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Home My WebLink AboutMiscellaneous - 137 LANCASTER ROAD 4/30/2018 / 137 LANCASTER ROAD J 210/104.D-0159-0000.0 um L U"" "ol L E • Date.... �aORTM ° TOWN OF NORTH ANDOVER F p PERMIT FOR WIRING ACMUS� This certifies that ... / J Env�� a ........ '��<< ............. i ��R�T` S S/fes? has permission to perform ..... /15A�t.............,�.......� ............... wiring in the building of.........5.............1". R M v........................... at.......... ��5...� 605 ...... .4) ,North Andover,Mass. ....... ......... -o� z0a C- a Fee...y.S.......... Lic.No. .............. . !`lr. / ... t ELECTRICAL INSPECTdR Check # 3(?3zl 7631 (..onsmonwaa�o��a�ac�ewat`fs Official Use Only Permit No. Wa3 1 REM �1JaPartmenf o� }iia�arvicad Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07J leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M 527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) - Date: City or Town of: N NNW<-N— 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) 12 , (,-- r) Owner or Tenant /�M JY1gy N Telephone No. C�?� 1G-2X0'jq Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service 'Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: re La (� s-rem J Completion o the following!able m be waived by the Inspector of Wires. No.of I ota No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets. No.of Hot Tubs Generators KVA A oven- o.o mergency ig mg No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of DJection an No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. TotalTonsNo.of Alerting Devices No.of Waste Disposers eat ump -um er _ons __ o.o e - ontatne P Totals• �• � Detection/Alertin Devices Municipal No.of Dishwashers Space/Area Heating KW LOcal❑ Connection E] Other Heating Appliances KW security ystems:* 1l No.of Dryers g pp No.of Devices or Equivalent No.of Water o.o --No.-Of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications . rung: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: 7—OZt,2O7o2 Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by.municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the.owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent..The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I cert,under the pains and penalties of perjury,that the information on this application is true and completer 5 3 3 FIRM NAME: S�cUr(-r� S�rIJLCes LIC.NO.: Licensee: �Q Signature ��' `"-3 LIC.NO.: S (If applicable,enter"e�em t'•in the lice a num er line.) /_ s Bus.Tel.No.: `� 59�. Address: 0 L I NTG� � Ay� �f(S , 1JH �q-p Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SS O U 97' 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: $ y� Signature . Telephone No. .. .:.....:: a..,It ... ...... ..... ... ."..1 ... .. .. .. .. ..... _... jo .. .. .....__ r ... .__ ... ... r r. •, .... .. r... .�• !:.::.�—..moi' r COMMGNWEALTWVF i,4,'6S(;+. HUSETT'S T ' 'OF ELECTRICIANS REGISTERED SYSTEM TECHNICIAN .' ISSUES THIS LICENSE TO i KENNY Q WONG .. r:Cz� PIELDSTONL DRIVE ' BURLINGTON MA. 01803-4213 5966 D 07/31/07 . 99176'11.• 1 Fold,Then Dela6h Along All Perforations :w f. vl• _ _ ��y: ...GS — 1. f Ir, w.ti �4z r. _ ....... .. .,.,t.. .t ..... ..._ ....._... .. ..X, _y' ..._-v.. ..r.-. ...... �-..n _. ,.,.:^ �... _ •.�,,:y .�Y may:. 1': :r,.r(;•• "1... lar. .kn. •.S: .I_ DEPARTMENT OF PUBLIC SAFETY lug License: SEC SYS CERT.CLEARANCE Number: SS CC 001975 Birthdate: 10/09/1969 Expires: 10/09/2007 Tr.no: 110.0' Restricted: 00 KENNY WONG 22 FIELDSTONE DR G— BURLINGTON, MA 01803 Commissioner Z. ..... .._..-a ._...: _ .._.... ...... i .t. s. ......... -......:.•..r. _. _.. ......:::.•_"r.,.4: ;:�,:::::::': .II:�.S.^ f.r:iy._}tmlC...Lil,. rr e z LAWRENCE H.OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fax 978—352-2858 cell: 978-502-5921 May 7,2012 Mr.Mark Bunker Bunker Building and.Remodeling,LLC. 6 Glendale Street Haverhill,Ma. 01832 RE: Residence 137 Lancaster Rd.,North Andover,Ma. 01845 Dear Mr.Bunker As you requested I visited the site 54-2012 to review the situiation at the rear door window assembly at the rear of the house entering on to the deck..A new door window had been installed in the existing opening however there were insufficient jack studs supporting the header. I prepared and certified a repai sketch dated 5-6-12 , I revisited the site 5-7-12 to review the completedwork. Based on the above site visit. I can certify that to the best of my knowledge the the work as shown on my sketch was installed correctly and that with this repair the header and support conditons are.sufficient to support the loading conditions of the 8th Edition of the Massachusetts State Building Code for 1&2 Family Residences. Should you have any questions please do not hesitate to call. Yours truly, I N1,-- L' ence H. Ogden P.E. Structural 27765 e C� F WRE34CE G HARow v GDM SFS 0,AL EN�'� Fm 3vvkfe (3 vI X0106 ArvD P.V-194 V*€-ck kMPL Go 44Z€F A-r $ vM P ovr omro pEG� o�trk �� t7 dv�2 w►n��r�� A-�S��t3 L X�6"mme- 4u'VEP, 9 ZVA tR. Y- € .. TO WOOD z k. FUIL(- a eA.P.We 1 0 , i t G L AT �a ADR d Go�naa.cT To SL-k � Z 2 WINDOW . A t912 i aQSti��G 3 � sr'0 5 OIL LE06-N 01 APQeg Zig E2 t1 OF�y WREN ti HMOcj N Lawrence H. Ogden P.E. 10 65 0 198 East Main St wai f vGeorgetown,MA 01833 97f> 357. S Vit& +z_ 9375 Date. . .iD�. . . . . . . . . . , HORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s o• a 4s •°•,n°•A"4y i ,SSACHUSE� f This certifies that .L``�1---�. R--mrvlkll . . �. . . . . . . , has permission to perform 1 . . . . . . . . . . . . . . plumbing in the buildings of -,jC .Me.S. i��!Q'!