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Miscellaneous - 150 PINE RIDGE ROAD 4/30/2018
V� � 150 PINE RIDGE ROAD J 210/065.0-0134-0000.0 1A Date...........................E3 ....... pORTM TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that .....( ^ ' '.................................................................. has permission to perform .................................... wiringin the building ........................................................................... at..'�v... ................ .North Andover,Mass. Fee..................... Lic.No4 -3, ........................................... 7 .. ..... ....... ELECTRICAL INSPECTOR Check # 8076 1 Commonwealth of Wamactx tb Official Use Only Permit No. F11117 4� eUeparfinenE o�}ire�ervice9 Occupancy and Fee Checked-35— 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 EC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO �IOl9 Date: 2— O City or Town of: NO To the In;ector of fflire By this application the undersigned gives notice of is or her'nt tion to perfprm the electrical work described below. Location(Street&Number) Q ) c 1 Owner or Tenant 'e Telephone No. Owner's Address Is this permit in conjunction with a "uilding p mit? Yes No ❑ (Check Appropriate Box) Purpose of Buildingt'h / / Utility Authorization No. Existing Service Amps OVolts Overhead❑ Undgrd❑ No.of Meters 1 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: yl — Z I Completion of the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o Emergency Lighting Q No.of Luminaires Swimming Pool nd. ❑ grad. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones t s No.of Switches 2 No.of Gas Burners No.of etechon an Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers eat ump Num er ...ons_ o.of Self-Contained Totals: ------ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW ❑ unicipa El Other (�Local 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 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 El ctrical Work: (When required by municipal policy.) Work to Start: v, Inspections to be requested in accordance with MEC Rule 10,and upon completion. j INSURANCE CO RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability' surance including"completed operation"coverage or its substantial equivalent. The { undersigned certifies that such cover5ge is in force,and has exhibited proofo e to the permit issuin offic . CHECK ONE: INSURANCE BOND El OTHER El (Specify:)` .eu"/� )Z43 L t 04"' I certify,under the and enal'es o er'u ,that the ' rmatian on this application is true and co P f J tY �P PP mp ete FIRM NAME: d)bA fv ( LIC.NO.: Licensee: ,/) Signature LIC.NO.: (Ifapplicable t ex t"in h lice numb h e.) ` /H dA Bus.Tel.No.• Address vt1 �.,' �d t � Alt.Tel.No. *Per M.G.L.c. 147,s.57-61,security ork 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 p o Signature Telephone No. PERMIT FEE: S OF9 -7 WIN Generators Residential& ilc each additional meter..$10.00 TOWN OF ANDOVER Commercial: Sewer Ejection Pump: $25.00 ELECTRICAL PERMIT FEES a)including photovoltaic & Signs: $25.00 each ballast (E ective March 12, 2003) generating Equip Per KV-A--$4,00 , Smoke&Heat Detectors & b)un-interruptible power systens Initiating.Devices: �tD per KVA$1.00 Residential: $1.00 each ", SIS c)batteries over 100 amp. hours,Per Commercial: $60.00 up to 10 NO SE CABLE ON cell$1.00 \4evices over 10-$1.00 each OUTSIDE OF BUILDING Heat Devices: $1.00 each S ace Heaters: Air Conditioners: $40.00 each Heat Pumps: $40.00 each area\heating$1.00 each Alarm Systems Security: (for fire Hydro-Massage Bathtubs/Ho Sub- anel: $25.00 Tubs: $20.00 each Swimmin Pools: systems see smoke/heat detectors) Residential: $40.00 Lighting Fixtures $1.00 eac Residential: Commercial:up to 10 Devices Lighting Outlets: $1.00 each Above Gni•\ound: $25.00 $60.00 additional devices over 10- Major Appliances: (not listed G, inground:`$50.00 $1.00 each $20 each ^-JCommercial Pool: $100.00 Carnival Equipment: $50.00 each Motors: (per hp or fractional �. Switches: $1.00 each Ceiling Fans: $1.00 each thereo $2.00 Temporaryervice: Commercial New Construction or Oil/Gas Burners: Must have.Util •Authorization Number Alterations• Residential$20.00 each Residential$ 5.00 $100.00 per•1,000 Sq. Ft. of Commercial$20.00 each 'O Comercial $100.00 m Construction Space Office Furnishings:per circuit 10 Transformer: elocatable Partitions/Cubicles a)capacitors, er KVA $1.00 Commercial Service Change/ b) ,ductsl uit&conductors