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HomeMy WebLinkAboutMiscellaneous - 14 LINDEN AVENUE 4/30/2018 14 LINDEN AVENUE � 2101022.0-0002-0000.0 Date.......Q.. 113 5" 7 ,410R ft TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING ssACHU This certifies that ...t.... ......... . has permission to perform....... ................................................................ plumbing in th buildi5gs of.........vs..!c N.....44. ...•....................................... at.14....wkc................... ................ Mass. ......... ..... F e e ......Lic. No. ................... .............. PLUMBING INSPECTOR Check 4t ,+ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK lowCITY L ( MA DATE ( PERMIT#. JOBSITE ADDRESS /E� �Pt p iI_ OWNER'S NAME POWNER ADDRESS TEL JIFAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION: REPLACEMENT:PQ PLANS SUBMITTED: YESE11 NOE FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I _ J]---!I___—..p -_ _._.lI __f ___ _ _r_1 ._.____t __-._-1 _-_,_-j i DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _-f .-___._J _-.____I --.------► .____.� _ i __..__.__I _.._..___I. .____.. .._....._1-.____. ._...._.f ._....__f ._ f ..____-! FOOD DISPOSER __ ► ._..-___1 _._.._.__E ______f __.__. ` ( __.._E .__.__...1 ._____1 __� 1 ._____ ...____I _._.__ ( ____.� FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN i ._.__J ---- SHOWER STALL SERVICE/MOP SINK TOILET URINALI___ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES _I I _# 1 i , f _ ...__.._.I ._.� L .___4 1I A WATER PIPING i ( i � OTHER ..�._-=.�._..._� ( _� i .---..._.1 i i ( -----._.( f ...___._i ._.__._...__I f f INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ]f NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY4 OTHER TYPE OF INDEMNITY L- BOND M 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 hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be! compI' a with all Pert! rov on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME � � LICENSE# SIG URE Mpg JP n CORPORATION 0# _(PARTNERSHIP P# LLC[� r COMPANY NAME ! _ ; ADDRESS Lit �k CITY - ....__.._.._.... .y STATE ZIP 8 � � j TEL FAX L CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ L o - FEE: $ PERMIT# PLAN REVIEW NOTES y� t' The Commonwealth of Massachusetts Department of Industrial Aceidents r I Congress Street, Suite 100 Boston,MA.02114-2017 www.mass.gov/dia o2M 5��y Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. /,lease Print Le 'bl AU' licant Information Name(Business/Oigariization/lndividual): Address: City/State/Zip: Phone#: ; �a.. A.re you an employer?Check the appropriate box: Type of project(required): em to ees full and/or part-time).* 7. ❑NeVV'donstrudtlon 1.Q I am a employer with • • P y 2.❑I an a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[Noworkers'comp.insurance required.] 9, ❑Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10❑Building addition 4,❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 4 proprietors with no employees. 12.Q Pr—tg repairs or additions 5.❑I am a general contract.pr'and I have hired the sub-contractors listed on the attached sheet. 11 Ro6f re�airS These sub-contractors have employees and have workers'comp.insurance.t 14. Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c- 152,§1(4),and we have no employees:[No workers'comp.insurance required] *Any applicant that checks bbk#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such $Contractors that check this liox must attached'an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workerscomp.policy number. 'compensation insurance for°my employees. ,below is the policy and job site X am an employer that is providing-workers information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: 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 MGL e. 152,§25A is a criminal violation punishable by a fine up tod a fine of up o $250.00 and/or one-year imprisonment,as f this statement may be forwarded to the Ol as civil penalties in the form of a ffice O Ian ORDER day of the DIA for insurance a day against the violator.A copy o coverage verification. jury that the information provided above is true and correct I do hereby certify under thepains andpenalties ofpe . Date: Signature: 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#: � r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their eaAployees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hvee, 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 ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'ox 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 applicantmho has not produced-acceptable evidence of compliance with the insurance coverage ieegi fired." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." I Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city ox 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 workexs compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license numb ex 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"fob Site Address"the applicant should write Fall locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Date.......Ifx..:5 .................... OF NORT►y,� 0 °°� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SS ICHUS� This certifies that .. -ll '................ 