�. . . . . . . . . . . . . at. . .� �. . �'.cx�"��.R,. .1�C .•. . . . ., orth Andovet, Mass. Fee' //_�N.-b', Lic. No. ,%. . . . . . . . . . ". . . . . PLUMBIN INSPECTOR Check # ! _�_ �,0 i AID MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUM 131NG WORK iCITYI /v047k Aj,,fXyg�t, 1 MA DATE I y1i 41 L IPERMITiff JOBSITEADDRESS / LG�Cccs7 /1 r, OWNER'S NAME ; OWNERADDRESS I Sla+. I TEL JFAXI I TY:P11.0k OCCUPANCY TYPE COMMERCIAL( { EDUCATIONAL RESIDENTIAL( PRINT CLEARLY NEW;( ( RENOVAT100:1A REPLACEMENT ( ( pLANS.SURMITTED: YES( # NO] FIXTURES-1 FLOOR- 13SMI 2 3 4 5 6 7 a 9 40' 1t 12 13 14 BATHTUB _I . .. .i. . : 1, ; -i !..- ;,------ =SS OONNECTION DEVICE iOEDICATEOSPECIALWASTE-SYSTEh1 _ : ._ .:.--......_; ��:e.. .._. .,.....,_ ...- i .___:..y _..... DEDICATED GAVOIUSAND SYSTEM ... i ,. ! !... i I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM j ! ....._. :........ ...... __. .- DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN !. FOOD DISPOSER FLOOR IAREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN t SHOWER STALL SERVICE/MOP SINK TOILET _..--- URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES. WATER PIPING - -- -—. .OTHER - +: �- INSURANCE COVERAGE: --- - have a ctirront. hsilratice policy.br its suhstantial equivalent whicli meets the tegt>irenients of MGL''Ch.942. YES( I No ( IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATEBOX BELOW LIABiLITY INSURANCE POLICY OTHER TYPE OF INDEMNITY( , AOND(• j OWNER'S INSURANCE.WAIVER:f ani aware that the licensee*es not have the Insurance coverage requited by 0fiapte042 of the Massachuselts General Taws,and that tq signature on tiiis permit application—Wives this relittnfuent. CHECK-ONEOI LY: OWNER AG%T. SIGNATURE OF OWNER OR AGENT I hereby certify that all of lime details and infonnation I liave Submitted of entered rergarding'this applicaliorl ate true and accutate to the best or my knoerledg'e and that all plumbing work and Installations performed under the permit issued for this application%trill be i mplianc ralh all Peflinenrgvisi oflhe Massachusetts State'Plumbing Code and Chaptgr 142 or the General Laws. PLUMBER'S NAME I fix i.- woi ce04w,- ILICENSE ff I IO�f'o�i i' SIGNATURE MPI ,1P� ( COf2PORATION1 ltf ;PARTNERSHIP( (IfI �LLC 1#) COMPANY NAME{OT,,A S PLAdv"131`- I ADDRESS I t f QL( �rp>,��G ✓� I CITY OGVe -,�%A STATE Ilji'� ZIP QIQ3tS I !ELI 97B—Lf -(moi FAX I — 2,6 ..I CELL I i EMAIL P13t 'OL41LOV4e-2 ftI. . c�� . I i ROTCIEIf QLUM]d1[14TG l[16TSPMCT7[GN16TI 37l'ES ar-Low aor"O r + m YJSE:o-Nmy T INAL INSPECTION NOTES �f 1`HIS APPLlCA'TIO6VSEMS AS THE PERMIT Yes No FEE:' PEMOT ]P]LATNT M,Iymw-NO=-s 42 s w 1 1 I 1 � AX The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le>?ibly Name(Business/Organization/Individual): �U5i�b1�e tv Address: LRA (,nKkc o Wit! City/State/Zip,: �, L� 114. oC— Phone#: ,��r Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2.[AI am a sole proprietor or partner- listed on the attached sheet.x �• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g ❑Building addition [No workers'comp.insurance 5. F1 We are a corporation and its required.] officers have exercised their 10.F1 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.❑Roofrepairs insurance required.]r employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box Of must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lain 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: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert,4 under thepains andpenalties fperjury that the information provided ov, is true and correct. Simafore: Date: 10)1z, Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: a 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. Iran LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: Tho GoWjp0z1weajt� ofMassaclivsPtts Department of ladustrial Accidents Office of investigations 600 Washington,Street Boston,MA 02111 TO,#617-727-4900 eyt 406 or 1-577:MASSAFF, Revised 5-26-05 Fax#617,4727-7749 www.mass,gevldiia. Date. .//pAz ..... WORTH OjOy�,.ao ,• 6 4' W TOWN OF NORTH ANDOVER f A - PERMIT FOR GAS INSTALLATION 9SSAcMUs£S This certifies that .. . . .S. ...r`"h ? . . . . . . . . r has permission for gas installation L �.�. .C`v<? . . . . . . . in the buildings of dQ(Y!f A °Z, . . . . . . . . . . . . . . . . . . at . . . . . a 5 [ef?