Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 1451 GREAT POND ROAD 4/30/2018
1451 GREAT POND ROAD 210/062.0-0059-0000.0 Date...... . .....l. ....... of NowrN,h TOWN OF NORTH ANDOVER ° p PERMIT FOR PLUMBING i ssACHUS� a ' This certifies that................. ..... .......'.....!.!......... :-dlt-�................................ has permission to perform...... . .....rf..��sj-................... plumbing in the buildings of .......... P.. ... 4...................................................... at....., a ........ eY.�' ....... North Andover, Mass. Fee.2.�Y....Lic. No. t D.`1 j... ................................................................................. PLUMBING INSPECTOR Check A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 7 a CITY MA DATE f PERMIT# 0 JOBSITE ADDRESS �`�SI v• - � OWNER'S NAME _?{�,��� POWNER ADDRESS r��-c � TEL F— __.__JIFAX TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: M RENOVATION:W REPLACEMENT: Q PLANS SUBMITTED: YES NOM �L FIXTURES"I FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER € .-- _.-€ _-_! _ _ _€ .___) _-- { __.._J J _..-..J _ _J € ----.._-€ 61N DRINKING FOUNTAIN € -__-.J ..-_ I ( _._._€ ! __..._._I ! ..__.__.._.( _.-.._...! _-_ -_-! _-...._i FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) ( ! ._.,.J M.___J __I __..__J ...n __! KITCHEN SINK ( -- I �� -._- ( I __.� I J .__.. ( ____-- I LAVATORY ( _ ! __._---( __-_-. f ..___J I ROOF DRAIN SHOWER STALL i ..___.._ 1 �I E---7jj ____Y.I _-___1E_._.! SERVICE/MOP SINK _ ( _^ f _ _€ --___€==---I _ TOILET ! € € J _i J== URINAL I WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATcR PIPING OTHER _ _ �s _ _ _ __ E € I ..__._._.I .___..-� € ' .-----.._€ _.....__._► .....____€ _€ f € ...__... P _____€ -1 --j -__ J _ € INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESK 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 © BOND DI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Q PLUMBER'S NAME c c. ¢.l LICENSE# �� y`�I SIGNATURE IMPu€ JPCORPORATION D# PARTNERSHIPQ#®LLC # COMPANY NAME f o,y� � ADDRESS CITY {� V(v1� _ ]STATE I,¢�cr _ ZIP P S �� TEL P FAX _ CELL EMAIL RO H PLI BING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL JINSPECTION NOXES li Yes No r THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r 7� The Commonwealth of Massa chusetts z Department of IndustrialAccidents :-- d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): / A, G�-te r n�ti Ge! Address: /2 City/State/Zip: Vg� C uc� N 4t ©16X-Phone#: 73 Are you an employer?Check the appropriate box: Type of project(required): 1 Rl am.a employer with �.. : employees(full and/or part-time).* 7. El New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $,,IMemodelirig any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t � 4.r]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.EJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance. 13. Roof repairs 6.❑we are a corporation and its officers have exercised their right of'exemption per MGL c. 14.Q Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] 7. *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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. . I am an employer tliat is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: 1AA V__ Policy#or Self-ins.Lie.#: Expiration Date: �� Job Site Address: S / ��7 � City/State/Zip: A) /4 it r 0 1 S�Ct5 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under thep 'ns a enalties ofperjury that the in ormation provided above is true and correct. Signature: Date: Phone#: ?t6 / Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for theiremployees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation'policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom ` of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple 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 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-MASSA-FE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Date-1.1,-1...