1 � ............................................................. has permission for gas installation .. �/.I�r............................................... in the buildings of...............1'.. i...... � ........... / / at.....f�.L/. ,r.....,e�.�..U,0L................................., oath ndover, Mass. Fee..... -owPL.ic. Nol�?.L�,��. .......... ... ....✓' ..... ........... GAS INSPECTOR Check# 10161 r ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYP II MA DATE Y r PERMIT# JOBSITE ADDRESS I ,�` , -ruJ4� OWNER'S NAME V OWNERADDRESS _ TE _ — FAXL_ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAIy, PRINT CLEARLY NEW:El. RENOVATION:E] REPLACEMENT PLANS SUBMITTED: YES D NO Rj APPLIANCES 1 FLOORS-- BSM 1 2 3 1 4 5 6 7 8 1 9 10 11 12 13 14 BOILER ' BOOSTER _ 1­3 --�- CONVERSION BURNER COOK STOVES DIRECT VENT HEATER DRYER 1 c FIREPLACE FRYOLATOR FURNACE GENERATOR _ I ,-. ( � I —i -. I _ � __. - 1 j GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT . OVEN POOL HEATER ROOM/SPACE HEATER I R OF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _dTHER ........................... - T INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY �I I OTHER TYPE INDEMNITY Ej 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 E- AGENT Ej SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance all Pertinent lo f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTERNAME Y �""" – LICENSE#� 'SIGNATURE MP MGF EjI JP [I JGF LPGI® CORPORATION C]# PARTNERSHIP 0#L---.�..:�_..9 LLC E3#LSI COMPANY NAM ADDRESS CITY _ __—� STATE ]]ZIP TEL W 'I Y Q FAX — CELL EMAIL _ i 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 y 3 o The Commonwealth of Massachusetts _ Department of IndustrialAccidents Congress Street,Suite 100 _ Boston,MA.02114-2017 �` www mass.gov/dia o�M sy1V� Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERWTTING AUTHORITY. ' .,Please Print Le 'bl Alicant Information "Z6�.Name(Business/Oiga-iization/lndividual): Address: City/State/Zip: - l et. 0 t l:� 3 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(frill and/or part-time).* 7. ❑NOw'd6nstr6ction 2.❑I am a sole proprietor or partnership and have no employees Working for me in 8. Remodelilig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I1.❑Electrical repairs or additions . ,F proprietors with no employees. 12,[]Plumbing repairs or additions 5.❑I am a general coniracto and I have hired the sub-contractors listed on the attached sheet. 13%[J R66f repairs These sub-contractors have employees and have workers'comp.insuranee.t 14. Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§l(4),and'we have no empldy6e [No workers'comp.insurance required.] *Any applicant that check's box 4i must also fill out the section below showing their workers' compensation policy information: Homeowners who si&m i,this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such TContractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date:. Policy#or Self-ins.Lic.#: lob 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Iuvestigdtions of the DIA for insurance coverage verification. X do hereby certi r thepai d allies of perjury that the information provided aho a is ue and correct. Date: Si ature: Phone Official use only. Do not write in this area,to he completed by city or town offlciaL City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empl`o'yees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of bine, 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 receivefdr,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 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 requi'red." Additionally,MGL chapter 152,§25C(1)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 numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial-Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant thai must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia Location AJ f4yL No. (2,51 1 Date v,3 0 6 9 — NORTHOf A TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ s„CH„sE<� Foundation Permit Fee $ _ Other Permit Fee $ RECEIVED P YNQTr Connection Fee $ Water Connection Fee $ MAR 'a �MOTAL N®.Andover Collector Building Inspector 1 4 Div. Public Works PER-MIT NO. 6�sI APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 IAP K40. I LOT NO. 2 RECORD OF OWNERSHIP iDATE BO K PAGE ZONE SUB DIV. LOT NO.`, y— LYJCATION t� PURPOSE OF BUILDING 714 OWNER'S NAME NO. OF STORIES S OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME .4 v SPAN -- DISTANCE TO NEAREST BUILDING (/V DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOA ORD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST d 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 BE FILED AND APPROVED BY BUILDING INSPECTOR DAT LED "� BOARD OF HEALTH SIGNATURE OF OW OR AUTHORIZED^&T OWNER TEL F E EO . CONTR.TEL.# 7 CONTR.LIC.# PLANNING BOARD PERMIT G gT 19 / BOARD OF SELECTMEN BUILDING INS CTOR I BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _rO TORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY FFICES 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 HA —_ —— PIERS TL—ASTER _ DRY WALL UNFIN. 