--. . PA, North Andover, Mass. Feel?7�. . . Lic. No., P� . . . • ,,/ GAS INSPECTOR Check# �'OHO ZS _ 8120 �A V4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: l /hwCe Ie*t. , MA. Date• L{ (a iZ Permit# Building Location:1 � �G�fGi t 2 P.O Owners Name: ►10K_ Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New: ❑ Alteration: ❑ Renovation: g Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES - - - - - - - - - -W W - - C6 - w Q 0 Cd z Z MW O w W v0 [� O = W Z I-- zF- 0 J W Z W 0 o a Ix zix 0z W W m o = O JX > � L)) Z W , 0 W . o a W 1 = LL 1° ZZ J (W7 LL v1 2 Z W W Lu O Q W W Q > O O W Z Z W Q 1=- V o o LL 0 0 = 2 J O > 3: O SUB BSMT. BASEMENT 1 FLOOR l 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR ' 7 FLOOR >3 FLOOR Installing Company Name: � Check One Only Certificate# (( ❑Corporation Address.WC—An ,Gt, City/Town: �.�'t State:_ . ❑ Business Tel: Cjl?-,-4M– IM Fax:TE;343-Z-3-M Partnership El Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ElNo❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent El By checking this box❑;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 COW' men provision assachusetts State Plumbing Code and Chapter 142 of the General Laws. rAFFR 3 �. Type f License: PI ber le G Fitter Signature of Licensed PlumbedG-is Fitter aster " ' Journeyman License Number: 103'68 OFFICE USE ONLY [] LP Installer The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizafion/individual): - - Address: - City/State/Zip; ` �� - Phone Are you an employer?Check the appropriate boa: 1•❑ I am a employer with 4. ❑ I am a general contractor and I TyE f project(required):' employees(full and/or part-time).*' have hired the sub-contractors 6. New construction 2.[XI am a sole proprietor or partner- listed on the attached sheet [7. ❑Remodeling ship and have no employees These sub_contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑.I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. C. 152,§1(4),and we have no insurance required.]t employees. [No workers' 12•❑Roof repairs comp.insurance required.] 13.❑Other "Any appEca2t that checks bax#1 m_st also fill cut the section be?oi�,ahoe,��=W� _ T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit new affidavit indicating such. tContiactors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. J'am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Compiny Name: Policy#or Self4w.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL 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. X do hereby ce fy under the pains and enal 's ofperjrurJY that the information provided above is true and correct Signature: ULO Z Phone 4: 1Y,:�09 _[y 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 idomaintenance,-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 bean 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 unfit acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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. Beedvised 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 a�P ra 0-,for the is beLing requested,not t'1E D epart'•1':ent 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 writs"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 homeowner 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 nothesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel. #617-727-4900 ext 406 or 1-8.77 MAS.SAEE Fax#6.17-72.7-7749 Revised 5-26-OS r E.r t /74 Y 4\ 4�SLoi-rlep,6 (2�7) TO (jtt 1 ;tt 1� �ttt (i i� i i d o - f go? I� I� Step 1 : Ventilation Hood Placement: Requirements For best smoke elimination.the lower edge of the hood should be installed 30"above the appliance cooking It is strongly recommended that a suitable exhaust hood.be surface. (See Figure 1). installed above the appliance.Downdraft ventilation should If the hood contains any combustible materials(i.e.,a not be used.The following table indicates the ventilation wood covering), it must be installed a minimum of 40" hood options and blower capacity guidelines that are above the cooking surface. recommended for use with all Thermador cooktops. Due to the high heat capability of this unit, particular NOTICE: attention should.be paid to the hood and duct work Most hoods contain combustible components which must installation to assure it meets local building codes. be considered when planning the installation. Do not install a microwave oven/ventilator combination Consider Make-Up Air: above the cooktop,as these types of units do not provide the proper ventilation and are not suitable for use with the Due to the high volume of ventilation air, a source of cooktop. outside replacement air is recommended. This is particularly important for tightly sealed and insulated Select Hood and Blower Models: homes. • • For wall A qualified heating and ventilatingcontractor should be installations the hood width must, a minimum, equal the nominal width of the appliance consulted. cooking surface.Where space permits,a hood larger in NOTE: width than the cooking surface may be desirable for Ventilation hoods and blowers are designed for use with improved ventilation performance. single-wall ducting. Some local building codes may require • For island installations the hood width should, at a double-wall ducting. Before starting installation, consult minimum,overhang the appliance cooking surface by local building codes and agencies to insure that the 3"on each side. installation will meet local requirements. Cooktop Width Cooktop Configuration Ventilation Options 30"or 36"Pro Wall Hood 30" 4 burners 30"or 36"Custom Insert w/optional blower 42"Island Hood w/optional blower 4°�burrners-with-griddlb 36"or 42"Pro Wall Hood 36" 36"Custom Insert w/optional blower 6 burners 42"or 48" Island Hood w/optional blower 48"or 54"Pro Wall Hood" 48" 6 burners with griddle 48"Custom Insert w/optional blower Important Notes: • It is recommended that a Thermador Professional wall or island hood or custom insert is used with Thermador Professional Cooktops. • Refer to www.Thermador com for a complete selection of Professional Ventilation options, Blowers, and Accessories. • For high output gas cooktops(60,000 BTU or greater),Che.minimum.of,one__-1) FM.of ven#ilation.per 100.13TWV recommen-del'a lfi fhe Cooktop has a griddte-add-.200_CFM_to tF_e estimated blower capacity.Additional blower capacity may be required for longer duct runs. • For island applications, it is recommended to use a hood width that exceeds the width of the cooktop by 6" (overlapping the cooktop by 3"on each end). • "*Not all 48" Pro Wall Hood models can accommodate a 1300 CFM blower option. • CFM ="cubic feet per minute"(standard blower capacity rating). English 4 F Section 4:USING THE COOKTOP Using The Cooktop Sealed Burners The cooktop features f u or six gas surface Setting Indicator umers,_each.�ated of 18 090'BTU7HR"(15,000 BTU/HR using Propane). The burners are a _ mounted on top of unique-shaped pedestals. OFF This makes the burner assemblies accessible for easy cleaning. On all models, the two left burners have the exclusive ExtraLow feature, the remaining burners are standard. Each burner has its own control knob. \ Knob � Bezel Standard Burner Control Knob 4 OPERATION OF THE BURNERS 110 , • Press in on the knob and turn it counter- 0 clockwise to the setting on the knob. • The igniter for the selected burner clicks and sparks. • After burner ignition,the igniter stops clicking. • Rotate the knob to any flame setting between HI and SIM. Star Brass Burner Base The blue signal light, between the burner knobs,will light when adjacent burners are lit. The light will remain on until the adjacent burners are turned off. CONTROL KNOBS The control knobs for two gas burners, one in BTU for Standard Burners front and one in the rear, are located directly in • HI is equivalent to 18,000 BTU/HR front of and below the pair of burners on the (15,000 BTU/HR using Propane). control panel. • SIM is equivalent to 2,100 BTU/HR., The symbol above each control knob identifies BTU for ExtraLow® Burners either the burner position on the cooktop or the • HI is equivalent to 18,000 BTU/HR griddle control,depending upon your model. (15,000 BTU/HR using Propane). • SIM is equivalent to 3,000 BTU/HR. LEFT REAR LEFT FRONT RIGHT REAR RIGHT FRONT • XLO is equivalent to 370 BTU/HR. Burner: Burner: Sumer: Sumer: !QD i5D El I r i I CENTER REAR CENTER FRONT GRIDDLE: Burner: Sumer. i I a 7 3t inch Professioml Series Ran eto PCG366G 9 P ermadur Optional accessories PA12CHPBLK,PAI2GCVRHC, PAI2GRILHC,PA36GLBC, PAGRIDDLE,PAKNOBLK, PAKNOBLU,PALPKITHC, PWOKRINGHC Knob material Full metal i LP Gas Connection Rating BTU 90000 Sealed burners Yes /r Included accessories 1 x island trim Location of 1st heating element front left Power of 1st heating element W 0.1-5.27 Power of 1 st bumer BTU ~""`18000'l Location of 2nd heating element back left Power of 2nd heating element W 0.1-5.27 bower of 2nd bumer�BTU �� 18000 Location of 3rd heating element front centre/cent Power of 3–rd b—um er(BTU).__ — 18000 Location of 4th heating element back right Power of 4th heating element 0.62-5.27 _ower of 4th bumer.BTU- 16000_ Location of 5th heating element front right Power of 5th heating element W 0.62-5.27 Power of 5th burner BTU 18000 Location of 6th heating element front middle/central Power of 6th heating element W 0.62-5.27 Power of 6th burner BTU 18000 • 1(800)735-4328 i WWW.THERMADOR.COM 15551 MCFADDEN AVE,HUNTINGTON BEACH,CA 92649 COPYRIGHT 2012 SSH HOME APPLIANCES CORPORATION,ALL RIGHTS RESERVED Generated On 02/09/2012 11:18:51 -7 .751> �Yle_11. b" SPECIFICATION SHEET PK 2 RANGE HOOD Specially designed to be installed in custom canopy hoods for use over residential commercial-style cooking surfaces. FEATURES • Italian design • Cabinet mount—custom application • Finish:430 Stainless Steel • Widths:29-13/16';38-7/16" 14-3/4" • 8"round duct connector/backdraft damper 07-7/8" • Halogen lighting(2 bulbs included on 29-13/16"hood or 4 bulbs on 38-7/16"hood;Type GU10, MR16 shielded, 120 _ volt, 50 watts max.) • Slide controls:on-off, 3-speed 5, • Quiet, dual centrif . al blowers with two high-efficiency motors produ 1000 CF N • Easily access—ib e, washer-safe aluminum/stainless steel filters • Heat SentryTM-automatically turns blower to high speed when excess cooking heat is detected OPTIONS 29-13/16" 38.7/16" 1y1�16' • Stainless liner(Model Nos.L2936, L2942,L3848, L3854, L3860) • Ambient light panel (Model Nos.ALP36,ALP42,ALP48, ALP54,ALP60) Mount range hood so bottom of hood is • Exterior blower version(PKEX22)available,providing 600, 24"to 30"above cooking surface. 900, 1200,or 1500 CFM exhaust R HVI-2100 CERTIFIED RATINGS comply with new SPECIFICATIONS . testing technologies and procedures prescribed by the Home Ventilating Institute, for off-the-shelf VOLTS I AMPSJ ,CFM fj SONES DUCT HVI products,as they are available to consumers.Product performance is rated at 0.1 in,static pressure,based 120 6.23/7061 G1000 10.5 8"round on testsconducted in a state-of-the-art test laboratory. CERTIFIED Sones are a measure of humanly-perceived loudness, based on laboratory measurements. C &US BEST Hartford Wisconsin www.BestRangeHoods.com 800-558-1711 BEST Mississauga, Ontario www.BestRangeHoods.com 877-896-1119 REFERENCE QTY. REMARKS Project Location Architect Engineer Contractor Submitted by Date 90H 99042853K PK22 MOUNTING WOOD OR METAL FLANGE (2) METAL TO SECURE SIDES OF UNIT SCREWS _ I CUT A HOLE IN THE BOTTOM OF THE CABINET I � 1-5/8" 1 14-15/16' 8-3/4" SEE 4 SCREWS CUTOUT 4-9/16" (Typical) DIMENSIONS A 1-9/16" METAL OR FLUSH UNIT OTHER NOW TO BOTTOM COMBUSTIBLE OF HOOD A = 26-1/8" (PK2229) MATERIAL 34-3/4" (PK2238) (Build to Measure) BEST Hartford,Wisconsin www.BestRangeHoods.com 800-558-1711 LNv4x BEST Mississauga,Ontario www.BestRangeHoods.com 877-896-1119 i a Date..... AORTFt TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ '. .--/.'1'l.—nf ....... has permission to perform ........1e..r.rz.k.P?V........................................ wiring in the building of............ ............................................. at........1.- .7a.....L71PvC#6;15'77��.... North Andover,M S. > Fee..a./7.?&..... T ic.No.10.6.:"D.............. ..... ... .. .... E ICAFLINSPCTOR,� R, Check 4 108,11 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked r` BOARD OF FIRE PREVENTION REGULATIONS [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),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: A f(Ll L 10, -)_o� 2 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) 3-7 L_ANC _1..-r;iZ Owner or Tenant fL1 t-L.1S54 TA'1Wn-- Telephone No. Owner's Address Sar-+c Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building V-&J\bC=t✓C Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: fL6r''_.DO6;t_ Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires 1 No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires \�-� Above ❑ In- ❑ o.o Emergency Lighting Swimming Pool rnd. gr d. BatioUnits No.of Receptacle Outlets O 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. TotalTons No.of Alerting Devices No.of Waste Disposers \ Heat Pump Number Tons I.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: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [a' BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: & ( i�S�r"tan/ L l,(;C i rZt Lo LIC.NO.: �Lo S 3 J Licensee: (+C-A-tJA LfA)1P`'Aw Signature LIC.NO.: (If applicable,enter "exempt"in the license number line) Bus.Tel.No.•0178-771-S 4 71 Address: S 0*56 S-(. I_thiGS'--)hJ f al e"4,z- Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. p�. ®� � -c �- LAWRENCE H.OGDEN,P.E. 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fax 978—352-2858 cell:978-502-5921 May 7,2012 Mr.Mark Bunker Bunker Building and Remodeling,LLC 6 Glendale Street -- - Haverhill:Ma,,-0.1832 RE: Residence 137 Lancaster Rd.;North dover,Ma: 01845 lunker Dear :r As you requested I visited the site 5=4-2012 to review the situiation at the rear door window assembly at the rear of the house entering on to the deck. A new door w ndow.had been installed in,the existing opening however there were insuficient jack studs supporting the header.. .1 prepared and certified a repai sketch dated 5-6-12 . 1 revisited the site 5-7-12 to review the completed work. Based on the above site visit. I can certify that to the best of my knowledge the the work as shown on my sketch was installed correctly and that with this repair the header and support conditons are sufficient to support the loading conditions of the 8th Edition of the Massachusetts State Building Code for 1&2 Family Residences. Should you have any questions please do riot hesitate to call. Yours truly, L ence H. C?gden P.E.' Structural 27765 4 of C iMRCE �G HAROLD v DW H �osz. 3v+►1tic�t� Q ut c:a'tn7G h+ve 11� �trc�G l.tC 6 C.LaVDAL.E OT(ZeC't° fiwq i A:-,r j3piv%P our oivro SEG ova R D�ar2 \,u it. A-56EM93 L P Z x-.4, r—tAr tk-T e,AC,+f r X40 r, Z Rows C►M?59,v 4-3llb ID w 22,439 `t vtxv WOOD se-PLEWS A-5 5 440wN aA e-4 E n.p I� A?4 c. 6 FAR( Ago Aj P-vr !7�7 f il 2-A'Iz y m0ow Por tz �`� ► T' d QF-Awon-vc. $ftisA� 14 QF,y�� ° WREN s ft" N " ; Lawrence H.Ogden P.E. 65 0 198 East Main St A�� Georgetown, MA 01833 S/ At ENG\ Date. 4 .0R':��, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� 1 This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . plumbing in the buildings of ..... . . . . . . . . . . . at ./. .-3. . . C G. Y�. . . , North Andover, Mass. Fee y.7- .a�Lic. No./ ;.%i /.1.. . . . . . . vPLUM13ING INSPE.ETOR Check # 12 8279 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or Print) NORTH ANDOVER,MASSACHUSETTS Date 10- 0?-01T Building Location . 7 � vncc,r- eT Permit# a; ' Amount yJ•�' Owner /In, -}- �@-] � 1 New 0 Renovation � Replacement Plans Submitted Yes 0 No FIXTURES rz SWIM B4SMINT M ERM m mm 3MIIOCR 4MBoat SIBrFLOC t '' 6IH IIOat 7IB HDM SIB T�IDat (Print or type) Check one: Certificate Installing Company Name_ ]{. r 110 �-}' ❑ Corp. Address 2 !— rV /`^ .d Partn . La.�rrylct Mh 01A43 Business Telephone 1_(,c�� . ZS 4, _ OG j S Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the>p of insurance covefage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond E] Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have an one of the above PP Y three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installatiorAperformed under Pernrit Issued for this application will be in compliance with all pertinent provisions of the Massac to P g Code and Cha 42 of the General Laws. By: igna e o kens um Type of Plumbing License Title Z l City/Town umber Master Journeyman APPROVED tor�cE uss ONLY 412 �- -� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AIA-02111 www.mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 2 Rl! e� City/State/Zip: G1;wJ70_P6L 1�4X Phone#: 6-.9�? 2U1 A;tan an employer? Check the appropriate bog: Type of project(required): 1. I am a employer with 2 4. ❑ I am a general contractor and I 6. E] 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.1 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for 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.E] 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' 13.0 Other comp.insurance required.] *r.riyapyhc nt that checks box#; also tillout 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. h'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C (C/C_ �v,frrleS r_r- A4)T)r6-41C?_ Policy#or Self-ins. Lic.#: Expiration Date: 10 0/" ,/O Job Site Address: 37 City/State/Zip: /\/O Amdo L e/, 1AA J 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 p 'ns and penalties of perjury that the information provided above is true and correct Simature: Date: D3o / Phone#:6Y I — Ci O S - 2-,, 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,of 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 theounds or building appurtenant gr g app ant 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 Iicensing 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 compliance acceptable evidence of with the insurance P 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 toyour situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability.Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. .The affidavit should 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 pertnit/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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Dement of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA.02111 Tel. # 617-7274900 ext 406 or 1-877-M-ASSAFE Fax# 617-72.7-7749 Revised 5-26-05 wr"rA,.mass.gov/dia No 2802 Date....d..�yl 0 y ........... ......... f 40RTq 1 or;.<;�``°;•�."ooh TOWN OF NORTH ANDOVER PERMIT FOR WIRING ssHcHUS h This certifies that .......... ..`. .......E.J c................................................ has permission to perform ........ ....... .` ..)...................................... wiring in the building of.... .................................................. �C al..L7,/....7... ..L ��.1.!.�`C.'.f.`.1......�. a............. .North Andover;Masse- Fee. ass:Fee. ...... .......v.. Lic.No. �.. 3 L ,ELECTRICAL INSPECTOR Check # S !/ WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Official Use Only ^ Permit No.� !-- /fr� aefraztfuears oa�u�lce Sam Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date_r2w' Z0 To the Inspector of W res: Town of North Andover The undersigned applies for a permit to perform the electrical work described bel Location(Street&Number Owner or Tenant__ Owner's Address Is this permit in conjunction with a building rmit Yes ❑ No /(Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgrnd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work LJ X No.of Lighting OutletsTotal No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA — No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone No.of Ranges No of Air Cond Total No.of Detection andTons Initiating Devices Heat Total Total No.of Di osal No. Pumps .Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices No.of Dryers ❑ Municipal ❑ Other Heating Devices KW Local Connection No.of No.of Low Voltage No.8f Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tulls 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= N have submitted valid proof of same to the Office YES= NO = If you,h the ked Y please indicate the type of over ge y checking the appropriate box. INSURANCE = BOND = OTHER = (Please Specify) / Al Estimated Value of Electrical Work$ (Exp ra' n te) Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of pe�'� FIRM NAME `�-9 rF LIC.NO. /./ �-33 Lkensee Signature LIC.NO, 000-VVV { L / Ahave .Tel No. (� j Address J(! I it,[ �7 t Tel.No. OWNER'S INSU CE WAIVER: I am a e that t e License'doess noinsurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. (Signature of Owner or Agent) p PERMITI=EE $ Location 3 L (Lipt4q) No. Date N°RT►, TOWN OF NORTH ANDOVER Certificate of Occupancy $ 4 8 + Building/Frame,Permit Fee $ 20 Foundation Permit Fee $ c; ss�cNuse Other Permit Fee $ • Sewer Connection Fee $ Water Connection Fee - $ TOTAL $ 7- n Building Inspector li 7604 Div.Public Works Location lin LmcAsrrz eD L+-,O) Np. 4-31 Date �o NpRTM , TOWN OF NORTH ANDOVER pf� �ao ra1'40 3? ��` •e pL 5 — Certificate of Occupancy $ Building/Frame Permit Fee $ cMUs s� Foundation Permit Fee $ 0o Other Permit Fee $ � Sewer Connection ,Fee $ i o Water Connection Fee $ g ' TOTAL $ ik Building Inspector TQ. ? Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. ✓ PAGE 1 MAP 4-40. /ay�� LOT NO. / 2 RECORD OF OWNERSHIP 'DATE BOOK 'PAGE 'ZONE I SUB DIV. LOT NO. LOCATION / PURPOSE OF BUILDING ROWNER'S NAME NO. OF STORIES � y SIZE �1 (_� -/ 5z,��1�• OWNER'S ADDRESS G A..��,�� 1x-11 �C/� BASEMENT OR SLAB --15 O��O-� ARCHITECT'S NAME E4 A go - O SIZE OF FLOOR TIMBERS IST L1 x �a 2ND /e.) 3RD BUILDER'S NAME SPAN o� '64 DISTANCE TO NEAREST BUILDING 7 d / DIMENSIONS OF SILLS DISTANCE FROM STREET J " POSTS y! DISTANCE FROM LOT LINES—SIDES REAR �s..v GIRDERS AREA OF LOT l vL�s� FRONTAGE HEIGHT OF FOUNDATION I' i THICKNESS IS BUILDING NEW �7 �! s' SIZE OF FOOTING Q X e1 IS BUILDING ADDITION �� MATERIAL OF CHIMNEY 13 ?1, J IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND soh / WILL BUILDING CONFORM TO REQUIREMENTS OF CODEt IS BUILDING CONNECTED TO TOWN WATER Y f-5 r BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ye ' IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS PERMIT FOR FOUNDATION ONLY 3 PROPERTY INFORMATION SEE BOTH SIDES REGULATED BY PARA. 114.8& B.C. LAND COST �} EST. BLDG. COST 334`Od� PAGE I FILL OUT SECTIONS I - 3 PAID "" / EST. BLDG. COST PER BQ. FT. DATE �� PAGE 2 FILL OUT SECTIONS I - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING J��/f�� 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIM MUT PLANS MUST BE FILED AND APP OVED Yl�BUUILDING INSPECTOR___ O Moil GATE FILED �/ �6}iC��uii* Wr PERMIT BOARD OF HEALTH SIGNATUR F R OR AUTHORIZED AGENT FEEZ1'11 Glo -. — — 1 �p OWNER TEL. S"335 PLANNING BOARD PERMIT GRANTED 1 CONTR.TEL,# 9 7.s= t9� CONTR.LfC.a 120 } BOARD OF SELECTMEN OCT PERMIT FOR FRAME/BUILDING } ' ........_____FEE PAID* WILDING INSPECTOR DATE. BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYSTORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM .MULTI. FAMILY �_ OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- APARTMENTS I RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL NP FIN. B'M'T' AREA 1/1 1/+ % FIN. ATTIC AREA NO B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE t �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD1"'D T _ ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY _'� r •� } 9' STUCCO ON FRAME �' -+' w'=� L n ,• iii .ZQ!"it�,i,,t► BRICK N MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ � • .4 ,( SUPERIOR POOR _ i Gf ADEQUATE I-i NONE �6 5 ROOF 10 PLUMBING r GABLE HIP t BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT I SHED WATER CLOSET ASPHALT SHINGLES LAVATORY a42 { t WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ - ,„t• � ,y.TOM AM 3m TAR & GRAVEL STALL SHOWER _ 41) ' ROLL ROOFING MODERN FIXTURES _ 4 TILE FLOOR }} TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE ' FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR ' WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC r 3rd y NO HEATING r JI � 9 *ow To of over z _� = Tort`" dower, Mass.• ®G� ZS 19`��- O -w LAKE �.. CU(HIC NE�V IC KA �� Ao U n `r P. BU1' BOARD OF HEALTH Food/Kitchen PERM IT TO LD Septic System T n BUILDING INSPIjCTO� THIS CERTIFIES THAT......... ....a.Kp.A.... " `' za �T� �k``� \ oun atto" t1�to has permission to erect..lJ� ....f(l+A(�1Cr buildings on ...Mkl....1�A CAS R,.. ........ k.. .. Rough to be occupied as 1t�1 .:��rn1... . . WE�`.�CKN..... ....fir..��O.Q,.. !�n14►4r ................................... Chimney provided that the person accepting this permit shall in every resperct conform to the terms of the application on file in Final I 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. PERMIT FOR REGULATED BY PARA.FOUNDATION ONLY PLUMBING INSPECTOR . B.C. a VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough i b Z Final ti PIER MI F Ev P I P,_<<{ TtiI� ID FEE PAID ._.— ELECTRICAL INSPECTOR { �� CO rL Rough BLDG. PERMIT FEE Service 7 LESS FDA FEE . ....... . . ....... ............................. ................................................ BUILDING INSPECTOR DUE FRAME PERMIT $ PERMIT FOR FRAME/BUILDING Final a Occupancy I c rrntt Kegtired to Occupy f 3�ci ir>g GAS INSPECTOR a --- DAT - l� I D 'I 1 Rough Display in a Conspicuous Place on the Premises — � pY o MumnlUff Final No Lathing or Dry wall To Be Done FIRE DEPARTMENT b Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT * -7( oOl — `Z tc0$— o OCT 191994 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: e o vs1. 406�-ksl 0,14-10- Phone LOCATION: Assessor's Map Number D Parcel >6' Subdivision _ 4eC-,:�j Cdc l/e r�> �� Lot(s) Street � ,v C',�d�7c-,( �cr St. Number 3(7 ************************Official Use Only************************ REC NDATIONS OF TOWN AGENTS: /�' Date Approved 1 v� Conservation Administrator Date Rejected Comments Date Approved 2 Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved SeyEic Spector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit / 12-1e,-,573 Fire Department Received by Building Inspector Date Cf RT/F/ED FOUNDA TION PLAN LOCATED IN NO. ANDOVER, MA SCALE: /"= 40DATE 11191.94 Ir Scott L. Gi/es R.L.S. NOV 15 1994 ; ' 50 Deer Meadow Road ! North Andover Mass. 200.00' - 14 -UI/ \ � M S L. 07" 40 p 44,063 S. F. EDGE WETLAND NO- CUT co 75ti' NO-BUILD LOT 41 LOT 38 EX/ST/NG FOUND 35 84 .- 38' \I ,R= 350.00 1 L= 120.00'LANCASrER ROAD / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING /NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE WITH THEZON/NG DETERM/NATION OF ZONING iLFs y BY LAWS OF CONFORMITY OR NON-CONFORM/TY 13M NO_ANDOV ERS_ WHEN CONSTRUCTED. `"�,ra�E��s1E�Eg� WHEN BUIL T yq Sao V� i lowl 14, Ido Y fix.A ' _ -•-• `� Fstlrn to JIM t W- a __._____-+ + - MssssobrssttsStaNBslfdfn0 r rr DEPARTMENT OF PUBLIC SAFETY Cods 1s cause for revocation COMMONWEALTH ` ONE ASHBORTON PLACE o/this ifassss- 91 rte; ti OF BOSTON,MA 02108 MASSACHUSETTSt S : CAUTION I_i F. r { n of S T:It UPI FOR PROTECTION AGAINST EXPIRATION DATE C>(� o(� EFFECTIVE DATE LIC-Nd: •THEFT, PUT RIGHT THUMB I } 1 •" PRINT IN APPROPRIATE RES�1 IR*KIONS (16/30/199 +,)t3 ? i' BOX ON LICENSE. E BLASTING OPERATORS x � i;; P4i1L J STHILA 11 6 G S P R d N t', H 11.L R 1 MUST INCLUDE PHOTO. -1;z, Vt� A D 'JFR MAC $45 3f?-09015 F PHOT STING OPR ONLY) FEE: ' FFICIALLV - 1 �.I 0- r) 1 NOT VALID UNTIL SIGNED UR LICENSEE AND 9 1 V ! STAMPED-OR-SIGNATURE OF THE COMMISSIONER I , HEIGHT:DOB: j!! SIGN NAME IN FULL ABOVE SIGNATURE LINE �. SIGNRTURE OF LICENSEE �-r�c`zi,t��•>� y - - '4 + # THIS DOCUMENT MUST B, , CARR EDONTHEPERSONO' THE HOLDER WHEN EN GAGEDINTHISOCCUPATIO► ,IDTHEgg RIGHT THUMB PRINT - -"" a d r ftfi 'u��'a �f-%.'`,fry• _ - 2° - �r�r 'J :�r :^.�.-w�y.1'._-.1..ay.w"`�"'."''*"i:..'ti r+..�".'_>"�.�'>..-w�,^.-,-n .T`.ro:.,-.�:...�-ti-[,—e''7'`- -.�,•R,,... "'-. Location No.. 3 e- Date N°RT„ TOWN OF NORTH ANDOVER O? • 1 • Opp' „ Certificate of Occupancy $ Building/Frame Permit Fee $ E Foundation Permit Fee $ JAtMUS t Other Permit Fe .W, $ ZS' Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ZSR 7L��J Building Inspector u }tQ 7822 v Div. Public Works HOatH Of KAREN H.P. NELSON Town of 120 Main Scr�et, 01845 Director (508) 682-6483 BUILDING ; '°•:.:_"` 9+ NORTH ANDOVER CONSERVATION VSs'`" $` DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT PLANNING CHIMNEY APPLICATION AND PERMIT DATE 0 C, of® qL PERMIT # T �- LOCATION OWNER' S NAME >^ BUILDER' S NAME MASON' S NAME MASON' S ADDRESS -,7°'3 MASON ' S TELEPHONE 1a 4 MATERIAL OF CHIMNEY � �U/ INTERIOR CHIMNEY Clea /'!t EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: rlev 1001, DATE SIGNATURE OF MASON .c ��g2v CONTR. LIC. # D� J� EST. CONSTRUCTION COST/CONTRACT PRICEy�'� PERMIT GRANTED ( Zi q 4- FEE ROBERT NICETTA, BUILDING INSPECTO INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES s- NORT Town of � � t � � Y over No71-J r T ort, dower, Mass., 066 V.� 19��- ° LAKE C OC.IIC ME WICK 2�'9 RATED E BOARD OF HEALTH WNI' System itchen �y PERMIT T oql Z ^5 A, BUILDING INSPFCTOA THIS CERTIFIES THAT.A... T ? ...��. ` ,S AT ... .... .. Yet* ....1.A+1 ...�..................... La oun al I tqr�a�-q . has permission to erect..040..,..V9W. f buildings on ... ."'L.... C.AS ...�........(L$:St..��.. ° to be occupied asIFl4i't. . . !1!!1.. .. ��t . ....Ui-i"c-oniorm ........................ c�t��rnheyhl er'tnit shalt In eve res to the terms of the application on file Inprovided that the person accepting t s p ry pFind 10 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. PERMIT FOR FOUNDATION ONLY PLUMBING 1NSPE�roR REGULATED BY PARA 114.8,5. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. <0_&>9V 2 q FEE PAID `�� C.� PERMIT EXPgR6 MO ELECTRIC L INSPE O UNLESS CON 44 T Rough / �� sIleBLDG. PERMIT FEE��... .LESS FDA FEE - ..... Service. ... .. . ... 01 BUILDING INSPECTOR DUE FRAME PERMIT PERMIT FOR FRAME/BUILDING Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — 'o Fi - No Lathing or Dry Wall To Be Done ° Until Inspected and Approved by the Building Inspector. Burner E D T �� M�E� I I FINAL Street No. PLANNING M FINAL CONSERVATION �►.�' Smoke Det. II � �—� DRIVEWAY ENTRY PERMIT44 /3- 9 l ` SEWER/WATER � FINAL CERTIFICATE OF USE & OCCUPANCY Town of North Andover IJ gg 3 ti -� (''c4naEQ 1 ' Building Permit Number SA- 4 3 Date 1(0 , lq�i S' ? THIS CERTIFIES THAT THE BUILDING LOCATED ON 13-1 I.rOrlCAb`rE.4 &�t MAY BE OCCUPIED AS2t r L.E 'TMM'LLA IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. i NORTH f +oma,,,.•�.1aoo CERTIFICATE ISSUED TO k-LD �[EQ- Lb1 i4�' `� i ADDRE=in - + 'dJACNUb� g nS CtUP S. t' c z: