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Miscellaneous - 15 COLUMBIA ROAD 4/30/2018
15 COLUMBIA ROAD 210/052.0-0052-0000.0 Date./Y4w. . ..... r NORTk 01, 3� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �9SSACHUSEt 1 r This certifies that . . . . .i�,r. . . . . . . . . . . . . . . . . . . . . has permission for gas installation . A C?. . . . . . . . . . in the buildings of . Z4q.�q AS . . . . . . . . . . . . . . . . . . . • • • • • • at . /. S�. � 4 �� . . 41 . . . . . . . . .. North Andover Mass. Fee. ZS©�? Lic. No../P. O� . frE���� r— �.ff-t ,. . . GAS INSPECTOR Check# �9 78.76 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: , , MA. Date:_LZ — ZG GI Permit# J` Building Location:— C16/Ue,..L.f"'* `�� Owners Name: L Type of Occupancy: Commercial❑ Educational❑ Industrial ❑ Institutional❑ Residential Pr New: ❑ Alteration:❑ Renovation Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES 5 a Lu V �' W Z Y F- ca W Q' ~ Cn fn m x W W v !n H 0 x W W (� Z I— (7 -� >- to 0 Z Z 0 W W W W 0 h- O > w Z 9 m 0 a a IQ_ o w X W f' co W Q W W IY Z = W 9 IW— p x LL Z W W Z J FW- F- 0 Z J 0 LL N x Z W w Q' 0 Q w w m W 0 z 0 co F- > z F = v o o LL t7 0 x x 0 0 IW- > > > O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 6 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR —^ Check One Only Certificate# Installing ompany Name: t Ut t3 ��� El Corporation Address: // � City own: . (/ State: Business Tel: :10��-X334 Fax: Y c�3Q� ❑Partnership ' Firm/Company Name of Licensed Plumber/Gas Fitter: 6 G - INSURANCE COVERAGE: I 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,�%� 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signa reof Owner or Owner's A ent Owner ❑ A . t ❑ By checking this box I];1 hereby certify that all of the detail and information I have su mitted entered)reg in his application are true and accurate to the best of my Knowledge and that all plumbing ork and installations pert med er th ermi ss compliance with all Perti nt provision of the Massachusett State d for this application will be in Plumbing Code an Chap 14 f th Gee Law . l By Type of License: ,OPlumber Title ❑ as Fitter Ignature of Lic nsed Plu ber/Gas Fitter Master City/Town ❑Journeyman License Numb r: APPROVED OFFICE USE ONLY El LP Installer 9i 69 Date.*vh.1I/� . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r � r SSACMUS� This certifies that .!!r?.,6T.zi. . . . . . . . . . . . . . . F has permission to perform 1, 'C4hfureX. . . . . . . plumbing in the buildi gs of . . . . . . . R.�4f4. .�. . . . . . . . . . . . . . . at. v . . . . , North Andover, Mass. Fee3•�.,�'�C?.Lic. No.IG, of . /ISG h4�! � . . . . . . . . . . . . PLUMBING INSPECTOR Check # I MASSACHUSETTS UNIFORM APPLICATION FOR PER TO DO PLUMBING City/Town: MA. Date: �� � 6 Permit# Building Location:_��� 4 k,�� Owners Name: ZIN 514ki J Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional ❑ Residential New:❑ Alteration:❑ Renovation: ❑ Replacement: Plans Submitted: Yes❑ No❑ J FIXTURES w DEDICATED o SYSTEMS t2 H iY y 'n d cn `r "A s Z 4 W z to _'i U FN' W ❑ ❑ 7V � Z Q 4 w � � cc p m W a aQc in F- w Cn y Z d Q p _j = Q w ❑ Q Z cc h a X N Cn w H d U T O a T ❑ w j `J` Z ° LL Q Q ce a a Ln �_ o° �- u aa� d� o a s: `t s w W c� al o w 3 Q LYI 41 ❑ ❑ LL Z Y .3 ..7 0: O Q O ❑ N W } to -SUB BSMT. V' `" F' BASEMENT ST FLOOR 2 N FLOOR 3RD FLOOR + 4'FLOOR P 5T"FLOOR 6T"FLOOR 7T"FLOOR 8TH FLOOR Insla'Iii E,Cv,,,p&r ,game: IN V-\af U"'6 Ch"ck One C til Address: 6 13(;-,+-. ❑Corporation City Town: V State: ���� (o _i ❑Partnership Business Tel: Fax: (o(l Name of Licensed Plu. er: irmlCompany V � INSURANCE COVERAGE: I have a current lia�Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.942 Yes El If you have checked Yes,please indicate the type of coverage by checking the No El 9 ppropriate box below. A 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 942 0 Massachusetts General Laws,and that my signature on this permit application waives this requirement. p f the Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitf d(or entered)reg rdin t s ' Knowledge and that all Plumbing w-rk and installations perrrorme'under the permit' sued g r is apFplieatio re it ee n co V fiance with all y Pertinent provision of the Massachusetts State Plumbing Code a Chapter 142 of a Ge er afe tc the bes�of my a . 