3 BASEMENT 1 I AREA FULL FIN. B'M'TAREA '/ 1/7 1/1 FIN. ATTIC AREA _ NO-B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD\N'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 BILK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIORI� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SF{);NGLES 4AVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & 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. &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 IL O B'M'T 2nd _ ELECTRIC _ 1 ststC'13rd NO HEATING C,J L_.U L V ..-�: L 4 ✓ u �,,..a..�-- --®.c' @-/J LI�J .':LiL✓ �r i/ ',� I, , I'� �'—� ■ L \ ! r y T _ own of 6 0 n over ` PRIEWAY ENTRY PEW01T � � _K�� � er, Mass_ /'�� 199� C HEWICK _r...,... AOR P�\�. SS 1 F BOARD OF HEALTH RMIT _ PE T LD A;5. THIS CERTIFIES THAT.I..a.................:........... ..7.... ...4 ........ ......................... BUILDING INSPECTOR P u$101*116.t b�� Rough haspermission to .... ........................... g � *-0jj1W-- -X•• Chimney toped as........ .... .... .............................. Final provided that the person accepting this permit shall in every respect conform to the"terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this P mit. PERMIT EXPIRES I 6 NTHS ELECTRICAL INSPECTOR Rough UNLESS CONST UC T TA S Service Final ... . ... . . ... . . .. .................... .......... BUILD INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector e .. 1 � !Y�`tlltiv,�GY{ Y1J(11��" , ..CYltivr6r4R yr t,.• ds yfrfil��in l' It":�';v''�.� �1�V'' `�' ,•,,. , ��•r� �,• i lull. '.",• r yf t�t r,\, l.,,'it.d.1,.11� ,.. . - � �•J ' ,• If! �� I��l it t 'I�(l�,!'1�1'II`l�'�1 1 ;•ft�� 3� �' 'x►""v r l�lJlllr l �! �( NO r� 1Q .O,I' ' 1 R,I H''j� N' 1 0\/ ..' ;. <•, SYSTCM �0( ATiOh Pi�jfJ�� (r'xrmp1t: Icfl (ronl �' I . '.:,41 ';i.•r'I�• '�:f,�'�;ti+ ,'I�c;:'.',v�i;,''f f:.t;�� 1'j. �' 77, •��i.. ,plri•�1� , ,•il - ✓ ' t Irv,�l 6�ft1 1lS br�b�Jjffirill,{'/ �'^ ;"1 1,..:._ � � .. u SII c �VAN1`ITY. RUM('CO %d ' '',+.j•4 i 1rt�(�V•(�U.vhj'(I'Y,l�l�( }i�f�lw�.V`3Art,llll�� ,I. •,I,', w,,'� .. ---�• YES SEf TI T ,r• I - ���'`' � � I I � ! I'll-.til r .� � � �• �'.�TUKE''OFrSER,YICC, ' ROUTih{E. EM SRO SO n . i;r' 4',UVO',C,Uf�Ull�'Il N F'u L ;T ` �A CH F1 r L O I � ` F1: ODES'. . --- $5'Q4°IU�r�6R�iY�YR �' PV "n"' OY t ;.� ,'1"�� 'i��w�'f�,l%aj1!I''''"f'I/4 '.Y�,��+•'I�Ii��!t''���'� `as Oil'1,'i' ^ � (•;r.•1:7,o-'ffifr�l'rl:,..,1'4Y� 'Y' '''I d.' r•'1 1 Y;1�3,,y„1�,.,,.`�ul:;lil,•,t,l'•V ,�,; .�' .. .... �.� ilk tot III,.'Jh''.1�' e•11't: .f ,. , ' .r tr.➢ r��y'll t�/{,l� ll.�/ J�1J1.11I••��'itilr�+rffl,, a-i ,r . . _, , It 1� 1, r� 1 Yrlt 'i4c11 t IrJ,ll���.ll',S” Vi . 1 I • . � U�„� � � iJ 11ZaNS.�C1(I�GD 1U ' .. - �I it ' (I IiF,Jo fit >I ,Id lt�l�• 'r ,fil„ 'r.'- .. '.. �. � I . Date .......... ........ . .. ..... ,&ORT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING 't-S CHUS This certifies that ... ........................................................ . .............................. 74 d has permission to perform ...................................... wiring in the building ........1....:.. .. ....... of........ ......... . ................................................................ at.�G�... ... . ..../ 6/ ......................../? ., ............. .North Andover,Mass. Fee.4, Lic.NoF4&- ........ ELECTRICALJNSPEI-�-'R ...... Check # --- 5777 11M UUIVLLVlUIV VVr l"[I Ur 1r1tL3LV1V-"LJL .i i C --�v�/� •r�� DEPARTMENTOFPUBMSAFEN Permit No. <� / B0ARD0FFMPREVFIW0NREGUL(W0NSR7a R,U0 Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASS CHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date '�, 6 - (2 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work d cribed below. Location(Street&Number) Owner or Tenant C Al A/l:Z t,-7 /� Owner's Address `t L =,7 7 771 Is this permit in conjunction with a building permit: Yes '' No (Check Appropriate Box) i Purpose of Building i Pi t Q ' Utility Authorization No. Pu g h tY rp ' ��-\ Z Volts Overhead Underground Existing Service .1 � rnps : / gr 1:3 No.of Meters New Service Amps Volts Overhead rUnderground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 0 t.0 e_ L-in-r No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round 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 -4 Tons No.of Disposals No.of Heat Total Total No.of Detection and IL Pum2s Tons KW Initiating Devices Noaof 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• hrxurta=CovWge.P►aa=totheta4marlm1sdNbmacW ltsGaEdLaws I1ja�eaumailia6�YhmaaneR> j'inclz�g('omPlete Co oritss�bs legttivala�t YES 10 NO IbarestftiWdva5dMdof=wlo he011ice YES I ffywharedrek#idYfN plea9eindra drl peofaN gby dredargttte bout ,`� RAW OHERfyl Estirrl*dVatreofEkchralWcrk$ s®G ao worklosm l Rid Final S>g<redunix-I iePtrialtiesof RFMNAME i- / / (\' e !�I G�y t c 4,� l Ix eNo, Licerme 0�(�6 t1• V L'1���1/1 SiIre I.ioa>,seNo Btsi=TdNa At Td No. OWNER'SINSURANCEWA1VER,IamawarethattheI-x doesnothalvetheirraaa= oritsakshiMa4ivalt:ntasm4*edbyMassadmM CUnwLaws ,c arKidu s m,& waives my gnaaae P� m4kmt (Please c eck on ) Owqor Agent Telephone No. PERMTr FEE$ -17(s- signature ure o caner or AgenE