... ............ . . ............................ ......... ............ ...... ... �/��...�. . ...... .. .... ......... .......... a.;. .......... ... .... :......... . :. . ...... . .. .. .... . . ........................ . . ....................................................................................................................................................................................................................... . ........................................................................................................................................................I ................ rA......................... .................................................................................... .................................................. .......................................... ................. Materials and labor to cost $. � .�........................... Payable ........................ on ... ............. and balance in ................ Irenthly installments of $ .................... each, payable on ........................ day of ealell and every month thereafter until paid in full (............% charge per year is to be added to above cost of labor and materials and is included in monthly payments.) Contractor will do all of said work in a good workmanlike manner. Upon completion of above work, all undersigned agree to execute and deliver to contractor, their joint note in accord- ance with his (their) above obligation and a completion as requested by the contractor. Upon refusal to do so, contractor may at its option declare the entire contract price or so much as then remains unpaid immediately due and payable. It is agreed that if permitted by law contractor shall be paid by the owner(s),all reasonable costs. attorney fees and expenses, in addition to the amount due and unpaid, that shall be incurred in enforcing the terms and conditions of this contract and/or any lien in connection therewith. It is further agreed.that this contract may be assigned by contractor; and also that the obligations hereof shall bind and apply to their heirs, successors or estates of the parties. The undersigned warrant(s) that he is (they are) the owner(s) of the above mentioned premises and that legal title thereto stands of record in his (their) name(s). PROVISO: This contract shall be void and of no effort if credit approved of owner(s) is refused. There are no representations, guaranties or warranties, except such as may be herein incorporated, if any, nor any agreements collateral hereto, nor is this contract dependent upon or subject to any conditions not herein stated. Any sub- sequent agreement in reference hereto shall be binding only if in writing and signed by all parties. Receipt of a copy of this contract is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing provisions have been read and the contents thereof understood and that no representation or agreement not here- in contained shall be binding upon the parties and that all of the agreements and understandings of said parties are con- tained herein. Owner or Owners are not responsible for Property Damage or Liability while job is in opera i I ; IN WITNESS WHEREOF, the parties have hereunto signed their names this .... lrLa day of ... ...... ....... 19. Accepted: i (OWNER HAS 3 DAYS IN WHICH TO CANCEL CONTRACT) Signed ................ .... ................ Owner Signed ............................ Owner Per 414z[/ el� e: �..................... Signed ...................................................................................... tative .- "FORTH < E i. own of X, over 0 No. '=' - A_ o L Ate) dover, Mass., 19 COC MIC RRREEE NNN777 Iv S\V A0RATE0 PP -J '9S HBOARD OF HEALTH Food/Kitchen PERMIT T D Septic System a BUILDING NSPECTOR THIS CERTIFIES T2 ... ... N..�. r......�*.*4t jr rro •.... ........................................... Foundation has permission to /r 419............... buildings on ...�3 ....Q4V.0.64...� ............ Rough to be occupied as....... �.l� .� .. .. .�. ......F..),I�ilt. .. Chime y e 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 STARTS ELECTRICAL INSPECTOR Rough .....I& , 4 ............. .... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL c1,`14rr 4 CONSERVATION FINAL Street No. Smoke Det. 0MAIED MIATCR FIKIAI �` 6'5 e DRIVEWAY ENTRY PERMIT NORTH TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 1600 Osgood Street Building 20, Suite 2-36 Sys gwttV. acs North Andover,Massachusetts 01845 SACHUSE - Gerald A.Brown Telephone(978)688-9545 Inspector of Buildings Fax (978)688-9542 HOMEOWNER LICENSE EXEMPTION BUIDING PERMIT APPLICATION Please Print DATE: �- (� JOB LOCATION: Number Street Address Map/Lot HOMEOWNER_ - C���1� a _0�3� Name Home Phone Work Phone PRESENT MAILING ADDRESS 'Sa/YW_q_ City Town State Zip Code The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements nd that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535