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Miscellaneous - 149 MIDDLESEX STREET 4/30/2018
/ 149 MIDDLESEX STREET 210/020.0-0006-0000.0 I i flc; DapaHillejji of Fire Services I'CrIniL No. e3 ZF BOARD OF FIRE PREVENTION R E GULAT(ONS �Rev. Occuirtncy::ntl Ice Cl:ccb:cd l Jf991 APPLICII�vork to be ATION FOR PERMIT TO PERFORM ELECTRICAL WORK pe`.crmed in accordance""ll'tt;e V tssaci,ase(ts Electrical Co:'c�iyEK S2?C1 IR 1?.00 �l'LI�SF-. PIU.!T IN INK OR T�I',F�J_L IRJ(()1�11A7:I�),�I) f City or Town of: ,K I)A ti Date: t ?o 111e I!l.spec;o!-of Wires:application tete undersigned gives By tnotice cf hts or her invention to Location (Sircv t& Yumber) p r(orm the electrical «ortc described belovv. L4 C -r = -- Utvnr.r or Tenant O«ner's Address Telephone No.,-, M is this permit in conjunction with a building permit? Yes Purpose of Building �� �,,;` j-t..� No 0 (Chcclt Appropriate Boz) Utility Authorization No. Existi"9 Service '�`1:) Amps iZC• / h(r 4'olis Overhead rr� r l� Undgrd No.of Meters New Service Amps , / —volts Overhead Dumber of Feeders and Ampacity i'ndgrd L J No.of Meters Location and Mature of Proposer(Electrical Work: c:em,le6un ofe folio thwitable n: be: n •revived by the Ins ectaro'h� res res. No.of Recessed Fixtu "' No.of CeiL-Sus No.of `" F (Paddle)Rans TramSarmers h^olt iNA o_of bighting Outlets No.of Hot Tubs / Generators KVA No. of lighting Fixtures Generators Pool rl d.e ❑ In- ❑ o.o .mergcucy ,rg itrng ' Baiter Umts No. of Receptacle Outlets Z No.of Oil Burners .1 ['IRE ALAR1%1S ',L, .of Loner No.of S+vitcttes 7 ----�____i d No.of Gas Burners � No.of Deteciton and No. of Ranges -1 fnitiatin g Devices No. of AirCottd. Total Tons No.of Alerting Devices No.of Waste Disposers i llcatPump Number Tons KW iYo.of elf-Contained Totals: -- ....._....... No. of Dishwashers / Detection,,+Alertin Devices SpacelArea Heating KW �� Local ❑ Municipal _ Connection ❑ other �No. of Dryers � licatinQ Appliances � KW Security ystems: .-- No.of Water No o °.of Devices or Equivalent Heaters K"' o.o Data Wiring: Signs Ballasts ' No.of Devices orEquivalent No.Hydromassage Bathtubs �- No.or Motors ! � Total HP. eleeommuumations Wain,: OTHER: No.of Devices or E uivalent rlrtach cdditional etail if desire.,or as required by the Inspector of 117res. INSURANCE COVERAGE: Unless waived by the d ow7ter,no permit for the performance of electrical work imy issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov5pge is in force,and has exidbited Proof of same to the permit issuing office. CIfECK ONE: INSURANCE © BOND ❑ OTHER Estima(ed Value of Electrical Work: .S Jt� '`' (l(4'Vlr :tpnation4 )ate) ien required by municipal oil Work to Start: t z_ , j p ') Inspectiotis to be requested in acoordancrr with NMC Rule 10,and upon completion. I cerci fi,under the pains arrd penalties of perjury,that the infortrration on this application is trite and complete- ['tRM NAME:`�+rt r .�Jr.v<� f=1.1 c- , , Licensee: t Wit. t ��• Sigrr:tturc r !!j a,�plicubte, eater"',exempt" jr�^1 '"`� LIC. NO.:�p�i in the liceri.re r,'irnber line_) Address: Bus. Tel. No.:`i 7y tfZ i ")ko•� 0`1YNk R'S INSURANCE WAIVER: I am aware dratthe Licensee does rot h,-�ve the Iiabitity in1surirceNcoverage normally regnired by lady-F3y my signature below,thereby%waive this requirement. tam the(cl►eck one)El o::ner ❑o:vner's,gen,.l/ Own,e!Agent Signature Teknhone No. PFR11417-r.•r,rv• a '{" 4 , ' Date �iIl �o.... .. NORTH 3? ` TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION h SSACHUSEt1 This certifies that . . . .6A14v. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . r),(��� �` -- . . . . . . . . in the buildings of . . . ��,tz/1. . . . '1!.`. . . . . . . . . . . . . . . . . . . at North Ando er, Mass- FV 5 W. Lic. No.. �,C).. . . . . . .��t�P� _ GAS INSPECTOR Check#���� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING CitylTown: /v Ab&+--21 , MA. Date: 10 /JL6 Permit# Building Location: N7 Nr©i) LsSC JT Owners Name: �f/� goo,ly Type of Occupancy: Commercial"❑ Educational❑ Industrial❑ Institutional ❑ Residential a- New• Alteration: ❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES tri z w z W WO m m O w v ~ U) p w >- z O LU rn w m p Fa- a tW- o 0 w X to > W ZLu 1! W O W W C > W W Z J FW- H O Z J lN. W F W O a Q Q Q m LU O z O N > z = J O a oaC > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 KLFLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate# Installing Company Name: Cf�/.L1���}-[ i �L}— �=/ � P-Eorporation Address:�/I EL!r � ,S% CitytTown: +ryQ puG��L State:_ 4 / r/ ❑Partnership Business Tel: �' &a 29;.-3 Fax: ❑FirmJCompany 0 Name of Licensed Plumber/Gas Fitter. F INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 Yes♦]No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Er, Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the ficensee 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 Owner's Agent By checking this box Q;I hereby certify that all of the details and information 1 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Type of License: By Ei f%mber Title ❑Gas Fitter Signatu icense PI ber/Gas Fitter [9-Master CityTrown ❑Joumeyman License-Number. APPROVED OFFICE USE ONLY ❑LP Installer 6183 Date................o.-d...................� � NORTI{ "° TOWN OF NORTH ANDOVER f PERMIT FOR WIRING SS CH S This certifies that ............................................................ ................................ has permission to perform ...' wiring in the building of.'t...j- l ............................................................ at�1��..� ..... ' ...v North Andover Mass. Fee...................... Lic.Nd"-...14 o ..:........... ELECTRICALINSP.LCTOR I/ U Check # __ Cpmmnt�eiOlth OfMassachusefts –__-- 7: Da Ze ►�t_3_ Department of Fire Services x Permit No. 7 —� BOARD - ' OF FIRE PREVENTION REGULATIONS Occupancy and Fee Clieckcd Rev. 11/991 (icave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL 1lVOR�C All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CN M 12.00 (PLEASE PRINT IN IAW OR TTA�SILL DVFORAM TIO�V1 City or Town of: 1� Date: a./l , <c�J j By this application the trtxlersigtted gives notice op h"IS o�her i tion to Tome Inspector of Wires: Location (Street& Number) a,j ' the electrical work described below. Owner or Tenant C_f 41 Owner's Address 10 M Telephone No.� Is this permit in conjunction with a building pe ntit? Yes Purpose of Building 7)� No F1 (Check Appropriate Boz) `wt`.. t Utility Authorization No. Existing ServiceAmps G /L C Volts Overhead Er Undgrd❑ No.of Meters j New Service Amps lZ / —Volts Overhead El Number of Feeders and Ampacity Undgrd❑ No.of Meters Location and Nature of Proposed Electoral Work: Com letion o the ollowln table be waived b the Ins croro lYirrs. No.of Recessed Fixtures "' No.of Ceil.-Sus No.o Total R(Paddle)Rans Transformers t'td A No_of Lighting Outlets ' No.of Hot Tubs / Generators ICVA No.of Lighting Fixtures Swimming Pool Ye ❑ - o.o mergency Ing No.of Receptacle Outlets v d' g'd. Batte Units No.of Olt Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and 1 No.of Ranges Total Initiating Devices o No. of Air Cond. No.of Alerting Devices �' eat Tons No.of Waste Disposers Pump . umberTons KW No. f- ontatn TOWS: DetectionlAlertin Devices � No.of Dishwashers / SpacelArea Heating Il Local ❑ Munrcipa Connection Other No.of Dryers Heating Appliances ecurity ystems: Na o ata No.of Devices or uivalent Heaters � °' ICV4 Si ns Ballasts Data Wiring: No.Hydromassage Bathtubs .i No.o[Motors No-of Devices or Equivalent Total HPC elecommumcations Wiring: OTHER: No.of Devices or uivalent ach y the Inspector of Iftires. INSURANCE COVERAGE- Unless waived by the oK•ner,tno Permit fo m pe dad formance of electrical bwo k may issue unless Oros the Iicehsee provides Proof of liability insu ance including"completed operation,,coverage or its substantial equivalent. The undersigned certifies that such cover ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE p BOND ❑ OT BER E] (Specify:) L.i.�1�,�: 1 Estimated Value of Electrical Work: Sint) -�1` (Exprr' ate y (1'Vhcn required by municipal policy.) ) Work to Start: 1 t 1c� Inspections to be requested in a000 I certrdance �NI Rule 10,and upon completion ,under the pains ahtd penalties ofPerlarY,that the hyorma'I on this upplicalion is true and complete- rum NAME: ' f't-ee c Licensee: I LIC.NO.: 1-1 f)e j C (IfaPPlicable a exem C"r, 45 6umberfne.)`� —Signature 4 I,IC.NO.: `f Q 1 pr"in the license n Address::, Bus. Tel.No.;It 757 42 i -1koi OWNERS[NSUItANCE WAIVER: I am aware that the Licensee does not herr the liability insurance Ali.Tel.NO.: normally ret7uired by law. B_v my signature below,l hereby waive this requirement. lam the(check one)❑owner Lam. Owner.'Abcnt Downer'sagent Signature Teknbone No. ( PFRMtT FFF- er l.d L l2 i 96()77 oe[l .., ii II I i Date/ �Yf r HpRTp TOWN OF NORTH ANO/OVER r .rr p PERMIT FOR PLUMBING s a � '11 ,Ss4c MUs� This certifies that . . .(�/. �?!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . t L �. '� ... ... . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . at. . �.��`?. . .<.?! . s.l.�.�-. .�. j. . . . . . . . , North Andover, Mass. Fee. Y.2. . . .Lic. No./6'. ? . . . . . . .+-. . .�!s- . . . . . . PLUMBING INSPECTOR Check # 67ZO MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS M. ° �--/3 -Q S_ Building Location 7 ( � /� (fix Owners Nam (1� C /�f7J(.. Permit#_ 14-2-7 Type ( Amount Tv e of Occupancyf�( �Y�,� New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES z z H w W U O 0. w z 0CC o a Q W z d0.d z a zUn z w o B��1r L f IST WM / M FLOOR 41H HADOR v 3I3�FIDCR 5M HDM 6M 11fM 7M HDOR SIH HDM (Print or type) Check one: Certificate Installing Company Name C / Q Cl)i J�,Q� ❑ Corp. Address I 'go �/�-�N(l t S t ' Partner. ,.� usiness Telephone — —.V-3 3 Ce g"'Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the ype of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent. I hereby certify that all of the details and in rmation I have submit d(or ente in abate a c o e true and accurate to the best of my knowledge and that all plumbin work and installatio perform e it I s fo t s application will be in compliance with all pertinent provisions oft t m ' Co e a Ch e f the General Laws. By: b ure o Icense um er Title Type of Plumbi g License City/Town Icenseum er Master a Journeyman APPROVED(OFFICE USE ONLY lqq Location No. c?o ,7 Date "21 -0 ;' MORTk TOWN OF NORTH ANDOVER A �` o Certificate of Occupancy $ Building/Frame Permit Fee $ .2 5/0 Foundation Permit Fee $ Other Permit Fee $ C/ TOTAL $ a T Check # -73 7 f 18 5 � 0 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT5 OR DEMOLISH A ONE OR TWO FAMILY DWELLING MU BUQ,DING PERMIT NUMBER: O DATE ISSUED: SIGNATURE: LS1 � Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION Ip� 1.1 Property Address: 1.2 Assessors Map and Parcel Number: V Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: B Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided R 'red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 &7crage Disposal System: Public Private 0 Zone Outside Flood Zone Municipal Q On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Ntstoric District Yes -No-- 2.1 O rn 2.1 Owner of Record Name(Print) Address for Service: N N Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Ja Z /.4 M Signature Telephone M ;VECTION 3-CONSTRUCTION SERVICES 90 , .1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supern r: 05 3 U Ix12, License Number o 0 ddress � Mn Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name 1 DA 9-7`1 rn J A Registration Number A dress -- Expiration Date Signature Telephone V SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) , Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will 4esult in the denial of the issuance of the building permit. Signed affidavit Attached Yes.....A No.......