Repair: Outlets&Fixture: $1.00 each conRoust have Utility Authorization Number Ovens Built in/Counter Top Unit (Associated w/ admount Transformers) $25 $100(first 100 amperes or fraction,one $10.00 each c)each m le$10.00 meter) Panel Change/Circuit Breaker: d)each han old$5.00 a each additional 100 amperes Residential: $20.00 e)per KV $1.00 capacity or fraction. $30.00 Commercial: $25.00 fl Primayieeders,$25.00 each(over•,.. b)each additional meter$25.0000 volts on-utility owned) Phone Jacks: See s and equip. $25.00 each Commercial Temporary Service: data/telecommunications Washers: $15.00 each $100.00 Ranges $15.00 each Waste Disposals: $5.00 each Must have Utility Authorization Number Receptacle Outlets: $1.00 each Commercial Repair and/or Recessed Futures: $1.00 each Water Heaters: $30.00 each Maintenance Permit: (Blanket Re-inspection Fee: $25.00 Permit)up to 2 Electricians$150.00 For Multi-Family & per air of Electricians over 2$50.00 Repair to Service Residential: Y $20.00 Large Commercial Project Data/Telecommunication: Residential New Construction Residential: $1.00 per port see Wiring Inspector for (Dwelling): $220.00 Commercial: $30.00 up to 10 pricing: __. (with service up to 200 amps)_ devices over 10-$1.00-each Must have Utility Authorization Number Paul I{ennedy(978) 623-8306 Dishwashers&Disposals: for services over 200 ams see below (Office Hours 8 ani to 10 ani) $5.00 Each a)for each 100 amps capacity or Dryers: $15.00 Each fraction add$20.00 *Inspection Schedule: Emergency Lighting(Battery Units) b)each additional meter$10.00 $ 1.00 each unit c)each additional panel/sub panel 1 ROUGH Feeders or Sub-feeders: $25.00 1 FINAL each 100 amp capacity of fraction 1 TRENCH (if applicable) thereof Residential Additions/Alterations: Residential: $5.00 each $220.00 maximum Commercial: $15.00 each Residential Service Change or ADDITIONAL Gas/Oil Burners: Underground Service: INSPECTIONS *$25.00 (if Residential: $20.00 each $40.00 applicable) T ) rr D .p Must have Utility Authorization umber pp Commercial$20.00 each a)one meter,up to 100 amp capacity $40.00 (revised 07/05) b)each additional 100 amp capacity or fraction$20.00 x i:. 40RTh ;A i OF .,ao ,°Ati0 TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION �SSACH U5 This certifies that . . . . . . . . . . . . . . . . . . ! has permission for gas installation . . . . y1 . w in the buildings)of . : -. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . k at . . , North Andover, Mass. ii Fe . . . Lic. NozC�� . . . . . . . . . . . . . . . . . it `r, GAS IN6E&R Check# 5919 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) q ti1 A,-10o✓ A- Mass. Date o?-/6 20&7 Permit# - Building Location Klo4l: 140wner's Name � �/- / Owner Tel# �7�� (�8�- P��Va Type of Occupancy New ❑ Renovation ❑ Replacement ❑ Pian Submitted: Yes ❑ No ❑ FIXTURES S �n �•' F � x z a o 2 w w x o v x P z -' a F- < E" z o a m ' w o o o W t~. o {zl x W E., in n. a � W W Lu Z w z ¢ x w w �: w w V x � a a ra o a w a� w > � w rz x Q �a o o w a o w 3 T O O x w D 3 A c7 a v a > A a ru'- o :D -H SUB-BSMT BASEMENT IST FLOOR 2ND FLOOR 3RO FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name - � 4 Q �. Check one: Certificate Address �� y r 16L yC / ,L_ ❑Corporation /1,74 eP/96 ❑Partnership Business Telephone#_ �'� ' j 7 7 / L�irm/Co. Name of Licensed Plumber or Gas Fitter 12-Cr If: J f /,—R— INSURANCE COVERAGE: I have a current li 14 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 coverage by checking the appropriate box: A liability insurance policy 0-"� 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 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in nmpliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of=G . By Type9 License: wflrumber. Signature of Licensed Plumber or Gas Fitter Title ❑Gas fitter tester License Number /A F,� Y City/Town ❑Journeyman APPROVED(OFFICE USE ONLY) Location /50 ill p No. / oZ Date _a y 1 3 NORTH TOWN OF NORTH ANDOVER f 9 Certificate of Occupancy $ _ MUs t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4 D Check # /6-3 1 6 4 8 1 /Yl M Gam_ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERT NUMBER /- l DATE ISSUED: Z ` X MI SIGNATURE: 't/G Building Commissioner/In for of"Buildings Date z SECTION 1-SITE INFORMATION I + o 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �o 3s Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R red Provide Required Provided Required Provided 1.7 Water SupplyM.G.L.C.40. '54) r' 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name Print Address for Service SigCre Telephone 0 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervis Not Applicable ❑ Lioen Construction Supervisor: C71Q`j 9 0 • �. �,.ii� License Number 20 mn Addre B Expiration Date nature Telephone 3.2 Registered Home Improve ent ntractor Not Applicable ❑ Company Name yuqL'I'0 tj �eu��4k+r, 1 Registration Number r Address Expiration Date /� S ature Tel one Y) f 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 buildipg permit. Signed affidavit Attached Yes...... No.......