[M..<...................... °�NOariy,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ' ssgCHU This certifies that .............d... .. � C ` has permission for gas mstallation ............. ............... ....................................... in the buildings of..............�t...2�........ ............................................................ at.............1..4.................................................��- ...P :.`.`..�9' North Andover, Mass. Fee.. ....... Lic. No. ..r. 1.. ..................................................................... GASINSPECTOR Check# ISI MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I CITY � MA DATE �/ PERMIT# S �� ��,,,,�,� _ C�- iii V JOBSITE ADDRESS / �f 5�/ I/ OWNER'S NAME I_— 2–& G' OWNER ADDRESS TEL _ _— FAX fYPE OR OCCUPANCY TYPE COMMERCIAL[J] EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:.0 REPLACEMENT:® PLANS SUBMITTED: YES 0 NOE] APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 S 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACES FRYOLATOR FURNACE GENERATOR GRILLE r INFRARED HEATER LABORATORY COCKS �— MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER �— ROOF TOP UNIT TEST UNIT HEATER _ —I UNVENTED ROOM HEATER i =1 WATER HEATER - OTHER F -.1 INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JJN NO [j I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Rf OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in ca►�ppcliance wit :11Mpenprovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (/, t PLUMBER-GASFITTER NAME .1 _q ��( LICENSE# SIGNATURE MP KI MGF 0 JP 0 JGF 0 LPGI CORPORATION Q# PARTNERSHIP®#=LLC&J# COMPANY NAME: _ ADDRESS[. CITY 4 STATEEZIP .TEL FAX CELLEMAIL W _ ,,,"VOUGM GAS INSBVCTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION N S k& Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES w `1 r The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am.a.employer with . employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. �Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. El Demolition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.F1 We are a corporation and its officers have exercised their right of'exemption per MGL c. 14.E]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-con`traciors have employees,'tlicy must provide their workers'comp.policy number. I am an employer that is piovidiing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: ' Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sijznature: 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#: r f Information and Instructions !`f Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." " An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub'contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation'policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current r 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-NIASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia .a, -_- � 'OWMmot . :' i Off.h. . so QF ' lSIIES TF{ .:E OLL6W UtB.Et�s�i3: MRCO ISE "DR GT6 992Q4 10 OMMONWTH OF:M U � • • PLUMBEASFITTERS . [SSULS ?tib FaLLOW1 C Gft L 1 At E—, U. 1tltiEHAEL M MARC©CSX' . I GO P 1 [G HEAT IR,, a1MU ov MA o1826 o /o t8gg20 �; I 3 t y i ti Date... ��.............. R r►ORTN TOWN OF NORTH ANDOVER n PERMIT FOR WIRING ,sSACMU5�S� This certifies that ................ `✓`(1 G...Zj......L. C .. ..... ....................................................................... has permission to perform ............ �' ���'r�.I.r `"� .... .................................................................................. wiring in the building of.................. P .P...(e�..........,..D ..........nn................................................... � e ` '""."�.....led'North Andover,Mass. at ................................................................................... � Fee...2C.........1. ..........Lic.No. ................. ......................(...................................:. ...... .............. r� ELECTRICAL INSPECTOR Check 4t The Commonwealth of Massachusetts Office Use Only Department of Fire Services Permit# 7,J 4 BOARD OF FIRE PREVENTION REGULATIONS Occupancy&Fee Checked Rev.1/07 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code(MEC), 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: May 5,2015 City or Town of No.Andover,MA 01845-1215 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) 1451 Great Pond Road Owner or Tenant Arthur&Michelle Zerbey Tel. No. Owner's Address Same i Is this permit in conjunction with a building permit: Yes �X No (Check Appropriate Box) Purpose of Building Utility Authorization No. i Existing Service Amps Volts Overhead Undgrd No.of Meters \ 0 New Service Amps Volts Overhead Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Kitchen&Sun Room Remodel Completion of the following table maybe waived by the Inspector of Wires. R No.of Lighting Outlets No.of Hot Tubs No.of Transformers No.of Lighting Fixtures 21 Swimming Pool Generators No.of Receptacle Outlets 23 No.of Oil Burners No.of Emergency Lighting Battery Units ,No.of Switches 14 No.of Gas Burners FIRE ALARMS #of Zones No.of Ranges Gas 1 No.of Air Cond. Tons No.of Detection \ No.of Disposals 1 No.of Heat Pumps kw No.of Alerting ^J No.of Dishwashers 1 Space/Area Heating kw No.of Self Contained Ux No.of Wall Oven 2 Heating Devices kw Local Municipal Other No.of Water Heaters 1 No.of Signs Data Devices No.of Hydro Massage Tubs No.of Motors Telephone Devices 1 Other: (1)Sub Panel (2)FHW toe kick heaters (11)LED Post Modules,(6)LED Riser Modules, (1)Transformer Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: $12,270.00 (When required by municipal policy.) Wo,,kto start: May 5,2015 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue miless 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 the exhibited proof of the same to the permit issuing office. CHECK ONE: INSURANCE F-7 BOND[ OTHER r(Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true&complete. FIRM NAME Dumais Electric N LIC. NO. 12170A Licensee Mark A. Dumais Signature LIC. NO. 26665E (If applicable, enter"exempt"in the license number line.) Address 8 NewportStreet Bus.Tel. No. 978-683-9438 Methuen, MA 01844 Alt.Tel No. 978-685-4553 *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 insurance covera a normally required by law.By my signature below,I herby waive this requirement.I am the(check one) owner 1)wner's agent Owner/Agent Signature Telephone No. IPERMITFEE: �^ f , . _� ..r - - r I �I i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 5�•` www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Dumais Electric Inc. Address: 8 Newport Street City/State/Zip: Methuen,MA 01844 Phone#: 978-683-9438 Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 9 4. ❑ I am a general contractor and l employees (full and/or part-time).* have hired the sub-contractors 6. L]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' y p n'• 9. L] Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.® Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Insurance Company Policy#or Self-ins. Lic. #: U137C833078 Expiration Date: 2/2/16 Job Site Address: 1451 Great Pond Rd City/State/Zip: N Andover, MA 01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct. Signature: _7n. 0. 644/11� Date:5/5/15 Phone#: 978-683-9438 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual, partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Revised 7-2013 Fax# 617-727-7749 www.mass.gov/dia Please visit our web site at http://www.mass.gov/dpl/boards/EL DUMAIS ELECTRIC INC MARK A DUMA I S (EL) 8 NEWPORT ST METHUEN MA 01844-3425 Fold,Then Detach Along All Perforations QQ ;COMMONWEALTH OF MAaSAO`HUSETTS.:«.::.> BOARD'OF ELECTR 1 C'1`ANS {tSUES THE. FOLLOWING Lj,CEN5E 1S 7 REGI STEi2?~D MASTER E ECT,R 1 C IAN' DUM:AIS ELECTRIC y, y 8 NEWPORTyST` _y t METiiuEN MA 01844-3425 21306 . . Please visit our web site at http://www.mass.gov/dpi/boards/EL A� MARK A DUMAIS (E L) 8 NEWPORT ST METHUEN MA 01844-3425 Fold,Then Detach Along All Perforations COMMONWEALTH OF MA,SSACHUSEiTS:.;;;, '< 60A D'Of ELECTR I Cl ANS :. ISSUES .THE FOLLOWING LICENSE, s..: AS A: BEG .EL TOURNEYMAN ECTRICIAN Q F.. a MARK A DUMAIS �. 8 NEWPORT ..ST` . ? METHUtN MA 01844 342,E 26665.E 07/3 06 :::; .j 27307 Date. !ql!�.... ... . HORTM 3=pry`t,.ao ,e�tipL TOWN OF NORTH ANDOVER O 9 PERMIT FOR GAS INSTALLATION . y SACHUSE�S This certifies that . .�5?.��'`. . �?'� r^�. °`S ' has permission for gas installation Y. . . . . !� . . . . r in the buildings of .2:e- (Z :L� . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . �, . . �P° r�?. . . N rt An v r, s Fee.�A.M . Lic. No.T�`.a. . . . . ' (2 GAS INSPECTOR Check# 8199 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) IVO ,� e., Mass. Date City,Town Permit # Owner's r Building ) �. .j^ N�lme AT: Location Type of Occupancy: New Renovation ❑ Replacement ❑ Plans S Witted Yes ❑ No ❑ N y $' N NV 6 F Cd 0 O O y S O J Ct W rM cc v m = 0 Z O Wag 4 z O O O Z 1-1 b < W < Y Z f' N O W tj N fC 03 W 2 < Z aC aC G7 W W ~ W V J ly.. W 0 1W- Z .Jg f Z 1- H r N m Z 0 Z W O N = G Y < W < {C < Q < O O W O W H :5 L. 14 W o tr y s u�. 3 o c� 0 o d r a Su B—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 7t 4TH FLOOR 6TH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Check One: Certificate (Print or Type) Installing Company Name To_=gend Oi 1 CO Ince ® Corp. Address 27 CherryStreet ❑ Partnership _ ❑ Firm/Company nanverS, MA 01923 a Business Telephone 978 777-0701 Name of Licensed Plumber or Gasfitter ^InQ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. I have informed the owner or his agent that I do not have liability insurance including completed operations coverage. P Signature of Owner;' nt I have a curren liabil' ins ranee pol' y t elude completed operations coverage. ❑ By lv l Z TYPE LICENSE/lignatu r LicensedTitle ❑ Plumber or Gasfitter City/Town ® Gasfitter ❑ Master APPROVED (OFFICE USE ONLY) ❑ Journeyman License umber PER3,ff No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 . MAP 4J0. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE — ZONE SUB DIV. LOT NO. LOCATION�S-, G��'�" � RPOSE OF BUILDING OQ ` /1]�T,k ;�l J /d�'"4 1Gl _, 9YVNER'S NAME y-�sJ1NvYI�/ 5�2 �I NO. OF STORIES r-C7�+" SIZE ✓ �L,PNf-NER'S ADDRESS V/(/G C-1 OjA BASEMENT OR SLAB ARCHITECT'S NAME TT OF FLOOR TIMBERS IST��/D 2ND 3RD ILDER'S NAME �� SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS ?STANCE FROM LOT LINES-SIDES //jyf REAR " " GIRDERS AREA OF LOT jVV FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW OF FOOTING 8 X II ILDING ADDITION y4E7�' MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES T. BLDG. COST cqv`/� PAGE 1 FILL OUT SECTIONS t - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 L-SATE FILED / NUILDINQ INSP[CTOR 81 A RE OF or;; W ER O UTHORIZED AGENT ti F E E �ZS^. OCA OWNER TEL.# PERMIT GRANTEDCONTR.TEL.# ZZ 19 CONTR.LIC.X H.I.C.# 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 S INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HLA,TER PIERS PIASTER _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ '/ '/i 1/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS 8 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARD%'J'D _ ASBESTOS SIDING _ COMMCN 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 WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE 1 IP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.( FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROIL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. S 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 1-3'dNO HEATING NORTFI Town of r 6Andover 0 .,10.4 S for dower, Mass., 2awr �.� 1911 �A0RATED G.P� "ys BOARD OF HEALTH Food/Kitchen PERMIT T D I Septic System f THIS CERTIFIES THAT t�.'�C...... .,... .Q, �r.4�`�� . ..... (�,,,,............................................ BUILDING INSPECTOR "' """' Foundation lt p EGLL ....... Rough has ermission to erect.....................::................. buildings on ..., .. . ...... /��C......1..�'a4:.:��............ ...... gh to be occupied as.... ......`F....!Z� 17........ � .......V: .Q�__c:x ...................................................... 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 I i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXP SIN_ MONTHS UNLESS CON TRUC N 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 I Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT d. d Y /" Y C v II f` Y /u Y l v aSF . Id k 56 % Y � Y l6 � a N 9h�e�� 70 11 C C- r Ky YYY 77 •-� __. � _. �, . .. _.__ . � �g� axil_ _ � ..-------.- � _ . __. . .._ lo 3 � Town of North Andover t NORT#q OFFICE OF 3a o•`". 410oc COMMUNITY DEVELOPMENT AND SERVICES A ♦ p9 ` 4 146 Maul Street ,, "�,,r,o•.�`c5 KENNETH R.MAHONY North Andover, Massachusetts 01845 9SSACHuS�t Director (508) 688-9533 HOMEOWNER LICENSE E_iF.'.1v1PTION Please print. DATE a g� JOB LOCATION q pal-0 AW Number Street address Sectio/n� of town "HOMEOWNER" �O94P14 N7YZ ,e?-2/ 6!5q— Name Home phone Work phone PRESENT' MAILING ADDRESS jV-S:2 ��A - ��D YW Cdr r41-��0� ^,tA City/Town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he:she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-vear period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes. by-laws, rules and regulations. The undersigned "homeowner" certifies that he-'she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE :APPROVAL OF BUILDD G OFFICIAL Note: Three family dwellings 35,000 cubic feet, or lamer, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF APPEALS 688-9541 B=ING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D.Robert Nigeria N is had Howard Sandra Starr Kathleen Bradley Colwell TOWN of NORTH ANDOVER AFFIDAVIT Hme hp:m t Contractor Ia# Swlanent to Int An icatio n M�c. 142 A requires trot the "racanst amticn, altsatic n, mvmda4 nor, modenznration, oanyeadrn, igXMEMnt, rauml, d®oditicn, cr canstnntim of an adiitaan to any pre- adstirg build- irg cmtaird% at least are but not=re dmfs r dwellirg units...or to sti bxes 4dch are adjacent to such residErre cr ht<ld!W'be doe by re st contract , with certain emacs, slag with other �quir�ents. Type of Work: Dock Est. Cost ODp Address of Work /CSS/ C I ypep Owner Name: Jd,s X14 -T k3fiam-1)T74 `7)q Date of Permit Application: Vg_a; I hereby certify that: Registration is not required for the following reason(s): Far of Bee Use Qtly Work excluded by law P.Mnitrb. Job under $1,000 Date Building not owner-occupied =�� �linfyo)wn Permit Notice is hereby given that: OWNERS PULZ.ING THEIR OWN PERMTT OR DEALING WITH UNREGTSTERM COLS MCMRS_:- FOR APPLICABLE HOME 1MPROVaM WORK DO NOT HAVE ACCESS TO `IIiE ARBITRA- TION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed user penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Own ei- me i 1 J.330 AC. H LU 2 _3B.t 2 S'fORY —I9 MOOfi f � t I r neo ^,ERTIFIED f0. FIRf;f E,-;SFX THS PLAN IS Nor_IUDE FAON AN INS-F# J(T SUFiYEy NDT Tp gE.U9Ep FqH Ay( OTFfA THAN MORTGAGE. NORT}�N ASSOCIATtS ACCEPTS ��qq B LITY RESU.TINO FROM SAID RELIANCE OF NON MORTGAGE SERVICES, a II TATE THAT IN MY PROF(ESSI�NAL ppppINION INCIPALE STTOJC �la ~ RE A �p F THE LD_CALS� N ) E MITH T�SETBACX �1 REODURCDENISRYOF THE Locai IN8 ORDINANCES AlO THA TT}}#£AAEE � NO �p�(�ENTS OF MAJOR IMPROVEMENTS tI EA NAY ACROSS PROPERTY,LINES EXCEPT AS COMtlIITY. 9�Olt�` A I CERTIFY THAAT PROPERTY IS LOCATED IN FLOOD HAZAND ZONE ( 1 4 Mp SVS Location /S� / �•+C'�=f�7� /JGfiJ 1'�t� .Mo. Z-11Date Z V s �ORTh TOWN OF NORTH ANDOVER O? •' 1 R p Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s�cHus Other Permit Fee $ L <� Sewer Connection Fee $ Water Connection Fee $ RECEIVED FAY40TL �f, • y JAN 2 6 1992 f/ Buildinginspe&or -/ G No. Andover Collector Div. Public Works PERMIT NO. 62-01--,'Z DAPPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PACE i MAP h40. LOT NO. 3 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. wwj /511 I /OB JIB/ r i7 LOCATION PURPOSE OF BUILDING .-/ C AN OWNER'S NAME--ey.��y .. NO. OF STORIES SIZE -716,(/ OWNER'S ADDRESS ``1aAq BASEMENT OR SLAB )07// ,S41UAAQ 7V64-S7 ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST /1Q'� 2ND ' 3RD BUILDER'S NAME �ez " SPAN 10,7"/(70l` 'Tp PC A^V� rom DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "' " POSTS yX gr --- DISTANCE FROM LOT LINES-SIDES REAR " " GIRDERS /X Q- AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION �I[I� OO TS,�,4j4P15 THICKNESS IS BUILDING NEW n SIZE OF FOOTING o� X IS BUILDING ADDITION T�.,� ��/ y1� �57-���/- T �N MATERIAL OF CHIMNEY IS BUILDING ALTERATION r"K IS BUILDING ON SOLID OR FILLED LAND SdLI WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 7C�ViS2 IS BUILDING CONNECTED TO TOWN WATER �gT BOARD OF APPEALS ACTION. IF ANY -7 IS BUILDING CONNECTED TO TOWN SEWER yC�' IS BUILDING CONNECTED TO NATURAL GAS LINE /�JQ INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SbfFT. 1 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 k ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED ANDAPPROVED BY BUILDING INSPECTOR 6 DAT LED BOARD OF HEALTH S URE OF OW R AUTHORIZED AGENT OWNER TEL. S # NNS FE CONTR.LIC.# PLANNING BOARD PERMIT GRAN 19 BOARD OF SELECTMEN , � ; tt JAN 116 {992 I BUILDING INS CTOR BUILDING DEPARTMENT 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 _ 3 1 2 13 CONCRETE BL'KT PINE BRICK OR STONE HARDWD PIERS ✓ PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T AREA _ V, 1/1 1/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE — WOOr) SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMCN 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 WIRING STONE ON FRAME _ SUPERIORPOOR ADEQUATE II NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ 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 I I 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 GOAD B'M'T 2nd _ ELECTRIC 1st 13rcj, NO HEATING h _--jibNAL PLAWW1iNG_____'_F1HAL S EWE 1h Qff,8,717� 0 R T 11 own of 0 n over No. 020 pri , ,NIM AV )RIVEWerMass. 1957t AY ENTRY PSRAA11T - Al CME WICK Or BOARD OF HEALTH PERMIT T LD THIS CERTIFIES T1HIAT43ZW. #'.W... .. .. ... ...e 0 0*70...... . . ....... BUILDING INSPECTOR Rough has permission �M�fi,...r ...U. .-Po Chimney tobe occupied as...........: .... .................................................. Final provided that the person respect conform to the terms of the application on rile 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 PERMIT EXPIRES 1 6 M NTHS ELECTRICAL INSPECTOR Rough UNLESS CONST UCTIO A T Service Final A01 ' BUILDING INSPECTO GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises Do Not Remove Burner FIRE DEPT. No Lathing to Be Done Until Inspected and Approved by She SWIEET ot.NO, D Building Inspector Location Loca Z No. 02-0 Date 4V-4t MOItTM TOWN OF NORTH ANDOVER OD 3� o Certificate of Occupancy $ ------ 41 BuildinglFrame Permit Fee $ �— A..