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Miscellaneous - 15 MIDDLESEX STREET 4/30/2018
15 MIDDLESEX STREET 210/043.0-0001-0000.0 i \ Date -!.r ...... 1 1144 TOWN OF NORTH ANDOVER o���'„e`� ••. 009 PERMIT FOR PLUMBING HUg� This certifies that... ... ,....! ,1�... ! 4. ..... ....................................... has permission to perform.................................................................................................. plumbingin the buildings of............................................................................................. n� fIff� ........, North�lndover, Mass. at... ./ l t.ctd.��eS�y.. �.,... Fee..'7 ..........Lic. No. 1�j'. ,. ............. �m ............................ h PLUW`BING INSkCTOR Check# J The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 'tet www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information A Please Print Le 'bl Name(Busine/ss'/Organization/ludiAdual): Address: (CJ a;l �71� City/State/Zip *6 CO Phone#: �"-��;/� `"�3 F-0 Are you an employer?Check the aploropriate box: Type of pro' (required): 1.❑I ama er with employees(full and/or part-time).* 7. e nstruction 2. am a sole proprietor or partnership and have no employees working for me in 8. Remodelirig any capacity.[No workers'comp.insurance required.] 9. EDemolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.=umbing f repairs or additions proprietors with no employees. 12. repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insirance.x 6.❑We are a corporation and its office have exercised their right of exemption per MGL c. 14•❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submif•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not.those entities have employees. If the sub-coniractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.•Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der the pains an en ties of rjury that the information provided ab ve is true d correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 w i 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 contraot'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 theperformance of public work until acceptable evidence of compliance with the insurance��-' requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out.the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit erm multiple it/license applications p p ppli ations m any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address;telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY - ( MA DATE f_. ( PERMIT# JOBSITE ADDRESS I OWNER'S NAME C� POWNER ADDRESS ✓•Yin _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:REPLACEMENT: O PLANS SUBMITTED: YES Q NOD FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 114 BATHTUBCROSS CONNECTION DEVICEDEDICATED SPECIAL WASTE SYSTEMDEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 4 . f _._.t ► __ _ I .__ I �_J t DEDICATED WATER RECYCLE SYSTEM DISHWASHER _I E _. _1 _ I J I __... ! _ _ �1 1 DRINKING FOUNTAIN IL---- ______1' __j ..__..._! FOOD DISPOSER FLOOR/AREADRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY --ii ___._.1 —'—J--j__—j I I ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL J, WASHING MACHINE CONNECTION ° J TER HEATER ALL TYPES WATER PIPING I } .___...J _f I -- -- I I _ _ OT EHOT EH R _ _ _1 I _1 __...__I -__ I ._-__I __.._.__I ._..._-j -_A ._...--I= ( __..._.-J I I INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ,_ NO IF YOU CHECKED YES,PLEASE INDICATE THE T OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND D OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑i AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the bes f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co nce with all Pert' t r ision e Massachusetts State Plu bing Code and Chapter 142 of the General Laws. PLUMBER'S NAMAJA LICENSE# I NATURE --v- 'Aw MP 01 JP RPORATIONR# PARTNERSHIPO# (LLCM COMPANY NAM DRESS 6 6 V 1 CITY6—/2�7 of t STATE ( ZIP LO 74? ( TEL F y'tSC CE �EMAIL RO H PLUMBING INSPECT-ION NOTES BELOW FOR OFFICE USE ONLY FINAL TSPECTI *OTES , Yes No ` THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: PERMIT# PLAN REVIEW NOTES t Date..... .......... ..7r.......... ^� NORTH - °'"a TOWN OF NORTH ANDOVER F 9 PERMIT FOR WIRING �,SSACNUS� This certifies that .......... fir 4....... .!T.............................. has permission to perform ....fflM....... .......4M�q mw wiring in the building of....l ? ......... ................................. at.. �/s ll...z� M: , .., .f1C.......5.../................ North �A�ndover,Mass. Fee., .-�' Lic.No./3 .? .........� �Af ..�"A'4e- -�� ELECTRICAL INSPECTO Check # . 6646 Commonwealth of Massachusetts Offiei 1 Use Only ` _ 1 Permit No. Zy Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) 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 PRINT IN INK OR TYPE ALL IN ORMATION) Date: ,,5--1 2 OA�' City or Town of: / r� ©�/,�/' To the Inspector of Wires: By this application the undersigned gives notice o h' r her intention to perform the electrical work described below. Location(Street&Number) UPIPs Owner or Tenant ,9el7/'y 01-o�4,o /-Q 4e,-' Telephone No. 7 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. P g d`�S� 2 dlCP Y 2d�3..�� Existing Service Amps IgOl c9oVolts Overhead Undgrd❑ No.of Meters New Service f62— Amps PP/ QVolts Overhead Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: r Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 11 o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained Totals Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Kir Security Systems:* No.of Devices or Equivalent No.o Water KW No.of No.o 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: 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 pent!ties o perjury,that the information on tkis application is true and complete. FIRM NAME: Anp, q�J' G �^ c/ LIC. NO.: 4 Licensee: PZ- Signature LIC. NO.:/ (Ifapplicable,e ter "exempt" ' the license number h e.) /� /q Bus.Tel. No.: i� �p�D-t � Address: j / *Security System Contractor License required for this work; if applicable,enter the license number here: 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, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 774Date. . .7. .. .... NORTH o= TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION SSAC HUSEt . N:. This certifies that . . ��-U .Q l .I'? . . .