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HomeMy WebLinkAboutMiscellaneous - 138 OLD CART WAY 4/30/2018 (2) 138 OLD CART WAY 210,107.8-0120-0000.0 I Location �-� W IJP No. 7 Co — C. Date TOWN OF NORTH ANDOVER`- S Certificate of Occupancy $ Building/Frame Permit Fee $ ?ss�cHusE�� Foundation Permit Fee $ Other Permit Fee(,.'�LXIyy1 $ 2S Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Z5 Building Inspector i 7935 Div. Public Works REN H.P. NELSON � �� ' ' 120'Main Street, 01645 KATown of Disecmr �!��� (508) 682-6483 ^.g NORTH ANDOVER BUILDING co.NSERVATION SAC DIVISION OF HEALTFI PL_,NNIM" PLANNING & COMMUNITY DEVELOPMENT CHIMNEY APPLICATION AND PERMIT 11 DATE 3 PERMIT LOCATION C7n C f/,ee < < i^ OWNER' S NAME BUILDER' S NAME MASON ' S NAME /T P.�� Jv� ✓ �o�'�� MASON ' S ADDRESS 3 MASON ' S TELEPHONE MATERIAL OF CHIMNEY INTERIOR CHI14NEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES ` THICKilESS OF HEARTH jC � Will chimney or fireplace conform to requirements of the code and have rules and r gulations been received: DATE ` 5 SIG;+hTURE 0 MASONONTR. LIC. EST . CONSTRUCTION COST/CONTRACT PRICE ?00r, UC% 7 ` GU PER2,1I'1 n GRANTED 23 �1,� FEE �-� RC r CETTA, BUILDING INSPECTOR I1;S PECTED RE.•IARKS It SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES i IN � ORTF- : owio c over I L No. 5 7{{/r '0' L t NNort i dover, Mass., 19 BOARD OF HEALTH PERMIT T Food/Kitchen .I Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... .: .. .......�'..' + ���13�'I" I Foundation has permission to erect.. a:A:.iAA. .:.:.... buildings on .1 .: .. ..�.............f........":............................ ........'... ...'....... t-,�,�1� �` KP 6 V �1.11k .f \%�tf� '� Ll A..:1. �� .L :.4i,. )l.J.ilt: ),..:�).�:......:.i...�.. �'.§.... C coney )�[. Z i to be occupied as............................ ................ . ......... ........... .... ...... ....... .... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspectio Alteration and Construction of Buildings In the Town of North Andover. �RMIT FOR FOUNDATION ONLY PLUMBINGYINPECTOR REGULATED BY PARA. 114.8-S. B.C. .,/ I VIOLATION of the Zoning or Building Regulations Voids this Permit. ,G YJ l Z �� FEE PAID as , a D PERMIT EXPIRES IN 6 MOI b�r � ELE RICAL INSPEC UNLESS CONSTR CTION STARTS Rou PERMIT FOR FRAME/13LII( DIING :..:.................................................................................................. Service BUILDING INSPECTOR FEL GAS INSPECTOR Occupaiic- Permit Required to Occuj)y BicilchligRou � ! Display in a Conspicuous Place on the Premises — Do Not Remove Final P Y P �'' Final J No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. LL Burner • v / Street No. PLAN NING NAL CONSERVATION —FINAL ; � /11 I� Smoke Det. Sep-, tT f SEW ER/WATER FINAL DRIVEWAY ENTRY PERMIT l j CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number �i4 —S'7!o Date AyC3 Z4, MR THIS CERTIFIES THAT THE BUILDING LOCATED ON M3 ©L-0 CA4C-1 WAY ( t Z1) MAY BE OCCUPIED ASgiMUL 14MI .a lM4 %Aj Z6Ae-4&IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. : CERTIFICATE ISSUED TO ADDRES W L R 'y °•.res A,� "''"C""b` di In ec10—yr-7 �?��7'qq " Location, 3r3 V Q4T 1� ,�1V No. 5 (o Date 4 Z TOWN OF NORTH ANDOVER t � S Certificate of Occupancy $ 3 Building/Frame Permit Fee $ i 71 ewwns•I• �SSAGNusEt Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ ' Water Connection Fee $ i f TOTAL $ Building Inspector „{v5'94 08:46 MOO PA:!) i f * 7 7 7 0F Div. Public Works Locationy?7 'atii a i No. } Date M°9 TOWN OF NORTH ANDOVER •O "•, 0' ~0 t j A Certificate of Occupancy $ • + ;> Building/Frame Permit Fee $ + s�"" Foundation Permit Fee $ � Ss MUS t • Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ ~ TOTAL $ t Building Inspector d Div. Public Works Locaticli No. - f Date ��—'Q I r TOWN OF NORTH ANDOVER O:O'�„`o •••BOOR } „ Certificate of Occupancy $ +� Building/Frame Permit Fee $ O `y' ,SSACMUStS Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ so � 7" , .� A ( � Div.&ilc Works 4 PERMIT NO. � APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 ` .MAP +40./aQ I LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE — ZONE SUB DIV. LOT NO. ��D P DRV LOCATION Us/� / .� PURPOSE OF BUILDING OWNER'S NAME7 `Z (-,v NO. OF STORIES SIZE 33 dQ S r _'u OWNER'S ADDRE c.t/d0 Qht BASEMENT OR SLAB C �' 2� z�L44L ARCHITECT'S NAME er.d„ SIZE OF FLOOR TIMBERS 1ST a )e10 2ND lQ 3RD BUILDER'S NAME '. SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS '3 K2- r 'e-r- DISTANCE FROM LOT LINES-SIDES REAR "" "" GIRDERS Y- �2.k / AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION r THICKNESS /CL 7 IS BUILDING NEW SIZE OF FOOTING �� �/ X ll Y V IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND i WILL BUILDING CONFORM TO REQUIREMENTS OF CODE �'e IS BUILDING CONNECTED TO TOWN WATER �Lp� BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER � v IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION PERMIT FOR FOUNDATION ONLY LAND COST /3 S o a SEE BOTH SIDES REGULATED BY PARA. 114.8-S. B.C. ''[n'►__ EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FTr SCJ, O PAGE 2 FILL OUT SECTIONS 1 - 12 REST. BLDG. COST PER ROOM DATE R+ FEE PAID 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 --fff HIST FOR FRAME/BUILDING DATE FILE DATIN EFF PAID- BUILDING INSPECTOR SIGNATURE OF NE OR AUTITOMIED AGENT F E E ��G�O OWNER TEL.# *- 3-b V PERMIT GRANTED CONTR.TEL.N t 19 CONTR.LIC. H.I.C.# BLOC.PERMIT FEE (p(o 1 � 1 s� aov 3 0 - tEss FDA FE oc� X177 DUE FRAME PERMIT= — -�w CLV BUILDING RECORD ~ ` 1 OCCUPANCY 12 ,SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH ' CONCRETE d 1 2 I_ CONCRETE BIL K. PINE BRICK OR STONE HARDWD _ " PIERS - PLASTER {/ _ DRY WAIL _ UNFIN 3 BASEMENT il AREA FULL FIN. B M'TAREA _ 14 1/1 "/ FIN. ATTIC AREA _ NO 8 MT FIRE PLACES 2 HEAD ROOM MODERN KITCHEN 4 WALLS II g FLOORS CLAPBOARDS B 1 2 3# DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COM/,AGN VERT. SIDING ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) I GAMBREL MANSARD TOILET RM. (2 FIX.) ! FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER; " ROLL ROOFING MODERN FIXTURES o - TILE FLOORI - TILE DADO 6 FRAMING II 11 HEATING WOOD JOISTPIPELESS FURNACE FORCED HOT AIR FURN. TIMBEL ER B STEAM STEBMS. S. OT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS L OI } B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING _ _ _ �,`` O R"f F.a Town of r �� over �� No: 57 o q y ti rt dover, Mass. 191+ T 0 LAKE , CCC HICHEWICK 7 A00RATEILD D Ia �E BOARD OF HEALTH ! Food/Kitchen . PERMIT To Septic System BUILDING INSPECTOR j THIS CERTIFIES THAT K AI�...�Rg"- TQ-UbT Foundation has permission to erect..UX040....F.{tiITAE... buildings on ..at.�l........7*13.8....OLb Pi.�... Y...... Rough to be occupied asStN6t.rr- Tkm � yChimney¢� � � provided that the person accepting this p rmit shallin 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough 1 124 -1 t 00 " Final PERMIT EXPI 6 MOl��T FEE PAID 53 ELECTRICAL INSPECTOR UNLESS CON 'TRIJ NJ T. IR Rough PERMIT FOR FRAME/BUILDING ........ ................. Service BUILDING SPECTOR Final [?ATE: l EE PAID: S^lo °O_ Occupancy Permit Required to Occl.tpy 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 PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Wg --776 —77 )1 zSO- 82' - � � 1 ol °1 o b' LaT'#2/ } 47, D� _ o D A QLD S A'"65Y CE,cT/�To rye T/TLE AlS!/,eOICAVO �L or RL.41t/ 7TH T.�/E B,oN,e T.VgT TisiEOwECG/.W/S 4OC,47E0 O,V T//E LOT./S.S.fl9/Y.V ANO T//AT?ODES COAllffaeAJ jY/7'// Tf1E YOsNN' p�.trt�.A.voo�B.� 20N/.vG ,�E6!/LAT,YJ,t�S ,� � /� • ,�6v1.e0/.t�(s JET�/C,t'S FGO�fI JT�PEC7J f LvT U,✓ES.'' /�/O.C�Tfi/ fi',</GYj✓E.e/ �..SS LOCATED/NETFEDEE.oG f,CGioOLO O APEAoT O.PA�iV J�O.P ��H r,�,N�S 2.sOo98 ODDBC /•C.,z � ,�EAGTy �,evsT ��►� OArEa 612193 ! StO��v 9�'°��. v�yo�' �vorFa,P �fE.P.P��tf•9GrE'.t/civEE,Piti6 SE.P�/�'ES Bovvo,Ps/Gt�'T .v. BouvpA,eY qT/O.(/ TA.rE.S/ F,POiYI EX/JT/NG .PELO,PpS. 64 ,ST,rEE7- A.t/ODYE.� /l1.4S,S.vGf/l/SETTS o/Bi0 FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: _z , ���L � R,(Isz- Phone ��S- 71V LOCATION: Assessor's Map Number Parcel __02 Subdivision ���� c,.�G� etre �c - �� Lot(s) Street St. Number ************************Official Use Only************************ RE NDAT S OF TOWN AGENTS: Date Approved f Co Servat on Administrator Date Rejected Comments Date Approved _ Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved % a Sdptic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit `%%C� n f Fire Department �"�/t7��i�-^-r,./-t/-�,.V�.E^r/� (-��-D7�'�'iu�-A�r.(:r.✓' ��--w"y f� � �//�'7 Received by Building Inspector Date 4 q,^'_ s.'t ✓ ..•„^•,=•r�-MJF ;< � ,w�,.f y �,'a...�i_. - tiv ice} - �� •� _ . ',rte. �' J �,�`'.5'• 'f. ��.r-�.,.`?•� lir � - .�T'�'�•' �L; ' T„F•!N�• ire _ - •T - �,Ya� / .,. -. � Yom" y,..'•+n, ��.,_t'c�-'C' � _ y COMMONWEALTH ^�_ ' f TNIONTbf PUBLIC SAFETY . _ 'r ' OFoWi ASHBORTON PLACE �f %'r MASSACHUSETTS I�OSTON,MA 02108 �'` "" ¢rocairon ' I LICENSE tills pf EXPIRATION DATE C O N S T R. SUPERVISOR CAUTION == + 0 /21/1996 FOR PROTECTION AGAINST EFFECTIVE DATE LIC-No. RESTRICTIONS THEFT, PUT RIGHT THUMB NONE E 02/28/1994 ()42845 PRINT IN APPROPRIATE X0 I 4ICHARD G Fi3RSTE3: POIDEPO �.. � BUSTING OP R�ATOR ' ^"' �- ,y f'; •:; �f: ' SS it 032-42-7162 j ANDOVER MA 01810MUSTfNG ' .'aY��•J: .r.� -_ PHOTO(BLASTINGOPRONLY) FE •� �� f I '• �!yf•,�^'�``{�. t c `O 1� NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY MAR 13 1904 ' ' Jr �- r .:• c` ` 1� HEIGHT: s STAMPED-OR-SIGNATURE OF THE COMMISSIONER 1 Dob: 08/21'/19='" ' p ���r yOr_,•.'�•'�' 7 �' THIS DOCUMENT MUST BE ( SIGN N • %";' %�;.r"•: ;� h �� CARRIEDONTHEPERSONOF - - SIGNATURE OF LICENSEE; Y / THE HOLDER WHEN EI{ �w^'• yr °r Y i r '•I OTHERS•RIGHT THUMB PRINT GAGEDINTHISOCCUPATIOf} f MI Town of dover +.�. �i y Nort,� � yy dover, Mass., ���m 2 19 1+ T - LAKE �. T COCMICMEWICI V BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �� � � -'twST BUIVDING INSPECTOR THISCERTIFIES THAT...K.................................. ..................................................................................................................... Foundation has permission to erect-W000....Tr{2(LWIC'... buildings on .k*.�1........ ..13.8....GM...CA�...L?AY...... Rough to be occupied asS1N6QL � ! l ' .—................. Chimney provided that the person accepting this p8rmit shall in eiery 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. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. Rough Final PERMIT EXP 6 M01\?i ][,S FEE PAID ELECTRICAL INSPECTOR UNLESS CONT N T R Rough PERMIT FOR FRAME/BUILDING Service . ... ..... .... ... .... ................. .... . . ........... BUILDING SPECTOR Final DATE: FEE PAID: " Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT ._ 9 1 V� � t 1 �� pp. . .war •i .°/ t+ .�� , i� , +, ! +lye;"— •,i ! i IL .II t �IS�1 '�' •� I � 1 rte... �. ♦ ® .��r-sem r FORM U - IAT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: /J��<r1" Phone 22S- 72 7Z LOCATION: Assessor' s Map Number Parcel 02 7 — Subdivision Lot(s) Street St. Number l �o ************************Official Use Only************************ RENDATI,6RS OF TOWN AGENTS: 7"/,k � �/� Date Approved Co�servat- Administrator Date Rejected IT Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved % S is Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date ATTEST: t z 4 ATrue Ccs, Tflwn Town of No..4w 2 Zo -Zs ._ dover, Mass., Al- LAKE '9A,C 0 CHICMEWICK i~'•�• 0 q',T E �G BOARD OF HEALTH Food/Kitchen ... PERMIT T D Septic System • BUILDING INSPECTOR ^^_`�2J4L F� ................................:................................ THIS CERTIFIES THAT.....................:......t .....:.......... ..... Foundation has permission to erect......4�PO�............... buildings on ....1.3. ...�P..�.�1....a1.�..W.!�'.. .................. Rough t0 be occupied..as..................... /..Q .�C 1 �Gi� /l A � Chimney ... '........... .....F. . ......................................... . ...... ...................................... Ch' e provided that the person accepting this permit shall in a teary respect conform to the terms of the application on file in Final P 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 UNLESS CONSTRUCTION TARS ELECTRICAL INSPECTOR Rough ....................... ............ �. ..M Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - Do Not Remove Rough P Y P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. • FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary w approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: V 4E/S,�E-y Phone LOCATION: Assessor's ll Map Number - x-10 7 b Parcel (.t/ Subdivision W &)&t Lot(s) Street CA<7' St. Number ************************Official Use Only************************ /RECOMMENDATIONS OF TOWN AGENTS: Date A Conservation Administrator Dat e/�"eI/cted Comments V` I� . Date Approved Town Planner Date Rejected Comments Date Approved Food I tor-Health ._Date Rejected Date Approved 1—?1_27h4 tic Spector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date i • , ' • ` SO`�OAao�H li .i it crT�= ACL prp(afG iS JC H" -fd PVC, � N (. .SEPTIC ra N� PUC •QEF 5 vuI 1 I � .I•. L A u I LT U-11 P r SE FACEDISSAL SYSTE .Lb a4TED IN i PERMT NO. �/ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. �/ PAGE 1 MAP 4d0. f0 7� I LOT NO. C� da��0 (,��00000 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. al V5175 q w LOCATION '� ��o✓� PURPOSE OF BUILDING J!-r-Q)&AP"� C5 / ly OWNER'S NAME `�.�^ 2) � �(SLE /T NO. OF STORIES � TLSSIZE /O X/Q/ OWNER'S ADDRESS /3a-f 0 mss-. r4 -7- '`// // BASEMENT OR SLAB O 7' ARCHITECT'S NAME Nor Q(p�p--/aCfF ,,6 VV� 6 /7I"a SIZE OF FLOOR TIMBERS IST ��(� 2ND 3RD BUILDER'S NAME --C.f'f��/ ��y MAL �II'T1`�/"� A SPAN -- DISTANCE TO NEAREST BUILDING '00 /Z Gni {T' L DIMENSIONS OF SILLS•C DISTANCE FROM STREET aoO /ci� POSTS x U DISTANCE FROM LOT LINES-SIDES !o O REAR 20 """ppp GIRDERS AREA OF LOTA17, -71pZ FRONTAGE �O�I y HEIGHT OF FOUNDATION Njr 1/p1aX,,,f4gZe ICKNESS is II' I IS BUILDING NEW ES SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION`�v\�� IS BUILDING ON SOLID OR FILLED LAND 50.LI D WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ,Vo BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ND IS BUILDING CONNECTED TO NATURAL GAS LINE Al 0 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST _ 1 SEE BOTH BIDES EST. BLDG. COST OCA zoo FT COST PER S BLDG. Q. . PAGE 1 FILL OUT SECTIONS 1 - 3 EST. - 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 BE FILED AND APP/ROVED BY BUI DING INSPECTOR i DATE FILED // tx 6 } RUILDINO INiPIIK OR SIGNATURE OF OWNER OR AUTHORIZED ADEN / F E E o2s OWNERTEL.� CSab') 7a5 3�Io2� tL PERMIT GRANTED CONTR.TEL.# No c7 t9 �K CONTR.LIC.N H.I.C.# d `rte 04 3 -- ,0ss9 .- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILYS-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY _ OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT I , AREA FULL FIN. B M AREA _ '14 1/1 FIN. ATTIC AREA _ N_O B-M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDVI'D _ ASBESTOS SIDING COMMON _ VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY I WIRING STONE ON FRAME SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER '. ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 3 COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING Location O ���� IvA / No. l� Date ' r W NORTh TOWN OF NORTH ANDOVER Certificate of Occupancy $ • : ; Building/Frame Permit Fee $ cr Foundation Permit Fee $ s�cNust Other Permit Fee $ Sewer Connection Fee $ ------ Water Connection Fee $ v _ Jc� TOTAL Building Inspector Div. Public Works NORTH " dover Town of �� a No. 92.. o " >Aprt dover, Mass., '..,C E 0p rt D BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........G..*.T�41........ .............a...I...4.4..foo................................ ...............,..... Foundation has permission to erect...�..D...X..I... ... ............. buildings on ..... ..3..8........ ..1. ....C...�.�`'t-...w. . Rough to be occupied as.. . r'!�!N O V d� r` '��Slt�t�u'FIlI VSA O .� 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. mus+ KY e p t a0 ¢i F r%W% Le 646 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. t t01CA .` * 100 Fh%%A. SWO Rough ' ra 4 coloPERMIT EXPIRES IN 6 MONTHS �^� � Final a ELECTRICAL INSPECTOR 303-1 UNLESS CONSTRL N S 1.3031 � Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, 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. 1'i?RMIT NO. APPLICATION FOR PERMIT TO BUILD" * ***NORTH ANDOVER, MA nl\1'NO. /a7 L1)'I".NO. ' 7. 2. RECOHBOFO\1'NEHSIIIP DATE BOOK PACE 7/ay�ls Y177 fozY 7UhE SUBbIV. LOl'NO. a/ 1.0(:AIION 136 010 C147- 0,44/ PURPOSEOF BUII DING cC/Vy/ aa5l - -- /0 "-I /a. 7 r OWNER'S NAME Gggiiq F ElscW NO.OFSrORIE-S / SIZE ( WNER'S ADDRESS 132y 010 CT hr /, �, V BASEMENT OR SLAB ARCI.ltl'EC'I"'SN.AME_ aJ APP4/Nl34E W77 SIZE OF FLOORMBERS A I ST 2 ND 3 RD Ii1111 DER'S NAME 4/,17 /� 10k1e,+23L�E SPAN IV 4 T, DIS I ANCE TO NEAREST BUILDING 50 ol DIMENSIONS OF SILLS 014 DIS VANCE FROM Sl REE 1' 60.1 DIMENSIONS 01:POSTS DISTANCE FROM LOT LINES-SIDES `15 f REAR )/01 DIMENSI(NdS OF GIRDERS A/�,4 RHEA(X LO'r Y7 FRONTAGE aC/7 I iEIGI IT OF FO(1NDATI(N�l / If N� F S�6 TI IICKN(SS IS BUILDIN(i NEW �E5 SIZE 01-_1O(JI'ING CryD'.y k u` X AI IS BUILDING ADD[IION /Yo MAIERIALOFCIIIMNEY IS BUILDING ALTERATION ,I IS BUILDING ON SOLID CIRTILLED LAND 57d//D WILL BUILDING CONFORM TO RE(x11REMEN'I S OF CODE ES IS BUILDING CONNECTED]OTOWN WATER NO BOARD OFAPPEALS AC1IM IF ANY A/A� � IS BUILDING CCNNNEC'VEDTOTOWNSEWER /vo IS BUILDING CONNECI ED TO NA I URAL GAS LINE A10 INSTII('TIONS I PROPER'rY INFORMATION LAND COST 6 �eC ij- 1 ,-30 a Ct EST.BLrxi.cGST 054900 �7 PAGE I FILL Ol IT SEC`THINS 1-3 i 1 ( EST. BLDG.C(73'T I'ER SQ.FTff. �•L 1« EST. BLDG.COS r PER R(X)ti XoOH EI ECTRIC K-IE'I ERS t II1S'I'BE ON(xl"rSIDE(N-BUILDING SEPI-IC PERMI 1 NO. r AI"IACIIEDGARA6LSMUSTC(NNFO"iTOSTATEFIRE REGULATIONS a: APPAO\'EDBN': PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECr(Nt BUILDING INSPECTOR DA 11: OWNERS"1'ELb. f7f"'as^ 3*(1cJ C(WI'R.TELM C(NJTR.I.ICH , SIGNAI I IRE(A:()WNEIt OR At I I IORIZla AGI-141' ' PI-RMI T GRAN I PI FORM U - LOT -RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICA-NT FILLS OUT THIS SECTION'"************ APPLICANT ( ,,EmL-D L ' L-15L �a/V PHONE °�7�) 5 `T43 LOCATION: Assessor's Map Number /07 PARCEL /010 SUBDIVISION LOT (S) a STREET 01Q a&T• ST. NUMBER 13 **** ** ****** *********** *****OFFICIAL USE REC NDATIONS OF T WN AGENTS: CONS R TION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS s W t h- L� , i TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED �i DATE REJECTED C I SPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS f e It) e 2-42 �.��� c�� �/Q/ ��-�'-� `�l--c S��T�' / moi✓-�G� PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO �`TE Revised 9197 jm 07/10/95 16:28 ✓8`508 475 4575 HUNNEWY & CO. 0 005 1pxLz) 79• 6.0 r ak v 47, y/z r x,� , 1 � s° 4-:0 OLS .r , COY' cecr«r 7&1 r17e-- o r Zwa ewowe T.S/W��'�.vEC4«/S daaw"Ohl r1le4or fS-IQWMV AW0 r.4A17'/7'DaE$ a a✓,ALIcnf ,pWrl -,,Ve reav,..* of,w.IOA-"P .•r-C ZGovlv6 dE61/CATICWS ,4> fi�RO/,W JE7dwGt'3'f� -r-M&M-S !tvr 4-AMCM o /t/p.C��/ fYNGY�vE, � //�/�'�S'• FdRTiY CE,rT/AY rW'W7*7,WC.T 420rZLliN6 o'S�/OT cocera•a iN rye -MMCF44 .aaov.-WZAC0 .a.P6.a. ►5flaw�r ory FE/�+.;-� vu�ry P..tvc� '� , �"OFA14 v6d3C y►.�f. DA sI a 6�a�/93 J v �s FFsslv�'� �tioc.0 v�' .voT Fo,� .►riov ra.r y F,c� �'X/sy'it/G ,e�zae�s. 6le �.4.PJ�.sT.eEty A.vODY�,t �t1J4S.S4G//v�ET7S oi8iv JUL 10 '95 16:20 508 475 4575 PAGE.005 I 4 T,��� ref � - _ -F s t _. -7777 TOP c%F Fov�vATto►J 2cv�. 2� hr1c i t' ( 1JV 9-" 1'VC �` rvn`rJ = 2U2. `tq '�'c �SS CaJ�R 2�•� ��: F3 tt IN SEP IC 'r-ANK = 2 o2 . 3r7 c�vT I CJI 13ur-IoN f3 ox �¢ O —. 202 . ID 'l 1, 5 &L ovJ Co 4 G 1.'3; 1 (3 40hl� T '7 KE�c{ ( �' f G p" T �2E�.r. 1{. ( - 20(• o Yj. 2d 13c� C�IQ 71ecV4cH 2 7 `fi. 2 or i:. '1 . 1 �DW1�OA�U b�N�� � • i _ II��t 1,� 25o•a�� t I _ k'' ' TCH 46 PVG 1 t r (5 2. r e 1l , 17 , • ip: 1. U r HOLe N ! �R ric -rL rA : ' PVC E5w LITLam\ FUp � t r (nti 1 t,l 1!�}• i i to is wAlY 1 it tj uuiur 4 OF w 'AL SYST '^URFACE D IS pol S tj :LOCATED IN � l 25�•od I :t n • fl a ;laf3T/-/ A ;..PREPARED FOR.. -A L T Y J J��' 1 • fd�.31� D TE • '�,, E. � I. EK, 0 w N Cr- r c. - -r s ,. : MERRIMACK ENGINEERING`:SERVICES, INC. �(I'I PROFESSIONAL ENGINEERS • LAND SURVEYORS • PLANNERS: 66 PARK STREET • ANDOVER, MASSACHUSETT.$ 01810 TEL (5a9) 475-'3555, 373-5721 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checkedl BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed iu ac dance with the Massachusetts Electrical Code(M• ),527,0 11,12.60 (PLEASE PRINT IN INK OR E INF Rt TION) Date: " ` �` City or Town of: - / � .19 To the Inspector of Wires: L By this application the untie igned fives tice is or inten ion to erform the electrical work described below. Location(Street&N mber3 Owner or Tenant Owner's Addres Telephone Nt Is thispermit in conjunction with a building permit? : Yes._❑ No (Check Appropriate Box) Purpose of Building Utility ut horization No. Existing Service Amps i Volts Ov erhead ❑ Und rd g ❑ No. of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Cbm letion o the followin table ma be waived b the Inspector o Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.o Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In ❑ o.o mergency fig ing rnd. rnd• Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. Detection an No.of Ranges No.of Air Conti. Total Initiating Devices Tons No.of Alerting Devices No.of Waste Disposers Heat Pump NumbeFNZ No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area HeatingLocal ❑ Municipal Connection ❑ Other No.of Dryers Heating AppliancesSecurity Systems: o. o Water No.of Devices or Equivalent KW, o.o Heaters Data Wirin Si ns Ballast g Ballasts No.Hydromassage Bathtubs NNo.of Devices or Equivalent ent . s T tal HP communications Wiring: o.of Devices or Equivalent OTHER: Attach additional detail ifdesired,or as required by the bispector ol'Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance ofelectrical cal work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑' OTHER ❑ (Specify:) Estimated Value of Elect rical,Work: (Expiration Date)(When required b municipal .) Work to Start: -9-5 Inspections to be requested i :�-f n actor I certify, under the pains and penalties o er u that the informationonthis application istrueand complete.,and upon petion. IP .J ►Y, PP FIRM NAME: LIC. NO.: Licensee: John S. Bassett Signature LIC. NO.: 1533C (Ifapplicable, enter"exempt"in the license number line.) Address: Bus.Tel.No.: 603 594 592$ OWNER'S INSURANCE WAIVER: I am aware that the Lic; see does not have the liabilityinsurance ant. d No.: required b law. B m signature ce coverage normally q y y y gnature below, I hereby waive this requirement. I am the(check one)❑ owner Elowner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: , 1.11A Date.................................. 4, TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ,SSACMUS This certifies that ..... ...................................................................... has permission to perform .... ......................... ........................................... wiring In the building of:...R............. .............................. ............................... a,/3.0 ....................................................... .. ......... North Andover,Mass. Fee.. ............... Lic.Nog .�4 . el . ................�LECTRICAL INSPECTOR . ... ..... Check # <Z Commonwealth of Massachusetts Official Use Only b Permit No. �� CIL' Department of Fire Service Occupancy and Fee Checked ! BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in ac dance with the Massachusetts Electrical Code(MSC),527 C R 12.00 (PLEASE PRINT IN INK OR PE INF TION) Date: �l//`'�Z_—'� City or Town of: To the Inspector of Wires: By this application the unde igned Ives tice is or inten ion to. erform the electrical work described below. Location (Street&N tuber Owner or Tenant Telephone Owner's Addres Is this permit in conjunction with a building permit?_ . ; : Yes.-El ; No (Check Appropriate Box) Purpose of Building Utility luthorization No. Existing Service Amps i 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: Installation of Security system Completion o the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ n- ❑ o.of Emergency Ligliting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: PDetection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ElOther Connection No.of Dryers Heating Appliances Kms, Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydroinassage 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. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The ( undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BONDE1' OTHER ❑ (Specify:) ,A/% (Expiration Date) Estimated Value of Electrical,Work: 1 U V (When required by municipal policy.) Work to Start: �—d� Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: I Licensee: John S. Bassett Signature LIC.NO.: 1533C (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.: 603 ri 4 5928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the LiC19hsee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: Date Pxayy�� TOWN OF NORTH ANDOVER k PERMIT FOR GAS INSTALLATION This certifies that .6c,71 .( . .Y . ✓ . . . . , , , , , , , , , has permission for gas ' stallation . 0�l? . . . e- . . . . . . . . . . . . . in the buildings of. . . . .` '� at . . . . . (�.t. .( .. . . CAI-.- North Andover, Mass. 6 Fee . Lic. No. ��. � �'�. . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# 1-121 r 8544 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - CITY NORTH ANDOVER MA DATE N.9,2013 PERMIT# -1 JOBSITE ADDRESS F138 OLD CART WAY OWNER'S NAME LISA MYERS GOWNER ADDRESS ITE 978-681-7862 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES[-] NOF] APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER __ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER - - ---- .__ . FIREPLACE FRYOLATOR FURNACE T _-- GENERATOR GRILLE - I _._ INFRARED HEATER LABORATORY COCKS I MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST ---_- UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 --- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E]NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY © BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws;;and that my,signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application w' a in corppliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Ie) PLUMBER-GASFITTER NAME I BENEDICT BREITUNG LICENSE# X36 93 SIGNATURE MP❑ MGF❑ JP❑ JGF❑ LPGI 0 CORPORATION[]# PARTNERSHIPM# LLC❑# COMPANY NAME: EASTERN PROPANE GAS ADDRESS _131 WATER ST. CITY DANVERS STATE MA ZIP 01923_ TEL 800-322-6628 FAX CELL EMAIL tI`� 13 t1 -0, 3 1S 1 .ego P � �I� -`-- The Comrnonweazzh of_/tea sucrza s�z* jcparzmcn of Indrsrrial �icci�cn ��rte- �rTT�v<. o`1'nv�sr_�azion=(' yv" -Hwy,.mast_-O-PILn — � Q~' oTc ( ni7T�rT1�aZ1.UIl.. 11iallC� =;IL1Q2z��Zi111LC� -/LC)Il A L�U11^2ItI Un - -r XT02�_ -P-i HFIN PROPANE:= & OIL - �\a rT to Bnsin�ss/JrPam^arionllndividuali VVI 7R j I PEE-1 y C17 ��T aZ�/71TJ DANV=P,. I� 0192" phone : 978-75C-30DD ��r You an employer, Checl.the appropriai� boy: I Type of project (required): 3 1 4. F - air, a QOn� 2I onu2OL0; ani I 1. I✓ I am a, tmT)ioY--T vr]tCl r J .hIOV' COLSLrucT]OL p �iuL and/or par-rims nave.Hired the sut O=aciOrs sm loy � 7. — Y mod��ing 1 air, a sole-proprietor o,parmeT- listed ori the atza.cned sheat. 1� ship and have no employees These sub con actors have j J Zj oiitior, employees and have worl:.ers' adaition l y- worl=CT for mem any capacity. _ ❑ Butlam� [No workers' comp. irsurranee comp. insurance.- ;le,-m a' rtairs or addtnons 5. ❑ -de are a ca�Oration.and its l 0 ❑ ^ p reguired] Ppa�S Or adrd'TaOP.S 3.7 1 am a homovmer doing,all wort officers have el�ercise� thei 1 I-� plumain r� m rse�? No vaorl�ers' co r� L of eiempuon pe=11�1GL 1= p ooL repairs irsuanc rsgnired.] 1 c. 152 1(4), and we have ao (' GAS FFTING --=IoVmS- PNO worhen' I j-I / '✓'�'� ! com.P. ms=ance required.] 4=y2anli:= thz ate: box rI=ms:also L 1 oul t L`-S5cII�Bv1D9'show Tam*w�r.�' camp=aacm polis'n,T�'*�aii� are doing all wow and tam�ol"i r==Z-Ir r ,,,,,�siihrnY L I3 V,�i davit mriicaan=5,,- Hom,own.._�W=siir= anis amdasz:mdicam..g th.., ri 1vh✓fn�: 0-,00'those==s have �octo tna hack to bo,_mu_arra hee ar addmana snit shoves=the name o_to sdt-conaz-ta a� Z the snt-cant u=ns have�ioyee_tn�°M=L provide tam Worli�s' cow.poii� numb. Y am an fmpZOyfr that iST7-OVi�LT C WOr-kerS �arrzpensaiion insurance far ` �rnplov �eZvw is to A polz^t and job sib zforrrz�.arz -1s-t,rance Company Nam.a: !iB P i Y I�LJTU L 11�5UR.,IJr� CDtJIP. NY ,�5 � Date:; at 03 J 15 / 2013 olicy 1 or Self ins. Lic. VVC1-S41- .080E-D52 fpi-asoL - ob Siz Address: \ 3 I C-4 ..-'} (�a Ci Lttach a coP3- of the workers' compe anon policy declaration pale (showiuc the polis;! nnmbte^and eypira'aon datej- allure to secLre coverage as requrPd under SeCtlon 25A o'-IVIGL c. 152 can lead to the imposibon o Orilruna] penalises O a .00 and/or-one--year imp�isoD mcnt ass vwtD a=. moil penalties in iae zol� Of a STOP�+�OPY ORDER and, z nue ne up tO S1,500 f Lip to 1250.00 a day' against the violator. Be advised that a copy Oj th:s statement Tnay be 1or-w dtcj to The Of-lee 01 r�'estirations of the DIA for insw ance coveTa�`verirication. _ do hG'TeI77% Ce7ZZf% LLrcdeT Zh_e➢QZ7'LS ani prnaZrLs 0rpi°rwMI LyiC,JIE in formarjor pTOVLded above 2s a-d cOMacZ 03cm � 13/201 Jar?:! v Some Official v_se on17. Dc no rvri�e -71h'_5 a_°1, tG OP cOmp!�i�d b` ai 1- DT iOrVY O Cif;- or Town: �ermit��icensc= s sumpt -LP B, crL' Jl �iccl_r ril1C}r c p-_ _ I 6. O-her =hr,rF= i i COMMONWtAALTFI-oiF-MASSA cF"U§ TyS ewo-pam, PLUM LICENSED BERS ANP GASFITTERS AS A JOURNEYMAN PLUMBER ISSt 1ES THE ABOVE LICENSE 7.0: BENEDICT J $REITUNG 52 BUTLER ST SALEM NH 03079-392+4' 309$ 05107./15 1075G5 - . F15H.7Ann DORM Alnnp All p,_gorofiors r. i s