❑ SECTION 5 Descri tion of Pmposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing _-- Building Permit fee(a) X (b) 4 Mechanical HVAC �® �'- 5 Fire Protection 6 Total 1+2+3+4+5) IL-(, UVb Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT C�._�,� as Owner/Authorized Agent of subject property Hereby authorize `�--L'Z K-nle � to act on M Jt]I al atters relative to work au o ed by this building permit application. C/ Sign6ture of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I,���„ ,� l"�v,�,ate, as Owner/Authorized Agent of subject Property —V (9. !� Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge ndbelief 'a i Pri t Na e 1� Si e of Owner/A e Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 2ND — -- 3 RD SPAN DINIENSIONS OF SILLS DM4ENSIONS OF POSTS r DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION =�,'t THICKNESS Qc SIZE OF FOOTING X ` MATERIAL.OF CHIMNEY NJ12 N� IS BUILDING ON SOLID OR FILLED LAND j 1.lV-) IS BUILDING CONNECTED TO NATURAL GAS LINE LID 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. APPLICANT FILLS OUT THIS SECTION APPLICANT � .�� I �� _� -Vv�JLA PHONE_J + -5-335- LOCATION: Assessor's Map Number o Z.0 PARCEL — 0 0() SUBDIVISION!! LOT (S) STREET 1"� _ �c�- S'1".`.�,.-"� ST. NUMBER_L OFFICIAL USE ONL RECO ENDATIONS T, )NNAGENTS. CONSERVATION ADMINISTRA R DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALT DATE APPROVED DATE v�J . SEPTIC INSPECTOR-HEALTH DATE PPRb D � DATE RE CTED COMMENT ' PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm t r m mine!!m Mi wwww wbe oft3� J eq57 s ex Wells Fargo Herne Mortgage, Inc. ro nnS IIHE MILE*MRER& } MOUGAGE INSPECTION PLAN I CtttTrFY THAT TME 9UER%SNOIIN DO( 1 TD 581SACK n ous L11=7WO N tfRarlT,sroE t RiAR SEIRACK ONLY)err Northcover N 0 R T H ANDOVER i LE w° CH 'AP70 40 SE07M 7,UMrt AcrtOM utaaFR NAMc.6 u� I WRIHER CERTIFY 1NAr IM PIIOPOW t8 Mt LLooDUyn m W EUAgLEM n= NAS AWk OOMMUNITY PANEL N0.: 250098 0003C DAZE: 6-2-93 Dm 5� 0 TH4 COMPANY'IS NOT AN Fm Y=Dmmm MAGE ommumE 10 IME RECORDED om DATE OF THE LATH CEEO OF IIt70p{O. PAGE— 35 TMDW FR IRNMIIN AN 900 US5 THAN ONE FOOT FROM INE PROPMW LW R M ADYE5I D CERT.N0. jIMAT AA MORE PRECISE SURVEY EJB MADE TO VDl�Y MMMEASUR91E7 7rfls ER76M`J1110N GR DASIEL ON IM taGI111N OF SIVRWY MNO NOT PLAN IRLrr����rr//��PAGE REP7 A PROPERTY SuNVEY. VIOWICATION OF SILIM MARI PUW f_LL�DATED /=Z MA R6 ACCp1,E+Ug1Ea ONLY En!AN ACCUR A INSIRUMERT YS IC7EED oN '%&L&TinrAT1oN m BE Usm FOR MORTGA March 26, 2003 AS S140VM ARE NOT USED FOR THE FSTAMIS MENT PR q�pr � BRADFORD . tq Sia NGINEERING CO. P.O,BOX 1244 JAMES W. BGUCIOUKAS R.LS. Aas2 Illi 010]1 TOTRL P.62 Department of Industrial Accidents OVa of Investigadons 600 Washington Street Boston,MA 02111 www.masnov/dia Workers' Compensation Insurance Ailldavit: Builders/Contractors/Electridans/Plumbers AoDlicant InformatioD Please Print Lealbly Name (Business/orpnizationtla ividual)• Address: V\',- City/State/Zip: l��� (� ,/��A,�, /`. Phone#• �� Are you you an employer?Check the appropriate box: Type of project(required): 1`l I am a employer with 4. ❑ I am a general contractor and I employee's(full and/or part-time).* have hired the sub-contractors 6• New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7. ❑ Remodeling ship and have no employees These sub-contractors have s. El Demolition working for me in any capacity. workers' COMP. insurance. 9.JA Building addition (No workers' comp.insurance 5• ❑ We are a corporation and its ]0.❑ Electrical sirs or additions required.] officers have exercised their rep 3.❑ l am a homeowner doing all work right of exemption per MGL 11.❑ Phunbing repairs or additions myself.[No workers' comp. c. 152,11(4 and we have no 12.❑ Roof repair insurance required.]t employees. [No workers' c%W. kmu=ce required.] 13.❑ Other Any applicant that cbedm box#1 mow also 811 out date section below tbowing thea women•eompma don PoNcy infimmiba t Homeownen who submit this diidevil=&caft they an doing an wort end then but outside oonpaeton mud suhndt a sew a8'davd mdmatma such tConvwlon that cbectt this bot nod dkwhed an additional sheet dbowUV lbs none oflbe mb-contmam and thea V,0*4 n'con4 polkey info station. I ani an employer that h providing workers'compensation Insurance for my employees. Below L thepoJky anl,/ob slags information. �I Insurance Company Name: C,"ak– Policy#or Self-ins.Lic.#: W��.► w Expiration Date:_ -1 l ® b Job Site Address: �. � «1 �. C to r City/staftzip: � Attach a copy of the workers' compensation policy declaration page(:bowing the policy somber and exptraKlon date). Failure to secure coverage as requffef 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 wen 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 r the a of pedwy thin the lnfwme*n provided above Is lewd and correct Si lV5— Pho M Offlcial use only. Do not write In this area,to be completed by clo or town o.Wlal City or Town: PermkRJceuse# Issuing Authority(circle one): L Board of Health 2.Building Department 3.Cky/Town Clerk 4.Electrical inspector S.Plumbing Inspector 6.Other Contact Person: Phone 0: 1.111V1 111ak1Vl t Asim iilA%,a 16av1&av aa. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their ernployeea. Pursuant to this statute, an employ"is defined as"...every person in the service of another under any contract df hire, express or implied,oral or written." An employer is defined as ,an individual,partnership,association,corporation dr 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 hou se or the grounds or building appurtenant thereto shall not because of such employment be darned 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 bundings in the commonwealth for any applicant who bas not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGI-chapter 152,125C(7)states"Neither the commonweahh 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 b Please frill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their ccrtiScate(s)of insurance. Limited Liability Companies(LLCM 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 Accidema. Should you have any questions regarding dke law or if you are required to obtain a workers' compensation policy,please call the Department at the P listed below. Self-insured companies should enter their self insurance license number on the appropriate line. — City or Town OfHcida 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 die Office of Investigations has to contact you regarding the applicant please be sure to fill in the permiVliceuse 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�been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid a 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 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 wwwmm.gov/dia NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: t%Ljj1..,e,,— 94, is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150k Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. The debris will be disposed of in: (Location of Facility) Signature P 't Applicant Fire Department Sign oil: r Dumpster Permit Date T%ORTH Tovm of .. 4 L Andover No. • Z 4 ddW0 LA E - dower, Mass., COCHICHEWICK ADRATED PPS\ �y S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... Q..W.............. r.A.. .. ia........................................... Foundationhas permission to erect...16.....�.� . .................... buildings on....... .... .... ..... .. . .... .... ........ .............. Rough to be occupied as � �. .................................................. Chimney provided that the person acc ting this perrffit shall in eve res act conform to the terms of thea 1ication n ' ' N p pp o file m 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. 0�0/ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough ' PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough ............ .. ................4*.. Service . ................................ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove F nagh 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. F iP5f F�0P PLAN (EXI511NG) FAMILY DOOM KJfCHrN 13ATH I49 MIPPL. 5�x 5a�f NOPM ANbOV�p, MA s F I P5T F L 00P, PLAN C EXISTING) NI:W r3A5rMF-NT f3ULKN{rAC1 ENTRY FAMILY p00M MJ51W a - '� kr_MOVI; f;X15TIN6 WINDOW, l2t�MOVl; �XIST1NG WALL, d SILL OMNING TO f pOVf1F- NEW 131�AM; MATCH FX151NG, NI;W C,O, mMOVr- EY,15TNG POOP, 1N51"ALL N1;W WINDOW TO (3A1N ; M �Olt� ATCH �XfSTlNG MLOCATI; rrYJ5-nNG WINDOW •. O; P IJ5 FCC TOM & Loplf cm� 1�9 MIPP� 5FX 51ITf -614 M N, NOFTH ANVOM, MA f�LOCAT�1 WC & SINK DI;COt'.AT1VE� WOOD pO5T5 NF-W LANDING & 5TA1!?5 scv�: a'' n�r�:eiyios TO FIN15H cilz DE ---------------- 1?AILING - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ____ - - -- - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - P,,,FPR F�FVAION - - - - - - - - - - -- - - ---- - = - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -I - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FINISH 2NP FLOOP, ----- ----------------- --- -- -- ------------------ ---------------------- ----- ---- ----------------------------- -------------------------------------------- - ------------------------ --------- - FIN15H 15-r ROop, PtV,6 FOP 9 LOM CPAN� 14MIPMF5�X 5fFYTf NOP,TH ANPOVEr, W � � ^ . ' ^ ' ' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 0 L ---------------------------------- - - morry t�x&nN6A . . ,~.-- ~' `. ~^'`'. VFN-rj Lopll crl� � _ � _ PL.*s Foz ——- TOM & L orl Crl ft - - - - - - - - - - - - - - - - - - - - - - - - _____-_=___ --_-____- NOPTH ANPOWP, MA - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - LFff F� VMION 77 FIN15H 2W I:L0012 - - _-__ —_-_ - _- IE1 f�uS�f7 WiNbOW I I I [::] I P.A1L ING FIN15H 151"FLOOt? r• a••I 4 i NSW E3(,�,KN�At� [�NT},YWAY I Ct�AWL SPACE; VF-N1" ASPHALt SHINGLES ICS/ WATER SH1F-LP MEMC3P.AN1; TI f IC& Cr\055 5L010N 5/8" CnX ROOF 5H1:ATHING 2X6At16" OC E�XI5TINC WINDOW TYPICAL IAV�5 19r�TAIL: FASCIA & SOFFIT'TO MATCH F�XI5TING CONI1NUOU5 5OFFIT VENT' POUPL-t; TOP PLAT!✓ FLA5H METAL LWIP F-PGZ� / FIN15H 2NP FLOOR ICF/ WATMR 5H1rLV — — + TYPICAL rXTF-plOk'WALL: #�-38 INSULATION 5419ING M MATCH FX15T1NG PUIL ING WP.AP 1/2" G?X PLYWOOP 5H�ATHIN6 2 X,4 Ar 16" O.C. R-19 IN5UL.ATION P-l3 NDWZALA5 INaLAT90N POLY VAPOt?C3AI't lER oll i/2" GWri CONTINUOU5 Lt�1:2Gr-R 60 LAC (30LT tO I;XI5TINC+ F INC USS JOIST'HANG�f*5 PROVq�� OP1;RA L� FIN15H 15T FLOOR SCR��NI� VENTS — — + WITHIN FOUNI2ATION 2 - $*5 M,PAR tot' & C30ttOM CPWA-5PACE �lNISlf GP.AI� PROVInI; ACCESS t CRAWL 101 5PACF- THRU rX15VN 13A51;MF-NT POLM2 CONCIZF-TF- FOUNDATION r: }� }�n� O . . R�MOV� ALL ORGANIC iL �O�n�& �0�( �r�v v� WNER/ PULPM, CONFIRM - 5�x 5TITFf ADF-QUAT[� SOIL 13F-AMN16 CAPACITY Q WITHIN CRAWL 5PAC1: AIS NO1"N ANPOVFP, MA VAPOR U�AP.RIWR Location /q / No. Date 4)3 NORTIy TOWN OF NORTH ANDOVER Of .s° ,�,4•C 3: _ • OL � 9 • i ; ; Certificate of Occupancy $ yes',^°•tt� Building/Frame Permit Fee $ ,2 -5-0 s•+cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s 5 U F" Check # 4 ` 16 5 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER D O DATE ISSUED. a® SIGNATURE: BuildingCommissioner/I for of BuildingsDate SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: -�0 Map Number Parcel Number N�2T►-1, i-tN 1.3 Zoning Information: 1.4 Property Dimensions: U Zoning District Proposed Use Lot Area s Frontage ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record oyp -+-C_orzt C.rLil�0-L hcM A , es Name(Pri t) Address for Service: E� C �'L' 9 W E luJ LC t/ (5 Signature Telephone 2.2 Owner of Record: Te e NVrint Address for Service: Si lure Tele hone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number AddrAs Expiration Date i1 Signature Telephone !d� F � . SECTION 4-WORKERS COMPENSATION(XG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed WorkcheckaQ a liable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OF) CIAL:USE:UNY - - ;; Completed by permit applicant 1. Building 2 pOH (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) _ 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT OIL6 i7 l� _ as Owner/ uthorized Agent of subject property Hereby autho ' e to act on My 1 n ers lativ work orized by this building permit application. ��4 - V, a V 04 7:762 Signatur e Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION r � I, ,as Owner/Authorized Agent of subject property f Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date w ' NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DMIENSIONS OF POSTS DM ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40'S 54, a condition of Building Permit Number is-that-the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S150 A.. The debris will be disposed of in: Krm-111-ir=4 Q,-14F--Wk ce,5; A4,�So is Ca 36 Kd7 P .45 L& (Location of Facility) 0307 Signature of Permit Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector " F r4ORT/1 O ,6'qj. - - Town of North Andover * i Building Department � - - 27 Charles Street � CHUSE� North Andover MA 01845 Tel: 978-688=9545 HOMEOWNER LICENSE EXEMPTION Plea e prin�13LC-S DATE JOB LOCATIOUY ( ��• Number\ 1LI Street Address Section of Town "HOMEOWNE L� 1,9' 645(o -M (o%7— SgS r� ��� ?.fid `� Number Home Phone Work Phone PRESENT MAILING ADDRES 152 S �. �- N--ssa3�fS 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 HOMEWOWNER: 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 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, 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 ynderstpnds op ToWq of No. ndover Building Department minimum inspection proced s and r quir ent an th /she will comply with said procedures and require HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note:Three family dwelling 35,000 cubic feet, or larger,will be required to comply with State Building Code Section 127.0 Construction Control. NQRTM Town of over 0 No. z- -7 71 0 67 43 -4; 00 Coover � Mass., RA-r E D P*' C5 H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT-7rdP41161 it 100"0' CPAAM ...................................................................................................................................................... Foundation ! .85 A .................................................... Rough has permission to erect.....F ..................... buildings on ..... .......mtodle qb 0 x es'A. to be occupied as....A*!�........A. 1P,Cr ...... ...... .......... 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-La s elating t Inspection, Alteration and Construction of Buildings in the Town of North Andover. -P,071 02 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final Is ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S Rough ..........w04....................................... .............................—o.. d_ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove 'Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street NO. LSEE REVERSE SIDE Smoke Det. NuR ' Pf rTown of over p t� h � -3 -off oa 3 D �- L A (� dover, Mass., cocHic wicTc v ADRATED p` C) S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System O�� �� � C%I%AAoO BUILDING INSPECTOR THIS CERTIFIES THAT IL �� Foundation ........................................................................................................................................................ has permission to erect..... !. ................. buildings on .....l........ ..M1... / .�.M..�.....� � Rough to be occupied as....A A~ C ofto 0 00% 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 tot Inspection, Alteration and Construction of Buildings in the Town of North Andover. �d G 62 310 i PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR Rough .......... ....................................... .......................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner' Street No. SEE REVERSE SIDE smoke Det. Date.11. . 0.1<",°R7:'�a TOWN OF NORTH ANDOVER to p PERMIT FOR PLUMBING �y ,SSACMUS� This certifies that . . .-./ •!? {.-,. �. . • •��� has permission to perform . . . . �).{.�.�. . . . . . . ... ... . . . . . . . . . • • • plumbing in the buildings of . (f. .41 J6 /., . ..: . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . North Andover, Mass. Fee. . . . . . . . .Lic. No.`!/%.'.�.'. . . . �j` ` . . . . . . . / PLUMBING INS4ETOR Check # 583 ) 33 L). l ' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS / Date Building Location ( Owners Name ` (W Permit# Amount Type of 0'ccupanc3l/ tt / New Renovation Replacements Plans Submitted Yes ❑ No ❑ I FIXTURES H H z w w o cc w � A H z ' AR» RkSEME yr IST"M ,l / ZDHDM -IMMOCIR 4M HfM 5M HDM sM HDM 7M gm HDM (Print or type) /� R/ Check one: Certifcate Installing CompanyName/ J j�G ( ac ❑ Corp. Address 1/iG ��J� f ,r`- El Partner. ✓�► usmess Te ep one �- - ® Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy r/�' Other type of indemnity ❑ Bond ❑ Insurance Waiver: 1,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature er Agent I hereby certify that all of the details and informati I have sub 'tted(or entere )in above appy a'on a e and accurate to the best of my knowledge and that all plumbing wo and insta ons performed er Pe s for application will be in compliance with all pertinent provisions of the is State Cod nd er the General Laws. By: igna ure icenseci Firuer Type of Plumbingy,cense Title 4-7c, City/Town ic�'1Qum er Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date. . .�. . .!.'.. . ..... .. to "ORTH TOWN OF NORTH ANDOVER p p • PERMIT FOR GAS INSTALLATION ACHUSEt This certifies that . . . . . . . . r % rr has permission for gas installation . . . . { .. . ... . . . . . in the buildings of . . . . . . ! : .� . . . . ... . . . . . . . . . . . . . . . . . . . . . . . at . . . .. . . .. . . . . . . . . . North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . . . . . . . . . .^. . . . . GASINSPECTOR Check# Z0, 56G MASSACHUSEM UNIFORM APPLICATON FOR RNU TO DO GAS FITTING (Type or print) Date A? NORTH ANDOVER,MASSACUSETTS Building Locations ��r'` Permit# r Amount$ 2—, Owner's Name �� � U New Renovation Replacement ® Plans Submitted � w W W U� W O V F x x z O W F¢' F+ P" z z7 O zCn W w d p a G W -It H z F z a W o > w W `c��' a d� x O w 6 3 A 3 a ov a >W A a H o SUB -BASEM ENT a B A S E M ENT 1ST. FLOOR 2ND . FLOOR v 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7 T H . F L O O R 8TH . FLOOR (Print or ty e / / Check one: Certificate Installing Company Name (�- ' / p/ l Corp. Addr�ess 0 J'��� —r ��~ � Partner. A Business Telephone ^(, _ Firm/Co. Name of Licensed Plumber or Gas Fitt // /,, 'r INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:1 No If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent i hereby certify that all of the details and informati I have s mitted(or entered)in ab ap lication are true and accurate to the best of my knowledge and that all plumbing wor and in 1 ions perfo_ d un P it ed for this application will be in compliance with all pertinent provisions of the as us s Sta a ode nd 42 of the General Laws. Signature f Licens Plumber Or Gas Fitter Tit Plumb zdz Title City/Town Gas F. ter License Number Master APPROVED(OFFICE USE ONLY) Journeyman Date... .:�?..�.. F: "ORTIy °t�"`°:• '"° TOWN OF NORTH ANDOVER O a. 9 PERMIT FOR WIRING ;�SS�cHusE� r This certifies that . has permission to perform ..... � lyF�/ ......./��f ..... wring in the building of..... ......... r/ at:......�./...1. .. �M .. t.�e .�`.1`......ST... North Andover Mass. FZe...1/..�.v.. ..Lic.No l!j'/.. z' �. , ri / ELECTRICAL INSPiCTOR Check N �`� 49 "14 Commonwealth of Massachusetts Official Use Only — Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGU r'TIONS Occupancy and tee Checked [Rev. 11/99] (leave blank) APPLICATION FOR PERMJT T PERFORM ELECTRICAL WORK All work to be performed in accordance with the assachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK ORTff ALL INFO TON) Date: ,Z. /I& bo City or Town of. AJb,(.44-\ A,,.� To the f o Inspector Wires: P By this application the undersigned gives notice of lilUf her intention to perform the electrical work described below. Location (Street& Number) Owner or Tenant T s wt �-G. Telephone No. p Q7$ -68&Wsb Owner's Address L Ca rn Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building L �Jfyi v,C Utility Authorization No. Existing Service i tib Amps 120 / ZytZ>Volts Overhead Und rd g ❑ No.of Meters New Service 2— Amps 12U / j,40Volts Overhead Undgrd ❑ No.of Meters (Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �„ I e k, I ' %A D 6-M Le- —O 6a— Com letion o the ollowin 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 ❑ Inmergency ig mg rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection ing Devices • No.of Ranges No.of Air Cond. Total IniNo.of Alerting g Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained o Totals: "'"" "" " """"' "'"'" Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW ecuritySystems: No.of Water No.o No.of No. of Devices or Equivalent Heaters KW Si ns Ballasts Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent 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 t the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cover a is in force,and has exhibited proof of sa to the permit issuing office. CHECK ONE: INSURANCE VOND El OTHER [I (Specify:) 01 a f7A )� Estimated Value ofElectrical Wor 2-0 _L -c" (When required by municipal policy.) (Expiration Date) Work to Start: -2111,(03 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: lynt%t✓1 c-vis E-Lal C( , LIC. NO.: All 14 C) Licensee: en V\ Cry,'A -�n r3 Signature LIC. NO.: (If applicable, enterr�"exem t"in the licensermmber ine.) Bus.Tel. No.•.�7y��'�'"7�D�' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally�_�� required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agen Owner/Agent Signature Telephone No. PEIdMIT TEE: • e, Location r ' r -f' S r, No. i - � Date TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ J�cMus t Ojber�,Permit:Fee $ 'Sewer Connection Fee $ Water'.Cohnection Fee $ TOTAL Building Inspector Div. Public Works PERMIT NO. /(2 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K-JO. LOT NO. 2 RECORD OF OWNERSHIP jDATE BOOK !PAGE ZONE -. t I SUS DIV. LOT NO. �- LOCATION J;t A)_ �A ^.I�11` (C� j� PURPOSE OF BUILDING OWNER'S NAME /�V7 6}�e5 t9 )c ! �I �✓ NO. OF STORIES / SIZE / OWNER'S ADDRESS', �� - BASEMENT OR SLAB !' ARCHITECT'S NAME ♦ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME a �L_ tdOQ eDrh dyk t SPAN !7 r� b u/G O 1 � �,,r DISTANCE TO NEAREST BUILDING �� I' DIMENSIONS OF,SIILLLS v d�� DISTANCE FROM STREET 301 POSTS fe DISTANCE FROM LOT LINES—SIDES �2!rREAR `0 " GIRDERS L T AREA OF LOT !"�SJ FRONTAGE HEIGHT OF FOUNDATION /n ,^ THICKNESS IS BUILDING NEW d Y SIZE OF FOOTING X IS BUILDING ADDITION r MATERIAL OF CHIMNEY IS BUILDING ALTERATION �` IS BUILDING ON SOLID OR FILLED LAND p L rp! WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Kes IS BUILDING CONNECTED TO TOWN WATER O BOARD OF APPEALS ACTION, IF ANY 7 IS BUILDING CONNECTED TO TOWN SEWER / ,0 IS BUILDING CONNECTED TO NATURAL GAS LIN/Ev0 INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 200 — ,PAGE '70© —PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. f 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 /B BY BUILDING INSPECTOR DATE FILED 0 BOARD OF HEALTH SIGNATUR"fD OWNEIj OR AU�RIZ�D?GENT / FEE O �-� (//� PLANNING BOARD PERMIT GRANTED ig BOARD OF SELECTMEN OWNER TEL.#Z&4 CONTR.TEL.01 __ y4/ CONTR.LIC.q._�_` BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY StOR1ES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE _ B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 14 1/1 9 l/, FIN. ATTIC AREA _ NO BM'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS \ CLAPBOARDS B t 2 3 DROP SIDING CONCRETE �— WOOD SHINGLES EARTH ASPHALT SIDING HARD"✓'D ` ASBESTOS SIDING COMMON VERT. SIDING ASPH.TILE _ STUCCO°ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. CR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I_] POOR ADEQUATE NONE rj ROOF 10 PLUMBING . GABLE I HIP BATH 13 FIX.) _ 1 AMBQEL MANSARD TOILET RM. 12 FIX.) FG, SHED WATER CLOSET ASPHALT SHINGLES LAVATORY P� WOOD SHINGES KITCHEN SINK 16 SLATE NO PLUMBING _ u TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ V1 TILE FLOOR ,t TILE DADO 6 FRAMING I i l 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 RAF. LB'M'T 2ndErTRIC1st 3rd HEATING .r Town of North Andover '.' BUILDING DEPARTMENT Homeowner License Exemption (Please print) DATE `!g /�7L i .'� ;,• JOB LOCATION Number Street Address Section of town "HOMEOWNER" C7,-/ Name Name Home Phone Work Phone ! ,PRESENT MAILING ADDRESS City Town State Zip code ' The current exemption for "homeowners" was extended to include owner ':occupied dwellings of six engage an individual funits or less and to allow such homeowners to that the owner acts ' ,. or hire who does not possess a license provi . asded supervisor. (State Building Code , Section 109 . DEFINITION OF HOMEOWNER: 109 . 1 . 1) ' 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 ix famly ing, attached or detached structures accessory to such usesand/orlfar dcaell- , —'' structures . A person who constructs more than one home se 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 The undersigned "homeowner assumes responsibility for com li . : State Building Code and other applicable codes , by-laws , rulestl�edwith the regulations . .' The undersigned "homeowner" certifies that lie/she understands the Tow :.'' North Andover Building Department minimum inspection procedures and n of requirements and that he/she will comply with said procedures and . .requirements . HOMEOWNER' S SIGNATURE ►�p 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 . i s e u ro.. ► o k � Y ` : 0 TR T /.� 0 Er ljown OT An valv"o 0 DRIVEWAY ENTRY PERMITer, Mass., !�tf�G AoRPERMIT T SSq LD BOARD OF HEALTH THIS CERTIFIES THAT... �. ..... .. ./...P.�. W. ..�.G..................... �40 BUILDING INSPECTOR has permission to erect ..W.00.9d........ buildings on .� .�..................... .r....... Rough to be occie8a�., . Q•,R,r�. �ir....5.�.i�.f................................................ Chimney 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 Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONST UCTION STARTS Service P Final ... . . ....................................... BUILDING 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 Smoko Det. Building Inspector � r Location No. 2./- z Date l� TOWN OF NORTH ANDOVER a � s Certificate of Occupancy $ 11 •O•+�.o•�,�� �s�•►CHUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � Check # , 16156 1� Building Inspecto t a r. TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING qA p�qq BUILDING PERMIT NUMBER DATE ISSUED: ic SIGNATURE: --4 Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 210o- ao - 0 — 000e� " Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Pdbhc ❑ Private ❑ Zone Outside Flood Zane 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No Pit 2.1;owner of Record = 65z`e -V Name(Print) Address for Service: CA d Signature Telephone .7.2 Owner of Record: iijgnj me Print Address for Service: z S Q MtureTelephone 90 SEtTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 1 , icensed Construction Supervisor: V /GO P.O.Box 637 License Number NODI I$a MA M Address c 01 J/6�� �^ /�/5 C V 1�`� 5j Expiration Date .e 14ig.nature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name y �ROO)�$ Registration Number r P.O.Box 637 �... Address -Z Ol , Ifo �.2 Expiration trz)- i nature Tele hone v�sr'1 V!`i lt. '4• SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes...... No.......0 SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x (b) 4 Mechanical HVAC 5 Fire Protection 0 ! 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, —; L, Q�`y ��Q�� as Owner/Authorized Agent of subject property Hereby authorize_ y �jyo�u \ to act onMy behalf inall maters relative rized by this bu ing pennit application _ 7 __ Signature of Owner Date SECTION 7b OWNER/AUTH IZED AGENT DECLARATION ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print N e 77 atur of Owner/A ent Date 2WHEM NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 s 2 3 SPAN DIMENSIONS OF SILLS DINIENSIONS OF.POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE. (61n \. , I . ` z ' The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations ,•� Boston, Mass. 02111 . y Wofkers'Compensation Insurance Affidavit Name Please Print Name: Location: Cdy Phone # I am a homeowner perforating all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Comoany name: Duval Roofing Address No th Reaftig,MHA • City: Phone Insurance.Co. iZLZ t Comoanv name: Address Cit,r: Phone# Insurance Co. Pollcv# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to 11,500.00 andlor one years'Imprisonment-as wen.as_dAl.penalflesin the loon cf-a.STOPINDRK ORDER..and_a.fine of_(3111D1q-arfay egei -ffmL I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date ? Print name 0 phone#.� -Z�S Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensi ❑ Building Dept ❑Check if immediate response is required ❑ Licensing Board E] Selectman's OfficeContact person: Phone#. ❑ Health Department ❑ Other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: Ak ?I (1-cmdation of ility) I �i Signature of Permit Applicant -7 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector a NORTH Town Of No. ?/ 0 LA o �` dover, Mass., COC MIC ME WICK yt� ADRATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT.......... ... ,..... ... ........................................... ...................................... .................. Foundation has permission to erect........................................ buildings on ... ....... .( .............. Rough tobe occupied as... ...................................................................................................................................... Chimney provided that t arson acceptin his permit shall in every respect conform to the terms of the application on file in Fid this office, and to the provision f 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S T ELECTRICAL INSPECTOR Rough ........................................................................................................... JYService ...... BUILDING INSPECTOR Final Occupancy Permit Required to Ocaipy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Page No. of Pages r r � Builders License # 58443 Home Construction Re,. # 10928E ° ° uEMC(o7t, EEG 00 (9539 J44-E X94 (99S) 664-2559 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 PROPQSAL SUBMITTED TO 1 PHONE DATE STREET / � JOB NAME CITY.STATE A D ZI�ZODE JOB LOCATION We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) Lo#" Rip& Remove all shingle debris from roof&job site: ❑ 1 layer Delayers J91 layers or more Repair/or Replace any roof decking; not to exceed 50sq.ft. Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white or brown G," Install ICE&WATER underlayment along horizontal eaves,valleys, sidewalls and sky-lights&chimneys Install premium base sheet underlayment between roof deck and roofing shingles Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year jp- Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles J 40 year J.50 year Ll Lifetime J See manufacturer warranty policy for more details J Install new aluminum vent-pipe flange (s) I it Chimney(s) -counter-flash and re-step existing flashing J Cut& Install new lead flashing Ridge-vent/exhaust vent with low profile design, hidden by shingle caps 7 Soffit-ventilation ❑ Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site ❑downspouts Other01 I a � { f i �I l ii 'Please Note:All items in roof attic should be removed or covered due to falling roof particles, a':time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. We Propose hereby to furnish material and labor-complete in accordance with above specific�ns,for the sum of: 4 (� t "f / Total price not including options. dollars($ / ). Payment to bemade as follows: 30%deposit required before ordering materials. Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01834 Late charges f g o $50 per week for all outstanding bills due upon day of Authorized _ completion. Signature r �I -Accepting proposal means agreeing to the terms of the enclosed binderNo`s to This proposal may ber contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within - L days