`a�°' r-� . . .C C5 .. . . . . has permission for gas installation in the buildings of . . LZr -.R-` '. . .?. . . . . . . . . . . . . . . . . at (VA . . . . . . . . . . .. North Andove , Mass. Fes a� . Lic. No.3.2�� . . . . : '. GAS INSPECTOR Check# MASSACHUSETTS UNIFORM APPLICAT(Print or Type) ION FOR PERMIT TO DO GASFITTING ` yd1fN AIJl XCF- , Mass. Date 10 /7 A I Permit # Building Location IJP hIDOL6SE ST Owner's Name- amm' 1A) 1KW CL MA, Type of Occupancy$! New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N cc 8 Y W N N N U z ¢ N Z 0 Wz 0 J N w O U m ~ S !A Q o0 W ~ Q a z O r W Q ¢ O ¢ N O W d s z EO.. vs a ¢ R N ¢ W Z V W N W Q it O a W W W N J r Q S ¢ ¢ O ¢ W ~ W H Z (ll ¢ 0 H Z J h 1 F. W W O > IL P U J {. W Q W > ¢ W Z Q � Nq K Z O Z a O X LL .z O V' Z U. 7 3 D C7 J U C y G 60 1" O sue—BSMT. BASEMENT ' 1ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR GTHFLOOR 7TH FLOOR 8TH FLOOR Installing Company Name COLUMBIA CI&S rF MASSACHUSETTS Check one: Certificate # Address 55 MARSTON STREET X] Corporation 1862 LAWRENCE, MA 01841 -23 12 ❑ Partnership Business Telephone q 7 z-691- 640 6 ❑ 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. Yes W. No ❑ If you have checked Vis, 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 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 information I have submitted(or entered)inabo pplication are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene BY T e of License: Plumber Signature of Ucensed Plumber or Gas Title Gasfitter Master License Number 374 City/Town Journeyman APPROVE (OFFICE SF O LY BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING mss. r r NAME S TYPE OF BUILDING "# LOCATION OF BUtLDINQ . I PLUMBER OR GASFITTER , sj LIG NO. PERMIT GRANTED DATE —'i 9 _ GAS INSPECTOR I II , E "�- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASF;TTING E (Print or Type) ' 1yokCIN 1�MWCP— Mass. Date �(o Permit # _ Building Location_ 15 H IQ6LESEX ST Owner's Name 8A PL nt1 e AJL�K-'C JefJf7011Ek HA. Type of Occupancy SI1JGLE FAF1lL`� New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ m rr (n Wtp . Z ¢ `1-C N N u ¢ ¢ 0 ¢ m ¢ o 0 _ IV W J N W o U m F- s n C7 _ ¢ Q Z z O F ¢ Z O W Q ¢ ¢ W O a c W W 2 Q x LLIN W Q a O O W } W cn ¢F- z W ¢ C7 ¢ 1' =Y W }- U J h Wr. IIYn Z a W J 4 C ~ f" a N m Z O Z W O ,M a W > ¢ W M z. Q ¢ Q o o W ¢ o w SUB—BSMT. BASEMENT ISTFLOOR 2ND FLOOR I 3RDFLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR BTH FLOOR Installing Company Name COLUMBIA 6jAS GI= MASSACHUSETTS Check one: Certificate # Address 55 MARSTON STREET HCl Corporation 1862 LAWRENCE, MA 01841 - Z312- ❑ Partnership Business Telephone_ q 7 8-e I- 6+06 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9, No ❑ f you have checked Les, please indicate the type coverage by checking the appropriate box. k liability insurance policy $( Other type of Indemnity❑ Bond ❑ 3WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by `hapter 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 El hereby certify that all of the details and information I have submitted(or entered)in abo pplication are true and accurate to the best of my nowiedge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all ,eri;nent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. (/ h T e of License: Plumber Signature of Licensed Plumber or Gas itle Gasfitter Master License Number_3745 .ity/Town Journeyman PPPOVED O FICE USE ONLY) Commonwealth Of Massachusetts I I I ,c()III\ Department of Fire Services Occupanc% and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS k APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .\11 wrk to lie 1,crt'i"wied iq,jccopj�jpce�\itlj i (11e 11CO-ic,l1 COde(\11:0. 5-7 0111 1-1.0 (PLEASE PRL\HN 1AK OR TYPE.ILL INFO 11ATIoN, Date: - ' — op" City or Town of: /V 041, e- TO 117e IRVI�ec-lor o/ 13Y this ;Ippllcatloll the undcl-slalled Ilutice of his 01,her ilitclitioll to pel-f'01-111 lllcQlectrical Location (Street& Number)-. Owner or Tenant I=594 z— Telephone Nio6i? Owner's Address Is this permit in conjunction with a building permit? Yes No (Check ,appropriate Box) Purpose of Building 2 -r- LtilityAuthorization No. Existing Service Allips —Volts Overhead 0 Undgrd❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: v79-loolole--,A.T 4-Q V Com 1111ion oit;in ";X 'It U,4!h1hie MM 11 No.of Recessed Luminaires No.Of Ced.-Susp.(Paddle)Fans No.of Total Transformers K VA No.of Luminaire Outlets No.of Hot Tubs —Zliterators KVA .No.of Luminaires Swimming Pool F q P510!-.of Emergency Lio ghting ad. ijittl. j.13attery Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS rNo. of Zones No.of Switches No. of Gas Burners I No.of Detection and - L_Initiating Devices No.of Ranges NO.of Air Cond. t I No.of Devices 7t Toons i No.Of Waste Disposers R-e7at-�Pump Number Tons 7—KW 'No.of—Self-Contain Totals: ed 4 DetectioniAler.ting Devices I \1111111 No.of Dishwashers Space/Area Heating KW Connection El Other Connection No.of Dryers Heating AppliancesKW Security' -S--y—sic`in-s: No.I) Water NO.0 No.(�f— No.of bevices or Equivalent Healers KW signs Ballasts Data Wiring: No.of Devices or Equivalent - - No. Hydromassage Hathtilbs No. of Motors TotalHP Telecommunications Wiring:f Devices or Eqtii-,.alent OTHER: F,Jfinated VJue of Electrical IV-rk: (A hell rcl,'Juired by municipal p(,,I' kk o i,k to MMrt: Ill.--pCCtionsto be requested In accu rdancc with EIEC Rule 10. and LIP011 C0111PICtioll. INS1,111ANCE (5-NERk-C'E: I. nIv-.1s � aived b, [lie Io 1.01,1 - 61-11"llicc ofelectrical clay !ht: liculsec prootrli o ;lh Ile V'cl1 ilit 1;perition th;lt h cw. llibitcd i'l-oct('t 'wic ru Ilii' v mil. t il .,R.4 c- z AIC F� -7�1rizalL. oiler'll'.; IIL01!t;IIIIIIII-Cl-11LIV rc that 111': 1':,A 1 1 et by law. I-),y Ill\ I'VL 111i'. IV+IiI-0IN;lt. I Owner,'Aaent DatC9.1 .... ............... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 3S CHUS This certifies that ............. ........................... ............................................................. has permission to perform lee 11,'0 wiring in the building of.....6o o �..../ ....✓)............................................ aV.6...,0.097/,/ 0��,X........... ................... ..Nqrth Andover,Mass. Fee./P.0.. ........ Lic.No. Check # - 8590 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 9 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank 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 PRINTMINK OR TYPE ALL INFORMATION) Date: 47, — o�g -o 2 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of hiso her intention to perform the electrical work described below. Location(Street&Number) l ��e � Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a build' gper ' � t? Yes No ❑ (Check Appropriate Boz) Purpose of Buildings Utility Authorization No. Existing Service Amps / Volts OverheadUnd rd ❑ g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: r Completion of thefolloudng table may be waived by the Inspector of Wires. No.of Recessed Luminaires C1 No.of Ceil:Susp.(Paddle)Fans No.of Total . i Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o. o Emergency Lighting d. rnd. Batte Units — No.of Receptacle Outlets �No.of Oil Burners Fly ALARPd11S No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: ..'.....-"' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts . No.of Devices or E uival nt No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uival nt 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: �2-6-el� 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 pro of same to the t issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Spec' :) I certify,under the pains and penalties of perjury, that the informa ' n n thi ppli / is true and completes FIRM NAME: LIC.NO.: Licensee: Signature i LIC.NO.: (If applicable, enter"exe pt" ' he license n mber �� Bus.Tel.No.: Address: ( 1S I'll Alt:Tel.No.: J K - *Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $1dO �A' _, tom- � �C � q-o q G�'2.. ^1 The Commonwealth of Massachusetts k- ! Department of Industrial Accidents Office of Investigations 600 JEashington Street Boston, MA 02111 www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQibl Name(Business/Organizafion/Individual): Address: City/State/Zip: 1- G/`�Z Phone#: . Are you an employer?Check the appropriate box: 1.❑ I a employer with 4. ❑ 1 am a general contractor and I Type of project(required): mployees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2. I am .asole proprietor or partner_ listed on the attached sheet 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for mein' any capacity• workers' comp.insurance. [No workers'comp,insurance 5. 9• ❑Building addition P ❑ We are a corporation and its 10.❑Electrical repairs required-] officers have exercised their r'ep rs or additions ,� 3.❑ I am a homeowner doing all work right of exemption per MGL 11,0 Plumbing repairs or additions myself. [No-workers'comp. c. 1.52, §I(4),and we have no 12.[]Roof repairs insurance required.]t employees, [No workers' comp. insurance required.] 13.[].Other 'Any applicant that checks bort#1 must also fill out the section below showing their workets''compensation policy information, t homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the frame of the sub-contractors and their workem'cor p. irw,;,ation. 1 am an employer that is providing:workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie,#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compeusation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imp ' onmen 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 viol r Be ised that a copy of this statement may be forwarded to the Office of Investigations of the DI f r insuranc ct5ver ion. I do hereby certify d p ',,( d pe s f perjury that the information provided above is true and correct Signature: / Date: Phone#: e Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. *however the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or focal 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. lfan 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,notthe 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 numberlisted below, Self-insured companies should enter their self-insurancelicense number on the,appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating-current policy information(.if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each w year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The 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 42111 Tel. #617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia Date.................................. NORTH TOWN OF NORTH ANDOVER O P PERMIT FOR WIRING CHUSE� l This certifies that «M 6.................................../ C U l �/.................................... SES U(C i s ..... has permission to perform ............S ... cvr..iy.....S , i 1>' ......... wiring in the building of.�!�.......L-.to.w............................................ at............ .5`./!'1�DA��- SF 57 .........North Andover,Mass. t Fee..................... Lic.No............. xP .4' .. ELECTRICAL INSPECTOR 1, Check #oo ���� Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 9/051 (Icavc hl;,nk) l APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance Nsith the Massachusetts Electrical Code(h•ifC).537 C ivlR 13.00 (PLE,,ISE PRIiVT iiV IIVh OR TYPE,ILL IiVFORiVIA77UN) Date: J r-A,_p 60 City or Town of: To die Inspector t�f'.6Vh-e.5': By this application the undersi�uned �_ives notice of his or her intention to perform the electrical work described below. Location (Street & Nu ber) /,�5– e-�9E( k7—, Owner or Tenant . Z aj Telephone No, X17"`' -•`—F`��s Owner's Address is this permit in conjunction with a building permit? Yes. ❑ No 07 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: s7le&L- 7 Completion of the following table may be waived by the Inspector ol'Wires. No.of Recessed Luminaires No.of Cei1.-Susp.(Paddle)Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ t -o. ot Emergency Lighting b grnd. arnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No: of Zones No. of Switches No. of Gas Burners No. of Detection and (nitrating Devices No. of Ranges No.of Air Cond. Tons! No. of Alerting Devices Heat Pum Number Tons KW o. of Self-Contained No. of Waste Disposers Totals Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW' Local❑ Municipal ❑ Other Spice/Area n No. of Dryers Heating Appliances KW Security Systems:* No..of Devices or Equivalent No. cf`Vater KW No. of No, of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent ;1 No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional dead it desired, or as roquirect by the lnspertnr of 1 1'e.y. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Si69 inspections to be requested in accordance with NIEC 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 coveraae is in force,and has exhibited proofof same to the permit issuing;office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) I certify, antler the pains and penalties of perjury, that the itiformatiatr on this application is trite tart!complete. FiRM NAME: ADT Security Services, Inc. LIC. NO.: 1333 C Licensee:q�j/-,ty Q 60 �i C 2C� Signatur � LIC. NO.: p Z� (lf applicable, enter -exempt"in the livense number line.) Bus.Tel. No.: 60 -594-5900 Address: 13 Clinton Drive Hollis N.H. 03049 Alt.Tel. No.: 603-594-5930 *Security System Contractor License required for this work; if applicable,enter the license number Isere:<,ScS 000-5 117 OWNER'S INSURANCE WAIVER: i am aware that the Licensee dues not huve 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 agcnt Owner/AgentPER/YlI7' FSE: �g Sienature _ Telephone No. t-��j ...... n .. .. � �. .. � � ,i: �w a ` �, I lic I,il I :,e()111N Commonwealth of Massachusetts Department of Fire Services "e'll"t \10- Occtipanc\ and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 905] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK MI %loi-k to he performed In'Iccol-d'Ince\\ith the\1:1,,SiICIILISCUS Hccftical Code MFC). 527 CAIR 12.00 I'LL ISE PRL\F A_11'K OR TYPE,ILL/V I.N.Tit Ifl-TION) Date: to Cih, or Town of: . r7,0 a4/ To the h1NftL'l01'0/ ff"hT.N.' By this :Ipplicution the undersigned;ties notice()t'llis(.)I*licl. 0 - "Iteilti011 to Pelf)"Ill the electrical \Ncli-k desci-ihed helow. Location(Street& Number) 1-15- oW,,2WI,s e, �7— Owner or Tenant V 01- 4,1 np Z-0 ke" Telephone No `7 _?9_71f Owner's Address Is this permit in conjunction with a building permit? Yes No E] (Check Appropriate Box) Purpose of Building 2 I,- Utility Authorization No. Existing Service Anips Volts Overhead 0 Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ UndgrdF_j No. of Meters Number of Feeders and Ampacity )ZU`IO Ih( "idtfill big ICING n ILI V he I I a I I i.d by 1,11C It iqA o/ I I Dateq..,. .............. Fans Ifo._0T— Total Transformers KVA Generators KVA NORTH 0 1 6TOWN OF NORTH ANDOVER In- P10 Pleo. oll Emergency Eighting or rn d. I Battery Uilits PERMIT'' FOR WIRING !FIRE %LARMS [No.of Zones 49 "No.ot"Detection and Initiating Devices S CHU rotal t rons No.of Alerting Devices ns KWNo.of Self_C6j�taincd ........ ....... ............ This certifies that —4 Detection/Alerting Devices Loca ❑ Municip�l Other ...................................... Connection has permission to perform ... Security Systems:* wiring in the buildi ................ . ........................... KW ng of ....... No.of evices or Equivalent of Data Wiring: s- at.................................. .................... .North Andover,Maslasts No.of Devices or Equivalent :11 tip I clecommunications Wiring: Lic.No/3A_,4..............................•••,<� , n... No.ul'R!vices or EquiN alent Fee ........ ELECTRICAL INSPECTOR Check # red by municipal polio. 6557 -.1ance t0h \IEC RUIC 10,and LIP011 C0111pleti011. %Mod by t ic oktiicr. no permit for the PCI_I`0I_IIldI1CC Of CICUHL.tl �rork iiiay li'_Ale tllllk:- Ilic licellset: provides proof or liahility illstll-:Illcc Includill'-,--'()I11PIvtcoI()perationc0�erLIU_e 01, its I ailt ia I !Aldcr.i',licd(xi-firle'. tli:lt,'[Icll (ok i: it) • :111d hos c-.Ilibitcd i'l-imt 1"'t!�,Irie to Me INS( 10X('!, ❑ i3t;y,l) I_� ;ftil R ❑ Itir.uc i I V: mder'lie pet Il/:I,, R NI NAA I F: 3u.s. TA ',�o.:_ Address: Alt. ft. )C(All'ity SY,tcm Contractor Li(XIV;C I_L:LILlIi'cd for this t,,ork, Ifapplil(IbIC,—L[ItCl the license number here: ONVNER'S INSURANCE AAIVER: I ;.iiiimk;,re that tile nolhavc the 11:_tbility insurance —th I IUCILlired b) law. 'VC this IVtIUiI'LIlkI1t. I iiiii the(check 0110❑ )��nvr llk:l" tit- Owner,'Ngent D ate .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING If.....Zb MI s certifies that . ... .Me ,...... .............. has permission to perform ...1"d.0. i.-� ..................................... wiring in the building of ............................ at............................................................................... .North Andover,Mass. Fee Lic.No 13(K.-O.................................c f ELECTRICAL INSPECTOR Check # 6SS7 Commonwealth of Massachusetts 61- Department of Fire Services Occupant} and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9o;] (je,lve blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All .I,oi-k to he rei-fonlied in accordance X011 the%hSSUllLISCItS HQ01-ical Code(\11`0. 51-7(AIR 121.00 (PLE:ISE PRL\T/A'INK OR TYPE.ILL INF08,11.I TION) Date: Cih, or Town of: /V TO /lie BY this ;IPPIILalion the undersigned gIves notice of his or liel, intention to Pei-f0l"ll the ulech-ical work descrihed below. Location(Street& Number) -10W19eA'1 s Lo 57 Owner or Tenant ,-/, V 47,14,0 /— -,- Telephone Not Zf Owner's Address Is this permit in conjunction with a building permit? F-1 es Ltn No (Check Appropriate Box) Purpose of Building jmesl4ee, In r- Utility Authorization No. Existing Service_ :%Ilups Volts Overhead ❑ UndgrdF] No. of Meters New Service Amps Volts Overhead❑ UndgrdF] No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: r r V ompIc I iol I ol du ";dlo It i1,I,,/(/h IV"Ilov he I l:,:i It d;-y the blsptctor o/ 1t': No.of Recessed Luminaires No.of Ceii.-Su.sp.(Paddle)Pans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot'rubs Generators KVA No.of Luminaires Swimming Pool kbove ❑ In- o.of Emergency Lighting LYrnd. 4rilid. IZ?lBattery Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS rNo. of Zones No.of Switches No. of Gas Burners No.of Detection and InitiatinDevices Tons No.of Ranges No.of Air Cond. Total g No.of Alerting Devices .No.of Waste Disposers Heat PumpNumberIT0.11s; KW 1 No.of Self-Contained 'I otalls:I . . ,Detection/alerting Devices No.of Dishwashers Space/Area Heating KW j Local❑ Municippl! ❑ Other Connection No.of Dryers Heating Appliances KW 'Security Svsterns:* No.of Water No.o No.of Devices or Equivalent No.oT KW Data Wiring: — Heaters signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No. A Motors Total 11P d Telecommunications Wiring: OTHER: No.of Devices or EquiNalent Inuch.... "'I''IA JV,1101141-1. F�,tiiiiat;:d Value of Electrical Work: (kk lien required by municipal policy.) �k ot,k to Start: Ill:,locctions to be I-CCILICStCd in accordance with EIEC Rule 10, and LIP011 C0111PICtioll. INSLRANCE COVERAGE: L.illcss waived by the owner. no permit Cut-tic pci-lbl-IlIjInce of electrical work may li'.AIC 1.1111k:' Ill': lice"'S et:P.11A ides proof liahilit} insurance inclUdint-, --ollipIctcd operation"coivera,&of, its CLItllk;IIk-fIt. 11". I(Tcc. JIld has V-.1-libitv(I !?,root I"'t to the (Spcclly.-) 111:1_'K ONE': IN'S'l RAX0,*, ()11+11 inder'hejly.,'ns ofdpe,'11 N- ifie /jjv 1,.'!RN1 NAME: Iq 10-7 e- �eczr( - Jcensee: c 0. Address: 3us. Td. :'-.,CCLII-itY Sy,.Acm ContraLtoi,LiCQfi';C I'CLILIII-Ld [of-this Ifiliop 'able,ciaci the: 11LOISC IlLlIlIbcr here: 0NVNF-R'SINSURANCE AAIk'ER: ,'luvriIl:AII,;llICQ':.)1 "T IL:qlLliredb} law. rcyuircnlcnt. 1 ;1171 the(check onc)[] )v%nvr Owner/Acrent If=I T='• ti — Date MORTM s TOWN OF NORTH ANDOVER O - D PERMIT FOR GAS INSTALLATION Sg^CRUSE 3 This certifies that . . c. . ... . . . .. . . . . . . . . . . .. . . has permission for gas installation :` 14.E f. e . . . . . . . . . . . . . . in the buildings of . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . ?. ! ��. . . .y. . . North Andover,. Mass. Fee.3. .r. Lic. No./.-5'- . . . . . . ., !`��^ . . . . . . . GAS INSPECTOR Check# 3 ) 'v 6695 MAS.SACHUSEM UWORM APPUCATON FOR PERMIT TO DO GAS FITT3NG (Type or print) Date � NORTH ANDOVER, MASSACHUSETTS Building Locations 5l Permit# (—U4z, Owner's Name Amount S 1,6 New Renovation Replacement Plans Submitted a Onu O p x on m w G C F W z Q x a z c d a F F w p > I'. u = x c s 'o Q a c c > 3 0 m SUB -BASEMENT -� V p F C BASEM ENT y IST. FLOOR 2ND . FLOOR -, 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . .FLOOR. 8TH . FLOOR. (Print or e j Name (`� Check one: Certificate Installing Company Corp. Xddress / ,z/ foo j ��1 �17LV�30Yd— Partner. usmess a ep one _ Firm/Co. _ Name of Licensed Plumber'or Gas Fitter t 777- FINSURANCE COVERAGE ve a current liability lnsurance'policy or it's substantial equivalent. Chec onou have checked es ple e' dicate the a cove Yes Noo bili typ �e by checking the appropriate b6;7 ty insurance policy Other type of indemnity D Bond 13 Owner's Insurance Waiver [Am aware that the licensee doesn_ o Mass _ t�the Insurance coverage required by Chapter 142 of the . General Laws,and that my signature on this permit application.waives this requirement Signature of Owner or Owner's Agent Check one: er 1 hereby certify that all of the details and information I have submitted(or ened )in above applicationaree and ac best of my knowledge and that all fumbin work curate P and insta to the compliance with all pertinent provisions of plumbing Massachus 11 State Gas Code and Ch under Permit Issued for this application will be in Ge eral Laws. By: Signature icensed Plumber Or Fitter Title O .Plumber City/Town. Gas Fitter IC 5e um er 0 Master APPROVED(OFFICE USE ONLY) .1oumeyman Date. "pRT►, TOWN OF NORTH ANDOVER «� PERMIT FOR PLUMBING s o •�a This certifies that . . . ?!� . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . 1l . . . . . . . . . . I . . . . . . plumbing in the buildings of . . . . °. .. . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . .. North Andover, Mass. —v Fee. .3 .�.'"Lic. No./.7`�z. . . . . . . ... . . . . . . . . . . . . PLUMBING INSPECTOR Check # ° 3 7978 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIlV(; (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location Owners Name%J Date (J �� Permit#_��7 r Type of Occupanc Amount _ 3 2 ) 0 KNew rlRenovation Replacement ' Plans Submitted Yes No FDffUPES to U a U • O 6-4 C G ST&H41� _ Q q >i�St1.+VIII' BE)ELD R �;E+7DQ2 4aiKDM SIH E+LOM �f . 91HFLOCR I �. k (Print ore tYP ) Installing Company Name (p - f Check one: Certificate J�� Q f - , Corp. Address . Partner. Business elephone Frrm/Co. Name of Licensed Plumber. Insurance Coverage: Indicateu e typa or insurance coverage by clieckmg the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver. I, the undersigned,have been made aware that the lic three insurance ensee of this application does not have any one of the above Signature Owner ❑ ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and ins tions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massach6State Plumbing Code d ter f the General Laws. By. 31gnaeure of Lace ea um er Title Type of lu bing License City/Town rc ns f4am r Master F1 Journeyman APPROVED(OFFICE USE ONLY '-3 � G AORTH Town of No. 0 _ - o dover, Mass., all COCHICHEWICK ORATED 7 BOARD OF HEALTH �n PER IT T D . Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......... " ........tv..'..)................................................ ...... . ................... ....... Foundation has permission to erect................. ..................... buildings on ...IT.........1 ,.,�. .. .............. .......w.. Rough to be occupied as �... ' Chimney ............lw. .... ................................................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUT TS Rough ................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. Location /. l er A in A No. Date ! �aRTM TOWN OF NORTH ANDOVER .�?0�,,`•o I•,MOIL F 9 . � Certificate of Occupancy $ b''•"''t�' Building/Frame Permit Fee $ �Ss�cMust Foundation Permit Fee $ Other Permit Fee � R $ ! TOTAL $ Check # 18989 .GI� Building Inspectors TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 0>i'Off, IISC VIII - y B DING PERMIT ER-07 DATE ISSUED: IT1 k IGNA E- Building CommissioneLi2 for of Buildings .Date SECTION 1-SITE INFORMATION z 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O 15 114 M Number N Map Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed UseLot ea(so Frontage 11) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Prov)ded Re redProvided 3D �! to f a, 1.7 Water Supply M.G_L.C.40. 34) I.J. Flood Zone Infomution: 1.8 Sewerage Disposal System: Public Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record Name(Print)' Address for Service OA AAA-P- - Signature Telephone f Najne Print Address for Service: O z ii nature Telephone,. SECTION 3-CONSTRUCTION SERVICES l � 90 I.l Licensed Construction Supervisor: Not Applicable ❑ .icensed Construction Supervisor: 010330 License Number O ddress 7 Expiration Date Ygn ,. Telephone 2 Registered Home Improvement Contractor Not Applicable ❑ )mpany Name Q S �_ J l�yam, ,_/ Registration Number r Idres r 02— 13 e® 7 Expiration Date ^ ;nature Telephone Y SECTION 4-WORKERS COMPENSATION(RG.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....... No.......0 SECTION 5 Description of Proposed Work check all applicable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑. Accessory Bldg. 0 Demolition ❑ Other0 Specify Brief Description of Proposed Work: l/ 'J t ,A ` SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimateost(Dollar)to be Completed bd Crmit a licant I. Building ii (a) Building Permit Fee b Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit.fee t,l x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5 dV Check Number SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUU DING PERMIT I, an. as Owner/Authorized Agent of subject property Hereby authorize F,91.&4A-+.`c, �V r fit-- to act on My behalf, in all matters relativelo work authorized by this building permit application. Sigiiature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, a`6z 't^ ?' �1 • ' �""� '�`�+ ,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 C' Print Na Si ature of Owner/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3ELD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DUVfENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF C11IIvvINEY IS BUILDING ON SOLID OR FILLED LAND IS BUU.DING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM. INSTRUCTIONS: .This form is used to verify that allnecessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance an applicable with loan P y pp e requirements. APPLICANT n4 A- PHONE ASSESSORS MAP NUMBER 3 LOT NUMBER SUBDIVISION LOT NUMBER STREETS G STREET NUMBER IS' ............................................................................. OFFICIAL USE ONLY RECOMIVIENDATIONS OF TOWN AGENTS ............................................................................. DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPAR71v1ENT DATE APPROVED DATE REJECTED CONBUNTS RECEIVED BY BUILDING INSPECTOR DATE NORTH own Of . 4 over 0 10 No. – l A K Elover, Mass., COCHIC MEwICK A. 7 ORATED il" '`CO '9S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........' Foundation has permission to erect...... 10.1............... pWii�n ....... �......� S#W..... Rough to be occupied as.... Chimney provided that the pe on accepting this permit shall in every respect,conformto the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 4 *1 / PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS - Rough Service BUILD SPECTOR 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. Northpoint Survey cA( Services, Inc. 180 Etter Street Haverhill, MA. 01830 (q�8)-372-0835 r N/F CONTE BK.12415 PG.95 103.0' 10.5' +1 1 22.0' PROP05ED 49.0' /j161 X 32' POOL N/F EXISTING, N/F TROVATO 33.5'± D\LLING CA5C10 5K.50'1 P6.402 — \#IS — 5K.&O22 P5.15 LOT AREA= �? 10,300±5.F. m 103.0' MIDDLESEX STREET ZONING DATA REQUIRED SETBACKS DWELLING POOL OFhfq FRONT = 30' Ss9� SIDE = 15' 10' 2 G REAR = 30' 10' 0 Q GREGORY BOWDEN ai PROPOSED BUILDING PERMIT PLAN " #34610 BARRY T. LOW 8 ANNE G. LOW 9p su�vgP 15 MIDDLESEX STREET NORTH ANDOVER, MA. BOOK. 1310 PAGE. I PLAN NO. 608 DATE: FEBRUARY I, 2006 SCALE: 1" = 30' JOB NO: 4155.00 Residential Property Record Card PARCEL_ID:210/043.0-0001-0000.0 MAP:043.0 BLOCK:0001 LOT:0000.0 PARCEL ADDRESS:15L-81 MIDDLESEX STREET PARCEL INFORMATION Use-Code: 10.1 -- - Sale Price: 0 Book: _ 01310 Road Type;-_ T . Inspect Date: 05/14/1997 Owner: Tax Class: T Sale Date: 12/31/1976 Page: 0001 Rd Condition: P Meas Date: 05/14/1997 LOW, BARRY T Tot Fin Area: 1518 Sale Type: Cert/Doc: Traffic: M Entrance: C ANNE C LOW Tot Land Area: 0.24 Sale Valid: N Water: Collect Id: JBS Grantor. Sewer: Inspect Reas: M Address: 15 MIDDLESEX STREET Exempt-B/L% / Resid-B/L% 100/100 Comm-B/1_690 Indust-B/L% 0/0 Open Sp-B/L% 0/0 NORTH ANDOVER MA 01845 RESIDENCE INFORMATION LAND INFORMATION Style: CL Tot Rooms: 7 Main Fn Area: 828 Attic: NBHD CODE: 5 NBHD CLASS: 5 ZONE: R4 .. - - Seg Type Code Method S Ft Acres Influ Y/N Value Class Story Height: 2 Bedrooms: 4 Up Fn Area: 690 Bsmt Area: 690 _ q- Roof: G Full Baths: 1 Add Fn Area: Fn Bsmt Area: 1 P 101 S 10300 0.24 160,720 Ext Wall: FB Half Baths: 1. Unfin Area: Bsmt Grade: _ VALUATION INFORMATION Masonry Trim: Ext Bath Fix: Tot Fin Area: _ 1518 = Current Total: 319,800 Bldg: 159,100 Land. 160,700 MktLnd: 160,700 Foundation: ST Bath Qua]: T RCNLD: 144664 Prior Total: 298,300 Bldg: 149,500 Land: 148,800 MktLnd: 148,800 Kitch Qual:, T _ Eff Yr Built: 1962 _Mkt Ad" 1.1 Heat Type ST _ Ext 11 Kitch: Year Built: 1930 Sound slue: Fuel Type: G Grade: AG Cost Bldg: 159,100 Fireplace: 1 Bsmt Gar Cap: Condition: A Aft Str Val1: Central AC: N Bsmt Gar SF: Pct Complete: Aft Str Val2 Aft Gar SF: 455%Good P/F/E/R: 7100/100/77 Porch Type Porch Area Porch Grade Factor P 129 W 184 SKETCH PHOTO 24 Ct 8 104 Sq. 184 Sq.FG 85 45S.Sq.R. 20 P i urqu. 1� 36' 21 N %j FM 828 Sq_.R, 19q 23 a I g5 36 :4 Paroal ID:210/043.0-0001-0000.0 as of 2/24/06 Page 1 of 1 FAMILY POOLS &PATIOS,INC. CSL#010330 Fealsales -, service • supplies HIC#118204 70 South Broadway,Lawrence,MA 01843 WC#4951074 Tel: (978)688-8307 Fax: (978)6884949 LIAB#01098398230 SINCE 1978 /� Name rf. _1 Vl .e �Ot+a t Date PSu Address GOW State (J Zip % Home phone Work p one Cell phone Add'1# Cross street/directions n Estimated start date VV Estimated completion date We-propose to furnish and install one �v 3 Z 7_ ' t4 4d &J 5 f swimming pool for the sum of$_ �yo THIS PRICE INCLUDES: - •Manual vacuum cleaner kit Leaf net •8 Ft Steps •3-Step Stainless ladder •Wall brush •Handrail •Ropt:&Floats •Extension pole •Filter •Initial balancing chemicals Test Kit plumbed no more th 25fk from pool •8 to 12 Wk supply of maintenance chemicals •Surface skimmer(s) •Pump&motor h (supply depends on pool size) Copin •Choice of liner � � THIS PRICE ALSO INCLUDES THE FOLLOWING WORK TO BE PERFORMED BY.A LICENSED ELECTRICIAN: f,Bond and ground pool-wiring of a 220 volt filter pump-one 110 volt plug-wire find install one 220 volt indoor time clock-outside wiring to be done in PVC pipe-sixty feet of electrical run from service panel to filter l(*note:runs over sixty feet will be subject to an extra c.barge)_Initials . ��---- !�UU IN ADDITION TO THIS PRICE,ADD Ek'1IMA IED�HOURS OF MACHINE TIME AT$ PER HOUR THIS PRICE DOES NOT INCLUDE: ��// _Initials Any machine time in excess of that estimated above. P Additional machine time to be billed at the same rate as above due with the second pool payment. All hours of trucking will be charged at$ per hour per truck due with the second pool payment. Any dumping costs incurred for disposal of ledge,large rocks,or soil-re-seeding of grass around pool- spreading of loam-trucked in water -patio or fence around pool or any accessories except as noted below-additional fill,if necessary,for proper backfill or reshaping of hole- dis- posal of large rocks-fuel connections-heater venting-fuel storage tanks-permits-repair of damage to sprinkler systems or any buried . .i items(ex.dry well,electrical lines,cables,etc.)in the access and pool overdig areas-plumbing to filter in excess of 25 feet-stumping and/or removal of stumps.brush or debris.Homeowner is responsible for repairs of damage to known or unknown buried items. Water or soil conditions(ex.clay,pea4 live sand,excessive rck,,etc.)requiring a stone pack of the hole willtbe subject to an extra charge of$ minimum to$ G1l maximum. Use of the above mentioned stone pack will be at the discretion of the job supervisor. Customers must supply access for all trucks and equipment. 1 It is the owner's responsibility to obtain the building and electrical permits or to assume the costs of necessary permits. Initials Notes: �� o C.tM. lA Y OPTIONS TOTALS fllf , Diving board (. ) Basic Pool Price $ ,Main drain Estimated Machine Time Solar cover ( ) s.-- Options 441 Pool light �(3 ) 3b`� Heater PW v ) -- Subtotal $ ( �200 Environpool Plus, 8 head 5%Sales Tax t� Caretaker w/Electronic Valve, 16hd Additional`floor;:heads( . ): Totat. $::. .: f) Polaris Vac-Sweep Less 10%Deposit 4 1,(�CICJ-— 1-11 04 Polaris'retrofit only Balance of Contract $ Swimout/Buddy,Seat PAYMENTS: 113 EXCAVATION 1/3 BACKFILL+EXTRAS 113 SYSTEM START-UP The buyer hereby agrees to pay,'in full,the total amount of this transaction upon start-up of the installed pool.Your salesman or job super- visor will meet with you two to three weeks prior to excavation at which time all decisions including pool size,shape,liner print,and all options must be final. Changes after this date will be subject to extra charges where applicable. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.Credit card payments not accept n contract amount. BUYER dater )i d The Commonwealth of Massachusetts Department of Industrial Accidents l y Office of Investigations H, a 600 Washington Street Boston, MA 02111 www.mass.agov/dia i Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name (Business/c)tzanizatitm/lntlivi(lual): hticU clti 1 Address: 90 3-D �Y�a City/State/Zip: Phone #: Are ou an employer?Check the appropriate box: Type of project(required): IsLJ l am a employer with 3a 4. ❑ I am a general contractor and 1 6. ❑ New construction employees(full and/or part-tithe).* have hired the sub-contractors 2.F11 am a sole proprietor or partner- listed on the attached sheet. + ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q• ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *;any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. +f lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. `Contractors That cheek this box must attached an additional sheet showing the name ofthe sub-contractors and their workers'comp.policy information. 1 am an employer tliat is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name. _C.o _t �' � — Policy 4 or Self-ins. Lic.#: W3_ S� ExpirationDate: 0 Job Site Address: � 5- City/State/Zip: Fd�t. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth of a STOP WORK ORDER and a tine 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. �Sig'nat dhereby ce ify under the pains and penalties oj'perjury that the information provided above is true and correct. ire. �u-'-� Date: PJ Q (o Phone It: ° – Dlfic•ial use only. Do not write in this area,to be completed by cite or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: . ✓aw. uvauvv vU.JO.^tl\1 rGI,�C. I V16 • ACORD CERTIFICATE OF LIABILITY INSURANCE FAMIIDo3 DATE(IAWDD/Y1'YY) 01/06 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB International New England HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 299 Ballardvale St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Wilmington MA 01887 Phone: 978-657-5100 Fax:978-988-0038 INSURERS AFFORDING COVERAGE NAIC9 INSURED INSURER.A Safety Insurance Company INSURER 3 Family Pools & Patio Inc. INSURER C. Scottedal• Irmuranee company 70 S. Broadway IN_URER.D: Lloyds of London Lawrence MA 01843 INSURER COVERAGES TI-E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIE INSUREC NAkIED ABOVE TOP THE POLICY PERIOD INDICATED.t\CTWITHSTGJ:);hlr, ANY REQUIREMENT.TERM CIE;CONDITION OF ANI'CONTRACT OR OTHER,DOCUMENT VVITH RESPECT TC\MtiICH-HIS CERTIFICATE MAY BE ISzUED OR W,Y PERTAIN,THE INSURAFJCE AFFORCED BY THE POLIO.ES DESCRIBED iEREIN IS SUBJECT-0:61L-HE_EFMS,EXC_USnIS AIJD COIIDITIJ`a:3 CF SUCF- POLICIES AGGREGF,TE LIMIT'._SiOWN MLA'!HAVE BEEA REDLY_ED EY PAID CLAIMS. LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDlYYJ DATE(MM/DDtYY) LIMITS GENERAL LIABILITY EACHOCCURRE^ICE S 1000000 C X I COtAMERCIAL6ENERA _IARILITY $jNDgg12/31/05 12/31/D6 I PREIvt!SEs;Eaoc ul na` 100000 CLAIM`:MADE FX�OCCUR MEDEfP(Any::n=person) S excl F'ER.'—_0PL BAD=INJURY "1000000 X Blanket Al I GENERALACCFEGATE s2000000 GEF.L AGGREGATE LIMITAPP_IES PER: PRODUCTS-COMP.!OPA,G 52000000 POLICY }{ PEa Ll�c i Emp Ben. 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A APJYAU-C 3947232 12/31/05 12/31/06 [EeeCiq` 51000000 ALL OY'JVED AUTOS X SCHEDULED AUTO F6-01L"11t0JRr erson X HIR=D A.0 oG BODIL"INJURY X NON-OVdNED AUTOS (P=r accid=nt'i s PP.i!PERTY CANAC-E c (Per accident I GARAGE LIABILITY Al TC ONLY-EA ACCIDENT S ANYAU-0 EA AC ¢ OTFER TH4N AUTO ONLY ,4GG S EXCESSFUMBRELLA LIABILITY EAC H O(CUPRENCE S OCCUR CLAIMS MANE �— — - --- — -- HGGFs•:AT= S S DEDUCTIBLE RETENT ON $ WORKERS COMPENSATION AND TCR'i LI?41TS JEIH- R B EMPLOYERS'LIABILITY ANY FK)PPIETORPAP,TNER/EYE'U-IJE WC8936745 12/31/05 12/31/06 EL EA0-ACCI_,_I.IT S 100000 IT, OF=ICERT4EMBER EXCLLCED? IF yes,describe under EL.DISE.A�E-EA.E',1P_OYEE 5100000 SPEC AL PRCVISIONS below E.L DISEA,SE-POLIC`i LIMIT S500000 OTHER DESCRPTION OF OPERATIONS/LOCATIONS 1 VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Loc #1: 70 3 Broadway Lawrence MA 01843; Loc #2: 45 Route 125, Unit 3, Kingston NH 03848. CERTIFICATE HOLDER CANCELLATION NOMORT* SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL .IMPOSE NO OBLIGATION OR LIA8ILI-1v'OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHO y R PRESENTA_TIVE� ACORD 25(2001108) ©ACORD CORPORATION 1989 Y ,,Ix Board of Building Regua ons and Standards a h N : One Ashburton PI - Room 1301 Boston. Massachusetts 02108 Home Improvemento. tractor Registration Registration: 118204 t Type: Supplement Card Expiration: 2/1312007 FAMILY POOLS &.PATIOS INC ' GLEN WIGGIN ' 70 S. BROADWAY '> LAWRENCE M A01813 rt , Update Address and return card.Marls reason for change a DPS-CA1 �'� 50M-04/04 G101218 F" ; F] Address Renewal Employment Lost Card ; r 'G 1 Board of Building Regulations and Standards Li ense or registration valid for individul use only ;HOME IMPROVEMENT CONTRACTOR be ore the expiration date. If found return to: �Re istratid Y 9 118204< 3 B and of Building Regulations and Standards n �{ Oe Ashburton Place Rm 1301 FAX .ir t � :: 0 1`13/?007 2 B Baton Ma.02108 ,dement Card j ' FAMILY POOLS i5 >d� GLEN WIGGIN f 70 S.BROADWAY LAWS RENCE,_MA 01843 \ �. `Administrator Not valid without sigma r 'nom-.-- ... _ �1 1, { yy y f WX N 4j Y l i Y u` Lyg S t� 4.k J F 1117 F j .1 Y ., } V, 5 .N r _ � ✓�ie �anrinwn�vna� �/�aaaac/ucae� BOARD OF BUILDIN EGULATION$ License CONSTRUCTION SUPERVISOR Number CS: 010330 Birthdafe= 0y_)r1960 , t � Eei�07r91�b '7 Tr.no: 14273 Resf , s 5�. �i���Ot� t ; WILLIAM C`POUL�SS r i • $ 7088- b. ROADWAY LAWRENCE; Commissioner i ...._...... . _ ____ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before.the expiration date. If found return to: Registration 18204 p�ratia Board of Buildingg 2/(3/2007 Re ulations and Standards One Ashburton Place Rm 1301 # Pe P Jute Corporation Boston,Ma.02108 r FAMILY POOLS 8 P�gTIpS"iNia .§ �j WILLIAM GIANOPOULUSK;., r jt 70 S.BROADWAY LAWRENCE,MA 01843 Administrator Not valid without ' ..". ...... tature IT" r ..:,7777, z N, rwx++w:�prmr»gm,�-•; .. . . r .. r. ..,.:.....a«e.n,.A..•�._—..,..�.�..�.-..,..,Tem• .rc+a.amr..�, f g F13 Lei 4 B 1 ' e• . • t-'--- Id —�—� A BILL OF MATERIALS STERLING FRONTIETC- f 8-8'Plain Panels 08-009-5 08-009 L 3-4'Plain Panels 08-016.5 08-016 32'-0' 2-2'Plain Panels 08-018-5 08-018 4-2'Radius Corners 08-141 08-141L E F 741 8' 8' 81 4' 17-Braces 08-214 08-210 SIZE A B C D E F G H J K L 2'RAD, 2'RAD. 1-Steel Hardware Kit 08-204 08.204 16'x32' 16' 1 32' 8' 3'4" 8' 14' S'6" 4'6" 4'6" 7' 4'8' 1-1602 Straight Coping Set 6"Radius 10-001 10-001 NSNTTPE0-NON Divtxc 2'c1-2'Radius Coping Corner Set 10-138 10-138 POOL stoaopy N 1-Vinyl Uner ADJUSTABLE TURNBUCKLE BRACE ADJUSTABLE BRACE 32'-3' 8' STERLING° �r-0' FRONTI=R F_"''- STEP ' PCJLS POOLS 16'—O' 8' JPANO USTING 6'Step-Remove 1-8'panel and 1-0'panel. Insert 1-6'step, TURNBUCKLE BNUTS 35'-9' 2-3'panels and I-brace. AGED -STEEL POOL PANEL STEEL POPAN Do MAN 2 4 8'Step-Remove 1-8'panel and 1-0'panel. Insert 1-8'step, °�'DPLATE LATE 2-2'panels and I-brace. ONE PIECE FORMED TWO PIECE ANGLE BRACE ANGL 2'RAD. 81 8. 8' 41 2'RAD. CONCRETE FOOTER CONCRETE Replace 4-8'plain panels with: 1-B'Skimmer panel Optional Optional 2'POOL BASE 2'POOL 2.8'inletpanels 08-010-5 08-010 1-8'light panel 08-012-5 08.012 STAKE COPING LAYOUT 32'-0' 2'RAD, 8' 8' 8' 4' IT 2'RAD. _ 2' 2' 3. 32'-3' 16'-0' 8' 8' 6' 35'-9' 2' 2' 3' 2'RADr 8� 8' 8' 4' 2'RAD. ADDITIONAL NOTES THIS DOCUMLW 15 FOR ILLUSTRATIVE PURPOSES ONLY. Attention Deaden It Wyau ponsibiliy to sae that the safety package provided by FWP is delivered to pool owner and that the NO DMNG mp makes any Uase representations which arestated In its writes,womanly.Any&her ming labels are properly installed. representation,,statemenH,or cowracn made by U,s deokr/conNvctor so the cuamur regarding any matends pnodu ed by F WP oma tmhutaNe a the dada/contractor:)_i STERLING® BUILDING THE . ® FORT WAYNE POOLS®,TNG The dealer tr coet pl who sills or installs ywr pad is an independent contractor aandd won ew or employee d FWP.The construction methods ieustraled here ore ti *Diagonals given to 90"point of corners. NSPI TYPE FI and y to w andgraund a ditiam.There may be odditis d p ecoutions�a d/« FOLLOWING POOL R-1 6930 Gettysburg Pike me h s af°aan, an.T e pons hxiy i,he�naawa PCL S ❑STERLING® FT WAYNE,IN 46804 USA GENERAL • • • These dig dimensions compI9 wifih the National Spo and Pool In>fituM wg ested , 2 'es i =b (219)432.8731 mndards ran residenfid pods If diving boards or dides are to a :ed ❑FRONTIER" — ° 'lg www.surftbepoGLe9m 1.All verticil dimensions are from liner 1.Soil to hove minimum hearing capaciy of 2000 P.S.F. 3.Excavation shall be 2'darer than p�a� II around. m�III these'poals Please consult the manufacturer's instructions and the National Spa 8 GAse mss s t DRAWING NUMBER extru,iom on all pools. 2.locate top of pool at least 6-above surrounding FII aid,under Bose of panels and tomp well. Pool Institute's minimum standorcls prior a installing divi�hoanhis or dices on these F f?O"-r I = f2 6 land elevation. 4.Bockbll with non-e.pahsne material. pools.Far information conwmi g NS minimum standards,write:NofiondSpo 8 h�O O L S- JANUARY MIX 32 Pool Insfitute,2111 Ei,mhower Avenue,Alexandria,VA 22314•703/839-0093 1999 RECTANGLE 2 RADIUS STL-006 COPYRIGHT 1999,TORT WATH$100,500,INC. 71 ^•-- ..... h Location / 4 o. Z/ Date �//G141,/ of NORT" TOWN OF NORTH ANDOVER AaL Certificate of Occupancy $ * Building/Frame Permit Fee $ . _sJAcMuSEt Foundation Permit Fee $ Other Permit Fee $ PAID By � r Connection Fee $ af'JWCKection Fee $ ^ NOTAL $ O TOTAL� A10• A1401fer C011ecSOP' Building Inspector Div. Public Works PER%frr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1� MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE ZONE,Q � I SUB DIV. LOT NO. I LOCATION /S `7jj��[� PURPOSE OF BUILDING OWNER'S NAME �! r NO. OF STORIES SIZE y Ann 76 OWNER'S ADDRESS BASEMENT OR SLAB •-- ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST. ia 2ND 3RD BUILDER'S NAME SPAN I 1 --V ��ss DISTANCE TO NEAREST BUILDING ��,./'f0'O DIMENSIONS OF SILLS DISTANCE FROM STREET V�� YY 11 A�1 POSTS DISTANCE FROM LOT LINES-SIDES REAR .yt� " " GIRDERS AREA OF LOTp•/�A>`,/ t/Aa FRONTAGE HEIGHT OF FOUNDATION ` THICKNESS IS BUILDING NEW {�� SIZE OF FOOTING Put yjL X IS BUILDING ADDITIO MATERIAL OF CHIMNEY.��•!�' IS BUILDING ALTERATIONf-- IS BUILDING ON SOLID OR FILLED LAND 1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BEEFFILED ^AND APPROVED BY BUILDING INSPECTOR DATE FILED (,�[�J/ 1 W, -'i'Yr BOARD OF HEALTH SIGN URE OF OWNFR OR AUTHqfIZED AGENT F E E zo PLANNING BOARD PERMIT GRANTED d 4 �s BOARD OF SELECTMEN OWNER TEL.# 5�— 7S' CONTR.TEL. CONTR.LIC.# 'c� BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF' BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY WALL UNFIN. $ BASEMENT AREA FULL FIN. B'M'TAREA _ FIN. ATTIC AREA _ NAMM'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCQ ON MASONRY STUCf' ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONg. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 11 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL-SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS '1 GAS 'OIL + B•M'T 2nd _ ELECTRIC 1 1st 13rd I NO HEATING f v i 5d lf' nw, 4.0,v! T' o7wn o No. 144 vfrZ44 �" )RIVEVAN' ENT - Y PER. MIT __� er, Mass. fl J 9� oR QP SS BOARD OF HEALTH PERMIT T LD THIS CERTIFIES THAT/ 410".. .. ..Q.I�iA/................................... BUILDING INSPECTOR has permission to erect .`. e.o.Q.4....... buildings on ,�.�...�..j..� ..� !....� .. Rough 9 tobe occupied as. ,,c.x. :...Q �. .. ............................................... 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 UNLESS CONST TION STARTS Rough Service • 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 Smoke Det. Building Inspector Town of North Andover !.' BUILDING DEPARTMENT Homeowner License Exemption ------------ (Please print) DATE l Llq2 1•'. ;,'JOB LOCATION / _ TNumber treet Address Section of town "HOMEOWNER" T 4 J-- i .I • .q. "Na Home Phone �• . W rk 0 P ho ne PRESENT MAILING ADDRES�5 N(Ca 16/ QSt ity Town State Zi .The current exemption for "homeowners" was extended to p code :occupied dwellings of six units or less and to allow suchlhomeowner engage an individual for hire who does not possess a license rs to ' that the owner acts as supervisor . , provided (State Building Code , Section 109 . 1 . 1) :DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides s ' ; reside, on which there is , or is intended to be, a one to s ly or intends to . .: ing , attached or detached structures accessory to such use and/or lfardwell- ' structures . A person who constructs more than one home in a two- year period shall not be considered a homeowner . Such "homeowner" shall ,to the Building Official , on a form acceptable to the Bulding Officialbmit 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 . : State Building Code and other applicable codes , by-laws , rulesnan with the regulations . d The undersigned "homeowner" certifies that lie/she understands the Town of North Andover Building Department minimum inspection procedures an requirements and that he/she will comply with said procedures and d .requirements . .HOMEOWNER ' S SIGNATURE Sit APPROVAL OF BUILDING OFFICIAL Note : Three family dwellings 35 , 000 cubic feet , or larger, will be 'required to comply with State Building Code Se Control . ction 127 .0, Construction 14!-o x e IR + CSk1517tJ 5kIk:S M�� � (See o ,) -T` 334 ?O ,� - ,h► 974 zy NO e a 4 f� 1 I 1 I ► t s y Office Use only . 5 Permit No. MEW 01 4t &MmonlUjud� of RWj5ndVnttt5 occupancy&Fee checked 1 JJgm tmtnt of public 0afttg 3190 (leave blank) BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 Ward Area n n APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code,527 CMR 12:00 1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date -3-2-7-9.6 Date -n City or Town of �T �' ��V {� To the Inspector of Wires: ,; •- n ,• F Date......v�.,l .. F� 2953 � %ORTH TOWN OF NORTH ANDOVER 0MEMO �, 9 Cr PERMIT FOR WIRING a � 7 ScNuss S She This certifies that ....:...... . ..... ... ........... ......... ..... has permission to perform ........S.n.G.........�A l4 ..`�...................... _ - wiring in the building of...... L' C1 ........................... .................................... .�................ .............,North Andover,Mass. r / /-,i C- Fee..3)..AQ.... Lic.No...... .': ... ..........................:.................................... ELECTRICAL INSPECTOR *-- C X77 WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File