3y Type of License: 'itle A lumber Signature of Icensed Pl ber :ity/Town Master PPROVED(OFFICE USE ONLY) []Journeyman License NU ber; Q�(� The Commonwealth ofMassachusetts Department oflndustrial Accidents Office oflnvestigations 600 Washington Street 5� Boston,MA. 02.1.1.1 www.mass gov/dia Alicant Information Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers ✓-- Please Prin Le ib] Name(Business/Organization/Individual): j . Address: City/State/Zip: ltiaL 6l"Phone 1�Are on an employer?Check th appropriate box: am a employer with 4, Type of project(required): _ employees � ❑ T am a general contractor and T 2.❑ p yes(full and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheaet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers'comp,insurance. 8' ❑Demolition [No workers'comp.insurance 5. ❑ We are a corporation and its 9' ❑Budding addition required,] .officers have exercised their 10•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions Myself [No workers'comp. c. 152,§1(4),and we have no in required.]t• employees.[No workers' 12•0 Roof repairs COMP,insurance required.] 13.0 Other -Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicatingsuch. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ch. I am an employer that is providing workers'compensation insurance•for•my employees. Below is the policy anti'ob site , infornpation. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address.--4(( l�� City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to se coverag equired under Section 25A of c. 152 can lead to the imposition of criminal penalties of a fine up $1,500.00 and/or on)-year imprisonment,as well civil penalties in the form of a STOP WORK ORDER and a fine ' of u o$250.00 a day again the vio or. Be advised t o [n stigations of the DTA. r insur c cove ge veri cat' of this statement may be forwarded to the Office of ado hereby certify unl�er the .i natu nd a [ties o er f th t the information provided b ve is tr a and correct. l • Date: / cs (J!� `none#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: . Issuing Authority(circle one): Permit/Liceuse# L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing g Inspector Conts Pp, 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-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 he. 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/licease 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. u in advance for your cooperation and should you have any questions, The Office of Investigations would like to thank you please do not hesitate to give us a call. The Department's address,telephone and fax number: .True ComruowwcF alth O,i Massaea setts Depari`rznent of Industrial Accidents Ofce of Investigations 600 Washington Street Boston;M. 02111 Tel. 617-727-4900 ext 406 ox 1-877,MA.SS.A.FF Fax#617-727-7749-774 --- - - --- Date.................................. NORTN 1. 16 6 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 4' C U This certifies that ........ ................... .... ......... ...... r...... . has permission to perform .............. ....................... )4r(.rzelenl....................................... .. wiring in the building of............ .................................. .......f�lfelfy ........ North Andover,Mass. Fee..!��.......... LTic.NoR .107g�........a'z'i . . . . ... ...... I SPE R ELECTRICAL �t Check # 10430 : Commonwealth ®f Massachusetts Official Use Only Department ®f Fore Services Permit No. Ll3�) Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leavebiank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINTININK OR TYPEALL INFOR 4YYON) Date: City or Town of: NORTH ANDOVER 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) 1-jr 1-^,o 1411n 6 r,� Owner or Tenant Telephone No. Owner's Address SSA Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building kelwp ole/ 14'1'fc lw-,h Utili Authorization No. Existing Service/b b Amps //b /122 e, Volts Overhead Undgrd❑ No.of Meters r New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cefl.Susp. addle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators KVO' No.of Luminaires Swimming Pool Above ❑ •In- ❑ IN o.o Emergency Lighting nd. grnd. Battery Units — No.of Receptacle Outlets / No.of Oil Bu_pners FLEPY,ALARMS No.of Zones of No.of Switches No.of Gas BurnNo.. �d ][nitiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pum N1xber Tons KW No.of Self-Contained P / TotalP ..... .. .....................--......................._... Detection/Alerting Devices Municipal No.of Dishwashers / Space/Area Heating KW Local❑ Connection ❑ Other No.of Dryers Heating Appliances IAV Security Systems:* r5 No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts. No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: //Z/ // 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 unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FILM Mk E: LIC.NO.: Licensee: Signature LIC.NO.:,�f2.11 96 flfapplicable,enter"exempt"in the license number l,,in/g�.) / Bus.Tel.No.•f7 k Address: 1�0 t 14 ST /u o r"�/ /"A. Alt.Tel.No.: *Per M.G.L c.147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent. The Common weauh of Massachusetts ' i Department of Industrial Accidents � Office of Investigations. 600 ilWashingion Street .{;4 Boston, MA 02111 www. WSs gov/dia . Workers' Compensation Ins%iranee Affidavit: Builders/Contiractors&lectricians/Plumbers A licant Information / Please Print Le - gbly Nana (Business/Organization/Individual):_ Ze p,n Ze41/ S Address: / o /.1,4�Py City/State/Zip: o v fj, A,10,1 Phone#: . 9?�', ��o Fle mployer?Check-the appropriate-box: ' mployer with 4 Type of prgject(required): , ❑ I am a general contractor and I es(full and/orpar•t-time)* have hired the sub-contractors 6. ❑New ooristruction Proprietor.or partner_ listed on the attached sheet t 7• ❑Remodeling have no employees These su&contractors havei working for mein any capacity, workers' comp.insurance. 8' Q Demolition [No workers'comp,insurance 5. 9• ❑,Building addition P ❑ We are a corporation and its required officers have exercised their 10.QElectrical repairs or additions 3.El I am a homeowner doing all work right of exemption m self, g per MOL 11.[]Plumbing repairs or additions Y [No•workers'comp. C. 1.52, §1(4),'and we have no � insurance•re uired. # 12•Q Roof repairs 9 .employees.[No workers' c13. omp. lnsurancerequired.] n•Other - 'Any applicant that checks boa'#l trust also frit out the section below showing their workers'bompensation policy information, t fiomeownets who submit this afrtdavit indjcating they a-a doing all work and then hire outside contractors must submit a new of idavit indicating such. tcontractors that check this box muVr tacked an additional shset showifig Fhe nsne of the sub•conttacton and their Fieri a s'camp,policy irfn, adon. I arst o�e ,lQyeP Phrat es,pr�yidiFlg:t��,dtep�'e®rsr evtseat��a asasaaaa�ace op infornza don. ! 'ertapinyees: Belot is_tlse policy andjob si.¢e Insurance Company Name: " Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: ' City/State/Zip: Attach a copy of the wonders'compensmtion policy declaration nage(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL 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 u der the pains ad penalties of perjury that Lite information Prvided above is true and correct Siertature:• // Q Date: Phone 4fciat use only. Do not w.rile d iris a:ea,to he c��..,pd •ed.by City or t,�w�z official City or Town; Permit/License# Issuing Authorif�,(circle one): L Board of Health 2.Building Department 3.City town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.OtE�er Contact Person: Phone#: Date �° •��, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUS� .. This certifies that . . . . . . . has permission to perform plumbing in th buildings of .'` .� -: -. . . . . . . . . . . . . . . . at . A . . . . . . . . . . .. ... .I.. . .. .. . . . . :, North Andover, Mass. Fee -30.. Lic. No.'FG. / 1n. . . . f �.r.�..-:_��! ,/ PLUMBING IN5 �.CTOR Check # 2ZV0r 7E 7302 , MASSACHUSETTS UNIFORM-APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) �L6YLYN A ODICE� .. Mass. Date 10 oug Permit #12E& Z Building Location 1� �Ol uM�l A Owner's Name d ZA C 1�Ka5 ND�TN AN�bVEJZ. �� Type of Occupancy, New p Renovation ❑ Replacement Pians Submitted: Yes ❑ No ❑ B.P.# SEWER# FIXTURESSEPTIC# x x x o z r- > °J W Y .J N Q V F' z O Q � 41 z 2 N Q � Z O z N o. '-� 4j W H W Lc y — N �, z Z v X J N N 0 S U W N x O z 0 0 W Cr 2 Q N = C Q N Z a 9C 0 a x 0 44 W W F' F' W d 0 G . J N � � J O � p .L 4-1o W S O F Q x 4. t) 3+ x a z z Y d O x =: d W u be O � Y H O = N E' = Q N W F- �� ~ Q Q S H Q d v .J _j Q. Ir cc Ir. Q 0- C �. Y .� ta' N O O J 1- N U. 0 O sus-BSMT. I BASEMENT / 1ST FLOOR 2ND FLOOR 3RD FLOOR �D 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR installing Company Name SAY STATE GAS CO Check one: Certificate # Address_L5 .5 H A IZST n' 1 ST ❑ Corporation LA R W E HA ❑ Partnership Business TelephoneA7 7 8) G X 7- 110 ❑ Firm/Co. Name of Licensed Plumber.__E'kA_N C 1S X COQ KEK) INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No ❑ If you have checked ves. please Indicate the type coverage by checking the appropriate box. A 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: Owner ❑ Agent❑ Signature of Owner or.Owner's Agent 1 hereby certify that all oi,the details and information 1 have submitted(or entere above application are e d accurate to the best of my knowledge and that all plumbing work and installations performed under the issued for this apps be incompliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapte4 r ner BY Title gnature o n um r Cit,►/Town Type of License: Master Journeyman 0 '. i S O L'+cense Number l/1-7 Y BELOW FOR OFFICE USE ONLY ' FINAL INSPECTIONS SKETCHES FEE PROGRESS INSPECTIONS NO.- APPLICATION FOR PERMIT TO DO PLUMBING NAME do TYPE OF BUILDING LOCATION OF BUILDING_ PLUMBER PERMIT GRANTED t DATE �fl i --------------- PLUMBING INSPECTOR Date.. . . .. .. . v4ORTH 4. 0 TOWN OF NORTH ANDOVER I- PERMIT FOR GAS INSTALLATION This certifies that . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas ins Ration— in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . 7 at North Andover, Mass. Check# 17,q 6595 L-\\ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) K512TP A IvDDUER. —. Mass. Date /6 A l 00� Permit #_A5 9 ! Building Location /S COL.W O IZD Owner's Name ,61LQJ ZA&L4kAs f "4 )D 7N A JQ0YF_P_,,, N1A Type of Occupancy &S/DE/J71tgb New ❑ Renovation ❑ Replacement Plans Submitted: Yes❑ No ❑ N N Y W N Z0 ¢ N N zam JN ~ a UVw OmC f. !O— 9SrC 0: Cc :) JFo ° =y ,, ° 0. m W = Z > 0 � WW 0 o W z r W W Q) Uf - cc 0 1— Z j P Z r W W tl 0 > U. }. 0 J h W Z Q W Q C h y. yr m Z O Z W 0 _ Q W > W O Z. Q 6 Q a O O W a' 0 p hO d S 3 G tl .� U a > a a F C '.= O tr. � D �O 3uB-13SMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR I Tl Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01841 -23 JZ ❑ Partnership Business Telephone 1371B-687-1105 Exr *306 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. y Yes No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy X( Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: i arra 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/gent Owner[] Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accur to to the best of my knowledge and that all plumbing work and installations performed under the permit i f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen s. BY- Tvoe of License: Plumber Signature of cense Plum er or Gas Title Gasfitter Master License Number 374"5 City/Town Journeyman APPPOVEff O IC S_O BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO ADO GASFITTING ~s` NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE ��9 GASINSPECTOR y� Location No, � Date �a�Th TOWN OF NORTH ANDOVER � P i Certificate of Occupancy $ MUEZ� Building/Frame Permit Fee $ ACS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ � ' Check # • a 17761 G � // `Building Inspor `• A 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 026 BUILDING PERMIT NUMBER: DATE ISSUED: 1� -� SIGNATURE: BuUn-g Commissioner/Inspector of Buildings Date SECTION 1-SITE INFORMATION I d Z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 1,5 kh Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReTured. Provided ReqWred Provided s 1.5. Flood Zone lnfOfmatiOn: v 1.7 Water S�pty M.G.L.C.40. 54) 1.8 Sewerage Disposal System; Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SFFTION 2-PROPERTY OWNERSIIIPIAUTHORIZED AGENT +uFs v 0 rn 2.1 Owner of Record n ELLEN Z OOrLAM�_ Lp LtnV I&I i1 Name(Print) Address for Service 6N Signature Telephone 2.2 Owner of Record: ,,Name Print Address for Service: O II' Z ignature Telephone m SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Signature Telephone Expiration Date r 3.2 p stered HomenFE?� vement Contractor Not Applicable ❑ v w,l= o j �12 C� �' � Company Name M J4S G EEfvk,C�6CJ l �o2e.Esre�Z Registration Number r Ad ss r L"AlExpiration Date ^ Si nature Telephone V/ s 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......9No.......❑ SECTION 5 Description of Proposed Work check alta cable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify . Brief Description of Proposed Work: C—goo SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building 12 000 (a) Building Permit Fee I Multi lien 2 Electrical (b) Estimated Total Cost of 12 Construction 3 Plumbing Building Permit fee(a) X(b) 4 Mechanical(HVAC l2Q 5 Fire Protection 6 Total 1+2+3+4+5 2 UGC Check Number 14 / SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, A i s Has 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 �;Vj'-J CHS-ion Print N e Si at e of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 FD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NQRT1y TONM o ► over No. 300 /X_� - L A E - dower, Mass., COCKICKEWICK �d ADRATED 7S BOARD OF HEALTH Food/Kitchen IJERM IT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... ................ .... .......... ...... .... Foundation 0 has permission to erect........................................ ildings on ./06 ...... .... .......... Rough to be occupied as... ... Chimney provided that the perso ccepti this permit shall in every pert conform to the terms of the application on file in Final this office, and to the provisions, 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 ST S ELECTRICAL INSPECTOR JfRough .......................................... 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. f 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: LIS 7CJ�FIW/ 06G-A (Location of Facility) Signature ofi Applicant to )'Z--7)o q Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department ofIndustrial Accidents 600 Washington Street ;4! Boston,Mass. 02111 Morkers' Com ensation Insurance AMUR-General Businesses' narrg: (A address. Gi city V\—) 0 9)C C--Sl—ex- state: ZiD:0[ (a U-7 hove At 9 7� 9 work site location(full address): LD �OL—LAXAd ❑ I am a sole proprietor andhaveno one Business Type: ❑ Retail Q Restaurant/Sar/Eat' g Establishment working ia any capacity. ❑ Office❑ Sales(including Real Estate, Autos etc.) [11amane I employees(full &part time). El Other ::: MXM-11111�� I 012,11m.1r,5vwr—llllA F///74/NN101-111111N,�In/w/0 m,sk imli i7mlwi is/z/1 1 am an employer providing workers'compepnsa,,on for Mv employees working on this job. cortilpariv name,-- 0 0 M� .- - address: C� pace's 0 citv: /LL lily—?�4 Zi A hone#: t?oo 6 L5 /?-Z insurance co. 6eeI44o) #O-AF, Arvra-Alce, eve.poliev# I am a soleproprietor and have hired the independent contractors listed b'e'low who have the following workers' compensation polices: entiripsay name. address: city: insurance co. noliev N companv come- address: citv: hone All: Insurance co. RolicV Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penait ts Ora fine up to S1,500-00and/or one Ygars'imPrLsOmm"t As vvtU As civil Penalties in the form of a STOP WORK ORDER and a fineorsiclo.clo a da ■aainst me. l copy or this state meat may be forwarded to the orrice of lovestigatiolu or the DEA for coverage ve ;.cztloa. y gunderstandilista I do hereby ce [he pains n en les p rjury I e information provided above is true and correct sipar= Date lJ Ian 0 q Print name k4 ILA Phone# official use och do not write in this area to be completed by city or town official city or town: �011utltlkug]De�partmtat C1 check if im=EdUte response is required ClUcco3ing Boerd c3sel - ;_.,OM., ] -c'h -:ep..rmc.1 ectmen'l omce Health Department ctonruct person: phone 00 -:C]Otber Oct 26 04 07: 25p Michael Bedard 1 -401 -246-2868 p. 3 + HOME I?4pROVE-RENT CONTRACT Sold,Furnished and installed by: tT� � '�� 7HD At-Homc Services,Inc. Brand►Name: pate: d/b/a The Home Depot At-Home Services 345A Greenwood Street.Worcester.MA 01607 — Job#: �[ �L,�Y/3 Toll Free(800)657-5182; Fttx.:508-756-2859 Branch Number: pedeml IDM 75.2698460 MF..Lie#C 02439 RI front.Licit 16427 CT LIEN 565522; MA Home improvement Contractor Reg.#126893 �Jam' �C�G/L� /4• � Q��S Installation Address: �. Cites State Zip . WorkPhnne: T HnmeYhone: Purchase s; Driver'!Lie.k 8<Cz .Date: �e 4�-7. 6 31 X1 A3 G0' 43°2- Holuic (If Address; Clty State Zip (If different from Installation Address) Proied Information: 1/We/1'ou("Purchaser"),the owners of the property located at the above installation address,offer to coD.tract with ome Depot U.S.A.,Tnc, m Re nt" w fur n?ish•del'n�Toratod here nrby refethe rence and mon If aade a part lhereof. described on the attached Spec Sheet U S�y Home ection of the ot that it cannot pc farm its obligatit nstdue to a structural problem to cancel this contract if, w with the hon ome or because work d eq tired to'comp teethe job was not inciuded in the contract DEPOSIT PAYMENT OPTIONS (Subjcctto fund vcri6cntiea mdlor credit approval.) f_ 1. Check. 81 Check or US Poswl Service Money OrI CONTRACT AMOUNT $ t e➢nynble to The Home Depot). 2. Credit Card*ondlor other payment options-circle One Below*LESS DEPOSIT 5 O b Vies Mi lcrCard Diltovcr American Czptc!! BALANCE DUE The Home Depot flume Improvement Loan The Home Depot Credit Card ON COMPLETION $� �' Ir HILA.HDCC ONT,Y) Available CrcdirS __—( "Nllaimum 25%of Contract Amount due upon execution ,"ti'f Exp•nam: of this contract, Name n!ft appcws nn cnrJ: .. "By mylnur'signature below,Uwe ayrce to ellmv Home Depot to charge the above Indicate Payment Method For credit for the deposit Indica BALANCE QDUE �ON CO LC� referenced md. — (',erdhalder'sSignawrc Ilntc HIL or HDCC A,utborization Codcs �ifjLfPAi�� De osit Final Pa went Purchaser agrees that,immediately upon satisfactory COMPIction of the work,Purchaser will execute a Completion Cent ifreatc and pay any balance due. Purehascr also agrees to bejointly and severally obligated and liable hereunder, p the co Ebetween the partles and canEiriot be emended or modified its d finless n w tiny inaa.sepdra 3gr ecment siolned by bothl p udeseement NOTICE TO PURCHASER Do oat sign"'sir his contract I'D 01 you read it. You are entitled to a completely filled-in copy or the contract at twith the he time you sign. Keep it to protect cctrF huTrnDleote°�nw prohibCits tiumeorepalr cnntrnetorsgfrom rer�uc�8t o�nr n ceptou inR arc aComplerfon Certificate project fined hefnrc.this pmt it by the awncr poor to lite actual completion of the work to be performed under t e con ac. Cane lleifonafortans e p naafi n aofaihYn r ghtrt Tt�erelwili�he of-r icer harRe eql nl to 25%nitnf the cnetrnci nmountt. sfcthe Joh iA ,ean..iled by Purchaser Af 1'ER the third business day. BY yYiOUR SIGNATURE BELOW,UWE AGpFr-TU$E BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RL•CCIPT OF A COPY OF TTITS C(MTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCFL1.ATiON. BY MY/OUR SIGNATURE BELOW, I/WE• UNDERSTAND THAT THE AGREVENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND IIWE AUTHORIZE HOMF.DEPOT AUTHORIZED CONTRACTOR,TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RFIAAS1:TI1GM FROM AL(,LIABILITY INCURRED FRO T NS OR E•RRURS. SUBMITTED B .; _ Date: ' Ice Consul Ply:ACCEPTED 1 fL. yC-•�� lomaowncr Date: Homeowner NOTICE:ADDITID!4AI.TERM3.CONDITIONS AND WARRANTIri ARE STATED ON THtE REVEILLT CIDP.AND ARP.PART OF THIS CONTRACT Whin-Branch Flle Ycnow (:urwmcr Plnk-Selo Co,walmnt 5-18.04 C-SC AT-HOME installed ?° Siding and Windows Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only Registrattori: 126893 before the expiration date. If found return to: EBoard of Building Regulations and Standards U 8/3/2006 ,:. One Ashburton Place Rm 1301 T�rpt; a 'Oement Card Boston,Ata.02108 THE Home Depoi A€-*Mb$ rvi0 8UNROEUN CHH66Y— 3200 COBB GALLEMA P WY 020 XLTANTA,GA 30339 Administrator ___ _ Not valid without signator F2a111T No. �I APPLICATION FOR PERMIT TO BUILD— NORTH ANDOVER, MASS. PAGE 1 MAP 4,40. LOT NO. LNO. RECORD OF OWNERSHIP DATE BOOK PAGE - ZO"E SUB DIV. LOT NO. �I LOCATION / 1 y� 1 1 11i1W�pJ lr lad POSE OF BUILDING r F Q OWNER'S NAME en Lary brl nom_� OF STORIES SI E 0/ x s^v OWNER'S ADDRESS r�`1A�1�I L yt BASEMENT OR SLAB d 1 i� 1 vl- ARCHITECT'S NAME SIZE OF FLOOR'TIMBERS 1ST IND 3RD BUILDER'S NAME SPAN OV K as I DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS o�� DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION, THICKNESS IS BUILDING NEW SIZE OF FOOTING JI IS BUILDING ADDITION MATERIAL OF CHIMNEY ) IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND C�I� 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 r/J INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH SIDES LAND.COST EST. BLDG. COST G U PAGE 1 FILL OUT SECTIONS f - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM 4 ELECTRIC METEPB MUST BE ON OUTSIDE OF BUILDING SEPTIC PERMIT NO. 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED •IGNATU F OWNER OR THORIZED AGENT OUILDING INSPECTOR z 23 FEE OWNERTEL# PERMIT GRANTED CONTR.TEL.# CONTR.LIC.# H.I.C.# MAY 15 1997 BUILDING RECORD �; • ICY 12 .s THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM 75 — LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. PION INTERIOR FINISH B 1 2 13 r.p — — R -- - TALL M'T' AREA _ `TIC AREA _ ACES _ V KITCHEN FLOORS B 1 2 3 'TE F p D ILE TRS. R FLOOR I_ + WIRING jR.TE i-� NONE ti PLUMBING 'FIX.) _ RM. (2 FIX.) CLOSET _ .RY _ SINK AABING _ HOWER _ FIXTURES _ AOR DO HEATING FURNACE HOT AIR FURN. "R OR VAPOR IDITIONING H'T'G ATERS TING { ------- I Town of 9 _ No. aver Z /g � � m o 'F'" . LAKE dover, Mass., 191' 4-Co- ICHEWICK '�• E co 10%, PERMIT BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ••••••••••••••••••••••-••••••• ` BUILDING INSPECTOR has permission to Ar9et`....... •��.•4.).. .... buildings on Foundation 6�'ezlt�E '�j.. ... ........ ..........................to be occupied as Rough provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Chimney this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR • Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST 7'S ELECTRICAL INSPECTOR Rough ..... ......................... B DING. ..INSPECTOR. Service Occupancy Permit Required to OccupyBuilding Final GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough .No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. KAREN H.P. NELSONjTown of 120 Main Street, 01845 Directora • NORTH ANDOVER (508) 682-6483 BUILDING �,''• :: .e CONSERVATION eQ"""°` DIVISION OF PL INnNG PLANNING & COMMUNITY DEVELOPMENT DEMOLITION OF BUILDING AFFIDAVIT DATE '�a OWNER'S NAME & ADDRESS Elm rn Lamb✓i r).oj is ccIkkmbl� P-4 LOCATION OF PROPERTY TO DEMOLISH DESCRIPTION CONTRACTOR'S NAME & ADDRESS b� DEPARTMENT SIGN-OFFS OF '-PUBLIC WORF.S - WATER: SEWER: wm A C jAXES POLICE a '��•� ��y� EXTERMINATOR C, J DUMPSTER - ON/OFF STREET DIG SAFE NUMBER DATE RECD BLDG. INSPECTOR i 9 Town of North Andover 0* 50 6,6ti OFFICE OF �? q° °0� COMMUNITY DEVELOPMENT AND SERVICES ° 146 Main Street North Andover,Massachusetts 01845 WU,LIAM 1.SCOTT SSACMUS� Director In accordance with the provisions 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 111, S 150A. The debris will be disposed of in: C::9:n+y-� S Dos c D SSS rr�e"I l-p I(� (Location ofFa ility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. I I BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Location— No. ocation No. '?°� Date ORTM I' TOWN OF NORTH ANDOVER f 9 Certificate of Occupancy $ �J cwusEt� Building/Frame Permit Fee $ V Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # / -7 i 471) 7 �Insp�� Buildi TOWN OF NORTH ANDOVER i BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING aux f t � s x . .,A:. .n.. e211 BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/, r of B 41dings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Pr osld Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard . Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.I-C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record / s4, K zap 4Q NameePrint) J. k Address for Service: 3 0 <2— Signature Telephone .2.2 Owner of Record: Name Print Address for Service: z M 90 Signature Tele one SECTION 3-CONSTRUCTION SERVICES 3.1 Construction Supe ' or: Not Applicable ❑ Licensed Con truction,Supervisor: ��S'-�/ (/ (1L ! . oK License Number fit% M ^Addres 3 �= d 1 Expiration Date ic Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name /� 0 Y� M _ Registration Number Add Expiration Date m nature Tele hone s � 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 rmit. Signed affidavit Attached Yes...... o.......❑ SECTION 5 Description of Proposed Work check all aDDUcable New Construction ❑ -xisting Building: 11Repair(s) terations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify .N Brief Description of Pro sed Work: ��-aa+•�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be � I?FIC1 Ulla=Ol Wyk Completed by permit applicant I. 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 o u 5 Fire Protection T, 6 Total 1+2+3+4+5 �— Check Number SECTION 7a OWNER AUTHORIATION TO BE COMPLETED WHEN f OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT s I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b /OWNER/AUTHORIZED AGENT DECLARATION I, /i� as Owner/Authorized Agent of subject property Hereby declare that the st ements and information on the foregoing application are true and accurate,to the best of my knowledge and belief ,flf—int Name , i d � � l40 o / r ature of wrier/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1sT 2ND 3 SPAN DIMENSIONS OF SILLS DIIv ENSIONS OF POSTS p DMFNSIONS OF GIRDERS y HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i NORTH LED Town of Andover No. Q D - O0CoC„,� j dover, Mass.,- -7-- 0 ,42IM/ ORATED PPS` 5 ,9S H BOARD OF HEALTH PER IT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.............................. ........ ............ ........................ . .................................................. Foundation • has permission to erect........................................ buildings on 4 ..... ........ ...... Rough to be occupied a ... t�vis�ionsi�oif Chimney . . .. .. .. . ............... . . . .. . .. . provided that the persthis permit shall in every respect�conform to the terms of the application on file in Final this office, and to the the Codes and By-Laws relating to the Inspection, Alteration and Constrgction 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 STARTS ELECTRICAL INSPECTOR . Rough 44V................................................................. ........................................ 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. Z - SEE REVERSE SIDE Smoke Det. e JUN-25-2001 MON 02:32 PM FAX NO. P. 01/01 06/25/2891 14;30 5168295857 SCSAGENCV PAGE 92/92 13 ACO , E' m .>:'.....�.uu.p.,u+„�.. tyn 1 ",��i,;:.:f't .ro'f "� Er• .�iu, ;moi ie+ ���!,•,» (MAODD/YYI .r�p IRD n' < n, .v,:......,. r•......ly.u::w......v')�•NR .+..:.N... .{ ......:.,M!�!n r1M� �A. p �C�.� MSW `}� .., AA 'I I I �tl �r .n •�D/.,G n■ ..F..•µ..,{;:• �NW�I»'•��'^ :.•'S. h ".f:i' �• I� ,Y.Rr. ay r.<< '1 .! 1 0� ii �N• ....�...r ...�.....n..., ..::«!r r Cin•r w PRvvUCER 8C9 Agency, Inc. MI RTI TE IS ISSUED AS A MAMR OF INFORMATION 0 Z IJ< P.C. sad 220493 L b CONFERS NO FUIGHTS UPON THE CERTIFICATE 11 Grace 2204 Avenue Salta 300 0 THIS CERTIFICATE DOES NOT AA4END,EXTENR OR T HE COVERAGE AFFORDED BY THE POLICIES 5ELOW. Otcat Neck MY 11022.0493 COMPANIES AFFORDING COVE RAGE HOUR C Pn CMA Nuoxo. HermitageZripuranco CwVazy C Clarandon National Tne Co ta Nil-Ray Alumin= siding Corp. G Scottsdale %usurance Company 40 11mont Road Blmont DIY 11003 CO PA ]��]DD�RR�[ p.+41r.n• y :::..•,.W:.'MfV :.«...: ...!..IIlyygilvrllllflli.H:N. !:ti<j. �q".Iiri Nwr-w II'1�:r In••vImITr;....^NMw IF IFA�r•”,ukwi N 1 .!,7rn JJrrNN lriwlil} 7i;::t ir, I 1 �:::i:tliv..rl•[Inir•c..uN .J'i::IH:,..w ).'..:.W�i'rwiri�li JIB.Vrt:<:.,t'1r<,`�Y:,•IY+ N... .T.:![•:I y�!n t'�'y'i� p 9y�:.�'.r:vw.M1.W 4wrtnn:t!+..A•:111V.Y..�•y'...... M.u4i�f�J:�;:�'.'��f�.if:N f�irJl ntS ar Y. ,iN+rf •[i:'�<�Vfll,tl�; M UL�YNw�i:,if!t•!al TNI3 I*TO CQMFY THAT TIC POUCIE8 OF IN6URANCO DOTED B0.0W IWVL DMN I$fV&D TO T BIN NAMED ASOVF FOR T{IE POLICY VOR100. .MIy;W4R.•...sf;, cw .. •,.re::r:. INDICATED,NOTWII•H$TMHDIND ANY RiOUIREMeM,TM OR CONDITION OF ANY CONTRACT 0 1 OUMeNT WITH RESPcc f To WH(cw TWis Coen'ICATG HAY BE Ll"D OR MAY PMJYK THE I48LMMC2 AFF01WE0 BY TuE POLICgB 8 HEREIN 18 BUWfCT TO ALL THC TERua, pq =U�OND AND CONDITIONS OF MH 00Licia Wes SHOWN m4y Owe 5CeN pi0()OFD g PAt LTR TYPE OF MUMNee POLICY Num"A POLICYE DATE(MN/ATIO UMITB �► ALLMILTTY GENeRALA00RGUTE 17 000,000 A X COMNSPOA 0EWYALLIMILTTY =4431943 08425)0 08/2S/01 PRODUCTS-COMP10PA00 11,000,000 a"�'s"'N0° ® M PIRSO AL O ADV INJURY 41,000,000 OWNER'S b CONTRACT'OR'S PROT r'ACH OOCURRENCE sl 000 O O O FIRC OAMAOW(Any o.w ero) i 100,000 MQD Fq(P(Arty 001 1 i 5,000 p OMOD LE LIIDILRY ANY AUTD COMemdO3IN4LELtAJIT S ALL OWNED AVT05 WDILY U iv;ty 1 SCHGDULEO AUTOS P—) MIRED AUTOS BODILv IruuRY i NON-0WNEL1 AUTOS (Par�cad�nq i PROPERTY DAMArA $ GARAGE LMLITY AUTO ONLY-G ACCWGNT S , ANY AUTO OTHATwAngtlTOONLY:' 'i.. z.,.:N«r3w, yr!4•,,....r,r� EACH ACCIDENT I EXCIM LIAMUTY EAC,4 OCOUNUME 13,0004000 C x um-m .AFem nr.0009269 0$/05/ 08/25/01 AGGACUTRC 76,000,000 DIM TIN UMBRELLA FOFAS � WORMASCOWEN5AT70NMD x O _.e'••;;+':F��i'"'`•:nwy.':±�,^•:„ter uAn Dveres LIAaILm ( EL tACH A=DPM 1500,000 >8 IRE PP:OPRE RJ z INCL SCT00012360501 05j .i v3/14/OZ w orf;>F�•aoLlcruMR 1800 000 w PARTNCRSIpecurNr OFFIC9KS AKe EXC1 I eL DISEASE.EA EWILLOYee 13 5 0 0 0 0 0 oTneR I' DiTMAPTION OF CPCIATI0M&nCAT1CN$NEH W5pECM 11r.M8 ��a�,ilf a:;i:r.:r,l w.>rw•r.�I�r.,�,,: ,..d.v:! . .. •., ..... .........ncl. :,Rr1 .... :....•.: ;,• �tir::>iY.+,ry "'WARA, n r•l r...e..l M..l 4.f��•rr. y..u..fiN /n 7 1`..�r,;•r. �W.S'c .•4i Mw l.;r S:fii'1?;. ��-O� O�UL OF TFC A/OYR DESGIIl6D P011c}GG afi OANCIFLI.ED BGFOiiG TTi6 &.0 GATE V910 F,THE 159UIN7 OONPANY WILL INMVMTO MAIL 3—0_ a VW;n'6H NOTICE TO THU C>:"IrATr HOLDER NAMCD TO TMC LQT, auj r/ TO MAIL SUCH NOTICE SMALL*VM NO O"ATION OR G AWLRY OF ANY UPON TK OOUPA -M AIMM OR RCMw W rATIVFBr RUTH J {{,t�����Jyyr�,ypyy,,(�y,y./�},;, ....It:ll„(II(�I11�:NH:r..«,.�N�4•I:A�i�u.�(').::i-t::�L'.S'• n ... 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For more Information,call 1-330-929-1811 or visit HFRC's web site at For more Information,call 1-330-929-1811 or visit HFRC's web site at www.nfrc.org. www.nfre.org. SolarHeat1 Aiin t�i-'tb l Solar Heat c .�,ln 'Jisible 1-1-Factor �. Coefficient 1 Transmittance 1-1-Factor Coeffir_.ient Transmittance i . 32 3.2 . 53 . 341 . 53 Manufacturer stipulates that these ratings conform to applicable.NFPC Manufacturer stipulates that thFise ratings conf orm to applicable NFRC; procedures for determining whole product energy perforrnarce.NFRC procedures for determining n1-10le product energy perforrnence PJFRC 4 ratings are determined for a fixed set of environmental conditions and ratings are determined for a fixed set of enVirpnrneM51 ccnditinns and s ecific kroduct sixes, s eclilc roduct sizes. f{3 I f BOARD OF BUILDING REGULATIONS =4 rf License: CONSTRUCTION 13UPERVISOR '�},�f -iiiJlil%l iff lij r1t w Number: CS ' .r n; Birthdate: 08f16/1952 31,rai,g i.0," ;1C i f Expires: 08/16/;?()()lTr. no: 6529 Restricted Io: 00 a� i t it I PAUL S MACDONA.LD 2.5 MASON RD DUDLEY, 14A 0157•1 - -- -- - Admi;�istrator 1