•�''�; Foundation Permit Fee $ — �1-- ��ss�cwu5�t C9 Other Permit Fee $ '-0I Sewer Connection Fee $ ------ Water Connection F $ --- , TOTAL IBuIldIn nspector00 Dlv.Public Works ' Town of North Andover BUILDING DEPARTMENT ' Homeowner License Exemption (Please print) DATE J� 9 JOB LOCATION /,S/ Number Street Address Section of town "HOMEOWNER"7as<PQN 1-3Aa-rnLo —t7A Name Home Phone Work Phone PRESENT MAILING ADDRESS L2 S_l �C-1-6-0T_ R5� 2,0 A20 N,06s 1 6YZ City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code, Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory to such use and/or farm ,structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , -that he/she shall be responsible for all such work performed under the %;building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and : requirements and that he/she will comply with said procedures and requirements . HOMEOWNER ' S SIGNATURE Jt eX APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 ,000 cubic feet , or larger , will be required to comply with State Building Code Section 127 . 0, Construction Control . FORM U - TOWN OF NORTH ANDOVER LOT RELEASE FORM SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENT ADBY D.P.W. STREET APPLICANT PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE APPROVED TOWN PLANNER DATE REJECTED CONSERVATION COMIIISSION ' DATE APPROVED CONSERVATION ADMI DATE REJECTED BOARD OF HEALTH DATE APPROVED 1 f D Ti HEALTH SANITARIAN DATE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY, PERMIT SEWER/WATER CONNECTIONS FIRE DEPT. RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Health Boards, the Conservation Commission prior to the issuance of any building permits for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or Bylaw. C + + VW o I. t T .n ' + n�lx + + + + + t Q + + t T d + t + + 4 MORTGAGE INSPECTION PLOT PLAN NORTHERN .ASSOCIATES, INC. 11 BALLARD WAY, LAWRENCE, MA 01843 - Tel. 617.975.7117 3220 MAIN ST., RTE. 6A, P.O. BOX 253,BARNSTABLE, MA 02630 - TEL. 617.362.8839 90RTGAGOP: JOE BARTOIL DTTA DEED REF. BK 1904 PG 114 LOCATION. LOT 3 GREAT POND ROAD PLAN REF. BK 1908 PG 114 -TY, STATE' V. ANDOVER. MA SCALE.. 1= 60 ' DATE: MAR.115/8© JOB #: 88/ 452 N/F ALLEN T UST so .ss r • V .'_OT # 3 1.334 AC. O LO 2 0 r 138't 2 STORY "`- 3± WOOD 7A ' t / reo VO CERT.TFIED TO. F-IRST ESSEX 9QQO IS NOT MADE FAON AN INSTRUMENT SURVEY NOT Top BE , HER THAN MORTGAGE. NORTHERN ASgOCIAT�S ACCEPTS NO RE�LITY VREOTRESULTING FROM SAID RELIANCE OF NON MORTGAGE SERVICES. I TATE THAT IN MY pPpROF(ESSI)ONAApL OpPIINNION PRINCIPALE STRUC URS a N IRQ� 7 OUTBUILDINGS ZONING ORDINANCE N��YppTHTHhl1� TH CK ARE NOENCAOA S OF MAJOR IMPROVEMENTSITHER MAY ACROSS LINES EXCEPT AS SH�ITY. C TE? T �3 PROPERTY IS ( LOCATED IN FLOOD HAZARD ZONE ( ) 4 NO ��♦ • Date`.. .a�.Q3 r ",O RT:1tiTOWN OF NORTH ANDOVER got PERMIT FOR PLUMBING ,SS'A USES e This certifies that . . /. . . . . . . . . .`... .. . .. . . . . .".. .. ... . . has permission to perform plumbing in the buildings of >. . . .. . . . . . . . . . . . . . . . . . . . ... . . , North Andover, Mass. ,I Fee?b.�. . . . . .Lic. No.. e" 0p. . 9 . . . . . . . . . . PLUM8ING INSPECTOR Check # �rL 8 56L')' � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) o0 Mass. Date e:7 /6 y�o2Dd?-� �`j ��`• J,=--�- Permit# Building Location �� g / �iP[r�T J�GN D Owner's Name M o ~y / /4L.SidE"V Type of Occupancy New ❑ Renovation ❑ ReplacementvC Plans Submitted _Yes ❑ No El FEATURES z U z z W O z t�— w _j m U Q W z w w Y Q Cr Cl) C/) w cn 1-- W U) 5 v m Q U) uO z z Z a- 5 U Cr CO _ CC Q W 0 Y T a Q a- Q � X � w O w Q cw cr Q W z o Q o7 z n m O U Q S _ Z Y 0 0O I— Q Y Q lil LL Cr Y uJ H O D Z Z 1- U = Y J m 0 E E Q � X � O O 0 D 0 Q � cc m 0 SUB-BSM-r. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR s 7TH FLOOR 8TH FLOOR -H� I /} Installing CompanyN,�a/�)me._Fl.'n/�'( rGU✓d�ry <i Check one: Certificate Address /9.5 1.FIl11(11=72)1~1 07'1e cT- /k El J=l_,)el5 z27/-, /'i�ld� /❑ Partnership Business Telephone -,;1,5/—/GSD ❑ Firm/Co. Name of Licensed Plumber s INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes g No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ _-Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Si nature of Owner or Owner's Acient Owner ❑ . Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Signature Uor t Title Type of License: Mast] Journeyman ❑ City/Town License Number_ APPROVED OFFICE USE ONLY) f t Date,`-•................................. NORTH Oq TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 73'gACMUSE� This certifies that .....:......:............................................... ................................ has permission to perform ....-..... -�a..... -�� ........................................ y wiring in the building of....::..:..: at.kk/z.............. ��<, l' ............................. ................ ,Nort Andover,Mass. Fee..................... Lic.No. ......r. �'— �. .............. / ELECTRICAL INSPECTOR Check # /7 45 , 9 a& Commonweulrh of 01111C- U1, Chiky m L)cPurFTntn'f 0.1 Pu b I i c Sofd r-Y s-/ BOARD OF FIRE PREVEtA11C)I-j REGULATIOt-4S S_11 Qtirl 3/9() PLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK CoIc, $27 CMR 12:00 (PLE-A-5E -.Ui 11TK OR TU'F- D CiU)' or Towt, of A14i TO Cha Inspector of Wires-, The uruersiyned appjLeS for, a ptITWIC Co 21CQQ1iC-a1 WOO, 'le:Scrl C1 C'Clow. C,.q-Lar o 12"nc Iz crus ptrmLr in conjunction with a buijot,16 No L;3--- (Check Appropriate Box) Puq.,asc of Building TTli 1-Y AuChQrizaftot) NO. CIN'dijiCad El undg-rd Q No. of F-cers— tl,;w p Q I V 5 Gver4=ad El UI)04-rd No, of Ilware"r.1 tii--t,tr of Feeders and Awpacicy L-ic-aclor4 and Nat:Lat of Proposed rjcQccl"l W.-zk No. of Lighting Ouclacs No. of Hot: Tubs Tcanifor-wers Total KYA No of Ligh Linz,F"ture s Swi'a4ing Pool gTnd, calleratQrs KYA Na, of Re c e p C a C:1 2 Clu r I d C s I NO. of Q11 hur-ncr5 No. of EmargenCT—Lioc-9 ,-- Un i C 3 iii. of Switch OutletsNo. of Cas Burners FIRE ALAMS No. of 7-ones of Ranges No. of Detection and No. of A'lc Cond. rails '- -- - lnicia;ing No. of Disposals No of litac 0CaYLo '1 pt.WuEti Tons k�w No. of Sounding Devices No, of Dishwashers Space/Arca Heating Kw 1,40. of Self Contained Detection/Sounding Devices NJ. of Dryers Heating Devices Local 0 Kinicipal,E]Or-bar C o ii n e c r-i o No. of hater h a e r s KW No, ofQ Of L-,w YC'Ica2e LknS �ai a,6 C S Wiring No. lydro. t4assage Tubs tlo. of hocors TQt:al lip INSUTLkNCE COVERAGE: Nr5uanc co Che requiremcfiQ9 Caf)e"ral L-Xd3 I have a current L�ioil'9 Insurance Policy "cludilig G`DwPleced Operations Coverage or ics substantial equivalanc. YE SO' No Lj I have subail- t�� ej valja proof of saAlle co this office. YES El No (D If You have check4d YES, please indicate rhe CY-pa of covera6c by checking rhe appfQpriace box. INSURMCE Z BOND [] OTHER Q (Please (Expiration DaceT Escizaced Value of Electrical Work Work- to SL3CC B,.)u g h Final Signea -u.Aer the PtUlLiCS of perjur, FlF-h NME Licensee ---ETC NO Dues AQ,2 r e 3 A-44 Hex -�/YARS �2 4L-f,:1 No, --q 4L 4)-V,,2 AIL, Tel. No. 0,.'rfZRIS LIASUR.A-HaZ WAIVER. I am uwace chat the 1-ice'14aa dozy nor have cha insurance coverage or c ub- ALanCi&l eqQivalanr as required by H"3sarhj.5ect;s C'Ral:41 --,10 h -Ira on chi3 pe i Owner Agent Qllacy' one) Chi"' p" application waiv43 chis rcquiremet-iL. wye) (Signature of farrier or Agent: