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Miscellaneous - 137 MAIN STREET 4/30/2018 (2)
� .�-.,arae:.-.r.-sn�'w -:-T ' _—/ /�� f NORTH q p tt LID X67 tiO p Town of North Andover D.B.A. — Zoning Compliance Form ° •o 978-688-9545 9SSgcHuS This form must be reviewed with the Inspector of Buildings. Office Hours are Monday-Friday 8-10 am,and 1-2 pm Monday-Thursday. S r -�- Applicant Name - J V-\ Name of Business: (;'2 mc'1 11�' Address of Business: Mir Zoning District : Map Lot Phone: G � � -q+ Email \"(I CO(Ma-bA ` KZk Nature of Business: Q -k\'& Do you own this property? Yes No - � C If no, written permission is required from your landlord. Will you have clients coming to this property? Yes No Will you have any employees? Yes V-' No Will you have any major deliveries? Yes No�� Description of Business Activity(Must be Completed) r � C � rr e S S �rocy�k C�0� ; Signature of Applicant v` For Signage Refer to North Andover Zoning Bylaw Section 6 The prop ed use i use in this zoning district. Issued By Date ZZ -zo/b i i North Andover MIMAP September 22, 2016 136 MAIN ST 029.0-0036 140 MAIN ST 040:0-0005 Md�h S�rP 129 MA•iN ST 030.0-003 2 030.0-0001 150 MAIN S 133 MAIN ST 141 MAIN STr' 133 MAIN ST 133 MAIN ST14�? MAIN ST 143 MAIN ST 145 MAIN ST 030.0-0041 139 MAIN ST 133 MAIN ST 143 R MAIN ST L comma �e 030.0-0003 11 SECOND ST 149 MAIN S 030.0-0008 030.0-000r7 i 0 MVPC Bo Zoning Overlay Zoning Municipal Boundary 0 Adult Entertainment Distric Busine s 1 District Machine Shop Village Ove 0 Busine 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Rail Line 0 Watershed Protection Dist O Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates 0 Historic Mill Area ■Busine s 4 District NORTh Valley Planning Commission(MVPC)using data provided by the Town of —I 0 Medical Marijuana ■Genera Business District Of�t tea° q�0 North Andover.Additional data provided by the Executive Office of I ©Downtown Overlay District O Planne Commercial Dev ? •� r• ° O Environmental Affaim/MassGIS.The information depicted on this map is Historic District -i Corido Development Dist 3 L for planning purposes only. It may not be adequate for legal boundary Roads U Osgood Smart Growth(40 0 Corido Development Dist O --• '"" to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER i r Easements Hydrographic Features 13 Corrido Development Dist f` p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industri I 1 District 41 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ❑Parcels Streams Industri 12 District • t ,^ OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT -':Wetlands L] Industri 13 District o •� i ASSUME ANY LIABILITY ASSOCIATED WfrH THE USE OR MISUSE OF O Industri I S District �.` 'p. THIS INFORMATION Exempt Lands ' Reside ce 1 District �l °Lrr°•�tq- Reside ce 2 District S$ACMus� f1 Reside ce 3 District de ce 4 District I, 1"=30 ft de ce 5 District W��de ce6 District ,a a esidendal District Date � S�RYG1dU7yga;.^... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION Phis certifies that has permission for gas installation . . C �� �` c . , , , , . . in the buildings of. . ./� `Q tb... . . . . . . . . . . . . . . . . . . . . . . . at . . . . . ` -7. . . .,F : .�� t, , , , North Andover, Mass. Fee .':>2.6 Lic. No/1�� r . . . j► ... . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# 8715 PASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY � Y MA DATE - PERMIT .'' � _ __. - .� JOBSITE ADDRESS OWNER'S NAME ------- t GOWNER ADDRESS m TEL[-____��1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL,, EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:El RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YESF-] N00 APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER I _^ . I _ __ _ _ _ __ 177 ._J z. ... CONVERSION BURNER - J _ .� _TE _ —__ . � ) _ I I COOK STOVE DIRECT VENT HEATER DRYER ! FIREPLACE T-J _.I FRYOLATOR _J _,( :- ___.!= ;J FURNACE _ L J =-• ! GENERATOR . ..I GRILLE _..�. INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT -- -.! I lT _ 1..._ I_- - _ `_ I� OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST __..!I ( !LI - _ ! 1 I ( _—i __ I f, E_....J L—-1 UNIT HEATER UNVENTED ROOM HEATER i _._ _. 3 I ! _ J_ WADER HEATER OTHER HER r T f T �~ INSURANCE COVERAGE 1 ve a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES - NOn_I 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COV RA BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLI 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. l CHE ONE ONLY: OWT Q A NT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application re true and ac rate he es my ow edg and that all plumbing work and installations performed under the permit issued for this application will be in ompliance 'h all nt ro si of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 PLUM BER-GASF ITTER NAIM-Er -�!LICENSECy SIGNATU MP,4 MGF E-11 JP 0i JGF[-]j LPGI E:j] CORPORATION�� T �PARTNERSHIP D#_._ __..- _ LLC E# COMPANY NA 1 _. _ __. I ADDRESS 7 CITY - -- - --" ..____.._.._...__._._._.,_ -> .._ � STATE ZIP OY . TEL FAX .�_!l CELLEMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES h 4, mom` h t A ' y 1 ` The Commonwealth of Massachusetts - Department of IndustrialAccWnts Office of Investigations 600 Washington Street Boston,MA 02111 klip www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information r1ease Print Legibly PName(Busi s/Organization/Individual): IAS G G( '�V'' Address: Z' City/State/Zip: Phone#: ( ( � / 4-3. �O AreeMou an employer?Check the appropriate box: Type of project(required): 1.6-1 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 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# ship and'have no employees These sub-contractors have 8. F1Demolition 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.El I am a homeowner doing all work g exemption right of per MGL 11.E]Plumbing repairs or additions p myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]f employees. [No workers' 13.[i Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they 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.Linc.#: Expiration Date: `n, Job Site Address: fiT( �1(l�/ /' '�- � i 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 25 MGL c.152 can lead to the imposition of criminal penalties of a fine up or one=year imprisonment we ,as civil penalties in the form of a STOP WORK ORDER and a fine of to$250.00 a day ag • st the A lator. Be vised at copy of this statement may be forwarded to the Office of estigations of the DIA or ins ce c e e veri catio . I do b cert u to p s a dpe a ' ry that the information provided above is true and correct. Si atur Date: Phone#: V 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#: y Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,- express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint 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-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. AIso 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel,#61.7-727_4900 ext 406 or 1-877rMASS.AFE Revised 5-26-05 Fax#617-727.7749 www.xnass,govldia w COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS . • LICENSED AS A MASTER PLUMB ISSUES THE ABOVE LICENSE TO: + # TIMOTHY A GIARD im 60 SAUNDERS ST S NO ANDOVER MA 0184(183494 414 f 10301 05/01/14 090170 Date ��f�Q,�a. . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ./.� }?''. . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform APS- . . p!ew, . . . . . . . . . . plumbing in the buildings of. /740Je-10z 'bs . . . . . . . . . . . . . . . . . . at . . . . . . . . .North Andover, Mass. . --. . . . Lic. No. 3� . . . . . . . . . . . . . . . . . . . . . Fe PLUMBING INSPECTOR Check#�� a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ _i MA DATE -1 ' j PERMIT# JOBSITE ADDRESS �j u j OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: Q RENOVATION: REPLACEMENT: I PLANS SUBMITTED: YES 0 N0Eg FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _.,.. { ( 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _I _ .____._I f DEDICATED WATER RECYCLE SYSTEM DISHWASHER ( .__._.._1 ._ ..__.._ .._ 1 _I ) _---_ -f ----_1 ._-! _-_ ..1 __.__._._1 _. 1 �_! -.._. .1 DRINKING FOUNTAIN _..�...{ .....__....E � 1 __._....__I FOOD DISPOSER ..___._I FLOOR/AREA DRAIN ,a _I --_-_-� .-_-_� I i __.__--....f { -__-._{ .-____i _._....---I _...__-� I __-...___1 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY {rF- TOILET ---J - -ROOF DRAINSHOWER STALL ' SERVICE/MOP SINK ( _._( _.._r._..J URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _ _c -_i _ i — ' _ _1 . F ._._ _.--; Vr"AfER PIPING OTHER _. __.._ ...____� i _I 1 .._....._1 ___.__l _I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 01 BOND F 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. CH ONE 0 OWNER __+ T IQ ✓ SIGNATURE OF OWNER OR AGENT If I hereby certify that all of the details and information I have submitted or entered regarding this applicatfon are true and cura o t of y wledge and that all plumbing work and installations performed under the permit issued for this application will b complia anent isi the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. MM _f,��-,(�_Z,__,___,-__._-__-��9 LICENSE# /��G/_ SIG URE PLUMBER'S NAM —�- mpff, JP[I CORPORATION . _ PARTNERSHIP0# LLCt_-..__'....__ 11 COMPANY NAME�c ADDRESS gf Z CITY G�c�-v V"�' iISTATE l/�, ZIP Q l f_ TEL A.011 FAX CELL _.�' ..f� _7l.' ----------------- 6 MAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 1 1=s.L-L1 4• r ' i The Commonwealth of Massachusetts Department of Industrial Accidents U901 Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorslEl Please Print Le ibl .A_ licant Information � �( � I� ' � 6 ,c, I Name(Bus' s/Organization/Individual): Address: City/State/Zip: I Vd Phone#: Type of project(required): Areou an employer?Check the appropriate box:4. general contractor and I 6. El New construction ,eKE] Iamag 1. I am a employer with�_ have Hired the sub-contractors ? El Remodeling employees(full and/or part-time). listed on the attached sheet. 2.❑ I am a sole proprietor or partner- g, ❑Demolition These sub-contractors have , ship and'have no employees workers' comp.insurance. g. E]Building addition working for me in any capacity. lo, Electrical repairs or additions [No workers' comp.insurance 5. E] We are a corporation and its ❑ officers have exercised their 11.0 Plumbing repairs or additions required.] right of exemption per MGL 3.❑ lama homeowner doing all work c. 152 §1(4),and we have no 12.❑Roof repairs myself.[No workers' comp. employees.[No workers' 13.0 Other insurance required.]t comp.insurance required.] icy inform *Any applicant that checks box#1 dmust also fill out the section avit indicating they are doinglow showing their workers'compensation all work and hen hire outside contractors must submit n w affidavit indicating such. i Homeowners who submit this affidavit $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. �!M Insurance Company Name:. v r Expiration Date: .. Policy#or Self-ins.Lic.#: / - City/State/Zip: Job Site Address: ( Attach a co of the workers'compensation policy declaration page(showing the policy numof c d expiration nto a Atta PY impositionpenalties Failure to secure coverage as required.under Section 25 MGL c.152 can lead to the fine up or one=year imprisonment s we ascvilo£this stapenalties tement may be forwarded tthe form of a STOP. othe Office of K ORDER d a fine Of to$250.00 a day ag mst thev' lator. Be vised at copy estigations of the DIA or ins cc c e e veri catio . X do b cert u ze p s ry that the information provided above is true and correct. f Date: Si afar Phone#: Official use only. Do not write in this area,to be completed by city or town official._ Permit/License# City or.Town: Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: r + i COMMONWEALTH OF MASSACHUSETTS PLUMBERmmem S AND GASFITTERS LICENSED AS A MASTER PLUMB ISSUES THE ABOVE LICENSE TO: TIMOTHY A GIARD 60 SAUNDERS ST NO -ANDOVER MA 0184 -2414 10301 05/0 r 1/1 1;83494 � Location- No ocation No. SCJl v// Date elf aAfd &ORTN TOWN OF NORTH ANDOVER f � w a • s Certificate of Occupancy $ +ss,�CMUs t�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ fV TOTAL $ Check # 1*3 2372 B fdi, g Inspector �.tbft_ mss 0 c . O TOWN OF NORTH ANDOVER O� cocmcwiw "r SIGN PERMIT AOAATED �sSAC14Us�� DATE: December 13, 2010 PERMIT: S021-2011 THIS CERTIFIES THAT Groom Town, Lisa Grieco has permission to erect. Wall sign 11"x 144"Groom Town Pet Boutique & Spa on 137 Main Street North Andover MA 01845 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 Receipt 23782 Paid: 30.00 SIGN PERMIT APPLICATION 1600 Osgood Street-Building 20, Suite 2-36 TOWN OF NORTH ANDOVER Map Parcel DATE SUBMITTED Site Owner Ul.4 G G-Y-21 2 Applicant CA/2 6�-e_ t zs Tel C9 p Site Address \_�4� (VV-kAC J� Size of Proposed Sign it" INTERNALLY ILLUMINATED SIGN PROHIBITED How attached: a) Against the wall '� b) Roof Illumination: a)Not illuminated c) Ground b) Externally illuminated d) Other Materials: Proposed Colors: Background L�J �ryK- Lettering &"(-- w\�- Border_ Required Attachments: Photographs of building Note: No permanent/temporary sign shall be erected, or enlarged until an Material sample application on the appropriate form furnished by the Sign Office has been Color sample filed with the Sign Officer containing such information including Site or Plot Plan (Required for all free-standing signs) photographs, plans and scale drawings, as he may require, and a permit Drawings of proposed sign for such erection, alteration, or enlargement has been issued by him. r Other, specify Such permit shall be issued only of the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By- Law. Will sign overhang any public road or walkway Yes ( ) No (tom If Yes, Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED DATE FILED: SIGNATURE OF APPLICANT i E I i CO: tique, Pe" GROOMTOWN Bou� Spa •S®� Q 11" x 144" 1" MDO(wood) Sign Primed and Painted Gloss White Light Blue Vinyl, Pink Vinyl, Black Vinyl Gloss Black Angle Iron Frame/Brackets 0 mITOW�N ' tj .Mo ..sw 4 •� r :� , ;rot�rntts�lr a spo. ,F m � Y i� r 1 Date......1'. .y.:.. ..... f NORTH 1 4,�0 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SACHUS� This certifies that Z . T1( has permission to perform ........./.'..�%v ..................................................... wiring in the building of � �/f/ S/..................n....... ,North Andover,Mass. at.......... ............. . .................. Fee...�.z-� _Lic.No..L. 779�.Ay...... (N !1�``'/............... ELECTRICAL�kSPECT0 ? Check # � 92 �q� Commonwealth of Vamackueeffi Official Use Only !, cc��rrPermit No. "l Z� - 2epaJim of Serviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of. Vd A+M (f(l"Dov-(r 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) _ (.37 MAilv Owner or Te_!t ks-n rO 4 C i✓oi 0134 ��ha oM cw N �r Telephone No. gjf 3l7 jji� Owner's Address S A-7-11— Is - ` —Is this permit in conjunction with a bublding permit? Yes No ❑ (Check Appropriate Box) Purpose of Building C.o M 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: �g- f-tl f- eX(is��;,� Sho /' or ,,S,-o e- - v ,BOG i y �rd,0.rn7� - � �'-3-4 A Orxc r C/r-ci7 , Zo zt•�' /^ l2ov�� 9 1201/ 4 6^ Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency ig ng r rnd. rnd. Battery Units No.of Receptacle Outlet 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 I 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 r No.of Water / o.of No.of Data Wiring: Heaters Kms,2po Si ns 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 ofct ' al Work: (When required by municipal policy.) Work to Start: //F1111 S/,o Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such co er a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: (ec+J LIC.NO.: ( 2 7 Licensee: "�"l vZ z,� Signature LIC.NO.: (F' 2 7 3 2 .3 (If applicable,a ter "exempt"in the license number line.) Bus.Tel.No.: �`79-31 7 Address: ® C�0't`ei r tAO- A.� n n�t r Alt.Tel.No.: �' �6A2.77 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature Telepho4e No. PERMIT FEE: $ 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations �kqip 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): O . o✓�r ,---- Address: / L City/State/Zip: Phone #: �2�° 31/?` c 31 7 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 1 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.LA I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling i hip 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.❑ 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 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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: i Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as 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 unde the ins nd penalties of perjury that the information provided above i true nd correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Date./ �.�a. . . HORTM TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING : o SSACMUS� This certifies that . . ! .���. . . . . .+? �. . .f. . . . . . . . . . . . . . . . . . . has permission to perform ` .. . . . . . . . . . . . . . plumbing in the buildings of . . f?. at. .,13.E !.7.? . l??�`�!�'. . . . . . . . . , North Andover, Mass. f .Fee./XG. . . . .Lic. No..163.0.. 9 . .��?!1. . . . . PLUMBING INSPECTOR Check # � �1 8j� % J7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or Print) NORTH ANDOVER,MASSACHUSETTS 11 Building Location 131-137 T Date Permit#- FY J Amount //Q, Owner (r-( �.r q vg-( ,. L —� -�-T New 0 Renovation 0 cement Plans Submitted Yes No FIXTURES summ 13�.1'IIVT M Hi t I MELOCR �m 1Q,oaR 4M BDM sm1 s>B1Qncn 7MELOCR gm Hf at -- + (Pant or type) Check one: Certificate Installing Company Name Itis ❑ Corp Ad ss M Partner. Business Telephone - - ®'Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the of insurance coverage by checking the appropriate box:. . Liability insurance policy Other type of indemnity Bond .Ad Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature er Agent El I hereby certify that all of the details and inf tion I have su tted o en ) ' abo application are true and accurate to the best of my knowledge and that all plumbing k and install 'ons un P sued for this application will be in compliance with all pertinent provisions of the Ma bus State Code Ater 142 of the General Laws. By: igUULUrV o i um Title Type of PI bing Li e 163 6 APPRORO / City/ 71—censecense[Number Master Journeyman El VED tomcE usE oNr,l N - The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations Uf 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): 6 � - Address: City/State/Zip:_N .A'I Phone Are you an employer?Check the appropriate boa: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 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 me in any capacity. workers' comp.insurance. ' o workers' comp. insurance 5. 9. Building addition � p. ❑ 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.] t employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant±hat checks box#1must also fill out the sectio^belova showing their wery--s'compensation pot�cy i formation. .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.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 against the violator. B dvised that a copy of this statement may be forwarded to the Office of Investiga 'ons of the for insurance co era e v fication. I do ere by certify u er t ai a s f perjury that the information provided above is true and correct Sima Date.: Phone#: Official use only. o 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 i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants r Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cit; 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: 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 Fax#617-72.7-7749 Revised 5-26-05 vrwu,.mass.govfdia vFED M�GL9�l���v LGL�L� OLYMPIA REALTY TRUST Rentals Residential-Commercial 277 Lowell St Andover,MA 01810 President Tel 978.470.1843 Sterglos T. Fax 978-474-0769 Papadopulos Cell 508-265-9828 P lnl Stip w�N� ��y r�ss y -GjHrc 5/ 15 +," b`e 'r Fli^wYcer/ .e vh�e%'I. `,-( 1 F ,- Y- Y- 1— 12/05/02 THU 16:36 FAX 17815924990 DENAKIS LAW OFCS (j002 December 5, 2002 Mr. D. Robert Nicetta Building InfSfbctor Town of North Andover Municipal Building 120 Main Street North Andover, MA 01845 Dear Mr. Nicetta: As Trustee of Olympia IV Realty Trust I own the building known as Frye's Courthouse and located at 135-147 Main Street, North Andover. I am in the process of forming a real estate management company and would like to house the offices of my new company in Areas H and J on the second floor (as depicted on the sketch which I have included) of Frye' s Courthouse. Kindly let me know whether I need any permits in order to do this. Thank you in advance for your courtesy and cooperation. Very truly yours, Stergios Papadopulos alt Enclosure annt\stergio9nicettaltr12.5.02 12/05/02 THU 16:36 FAX 17815924990 DEMARIS LAW OPCS Ron 5� IT ,v i � `a'� \jA A.y i 777 _ .. ^T?.« .:..' •.2'!Jt its. �. o MMT IT A OLYMPIA IV REALTY" ;UST 135-147 MAIN ST.N.ANDOVER � 277 LOWELL STREET ANDOVER,MA 01810 K\s" `-(t4 k t 2-0 X3 1\441 • "- �.F��:"�'••�•L•5: sit .,. � IIIII!lli�llllllilltlllll-ilflllFillliSllllilllSllldll}�1i3(��\ Q`"� '� TOWN OF NORTH ANDOVER O� NOWrk 1 Office of the.Building Department �� ;6'°"OOL Community Development and Sea- -ices p 27 Chides Street Noi-th Andoaer,Massachusetts 01845 SS^CHUS�t D. Robert;Nicetta, Telephone(978;688-9545 Building C oin-iniSSloner FAX(978) H-9542 December 10, 2002 Stergios Papadopulos, President Olympia Realty Trust 277 Lowell Street Andover, MA 01810 Dear Mr. Papadopulos: Please be aware that this department is in receipt of your letter dated December 5, and your request as to whether or not you will need permits to move your realty management company into the second floor. Upon review of your plan there is not enough information to make such a determination as we will require a floor plan showing ingress and egress, bathrooms, whether any construction will be required, emergency lighting, smoke and or fire detectors, number of other occupants on the specified floor etc.. Please submit a more detailed plan as outlined above so that we may begin to answer your request in a timely manner. Respectfully, Michael McGuire Local Building Inspector u 2 C) Y Nashoba Global, Inc. dba Kumon of North Andover 48 Huckleberry Lane, N. Andover MA 01845 (978) 691-5675 November 12, 2002 Michael McGuire Town of North Andover Building Department 27 Charles Street North Andover, MA 01845 Sub: Request for Business Permit—requested details Ref: Leased unit at 135— 147 Main Street, North Andover As a follow up to our conversation earlier today, please find the requested details for the business permit. Site Plan: See attached for the unit located at the corner of Main and Second Street(upper level). There are 11 steps in the stairwell from street level to the office spaces. This floor is equipped with a fire extinguisher in accordance with safety requirements. Business use: The leased unit will be used to operate an after-school Math and English tutoring program for school aged children from Grade K to 12. This business will operate under the name of"KUMON OF NORTH ANDOVER," as an authorized franchisee of Kumon of North America. Operating Hours & Number of Students: Our initial operating hours will be Mondays and Thursdays from 3:30 pm to 7:00 pm, with an intention to expand to other week day evenings. At any given time, the anticipated number of students is 12 to 15. Parking: Our patrons will use the legal parking spaces available in the area like any other downtown business patrons. Adjacent Businesses: The adjacent businesses that use the common entrance at this location are Antonelli's Music Studios, I& G Tailoring and Designs, and A Massage Therapist. If you need further information, please contact us at(978) 691-5675. Sincerely,, (Shoba G. Donti) Nashoba Global, Inc. r y • Cp (% zr z ST 4i r j HE-LvCS r� G G FAA-0 S-rvD607 i q r Z• F1 t.3-3�-Q t-J (704 Square Feet) 2nd Floor(At the Comer of Main and Second Street) Proposed Layout Kumon N.A. Office Space Layout v1 November 12, 2002 No bcu Global) Svw- At , ku,cklefop-vl )-m - Ndhdou��, m o 1$ 5 rfln M 16IM-1 MC ��n o No. Andover - i 'I Location /3S /'/ ' �� ` 4 No. Date MORTq TOWN OF NORTH ANDOVER 4. N 9 Certificate of Occupancy $ �'�.�'••°''<�' Building/Frame/Frame Permit Fee $ sACHUS 9 7 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # L° Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Ato FOP M BUILDING PERMIT NUMBER: DATE ISSUED: ic SIGNATURE: —1 Building Commissioner/Imatofof Buildings Date z SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 0 old Map Number Parcel Number 1.3 Zoning Information- 1.4 Property Dimensions: "N Zoning District Proposed Use Lot Area(sf) Frontage(ft) 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Regaired Provided Re red Provided 1.7 Water Supply M.G.I-C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: > Public 0 Private. 0 Zone — Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record I i Ll -4 L 3S Itio 464i ,) C: Aj 4 A'i'< cr Name(Prinf) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: 0 Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 1 0 AA J�� t L&::� Li4en-ed Construction Supervisor: 0 0 h Lije-nse Number R=A) Aldre!� �,/Cs 0 1 r) Expiration Date Signatink Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M -71 Do Registration Number 1� Address or) dz 3,� -3 Expiration Dat Signature Telephone Q J SECTION 4-WORKERS COMPENSATION(NLG.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.......0 No.......0 SECTION 5 Description of Proposed Work(check au applicable) New Construction,,❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ -- Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: -\/ -= -a .4- r oo — i SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be �y Completed by permit a licant 1. Building / o (a) Building Permit Fee l! d 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT s I, as Owner/Authorized Agent of subject property q Hereby authorize to act on r My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, As Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si atur of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB r SIZE OF FLOOR TIIv1BERS 1 2 3 4 SPAN DIIv1ENSIONS OF SILLS DrMENSIONS OF POSTS DAdENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Nit�����µ� Page No. of Pages Tom DeFusco S ' f4X �17`/© �� 23 Dutton Road Home Improvement Reg. # 117756 Pelham, NH 03076 Tel 603-635-3017 Constr. Lic. #071037 Fax 603-635-3751 PROPOSAL SU TO PHONE DATE J r STREET JOB NAME CITY,STATE AND ZIP CODE JOB LOCATION S" ARCHITECT— DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: ............................ _Tn!..._r ._........... .Af....._p...._._...:._._(l . _��:c.. ......................_ ...rr ...._... .o._c�_ :............_ ..�...._7.-�-. ..........-�U_� '►_� r � ! rr .,.T .G ......... ......... / . - ...y2.....__....._.�- �..�...vC ....................... 3r . . °c..a _ ... _,......... 1. .............._.. �G4 -C �y _�. .._ _............... ............_ �v_r/1................ /L«tr...... _ .._ ................ . .......................... .............. ............ ............... ................ ._............_....._._..._......................... ........................................ ................_.............................. _. o v - a � ...._ ............... ..........................................................................._.._......_._..................... _............._........... .............................................. ................. ` ................_. rlf ................._. . . : _ f-: ..........- _ _............. _ .................................. _ .................. ............................... _ ........................... _ ....................... ................. ................ ___................................................................ _......................................................... �� jj / ..... ............................----...................................................................................................................................................... 3'. ............... ..............-.............................. ............. P 3prayLISP hereby to furnis.11 rpaterial and labor — complete in accordance with the above specifications, for the sum of: ollars ($ ay Pment to be made as follows: f_ C/rJ L ✓v O C) C IL e-e )� t^fJ C/ C�� U(, All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above Signature —S ---- specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by us if not accepted within days. insurance. Our workers are fully covered by Workmen's Compensation Insurance. A rryfaurr of 11raposal—The above prices, specifications Signature and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature I ":)RT' ED own of ..:: , Andover 0 No. D� co ,A dover, Mass., TED pP�\y�� '9S H ER BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System .�_ BUILDING INSPECTOR THIS CERTIFIES THAT......�> .. .�� .., ..... ...... .... .......................v ............................ Foundation has permission to erect...� /S 1�........ buildings on ......I .S .. 13 7 ✓W A4 6 ...... Rough . . .. .................................................... to be occupied as &..h(-42.2 ACP0 oe Chimney ......................................................................................................................... provided that the person accepting this permit shall in every respect.conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatiVZ spection, Alteration and Construction of Buildings in the Town of North Andover. 3 < b PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ! Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough .................... ....... Service BUILDING INSPECTOR Final Occupancy.Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location 1-37 ,1))A /y S No. y Date 3 b AOR,►, TOWN OF NORTH ANDOVER Certificate of Occupancy $ ;7s'••'°'t<A Building/Frame Permit Fee $ 3 9 s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 30 ✓ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .4 rF BUILDING PERNUT NUMBER: DATE ISSUED: << SIGNATURE: uaffl_ Cominissioner/I for of Buildings Date -2 3 1 r o a SEZ t tOr. 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 30 C r Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: -oning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Rf Provide ReqWred Provided ReqLlired Provided � 1.5. Flood Zone Infonmtion: 1.8 Sewerage System: Public ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION.L-eROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record o= U Gti l ✓ ,� /��e-. Name(Print) Address for Service Signature Telephone �1P ✓ O 2.2 Owner of Record: Name Print Address for Service: o Z rn Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number wn Address Expiration Date ic Signature Telephone r. 3.2 Registered Home Improvement Contractor Not Applicable ❑ v c/ " r Lr-- 2- Company Name al Registration Number r Address r / Expiration Det �^ Signature Telephone d+ SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) ` Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes......X No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ er ❑ Specify ` Brief Description of Proposed /Work: l�� des SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit a licant 1. Building ( ? (a) Building Permit Fee U� Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC �( 5 Fire Protection 6 Total 1+2+3+4+5 , O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf;i a matters r ve to w rk autho ' y this building permit application. 2- t ` 206 Si a e fer Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �.��-�-- moi✓/.�>ti-� u-�. Print N_'i�� Si ature oY Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2 ND 3 RD SPAN DHAENSIONS OF SILLS DINIENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH Town of No. '� lLA E o dover, Mass., � d COC HIC HE �A ORATED P �� 1 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System t� �� � ���� BUILDING INSPECTOR THIS CERTIFIES THAT.....I" .. 0.....colo.eth.................................................. ..... ................................................. Foundation has permission to erect...V I.M.. ........... buildings on ....1 .......MA.�......so. .................... Rough to be occupied as....S.1 WA......a .0 vk.b..% ..................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough TO Final � PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI N TARTS Rough 3 ?1 ' Service ...................................... ............ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. CITY OF LYNN BOARD OF EXAMINERS LICENSE NO. _ 3494 CLASS R-9 Robert R. B01anger. tesidingat 1278 Bridge Stre_et., _Dracut_ is hereby Licensed to have Charge, Control and Personally Super- vise Construction. Alteration.of Repair Work ,in the Classes of Construction asOmed above. Signed ,Ld AIRMAN 80Aen OL•EXAMINEAS RENEWAL FEE$25-00 LICENSE EXPIRATION 7/1/2000 LATE FEE$10.00-AFTER 7 MONTHS -y-z -��11. I��KMG^JKlM4�4P[��.I�Ir(�TI3P��r o '�' NOME IIl�RiWENENI COMiRACIOR Rrpistralioa: 120131 Exyiratioa: 10/22/01 fype: Udiaidual ROBERT R. BELANGER �Paq J"IROBERi BELANGER APAAMSTPAron 1218 BRIDGE S► DRACUT AA 01826 i9ropoar R. Belanger 1278 Bridge Street Dracut, MA 01826 (978)454-8918 PROPOSAL SUBMITTED TO DATE Fr es Court House STREET PHONE Main St. 978-6.86-5232 CITY,STATE AND ZIP JOB 0 TION No. Andover,Ma. i Dain St. ,No. Andover WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: ny 1 '1 ng, Wrap exterior walls with foil house wrap before installing vinyl siding. Install Alum. trim around doors and windows. Install alum, starter Install vinyl corner post at all outside corners. Install J Channel at all doors and windows. Install vinyl sill trim at window sills,ect. to terminate vinyl. Install vinyl siding. Cover three small roof trim with- alum, trim with-aamd vinyl soffit- Paint all elec. pipes to macth siding. Replace all broken or missing downspouts. I 1) Clean job site. We 13ropOfie hereby to complete in accordance with above specifications,for the sum of: dollars ($ Payment to be made as follows, nty Rive- 5 57.5 Go 7 All material is guaranteed to be as specified.All work is to be completed in a work- Authorized manlike manner according to standard practices.Any alteration or deviation from Signature specifications including extra costs will be executed only upon written orders,and will Note: This proposal may be become an extra charge over and above the estimate.All agreements contingent withdrawn by us if not accepted within days. upon strikes,accidents or delays beyond our control. RIxeptattte Of VroV00af-The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as Signature specified.Payment will be made as outlined above. 77-52— ^-r e Date of Acceptance Z C7 Signature V K CERTIFICATE OF INSURANCE DATE(MM/DD/YY) 21212 0 0.0-.--- PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION • ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JEAN D. LECLERC HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR INSURANCE AGENCY INC _ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ 1 006 WESTFORD ST _---- __ _ . -_ ..COMPANIES AFFORDING COVERAGE .LOWELL,MA 01 851 COMPANY FIRST FINANCIAL INS CO INSURED COMPANY ROBERT BELANGER B 1278 BRIDGE ST COMPANY DRACUT, MA 01826 C COMPANY D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS A_ND_CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDNY) DATE(MM/DD/YY) GENERAL LIABILITY T BODILY INJURY OCC $ COMPREHENSIVE FORM I BODILY INJURY AGG $ PREMISES/OPERATIONS If PROPERTY DAMAGE O_CC_ $_ UNDERGROUND PROPERTY DAMAGE AGG $ EXPLOSION&COLLAPSE HAZARD PRODUCTS/COMPLETED OPER BI 8 PD COMBINED OCC _ $__ CONTRACTUAL 818 PD COMBINED AGG -- INDEPENDENT CONTRACTORS PERSONAL INJURY AGG $ BROAD FORM PROPERTY DAMAGEPERSONAL INJURY � AUTOMOBILE LIABILITY BODILY INJURY $ ANY AUTO iI( (Per person) ALL OWNED AUTOS(Private Pass) BODILY INJURY I ° ALL OWNED AUTOS I (Per accident) $ (Other than Private Passenger) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY I BODILY INJURY 8 ! PROPERTY DAMAGE $ COMBINED EXCESS LIABILITY I EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM 1 $ WORKERS COMPENSATION AND i STATUTORY LIMITS EMPLOYERS'LIABILITY - i EACH ACCIDENT $ THE PROPRIETOR/ INCL ! DISEASE-POLICY LIMIT $ PARTNERS/EXECUTIVE -- OFFICERS ARE: EXCL - i - -- - DISEASE-EACH EMPLOYEE 1 $ -- OTHER - OMMERCIAL GENERA IABILITY COVERAG� F0131G414178. 6/27/199 6/27/2000 $500, 000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS — FOR: FRYES COURT HOUSE 139 MAIN ST NO ANDOVER, MA 01845 CERTIFICATE HOLDER CANCELLATION ATTENTION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE LOUIS J.MIEC JR EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL COUNTRYSIDE REALTY 1�—DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ROUTE 1 1 4 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY NO ANDOVER MA 0 1 8 4 5 OF ANY KIND UPON THE_C PANY, ITS AGENT R _REPRESE AnVES. I AUTHORIZED REPRESENTATIVE ACORD 25-N(T93) �� ©ACORD CORPORATION 1993' W� The Commonwealth of Massachusetts _FI; Department of IndustrialJccidents Office of Investigations Boston, Mass. 02111 Workers' Compensation InsuranceAffidavit dame Please Print Name' Z±, Location /.��� �2G�S ✓ �� Cis•! ,�y��,t9 ✓� �'yd-tgg S 6'lF2 G Phone rt �7� �✓�`f ���� I am a homeowner perTcrming all work myself. a �1 I am a sole proprietor and have no one working in any cap2C;bj QI am an employer providing workers' compensation for my employees working on this job. Comoanv name: Address Cithr. Phone T: Insurance Co. PCliCv# l Comoanv name: Address Cihr: Phone r' Insurance Co. Folic✓T Failure to secure ccverace as recuired under Section 25A or MG 152 can lead to the imecsiiicn of criminal penalties of a fine up to S1,°00.00 andlor one years' imprisonment as Neil as c:vii penalties in the form of a STCP`NCRK ORCER and aline cf(S100.00) a day against me. I understand that a ccay of this statement may be fcrNarded to the Office of Investigations cf'he CIA for coverage verification. !do hereby certifyunder the gains and penalties or perjury that the inicrmaticn provided accve is'rue and correct. SignaturG!� �—� --Date b o Print name Fhcne m Official use only do not write in this area to be comcleted by c::y cr town cnic:ai C,ty or Tc-Nn ' � P=rmitlLicensinc . � Building Dept ❑Check d immediate resgcnse,s required [I Licer]sing Board Cj Selectman's Office Contact gerscn: Phone m ❑ Health Department Other Office UseZ�dl) Permit Na 9�pant«rurt ed Pu6ue Sway Occupancy&Fee Checked/`%'.I I 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 Cade 527 CMR 12:00 •`90 —27 (Please Print in ink or type all information) Date ;? ",17 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number 4`5 7 l Owner o �f�b2l r 'ZI�2/��)C�i9/N Owner's Address Is this permit in conjunction with a building permit Yes 12� No ❑ (Check Appropriate Box) Purpose of Building •S✓ //�^t`i//1��� Utility Authorization No. Existing Service ,,,2 J Amps ZD Voits Overhead 17J Undgmd ❑ No.of Meters _ New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /LC4; Xl su,I C- .4 C 6.0-60 Total No.of LightSnq Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool gmd ❑ gmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di oral No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring_ No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Co plated Operations Coverage or its substantial equivalent YES NO = have submitted lid proof of same to the Office YES7 NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE vA BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Jf 2 0 work to start 3—.<*7— .9f- Inspection Date Resquested Rough Final Signed under the Penalties of perjury: FIRM NAME /. LIC.NO. Licensee /. Q/JOP2C� 9-7 -7, AV£h Signature CZ. t, LIC.NO. �ll � ��>> 11 Bus.Tel No. ' rC kc Address 97 WZ` a' �+ ��i� Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Lice ses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) �16) e�/ d Telephone No. PERMIT FEE (Signature of Owner or Agent) G?` No Date....-7.. ..., .... • HORTI� "° TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUSE� ` L This certifies that f a 1 G �T� T f' Z has permission to perform J ....................." ................. t wiring in the building of..... :.. ,�!tr c,G �/�((/.f r'c,c>u L't'-'/ .......... at...../.3...7.........141 y 1�.......................... .North Andover,Mass. Feelk,')..(AJ Lic. ............................................................ ELECTRICAL INSPECTOR C �` �OWY98 08:43 100.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only Al Permit No_ i!J 9rprrr.Ya.c°�P Sway Occupancl 8 Fee Checked N� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street$Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit f� Yes ❑ No I/ (Check Appropriate Box) Purpose of Building /�/J,d"t /YOJ� 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 Ampacdy n Location and Nature of Proposed E?ec Tical Work l 1_6xfZ7t 62 Ll 4,-)4 /2, 'i, Total No.of Liqnt8nq Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In 0 No.of Ughtinq Fixtures Swimmin Pool gmd C gmd Q Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Bumers 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 Moo" No. Pumps Tons KW No.of Sounding Devices Nod of Self Contained No.of Dishwashers Soace/Area Hearing KW DetectioniSounding Devices Municipal ❑ Other No.of Dryers Heating Oemces KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Si ns Ballases Winn 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 Co pleted Operations Coverage or its substantial equivalent YES i NO = have submitted`ylid proof of same to the Office YES NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE w/BONO = OTHER = (Please Specify) r (Expiration Date) Estimated Value of Electrical Workb 6!/2- UO Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury: LIC.NO. FIRM NAME ,. Licensee LICOA2l!' 7 �JS-1�F1? Signature LIC.N0. Bus.Tel N > Address Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantlai equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) 5� I(Signature of Owner or Agent) Telephone No. PERMIT FEE No Date. ` � �&ORT#1 °�<�``°:•�"a TOWN OF NORTH ANDOVER I PERMIT FOR WIRING ,SSAcmus Thiscertifies that :...........:........'....................................................................... has permission to perform.......:.......: ......................... /7� ....................... w � wiring in the building of....... ........................................................... :.......... G at...�.. ............. ........... '.......�.�............... .North Andover,Mass. . 1..... Lic.No.'.::!.f !.� Fee................ ............................................................... ELEcmicAL INSPECCOR 05/15/98 14:07 15.00 PAID WHITE: Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION:FOR PERMIT;-TO MASSACHUSETTS (Type or Print) J NORTH ANDOVER ,Mass. },- ; Date: Building Location f•.3 ?� Ma>°� SRPY� Permit Owners Name .l ,eQ,� I e,.0 • ,>: New ILK-kenovation L] ' Replacement j] Plans Sybmitted ,! FI TURES _ r Z Y a N 0 07 O Z ( Y W Y P a V Z ao _ a .� to _ Z vj� 2 O 1. U S Y In W Z H V it p O7 W � Q f NO Z Q Q 03 d Q q O Z tc Q W = J 0 O .t � cc � J W IL X W N !— V F' O m N O 0 2 0 0 W Z Z' W a 0 V Y < .t a acc it a o < l- 3 Y J O t1 [] J = h to U. v in < .Q in O j SU6—BSMT. a BASEMENT IST FLOOR Ll 2NO FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR ( (Print or Type) Check one: Certificate Installing Company Name k?�I( � t�<l Corp. Address Partner. Firm/Co. Business Telephone i Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy EDi�her type of indemnity 0 Bond a Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent\�,� ; I heoby certify that all of Uta details and inforntalion I leave wbrnif(cd lot entered)in atNr•e application ate Iruc and tsrrale to Use brit of any knowledge aad that all plumbing work and installations performed under rcrrrr' ssucd for this application will be in conrpiia With sit perlineat pro•- v1sions of the Massachusctis State Numbing Code and Clupter 142 of dee eat ws. By Title . sign\akture Licensed Plumber ype of Plumbing License City/Town: License NumberMaster 1:1Journeyman APPROVED ZOFFICE USE ONLY) . Date. . . .`�/��`� ' ti= 3650 - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING '�' ,'•• PAID BY CHECK -I's Hus� f This certifies that . 7)/4(-.! .c. . . .Fj. . . . . . . . . . . . . . . . . I app has permission to perform . . . . plumbing in the buildings of . .�.!�!!�h.'/. . . 1.�p.hr�.�.4 . . . . . . . . . at./17 . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No..'.9.7 fir. PLUMBING INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer ',i'Locatiofn.,/ 7 No. Date 40RTN TOWN OF NORTH ANDOVER • oA Certificate of Occupancy $ Building/Frame Permit Fee $ ^ �'�s''••°''<�' cHuFoundation Permit Fee $ s� sE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector cosi ti100 ►Rrn Div. Public Works f 'ER391T NO. _S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER MASS. PAGE 1 MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK ;PAGE ZONEI SUB DIV. LOTN. F— I — �/ LOCATION ,a . 7z^OAl" irrr PURPOSE OF BUILDING T,L6A I=*7Af OWNER'S NAME lz 4=-1 NO. OF STORIES SIZE ' OWNER'S ADDRESS BASEMENT OR SLAB C4"409- ARCHITECT'S NAME"..Ae Naggoapapd SIZE OF FLOOR TIMBERS IST 2ND 3 BUILDER'S NAME D,54L Ae SPAN DISTANCE TO NEAREST BUILDING �� DIMENSIONS OF SILLS DISTANCE FROM STREET O POSTS 1 DISTANCE FROM LOT LINES - SIDES �� REAR /0 GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW fvO SIZE OF FOOTING x IS BUILDING ADDITION v MATERIAL OF CHIMNEY IS BUILDING ALTERATION YE IS BUILDING ON SOLID OR FILLED LAND '5104.60 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �� IS BUILDING CONNECTED TO TOWN WATER Y•r-s BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 31-Irlogr3' IS BUILDING CONNECTED TO NATURAL GAS LINE y" INSTRUCTIONS 3 . PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE I FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ.'FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 7 • SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FI oulLffime INSPECTOR SIGNATURE OF OWNER Off AUTHORIZED AGEN F E E OWNER TEL.d SIR 4 S 5�3� PERMIT GRANTED CONTR.TEL I/ �7� a'a�t/ 2 1998 16 CONTR.LIC.# H.I.C. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and --partments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *'****APPLICANT FILLS OUT THIS SECTION ' APPLICANT_1?>&�R d 1 j<I jjk3t(/* PHONE j L G1'a2-a LOCATION: Assessors Map Number PARCEL a I SUBDIVISION--,//Z 1 LOT(S) STREET ' A—f lx) ST. NUMBER/v' I r — " ""OFFICIAL USE ONLY r ` RECOMMENDATIONS OF TOWN AGENTS: APR 2 1998 i i CONSERVATION ADMINISTRATOR DATE APPROVED '. GATE REJECTED COMMENTS } TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS i PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT „ C- -RRf DEPARTMENT rf Z. pJ RECEIVED BY BUILDING INSPECTOR DATE .rF / .hl P..r•�r���r fn t ..: r DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE j Number: Expires: Birthdate CS 066686 0711811999 07/18/1954 , Restricted To: 00 DANIEL T KINSELLA 26 WINTERGREEN CIRCLE MErHUEN, MA 01844 • f it _ i r R T/y Town of over No. 1.76 m zo dover, Mass., 19LA 9< w 0004ICMEWICK 1i~''�• '9 JR4'E p lip S E BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS -CERTIFIES THATBUILDING INSPECTOR ...................................................................................... Foundation has permission to acect....... . . ... ....... buildings on ......... . .. ............ ........4 .................. Rough to be occupied as.......................................�iQ.,e/c, ..............S..�r4�.P......... ....� plication ...............ile i.. Chimney C e provided that the person accepting this permit shall in every respect conform to ih 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST ,S Rough .................................. .......... ................... Service ... .... ... . .. ... ..... ........ B LDING INSPECTOR Final F Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. CERTIFICATE OF USE & OCCUPANCY f - Town of North Andover f , Building Permit Number 126 Date ap r i 1 24 , 1998 THIS CERTIFIES THAT THE BUILDING LOCATED ON 137 Main St Retail Shop MAY BE OCCUPIED AS T a i l o r Shop R ail IN ACCORDANCE WITH THE*PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY.' gORTM o;..• ,.�yo CERTIFICATE ISSUED TO,. 1,o u i s . x m i e c ADDRESS 1 1 TurnDike- St No . Andover MA "`"" Building Inspector , i t 1 -= ^�-ri>';s' 0 ,. O over No. 1.76 m Wf °o L..0 dover, Mass., - 19 ?e 9A-COCRICNcwiex 1• _ v E o E BOARD OF HEALTH Food/Kitchen- PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. _............................. Foundation has permission to aced-...... ........... buildings on ........./., :. ......:..../?2f�'� ...:....Sr'Y. ................. Rough to be occupied as........................:.............. —4,e C11 ...... . . . p / .. . . .5.6�:4�./•••......... .... chi provided that the person accepting this permit shall in every respect conform to th teres of the application on file in this office, and to the provisions of the Codes and By-Laws`relating to the Inspection, Alteration and Construction of Fina 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 STABXS ELECTRICAL INSPECTOR Rough ..........z.y................. 'Service .... . ... .... .. .. .. ............................................. B LDING INSPECTOR Occupancy Permit Required to Occupy Building GAS SPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove - Rough Final No Lathing or. Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT' Burner w✓ Street No. t Smoke Det. Location / —�y3 AA/AJ .,~ No. f/o12 I Date �o^Th TOWN OF NORTH ANDOVER °c + Certificate of Occupancy $ ��s'•n E<t'' Building/Frame Permit Fee $ •K NUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3d Check # CAS 4-L 174405 ✓� Building Inspector S TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 11b Sediee for uple 04Y HT1 BUILDING PERMIT NUMBER: 0 &—/ DATE ISSUED: / X SIGNATURE: It Building Commissioner/12EREtor of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel dumber: L4"5 V4Ar MAM ��- y � D 1 —,�;,7 & 0— Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Q) Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside blood Zane ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT '1='« • (l`-t 4-n S 110 M 2.1 Owner of Record Clympfq (�AIT 13'7 (?-P-a Y' e2 Name— (Print) Address for Service: \ Signafure Telephone o .2 Owner of Record: I. Name Print Address for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Li c sed Construction Supe icor: Not Applicable ❑ Licensed struction Su rvisor: l � 0 �1 P��a�jn.L }— 4/A License Number In Address 111 L'tL/� J / ( 10 /1 o .� q;;7U Expiration Date Signature Telephone r 3.2 Re stered Home lin oveme t Contractor Not Applicable ❑ v �a,ui� C���Yl�an Company Nle , ( / rn "I Registration N ber r Address 11 /Y r ,fs/s2e>�� I d o5 z �7 Expiration Date ^ Signature Telephone V' t SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work(check all applicable) New Construction ❑ Existing Building $ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: m SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building I n �� o© (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee.(a) x (b) 4 Mechanical HVAC S Fire Protection 6 Total 1+2+3+4+5 Check Number C A-S SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Chvner/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 I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and lie f Av iw wle-ew Print Name Si tore of weer/A ent Date ,f J NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS r DliviENSIONS OF GIRDERS r'7 DUv 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 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: 15, 41 (Location of Facility) I Signdfure of Permit Applicant r� dy ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a The Commonwealth of Massachusetts Department of Industrial Accidents A Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: aU Location: City ` Iii'" Phone # q�F I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ®� I am an employer providing workers' compensation for my employees working on this job. Company name: w Address ( d Al �7 p City: t' tMYlk' �" Phone#: q ! 1 7J Insurance Co. I Policv# 9,771/ Company name: Address City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment as w-ell_as_civic.penattiesinthefnrm-of-a_STOP WORK_ORDER..and..a.fine of.(.$10.0..00.)._aday against-me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby certify underthe pa' penalties of perjury that the information provided above is true and correct. Signature Date Print name (� U � P.honPhone# !�y 7y Fly ?,7 ySOfficial use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required E] Licensing Board F-1 Selectman's Office Contact person: Phone#.• F-1 Health Department ❑ Other DG, CONTRACTING WG CERTIFIED d D GULEZIAN PROS POSIDENTUAL A COMMERCiAL RENOVATiQNS W, 4.`?& -SANT; M ANOOVEP NAASS if, .. V,ml v' L13 R,W- 'a OFFICE.- : - 41 FAX M-68-M7+ ta-L978-81,15-4745 >`i1.t#3C��X004 H ::?i i' 7317II4 PAGE 01 — -o i. C'A , 'f ' 'f� OF LIASILITY INSURANCE a , E f t TPCi ': i � mT 7OIS-1,AM � ' 522 CHid�(NG ROAD ' BGHTS UPON T%.Nm 710N ? A3 f5f)E ' t3T Ali! pti A N alt7t 3t}AfiiDflVf" ,iitlix t$ri6 RLTE THE f 4( .ACsE AtF IDR DO .T19£ PRI 428 FE A5!'U i' E `&ss r,Q ARBELLAs PROTIGTIQN NORTH AAh:.OVER,MAbi846 ,Nwr:�izf3_ f�C FS-6Rd�GE _ T°4ii$£�L9L i51 aid€LiPA VtE USTEb S'ELaw nAVEr e R£i333iF1$gOR. tt41` f¢E93 vMt - ".�� uO1- {�& Ca P s. .JAY a r "� q_ kdl i I G w ANY COWR.AOT'DH C Ttiti i Edi 017MMATEQ:�7UTWJTHSTAt4VjMG .1RY;'E TAIH Tfs�}t$y / �+£PtFfGfti'�£G BY IH8 Fi?lt €SC#?E$EG!E'Rfi:!;f3 3;t13d'c6'�1 k ALL TNr TER ufS. XCLU 1 hiS Akb�^JNaY'IOtIS OF RLiop L� YY D Ck1A�EAFT kA1I1${t7£$�S C aT To i�WfiICff THi<S Cfiit.iFIC_ArrtEfE Na$(6 Qi? { Pn tCII S.xL;C4Ri ATE La iiTs,lHOtVN mAY mAV 81!E (�EDsSi ` ' 1r NiitRBFfi i7P� PaLm � CH A a BENi_tt4t.�bsts75�' � , ...-..-�•� .____ _..._ -- - X_;OCCUR F FXt,A,nyMUM este Copt 1 c Q £Fd3fiftSAF71tY 5 2.1 as'aLk CLAITgrf�W$R.° SrtPis. Tg r A{dl kti Sty #19015 -2 516,e €1$11 t"�Og . t C�►zf L� tt� f.. ALL E3►VWriALfrt= ¢ �.�� wag-d" } # _ 14ON'Oo'V bAUT,)S EA AOr, s �� :� ;M .i.FlY RL•TO � :S!:s?�rta�t sEAa�C'fi�rrr %�. — i }�` CI R ,.. ztr�BaltRLtE ' it�ir'1 12MM ^" OC SrR ENGE a 1� -f .oatogo: x .$ YYi�iCb'{i� t$ASTfgIiA'+.i - f ` I9 t Li Rs=tuaary WMS-27-74 -e�i��s ti,a r is ott,PA?Tsi �: is ,t 0`�131t 1331312004 — t i to e L ChcCt eri 1f)o ow r ly�GEscr 3a vn er E.L.DiBEaISE x EA EM?LCti EE S 101)wo_ t .s a&AfPROb:SIONS6eioa f OTHek _ E.L.CHWASC f POLICY"MIT `5 ���Q(}0 i 1 � i .CERTIFICATE HOLDER �AAi�gLLA f1t�13 ted[tiF'E7i�t?tE,�+IQVi!iiK.' M3t{(:tib@E£k?VGEd.LEEtHEFQREif_%PfRA7lttY f. ua'Yia 1ceB.sz�eCF;.?ii5 i5tiili�S4 9xSSN3ER iYtLt e�na�rSo tmaa. f� ga�E.vt€lti�tsxt VD'+'.�TT9'lt7Ei�A�t3'E'32S1 .:fiJ`7G!T�9E Y���Ct7'F,'R.YL'itbT.E'iXi'iJD�$197'41,-a fM!'Q$£tib 6MAiA_TlbM 611 LIMMUlY OF ANY X*fU u'P6a 7 E 1NSUh_Gk ft A6FNit 6R REPRESMATRt .lLirDfi33 25��L3KJOS) _ NORTH TO" Of 4Andover - V No. dover, Mass., COC MIC ME WICK ��� S RATED V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �� �� �/ A?44 S BUILDING INSPECTOR THIS CERTIFIES THAT.................... .. .................................... ...... .................... ........................................ .. Foundation has permission to erect.............4A.................. buildings on'j.o....I..y3.....AfA l�...................... Rough to be occupied as...... Am 10i O ��N�� ......A.#.^............... Chimney ................................................................................................. ..... ......... ...................... ... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and BYZs relating to the I spection, Alteration and Construction of Buildings in the Town of North Andover. 3 0 3O aloom PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STIRTS ( Rough .................... .....W. ..... ............... Service ........... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location �2 q /4YI4 (A.) S -� No. D-3 Date 3-,5 - 0-3 OfNORTN TOWN OF NORTH ANDOVER " � '•,ti0 3? OL f 9 Certificate of Occupancy $ ,sfACMUSE� Building/Frame Permit Fee $ 1— ' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 y Check # /� S 1 G 19 74t f Building Inspector f— TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Seed" Or Q#Wi� �H1 _s _ rn BUILDING PERMIT NUMBER: DATE ISSUED: 3 ��_©3 SIGNATURE: L Building Commissioner/12gWor of Buildings Date z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 137 Ma030 p 00 2 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: W Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided v 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record o i Y,,erq 12PA 17 in t-q i n el-f 1 Name(Print) Address for Service: (n, ? gr 1-174 4 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 L' ensed st n Su Conctiorsor: Not Applicable ❑ a� 0- �� � �. Licensed Construction i Supervisor: License Number�ber O 2� r �74* Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v b a I& 6 LjIgo -r4`a 11 2 Company Name U / 9 rn L4,9 ' P' v^ 4 q,, �'—/f f-/yJ lc,-.e/z Registration Number r Address e/ d3 Expiration Date Si nature Telephone Y/ SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......11 No.......❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: r� Dye 3 Cc1bNf3 i rorj 0 h 51_o v S cl� 1Pynaihs �- oul 4 �- d rens>xy Y f U t- P wdc)d % s l vie s d-r� / weer SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCWL USE,ONLY Completed by permit applicant 1. Building /Q O - © � (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5) / Q Check Number SECTION 7a OWNER AUTHORIZA ION 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 1, D is V �� d -��� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief V ( Ct -evv Print Name Si attire Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEVIBERS 1 sr 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS 1TEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE a The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Sv1b Workers'Compensation Insurance Affidavit Name Please Print Name Location: d�� City � Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. Company name: Z h le Address ' Phone#: Insurance.Co. Q Y /1 G Policy# r` �U �✓�'����"�"�� Company name: Address Phone#: Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment_as_welLas_civil_penaltiesinlhelnrm-f-a_STOP WORK ORDERand..a.fine_cf..(.$1DO.00)-atlay.against.mQ. understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. Y !do hereby certify under the �d penalties of perjury that the information provided above is true and correct. // Signature Date Print name 71e/ 1/l `°, G J Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑ Building Dept ❑Check if immediate response is required 0 Licensing Boafd ❑ Selectman's Office Contact person: Phone#. 0 Health Department ❑ Other r- � l� I Board of Buildin 1ar $ rss and Standards Tt)R Registration: 120199 i i"xpiration: 1111!03 _ TYPe: individual DAVID GULEZIAN s DAVID GULEZIAN 428 OLEASANT ST _ NORTH ANDOVER,F,RA 01845 �'"``� '-' Administrator . .. � r x�ttt�-: _ License: ccm57 WT":t= i'# R 102t Tr Rei tr.'c te-& 0=t j GAUD 3 VA U -N N Aisij.°0Vk' f?'t O E «5 i t s., s_ NvR � ri Town of Andover Ina = h 6)0 0 (� dover, Mass.c7c3 AORATED P'PV`� C7 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT....O�, „p�a �e kk BUILDING INSPECTOR ......... ............... ............................................................................ Foundation has permission to erect.... ...w A.�.�.�j....... buildings on .....1.. ..... .....M. ..... . ........... ... ............ 1. Rough ... to be occupied as .............�'..... 1` Sw A► W% rC.l�y.r►...... .... A.. �!V .S Chimney provided that the person accepting... ......this........perm.........it.s all 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 t42 ot Inspection, Alteration and Construction of Buildings in the Town of North Andover. 340 J 3 0 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 ....... . .�................................. .....� Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location/J �Z AIA (A) -,,A No. O fru 0q- c>3 Date MaRT� TOWN OF NORTH ANDOVER 3?O�t„•D I•,�� f w Certificate of Occupancy $ cHus Building/Frame Permit Fee $ s� Foundation Permit Fee $ Other Permit Fee S► $ r3 0 o TOTAL $ C)0 0 Check # C A c. 16 1 Building Inspector - 13L Date.....-3................-............. NORTM °f t"`°:•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUSE� � This certifies that /�NJO .t Ie C .......................... .................................................................. . has permission to perform le-e"�` °� ' .................... .......................................................... wiring in the building of..!2 u.Pm P�..`........ . ............ .............................. /39......J�� k/J S �— at............... ....................................;.....�(.0,,A oath Andover,Mass. Fee..3.. .......... Lic.No.A.�, l��..............................�� ....M .. ...... ELECTRICAL INSPECTOR Check # 1008 x; 3 ,, 0 THE CONI[l/IONWEALMOT MASSACHUSE77S f ?ec DEPART ZM0FPUBUCSAFL7Y Permit No. BOARD OFFIREPREV"HONREGULAHONS527CM1200 Permit Occupancy&:Fees Checked APPLICA7TONFOZ PERMIT TO PE-WORW ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) /37 7 r►%1,,, Sf_ Owner or Tenant V vin 1L11 �-Rln� y f i 1 Owner's Address Is this permit in conjunction with a building permit: Yes[�No (Check Appropriate Box) Purpose of Building mgtn) 114�4 or, I/1 Q L,) CL ,Z4 P,66,"" Utility Authorization No. Existing Service Amps .12p 1,2Vp 1,2VVolts Overhead Underground No. of Meters New Service Amps / Volts Overhead = Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE 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 Others—�� Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP tTHER Q=!:A e- L,,4,,,,,rt 4 41, sura=Cowrage.Pama ttothele9mmxi softs GmrdLaws rawaolmtliabhtyhmancetblic,Yinlxfi gCorr>p)e CovaageoritsmbW"Wegmvabt YE3 NO avesubnAaJvandploofofsww1DdeOffim YESfir/ IfyouhawdladmdYES,pleas nkaiethetypeofco by addng the- `—i SURANCErT � BOND Q MIER F-1 FxnseSM*) t Q, MJ,4+LA6-'1 A' Exlrr<ahmDale- Fsfirn; d Value dE1=cal Work$ xktoStart /�02�0.3 Ir�Ct1MDWRapes&ed Rough Flrlal nedunderTlieT �r-- MNAME \ TfK n LkmseNo. T l 6 ) wee L4 I�✓L `s Sigt><tttue LrMseNo & mess Tel.No 1P4 Tel.1\16- 9 43 /NER'S INSURANCE WAIVER,I am aware that the Lmw does nothave the insurance mve age orits suhswtblegrivalent as regrtired by Massachusetts ws / that my signah ue on this pen rrit application waives this rec�t :ase check one) Owner Agent Telephone No. PERMIT FEE rgnature of Uwner or Agent The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations • Boston; Mass. 02111 Workers'Compensation Jnsurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City. Phone#. Insurance.Co. Policy# Company name: , Address City Phone* Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.0o and/or one years'imprisonment_as weU_as_cimi.RenaMm jnsh&1orm_fa_STOP W-ORK ORDERand_a fm ct.(31AOA)D)-arlay.against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature date Print name P-bome.# Official use only do not write in this area to be completed by city or town offic:iar City or Town Permit/Licensing D Building Dept 171 Check Y immediate response is required Licensing Board Selectman's Office Contact person: Phone A E] Health Department Other i1 BUSINESSOWNERS PO;L1I/CY DECLARATIONS �� VERMONT MUTUAL GROUP ! 89,State Street,PO Box 188 {. Montpelier,VT 05601-0188 Type of Billing:DIRECT BILL. Policy Number: BP17032162 - RENEWAL POLICY Agency i Address Named Insured / Address INTERNET INSURANCE AGENCY,INC ' GUY ANDO 522 CHICKERING RD 56 WAVERLY RDNORTH ANDOVER,. MA 01845-2840, NORTH ANDOVER, MA 01845-2416 ;i i,. POLICY PERIOD From 03/28/2003 To 03/28/2004 at 12:01 A.M.' 'Standard Time at your mailing address shown above. 'Exceptions: 12:00 noon in New Hampshire. `$ INSURANCE PROVIDED BY: VERMONT MUTUAL INS $526 and at eachanniversaly;..,� TOTAL POLICY PREMIUM at inception is: p IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,WE AGREE;W TH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. ; BUSINESS DESCRIPTION Form of Business: INDIVIDUAL h' DESCRIBED PREMISES Morta eholderNa " !and Address Prem. No. Bid . No. Location/Occu anc (See Schedule!6�w !Mo rtgageholder(s) - 001 001 CONTRACTOR ELECTRICIAN BPD CS- If Applica;le) 56 WAVERLY RD NORTH ANDOVER, MA 01845 PROPERTY -Limits of Insurance for $ BUILDINGS . Actual Cash Value - Buildings Option (Y/N) • Automatic Increase - Building Limit (pct.) $ 2 000 BUSINESS PERSONAL PROPERTY % („ EARTHQUAKE DEDUCTIBLE ct .250 DEDUCTIBLE $ 250 OPTIONAL COVERAGE/EX s RIOn BUI boxes GLo SS DED mC�I of n,su�rance OPTIONAL COVERAGES-Applicable only If a $ per occurrence 1. ❑Outdoor Signs $ 2.❑Tenant's Exterior Building Glass level All Floors included 3.Interior Glass ❑ Basement/ground floor ❑ $ Ii per occurrence 4.❑Employee Dishonesty $ ! Inside the Premises 5. ❑Money & Securities (Special Form Only) 'i Outside the Premises COVERAGE EXTENSIONS $ 1. Optional Higher Limits-Accounts Receivable $ 2. Optional Higher Limits-Valuable Papers ADDITIONAL COVERAGES-Optional Higher Limits -Forgery and Alteration $ MEDICAL PAM YENTS Except for Fire Legal Liability,each paid clai sowners Liability m 40 ie oCoverage Form the amount of insurance we provide dclr`ng the applicable annual period. LIABILITY AND M Please refer to Paragraph D.4.of the Busines Limits of Insurance Liability and Medical Expenses $ 500,000 $ 5,000 Per person k' Medical Expenses $ 50 000 Any one fire or explosion; Fire Legal Liability ' See Schedule o F ms and Endo 5ements - BPDEC4) FORMS / ENDORSEMENTS AT ACH D TO THIS POLICY: BY COUNTERSIGNED (DATE) (AUTHORI D REPRESENTATI• )3 THESE DECLARATIONS TOGETHER WITH THE COVERAGE FORM(S), COMMON POLICY CONDITIONS, F NI !'AN ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREFORE, COMPLETE THE ABOVE NUMBERED , Includes copyrighted material of the Insurance Services Office,Ina Copyright,Insurance Services Office,Inc., 1997 ( VLY( INSURED COPY ,h` 02/21 /2003 Guy Ando III awl 56 Waverly Rd F 5 EATS ., N Andover, 4� MASTER,ELfECTRICIAN LICENSE r O,4EXPIRES SERIAL NO A18165 07/31/2004 881044 Location , No. Date TOWN OF NORTH ANDOVER n Certificate of Occupancy $ .6-0, . i Building/Frame Permit Fee $ a" �ss�cNusEt� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ y ! TOTAL $ V ' r rr PBuilding InspectorZ. Div. Public Works i' - Location N0. / Date01 NORTH TOWN OF NORTH ANDOVER C? i • O� f�r r n Certificate of Occupancy $ `' * : Building/Frame Permit Fee $ L � Foundation Permit Fee $ S—CH s f a ' Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ cY t Building Inspector Div. Public Works Z 10103•,po 0 RJtIT NO.' APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER MASS. PAGE 1 MAP 4-40. 3o I LOT NO. 2 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE ' y8 SUB DIV. LOT NO. �I LOCATION /37 /14,— Snme " PURPOSE OF BUILDING OWNER'S NAME / ��f•Es 040" /OaalL T NO. OF fTORIEs n SIZE es f�BSF OWNER'S ADDRESS /3 7 MI�IN ST BASEMENT OR SLAB C044JL SPwwE ARC1411TECT'S NAME M e. /fbLA.A`0 NJ74tj SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDINGDIMENSIONS OF SILLS DISTANCE FROM STREET O POSTS DISTANCE FROM LOT LINES-SIDES REAR '• GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW ^�O SIZE OF FOOTING 11 IS BUILDING ADDITION O MATER:AL OF CHIMNEY IS BUILDING ALTERATION vCt 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 Y�[� IS BUILDING CONNECTED TO NATURAL GAS LINE IlArS INSTRUCTIONS 3 PROPERTY INFORMATION v LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST E FILED AND APPROVED BY BUILDING INSPECTOR .977AC.I/AO '• DATE FLED /H.4f�el 7e� wthLmmo INSPECTOR SI"AT9*E OFrOWNER OR AU-fHORIZE AGENT FEE C' OWNER TEL _ PERMIT GRANTED CONTR.TEL+1 CONTR.LIC.0 CS O L L 680 H.I.C./ 11 1 . i i. . S ' r 11 � t`� I 1 I 1 r 1 �" Leh,S �!4.if""''p�B ► Y iE ' t DE irttlT OfNIC f1 1 _ x CON RUCTION SUPAISA 11 -8686 A t � Dlf18f1999••� A� � r' 'latfict¢d`tc: M t ♦♦ 1 PVA NIEL I Kr, ST-. � .. fir.I�NiMf� �]++•e� ,tu'. '-'/�._ R + BDESIGN S , I 2 Dundee Park, LL-6 SKETCH: � Nf�t � SEPAt�pTIQ}� SHEET# Andover, MA 01810 CLIENT: Gori grkU GT I O N SCALE: (508) 470-1022 (Fax) 470-2994 PROJECT: 13-t MAIN 5-t. N, AN OOV!:g,MA DATE: NEW 41-ocKIN ti t�-XisTi'4G WP• gETWE:S� volsl's F�ooR. ����G rJEW �2 LAYs F.XISTIN� ��i2 WHO. s�e FG, 6aj-i8. SEAL-ED F�o1Z. Jcl 5'r5 @ !6"pG. TIG�NT To sats;'S ' v . I 1 S - Ex►STING •� , � ' i � I 777. l.oAO-SE�2ltiL� FG. GWB. APPLIED Td ttl�. .:'oI�TS 5�Xt 45T':tQ C, ti r - tl-r 7 N+,RIN� 6NANW5 - G FG. �!i1t3• JoISTs wl �" I.o�Ir� �c;lt��15 LAYER 16 p A00iTk�NAL 51 A�Er� Ttl+ T ' APP�o�O '2� MT�� urk+r46j TO >;, G A. m V E I ITEC S NOTED A190V - AiZ�, Aw, I NEW PER UL. PNR. A5S5M I;L-f CESI:�N #ice 536 ' i ,��RED AR�hri 8SA No'9047 r�1y MASS I kyS. BOSTON OF bppS�'PG . R + B D E S I G N 2 Dundee Park, LL-6 SKETCH: TEt4m ITSEPAKA'TI Ot j SHEET# Andover, MA 01810 CLIENT: p'r}� GoNS'rkuGTIDN SCALE: (508) 470-1022 (Fax) 470-2994 PROJECT: 13-1 MAIN ST. N. AN0.0V59, MA DATE: 25-MAA-9� NEW 41.oCKIN6i FXIGT;`4Wf7, gETwEEu folGTs >✓I.00F2. vitJ� Ki Eli Zt.AY s Z 1'iZ Wo. s rG. SEALED F+-wcp- ,Joy "TS 16''4G. ' TIENT Tp ,;015""5 lilt IL ZZ '' Ex 15TING LoAO-13EAf�)t�G� . ` ONE E APP�iEO so W0. Ja15T5 E�XI�'STI t.'l c};.A,f.E� MTL. =N�(ZtN�j GNANNF��S � @ Z+ 0C, EGuREO To rC Y 0*0ISTS W` LoNU 6CKC;WS WT (I) LAYER I6`` OG. NE ' g S�ALE� TIG+�T APPI,lE0 TO MTV �ue,&tiNtj TD Pr 6i< A 6CVE; GRAN,EL-S �P.f�P N01GULAQ ITEMS NoTEO AOOVF, AA.F. ALLY NEW PIrR uL. ZNR. ASSEc^6L.'f GGSiaN #lam 536 rD AqG BOSTON M /155. �+j✓ I <)l/OFM�cP FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and ^apartments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION T APPLICANT_J7AN I/, 1 ��1, � �'1 PHONE f�-®'147 .. , �--—_ LOCATION: Assessors Map Number PARCEL.Q _ t SUBDIVISION Ato Al t LOT (S) STREET !3 7 ,.�itl,� % ,J„✓�` ���R¢, ST. NUMBER '1 J,.) S-7 IFR` S GouItT sL*„ —OFFICIAL USE ONLY I RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS I TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FIN TOR-HEALTH DATE APPROVED 9� DATE REJECTED, 1 SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT t*OFIRE DEPARTMENT 0/ ec (Q (le RECEIVED BY BUILDING INSPECTOR DATE r� The Commonwealth of Massachusetts ( Department of Industrial Accidents Office o//asesUgaUons U.1 - 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit I name, I location: city phone# C] I am a homeowner performing all work myself. ri I am a sole proprietor and have no one working in any capacity C] I am an employer providing workers' compensation for my employees working on this job. comrtary ramex. address:::.:. citY:: phone#- insurance c9: policy# I am a-sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers'compensation polices: company name:: 42 :T �::;a o SLae address.-:: �:2L P.JI� E�� 1'Civ �"/, fes/ city 4;0_ hone#r insurance:co sti0 j_:�1 p.vCj - op (icy# � gQlppgpy name: address. city' phone#. in aranee>co.. ...:: p N y# Failure to secure co era s required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprison nt as ell as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this state ent may a forwarded to the Office of vestigations of the DIA for coverage verification. I do hereby erti and the pains an enalties f Zerfury that the information provided above is tru7-,come Signatu Date -,-? S` i Print nameit/ /.,sL� Phone official use only do not write in this area to be completed by city or town official city or town: permit/license# Building Department []Licensing Board check if immediate response is required C]Selectmen's Office Health Department contact person: phone#; nOther (revised 7/95 P1A) p►ORr Tovm Of And No./tO 195 * s . dover, Mass., �O9'COCHICHE WICK '�_�1 DR's ED►PP`y �� S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ���. BUILDING INSPECTOR THIS CERTIFIES THAT .. �'.��...... (�K. /T>�LC.��' .... /�. ....��9.'r.4W ......... f /!�'! Foundation has permission to emm&......Q.1,770f.�' ..... buildings on ...l.. .. ............A.4.4.w............Z.....27A .............. Rough to be occupied as...................................................t� jll�l. ................:S!—n .l. ...................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST T Rough ............................ ........ ............................................. Service .... . . .. .. B DING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CERTIFICATE OF USE & OCCUPANCY i Town of North Andover Building Permit Number Date 8 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1 AJ S MAY BE OCCUPIED AS ETA f IN ACCORDANCE 4 WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CFr,RTIFICATE ISSUED TO ye 15 � ' ADDRESS W41;t A 7-0 •s�li 1 � �=ACMU3� riding b ctor r 0ORT Town of And ® ~ m s dower, Mass., _1998 0 LAKE , COCMICMEWICK L`/'1• •� 4Oq'�E SS U BOARD O HE TH PERMIT T D Food/Kitchen 9� Septic Sy r BUILDING INSPECTOR THIS CERTIFIES THAT .. ' ,.. ......G&W.06rAx&O. ...... /�. ....�. .40 .........1`.VZA_!/ Foundation has permission to w4&...../- .. T- / .,.... buildings on ...I.I.?............ ..41-ov............ .. .............. oug to be occupied as...................................................t 7 r., ................mi '... l .. neY provided that the person accepting this permit shall in every respect conform to the terms of the application on file in I�Fi 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 �. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST T - Rough .......................... . Service :.......... B DING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final ��v No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner St reet No. Smoke Det. 0 Date.... .. .... ... .. ... Ot..Ca oT�,ti0 3r c� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING CMusE� This certifies that ...................... .. F^ has permission to perform ...r.:... ;............................................................... wiring in the building of../. ''':%'? ..' ! -� .................................................. at.........7...............................:.�....�......................... ,North Andover,Mass. Fee? ............... Lic.Nor`-�`t'�i� .....� ..................................... ELECTRICAL INSPECTOR Check # ZN n L, 5 . TBE COMMONREALTHOFAMS&WHUSETTS Office Use only DEPARFMMVTOFPUBIICWL-H Permit No. BOAROOFFIREPREVE MONRF.GUTAHONS527CMR]2.-010 Occupancy&Fees Checked APPUCATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) J J Owner or Tenant T !' L Owner's Address ) "1 `7 I-d W[Z L S-r• 1i1U 00 UCQ, f t4. d Is this permit in conjunction with a building pennit: Yes' v ' No F-1 (Check Appropriate Box) Purpose of Building Utility Authorization No. _ Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work EL OC AT L% �rJ (� F/k7`UR�S G F ►9 r✓L No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total O� KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets j No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets j No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposais No.of Heat Total Total No.of Detection and Pumps 'Cons 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 Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER' k=a=Cowaage.Pamm ttothemgtme xizofMa%adtmzC walLaws Iba,&aommtLdilkkoxawePo yirrkxkg(!nV] a Covaageorilsaboniale4uvalaa YES 1� NO IhavestlbrrritledvaldptudefsametodrOffim YES ( FyouhavedmicedYESpleaseinic*thetypeofoDwrageby drddng 1� INSURANCE BOND M-HER. r7 (Plerse.Sux v)It _a EVhfimDae WolktaSMd 1 1 /a 0 / 7Nh_-R7pested gorge J 7 VahleofFJectlicalwolk$ O signedunda-Tr Fudies of p4jur3c d O FIRMNAME L L �� Li�rmNo. Limme Sigriatim V LmmNo W U° "5'V6b ka �Y Bus ltTel No. Address 77117131u, 'I 7 11 131 , ,Address �� �� - &�k /� y� Alt Tel No. OWNER'S INSURANCEWAIVER;Iamaware flu theLio wdoes nothavethe instriarmom ageoritssubstamdequivalernasrogtmedbyMamimsettsGalaalIam and thatmysigrahueonthispermitapphcationwaivesthismw*ff rnaI (Please check one) Owner Agent/ Telephone No. PERMIT FEE$ Signare o caner or gen -. a The Commonwealth of Massachusetts ` = Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # LI am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City Phone# Insurance.Co. Policy# Company name: Address _ --- — City Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,5co.00 and/or one years'imprisonments ntell-as_civil.penat iesmsheln►m-ofaSIOP WORK O _f_ RDER�anda fine $1AO.DD)_axlay.againstAle. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ' 1 I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct , Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town official' City or Town---�-- Permit&icensina — C7 Building Dept ❑Check if immediate response m required .❑ Licensing Board ❑ Selectman's Office Contact person: Phone#: ❑ Health Department -- ❑-----Other