❑ SECTION 5 Descri tion of Proposed Work check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify. Brief Description of Proposed Work: . SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ONE Completed by permit applicant 1. Building (a) Building Permit Fee Z 00c. Multi lier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) -' 4 Mechanical HVAC 5 Fire Protection / 6 Total 1+2+3+4+5 Check Number SECTIO a OWNER AUTHORIZATION TO BE COMPLETED WHEN —OWNERS A ENT OR CONT TOR 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, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS 1 ST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILD'NG ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE . � ; , q t�f j y . �, t Q" ro9, r t z& fmi� - 5 `"��—' , (1 Cc -, tf A r Ka .� L11, �� . �a7 1. ti �� � \ b % / � ; 11� �{� f �� g� Vis. A ,� ( \ ���3 r I � � ` % is J i tC��i Y j(��1 � y ll�' % ^1I 1.' z �9 . b �— -- " :; -� �� l: l + ;� �; All /� e t�° % M1'�, 11, (r ( %rte- '.x,ftt i �_, , -9"8 .d� _ } ✓ �� 11 y I �b /�< now US w 1 �A io 4� y� u l4 �fy % `3 e , ��Yy� j{�y� PAN / "Rd I n f°fi /' 5 i ' � 4R ,. t g pr �` �� i I tAnt x �F' (< 4� &�1 `! r F � ( . .. f =— { `� 2..' �.�_ a rr r "rfi .@�. :i -3r' r oa- l: e' ' �'. &z ?i'. z P -0c"° ': �VNWOd..f��.._.b4n,�._��t.k� 6; '�.,. r .. �,� _. .s1���, �., ��i: .a ,.-m � fie :. _ . .. .. t � .-� � ..s. 4 is C, .:<: ., ..- l _ The Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02191 Workers'Compensation Insurance Affidavit Name Please Print Name: _ (�t-f J )A J 's Location: I c�O i&D d W D City /Ua Q-t,,ja Phone # 1<7?�p- I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: 0 Q 0 Address Z© to (,So Phone# Insurance.Co. Policy#60On�>-3 Z Z r. Company name: , Address City : Phone* - Insurance Co. Policy Failure to secure coverage as required under Section 25A or MGL 151 can lead to the imposition of criminal penalties and/or oneyears'imprisorwr=tAs � �•a�up to$1,500.00 -welLas_ci�r�l�,p atties3n2helam-cf-a.STDPYY9RKDRDF.Rmd_afine-f-(,$IjWM)-ajday me. 1 understand that a copy of this statement may be forwarded to the office of investigations of the DIA for coverage verification. 1 do hereby eerbly aler a pains an pe /ties of perjury that the irrfor whoa provided above is true and correct. Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept El Check if immediate response is required 0 Licensing Boatrl El Selectman's Office Contact person_ Phone A 0 Health Department Other FORM U LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT �,/— cJ S A S PHONE — 73? LOCATION: Assessor's Map Number � PARCEL /0—V SUBDIVISION c LOT(S) �SC7 STREET ao r = « 6L= /&-(4t-r ST. NUMBER_ Z,5 ******** ***** OFFICIAL USE ONLY** ►*** ** *** * REC M�ENDATIONS F T WN AGENTS: CONSERVATION ADMINIS TOR DATE APPROVED Q DATE REJECTED COMMENTS s TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS- SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm i 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 Perrnit Number is that.the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S.150 A.. The debris will be disposed of in: (Location of F ,ility) i Signature of it Applicant ate NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector 24'-3%" Details: All framing lumber to be#2 SYP or better Design live load-60 PSF Footings:4 @ 10"x 48" Support Post: 6"x 6"pt secured to concrete Beam: 2-2x 1'2 bolted to post Joists:2x8 16"O.C. House band:with bitithane membrane barrier agged with 3/8"x 41/2"gals every 16 inches 1 I I I I I I I I I I 1 I I I I I I I 1 I I I I 1 I I I I I I I I I I I 1 I I I I I I 1 I I I I I I I I I 1 I I I 1 I I I I I I I I I 1 1 I I I 2'-II all 21-411 S'-IOW' X 3'-0" Dais Residence 150 Pine Ridge Lane Great Northern Deck North Andover, Massachusetts 687 Salem Street North Andover, Massachusetts 01845 r NORTH Town ofE . 4 over V% No. = — d3 �A co�H,C WICQ dower, Mass., ORATED S H � BOARD OF HEALTH P. ERMIT T D I Food/Kitchen Septic System `� BUILDING INSPECTOR THIS CERTIFIES THAT.......... .d. N. ..g.............................................. ........................................... Foundation ZI has permission to erect...1�1��xa. ........ buildings on ....1� .......,P. .^9.'�................. '�-// .......... Rough to be occupied as........ Ps � e ov....eea/'.......®� S-Ie UCd-rJ.r�........ Chimney ........................................................ ............ ................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 5A3 /") v 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 ✓,""...C............... ... .....:.... Service .... /�� BUILDING INSPEC... .......TO. R 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 y Street No. SEE REVERSE SIDE smoke Det. Location No. 9 Date NORTH TOWN OF NORTH ANDOVER H41 p i , Certificate of Occupancy $ ,ssACH Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # //23.S-- 147 - 3 /235-- 147 - 3 --- Building Inspector A TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 2 Q m DATE ISSUED. SIGNATURE: cIt4 Building Commissioned) for of Buildings 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: %ning District Proposed Use Lot Area Frontage ft :.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear.Yard Required Provide Recriked Provided RNWred Provided .7 Water Supply NcGL.C_40. 54) 3 f 1.5. Flood Zone Information: 1.8 Sewerage Disposal System ublic 0 Private ❑ `Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System 0 �8 SECTION 2-PROPERTY OWNERSH[P/AUTHORIZED AGENT "I A Owner of Record .. Gkr -, D /- 6 S / S, 6 ame(Print) Address for Service: Aj ignature Telephone 2 Owner of Record: [Mame Print Address for Service: nature Telephone :CTION 3-CONSTRUCTION SERVICES t Licensed Construction Supervisor: Not Applicable ❑ � � tensed Con truction Supervisor: S �" License Number I dress ^ Expiration Date nature Telephone t Registered Home Improvement Contractor Not Applicable ❑ j S z c s npany Name 5-- Registration Number Iress 1 Expiration ate .ature Telephone !J :a 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 unit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work Ccheck ail applicable) New Construction ❑ Existing /Build;g ❑ Repair(s) ❑ Mterations(s) /❑ Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t 1 v SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be �' � ; �i � �}�� Completed b Permit applicant ¢ � fit,„ � r' s 1. Buildut .. �,,. r < . ,. ,4_ : Mme..,. g d �_ (a) Building Permit Fee r Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC �- 5 Fire Protection VC 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHOR17ATION TO BE COMPLETED WHEN OW GENT OR CONTRACTOR APPLIES FOR BURRING PERMIT �_. I, as Owner/Au=subjecl 'g . Hereby a orize l My behalf,in all matters relative to work authorized b this building r.. y g permit application. $, Signature of Owner Date SECTI,ON OWNER/AUTHORIZED AGENT DECLARATION property ,as Owner/Authorized Agent of subject p Hereby de e that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief f Print Name Si ature of Owrier/A ent Date Ct 1 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR Tll\,MERS 1 sr 2ND 3ko SPAN DIMENSIONS OF SILLS DIAIMNSIONS OF POSTS DI ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE E i �� I ��te €,•arrvnea�rtue n�../l'P't��,yac�u�3€� BOARD OF BUILDING REGULATIONS t' License: CONSTRUCTION SUPERVISOR Number. CS 035867 i Birthdate: 12/15/1941 q a Expires: 12/15/2001 Tr.no: 11507 A Resulcted To: 00 RAYMOND V BERUBE _ 361 CHICKERING RD ..� e N ANDOVER, MA 01845 Administrator _ ✓tee{�insnoetraeall�-nlJF�irtle�a/�flt HOME IHpROOEHENT CONTRACTOR Registration: 105523 ` Expiration: 07/i7/2002 Type: Individual i RAYMOND Y, BERUBE Rayrond BeTube Chickering Rd. ADMINISTRATOR N Andover v_ MA w�1$Q� a The Commonwealth of Massachusetts d Department of Industrial Accidents Office of investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit z _ r Name Please Print Name: Location Phone # a �j Jfl-am a homeowner performing all work myself. �am a sole proprietor and have no one working in any capacity s I am an employer providing workers'compensation for my employees working on this job. ' r. Company name- Address City Phone#: i Insurance.Co. _ Policv# Company name, Address . COL Phone..#: , Insurande:Co. - --- Policy# Failure to secure coverage as required''under-Section 25A or'MGL 152 can lead to the imposition of cnminal;penalties of,8 fine up to$1,600.00 and/or one years'irlmprisonment:as well_as_civil..penalties.in-ffial m�fA-SIQP.W.O 3K_OkDFR.and..afine_of-.$1DO:M-asiayegainstme. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for doverage verification. I do hereby certify under th- pains and penalties of pe ' that the information provided above is true and correct. I + Signature Date// Print name �� �' 2 Phe Official use only do not write in this area to be completed by city or town official' I City or Town Permit/Licensing i oi Building Dept i ❑Check if immediate response is required Licensing Board F1 Selectman's Office Contact person: Phone#: ' E] Health Department i Other 1 j NORTH Town of And No._3 es LA o dover, Mass 'a 0?00 ., / COCMICMEWICK V AORATED S H BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System ' � BUILDING INSPECTOR THIS CERTIFIES THAT N S Foundation has permission to erect...... o ..R.............. buildings on .) ...... j..#V `�!�...��................... Rough �? U_vz / t0be OCCUpled as..........................................�.......... ^........ . `................................................................................... Chimney provided that the person accepting this permit shall in every respect,conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �� y . ,_ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. /f Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ..C........................................................................ Service INSPECTOR IN BUILDING S 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 s Street No. SEE REVERSE SIDE smoke Det. �1 1 MkwSS ACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIII(`, l (Print or Type) NORTH ANDOVER Mass. Date<5=.-AG � uildin Location �N �� 3 9 � � � /�.� • Permit # f 2 t Owners New /' Renovation Replacement Plans Submitted FIX 11IR! k w to w w91 to Z to to H W uj 0 U x FW- a w o w ►u t-. to a a y 4 W w w z x a �' w a I' a w t- x V2 Cr 0 x r z yW Wa 7 0 ~Uj 0 0 s x ,Q w < a In w ... Q u > a w z Q cs a d o o w o w t- a p U Y u. a U .s U a > c� n F— o SUR—ES IAT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6THFLOOR 7TH FLOOR BTHFLOOR (Print or Type) /v/v �iiC/ Check one: Certificate Installing Company Name ) G, Corp. AddressIDPartner. L1 Firm/Co. Business Telephone: 69SOU940 Name of Licensed Plumber or Gas Fitte�/Ld,C�,g�'� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ther type of indemnity [--] Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this. application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner I Agent F 1 hereby certify that all of the details and Infotmittion I have submitted (or enteted)in above aprlicalion are true and accurate to the best of my knowledge and that all plumbing work and lnstxllalions petfomted under Permit itsued tor this application wW be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Genual laws. By TYPE LICENSE: Plumber Title Gasfitter Signature of Licensed City/Town: Master Plur er or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) LiCense Number r510 Date.... pf NORTH TOWN OF NORTH ANDOVER - tt�ao 11.Q - 02 PERMIT FOR GAS INSTALLATION N F C`MUSES 4. This certifies thatf has permission for gas installation r t , in the buildings of. =' . . .. .: ... at e . . /. {l,.NorthAndover, Mass. Fee. - C/f -r. Lic. �No; � . . . GAS INSPECTOR WHITE:Applicant r CANARY: Building Dept. PINK:Treasurer GOLD.:File Date—�... ....................... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING ACHU or This certifies that ....... .................................. has permission to perform ...... .................. wiring in the building of "Xt/ A.1 ........... ........................ ... ............................... . . . .........North Andover,Mass.at...... . ......P. Lic.No ........ ELECTRICAL INS�CTO Check # 31940 5622 11=L U1VVV1U1V 1'YL3fiL111(Jr 1v DF.PAR7A1EW0FPUXJCSAFE7Y Permit No. tS 2Z� IOARDOFFMPREVEMONREGUT47TONSW 120 J, Occupancy&Fees Checked APPLICA77ONFOR PERMIT TO PERFO ELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE taASSACHUSST LECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) \ Date Town of North Andover ¢ To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work des ri below. jellLocation(Street&Number) 5D �j l A Owner or Tenant AS Owner's Address Is this permit in conjunction with a building permit: Yes n No (Check Appropriate Box) Purpose of Building 910q- b Utility Authorization No. Existing Service Amps �Volts Overhead 1:3 Underground ED No.of Meters New Service Amps� Volts Overhead r-1 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work &,91',70 A-1, tcJ, No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round round rl No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges /j No.of Air Cond. Total FIRE ALARMS No.of Zones �(. Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.HVJro Massage Tubs No.of Motors Total HP OTHER. Zv C//2G 61 v b Pinsrxntbdle Gala-alLaws InaearraeCawrdg�e. � Ihareaamatbata*ba==R&yi<rkjkgcmvle Covt2waitssI afbalat YES NO bde011i�YES have idle of Iha�esubmimedva6dp[oof same � YES,please type79,,�— EquMdVh1xcfEbckralWc& by dledclgdle INSURANCE BOND r7 � a (PleaseSpa*) J ��`� ��L f$ WC&ID A kspwfi nDa FxWesWd Rao anal Sgnedun&rTi,Fdmkiesofpaj q. � ) A G �( FIRMNAME (O LimrwNa r I�%3 _ I�oa�ae hy°l� �JJ /lL( Signa�ne Iba>seNo �/ BusillessTelNa 47k' �3-z�3/ Ir ALTe1Na OW1,kWSINSURANCEWAIVlaUamaWM theLiommdoesmtha 'worilsgarrialeguhmiErtasax madbyMassadxr=CffnWLam anddlatmysigrla monthispwritffkabmwaitsdisre4*Mat (Please check one) Owner 0 Agent Telephone No. PERMIT FEE$ Signature or Uwner or Agent +J UtrrrUnnn ANFLIGATION FOR PERMIT TO 00 PLUMUINU � (Print or T ► > ^'e • NORTH ANDOVER, Mass. Osis Pernik � 72, Location i Owner's Name New 0-` Renovation p Replacement p Plans Submitted: Yes p No.p FIXTURES __..... F q v N O Is s r � Y1 M s M s s t v s o O 00 Z w o s rr 0 � r � M so s s � ; Q . 1« s a s �. �.. XM IL t t S iMi R - IM s H M • p O44 - - - •ue—•eYT. _ . IST FLOOR iN0 t*L0011 silo FLOOR - _ eTR FLOOR WTH FLOOR OT" FLOOR _ tTM FLOOR - - ITN FLOOR Mock one: Certificate Installing Company Name Address_7� 13 Partnership Business Telephone �� Name of Llcensed Plumber INSURANCE COVERAGE: check one I have a current liability Insurance policy or Its substantial equlvaler�t, Yes p� No Q It you have checked jW. please Indicate the _. a coverage by checking the appropriate box • ` - 4 A Ilablilly Inaurance`poltd 13--- Oiher _-- Mme of Indemnity 0 Band Q _ OWNER'S INSURANCE WAIVER 1 am aware that the licenses the tnsu Chapter 112 of the Masa. General Laws, snare'th m t1 does not have lance coverage required by ry.. nature MY p on this permit app+lcatlonwa(ve:_(hla. - Check one: ...._... . . Owner Q Agent Q..: e ure o Owner,or er s en�. - I.hereby oertlty that all of the detaJls and Information I have rwbrrrftted for entered)In fbn web' d.... ... s_tallsabeslot InevAedga and the ail plumbtnq work and InilaAatlons performed under the rrM 1 =' pertinent provisions of the Alassachusetls State Pkem a applies be.kr A with sA b4+0 Code end l�apter 1�2 0l TRW nature of ljtbnii�bw �. dtylTown License Number AF'1MOVED 10FF10E USE ONLY) Type of Plurnbina Lleanse: Master Journeyman ❑ � I .•=/Ll";...;w[.��..L'�(."���`'—`�ba��w y:'�er�- - � `A s,:�' "�- --"- . '+""-..yam... -+".:', �.t Date. ;7 3392 T" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSAcmUS� This certifies that .�< ".` .i. .�. .r. .71;�. . . . . s' has permission to perform . . . . . . . . . . . . . . . . E: plumbing in the buildings of . .... °�. . . . . . . . . 4 at. . ,L S`�.0. . .F'.' �.�e. . . f. . . . . . . .. North Andover, Mass. v FeeLic. No.. .�� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR `. D�yp7 97�f2e18 15.00 PAID r WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING r (Print or Type) NORTH ANDOVER Mass. Date building Location /fid ,y� �� Permit # � Owners Name ar 1Y �s New Renovation Replacement Plans Submitted ❑ a V1 W N rW m c a v m r s N a c: � – y. z – cc _ t- a otu 4 W N N y�j y�j O 0. cc W 4 Wcc Wcc 07 W = t CC W Q W O W r = 0 cc W -1 d V W W O ? u_ 1.. J f-- W _ W J O W O N G W Z Q tL 4 g O O W d O W F-- W > q o. F- O SUB—BSMT. BASEMENT 1 ST FLOOR 2ND FLOOR 3RD FLOOR I 4TH FLOOR STH FLOOR 6TH FLOOR 7TIt FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name ANDOVER PLG. & HEATING CQ._, IN . Corp. 2122 _ Address 57371 /2 SO UNION ST. Partner. LAWRENCE , MA. 01843 [_J Firm/Co. Business Telephone: 508 685-8383 Name of Licensed Plumber or Gas Fitter rFnRrF I ARntF Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyOther type of"indemnity Q Bond 0 Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner F-] ElEl 1 hctcby certify that all of the details snd Irt[ormation I have submitted (or entered)in above application are true and aeeusate to the best of my knowledge and that all plumbing work and tnrtAWtions petformed under Permit issued [o: this application Will be in eomplsanee With all peigacat provisions of the f taruchusettt Slate Gar wde and chapter 142 of the Genctal Laws, B YPE LICENSE: Y Plumber — Title sfitter Sig ature of Licensed Master Plumber or Gasfitt"er. City/Town: Journeyman 99fi� APPROVED (oFmcc USE ONLY License Number V 6 1 G Date. NORTH TOWN OF NORTH ANDOVER rpb ��ap ,e 1 Fti Op PERMIT FOR GAS INSTALLATION 9SSACMUSEt This certifies that . ... . . . .�. . . . .. .. f has permission for gas installation .. " ''? . . . . . . . . . . . . . . in the buildings of ." . .. . . f. . . . . . . . . . . . . . . . . . . . at . . . . �' . �. j%:-.�.� .: . , North Andover, Mass. Fee.`. ` . Lic. No.. 14:52GAS. . . . . . .� I CTO TID. . . . . . . . . WHITE:Applicant CANARY:Building Dept. PINK:Treasurer /5-0 101,v-5Location •� No. Date NORTH TOWN OF NORTH ANDOVER 0 •� _ • OR 9 " Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ � s�cMusE 9 Foundation Permit Fee $ a Other Permit Fee $ TOTAL $ Check # 15797 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATf2 OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: m B o2 M SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION IO 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 Proposed Use Lot Areas Frontage 11 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Re red Provide ReqWred Provided R red Provided 1.7 Water Supply M.GL.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner ofec d 1 Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Telephone go SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address Expiration Date ic Signature ' Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M Registration Number Address Expiration Date ^z Signature Telephone �/ SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check au applicable) New Construction _g E sting Buil , g ❑ Repair(s) ❑ Alteratios(si) �- Addition ❑ Accessory Bldg. ❑ �w5 pemolition� ❑ Other „❑ �ecify Aa Brief Description of Proposed Work: ,r��/'�o✓� aG,2l�.J� �,vrJ /.✓S'�.�LG !�/.dODOC*fS fa.c� �`,kms. . �•rd �"# SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be UStONLy Completed by permit applicant 1. Building �^ (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of � Construction 3 Plumbing Building Permit fee(a)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereb horize 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 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 Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DiNMNSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH MNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover 4ii Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner . (978) 688-9545 978 688-9542 Fax HOMEOWNER UCENSE EXEMPTION Please print DATE JOB LOCATION"4 `SO, ) NC R) 066' Number Street Address Map/lot "HOMEOWNER RS3p ame Home Phone Work Phone 'RESENT MAILING ADDRESS 'S U City TownState 4np Code The current exemption for"homeowners"was extended to include owner-occupied dwellings of two units or less and to allow such homeowners to engage an indMduW**hire who does. not possess a license. provided that the owner acts as supervisor. (State Budding Code Section 108.35.1) DEFINITION OF HOMEWOWNER: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two family dwelling,attached or detached structures ac- cessory to such use and/or rY fiarrri stnx:ittres_ A person who cppstruds;more than one home in a . two-year period shalt not be'corisidered a homeowner_ The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner"certifies that he/she understands the Town of No.Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requiremen . HOMEOWNER'S SIGNATOR APPROVAL OF BUILDING OFFICIAL ' Date.3:7// r'.-). . .... . ORTH Of TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION iii • h 1 qs,S SAc,4us This certifies that . . . . .�.. . M .l.c.. �• .; . . . . � . . . . . . . . . . . . . has permission for gas installation . . R./.SCt+. .J ... . . . . . . . . . . . . . . in the buildings of . . I ��q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . S. ./?/h �. .l�. e r��. . . . . . . . . . ., North Andover, Mass. Fee. . Lic. No.. . . . . . . . .a4o . . . GAS INSPECTOR V Check# 5160 MASSACHUSETTS UNIFORMAPPLICATON FOR PERMIT TO DO GAS G (Type or print) Date /ll h J r NORTH ANDOVER,MASSACHUSETTS Building Locations ` (ti d' Permit# 6�d Amount$ Owner's Name U W New❑ Renovation ❑ Replacement Plans Su tt d ❑ oe H x x fYi CA F W Wa O O a" O W F c7 W WdW x �, z F o O FAQ F z d F� z d O 0• O wz O w O D A C7 a U w SUB -BASEM ENT BASEM ENT 1ST. FLOOR y 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type) fChe Corp.one: Certificate Installing Company`. Name � � �, S ��r�y2�Z� Address 0 0 k F-V /L'S ❑ Partner. 14. Business TTe ep one 7 ff irm/Co. Name of Licensed Plumber or Gas Fitter ��� L) /% ( `-1P 4--t- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes No Q If you have checked, es,please indicate the type coverage by checking the appropriate box. ❑ Liability insurance policy O 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 ❑ t hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Iss ed for this application will be in compliance with all pertinent provisions of the Massac etts State as Code an Chapter of the neral Laws. Signature of Licensed Plumber Or Gas Fitter Title Plumber f 2) Z6 Tit City/Town ❑ Gas Fitter License Nm er 0-Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Date.3 7e�7 NORTH TOWN OF NORTH ANDOVER ,ti PERMIT FOR PLUMBING ,SSACMUSE� This certifies that . . . .1 ...�... . .51� has permission to perform . . . . . . ? .. ... . . . . .. . .`. .'. . . . . . . . . . . . . . plumbing in the buildings of . . . /.h` !. . . . . . . . . . . . . . . . . . . . . . . . at .,/S. a. . . .H . . . . . . . . . . . .. . North sAndover, Mass. Fee. Lic. No.. 3 . . . . . . . . . . . . . . �LUM, BING INSPECTOR Check # i 6362 MASSACHUSETTS UNIFORM APPLICATION FOR PE IT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 2 Building Location U V11--0 � ners Name / Permit# Z / Amount G. Type of Occupancy � '`'e_k New Renovation Replacement �/ Plans Subm; Yes ❑ No ❑ FIXTURES F rCnn O W W UrzIni a z 3 w C C W SZSffiNIC r RASEMM SSL MOOR FLOCIR �II)HIDO[Z 4M 1HIDOR SM FLOM 6M HDOR - 7M FIDOR SIH)HIDM (Print or type) 'f ( / Check one: Certificate Installing Company Name V J ( �°l�t l,�,c L� E] Corp. Address 63 K. V `� �'� Partner. Business Telephone IlFirm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ri 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 in tallations performed under Permit Issued for this applicationwill be in compliance with all pertinent provisions of the Mass etts St a lumbingde and Ch ter 142 of General Laws. 10,01-By: Ig a ure or Licenseau er -- Type of Plumbing License Title O --� 6 City/Town Icense lNumDer Master Journeyman APPROVED(OFFICE USE ONLY ❑ 'E Location tN No. Sp 6 Date a.ttio7a`�y�X3 . NORToy TOWN OF NORTH ANDOVER 0� . ° 3r • OL F 9 + ; , Certificate of Occupancy $ E Building/Frame Permit Fee $ 30d .1 CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ '206 a Check # I 18625 �/ Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT i APPLICATION TO CONSTRUCT REPAIJ RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING Ivasm BUILDING PERMIT NUMBER: DATE ISSUED. SIGNATURE: Building Co ' onerfffor of Buildin Date SECTION 1-SITE INFORMATION 1 O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Num Q 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Distrid Proposed Use Lot Areas Fronto ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: v Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDAGENT '�'� �' i{ +i�t(iCt: ;�.^^, NO M 2.1 Owner of Record ::Ia 1 ..s +- Co LLQ j i.9 s �-S5 e �PIAIC ,eI d Ge �'o/9-C6 �1 Name(Print) Address for Service QJ Signature Telephone I 2.2 Owner of Record: Name Print Address for Service: Y M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ deo)/1-IJ It Li„i 6- Lrcensed Construction Supervisor: 7 / �e License Number to P (1.A)re�4,7 15 2 ,y o ,f�v�o� e �s.,lr � Address ic 4'V S 7 Expiration Date �. Signature V Telephone r 'a ;istered Home Improvement Contractor Not Applicable ❑ i Company Name d M Registration Number r Address 57 e- 29 -0066 Expiration Date Signature Telephone t" t SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes....... No.......0 SECTION 5 Description of Proposed Work check a0 a licable New Construction 0 Existing Building ❑ Repair(s) Alterations(s) 0Addition ❑ Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: we%k New C�litiPTS S69h,e %Lcb/2 l�L�� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OP-RCIAI,USE.ONLY Completed by permit applicant 1. Building .a (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(.a)X bbl 4 Mechanical HVAC ,30 5 Fire Protection Cie 6 Total 1+2+3+4+5 3 v o 0 o Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf 1 X1.1 m utters rela a to work thorized by this building permit application. 2-2- o 6- Signature ot'thvner Date SECTION 7b OWNER/AUTHORIZEDAGFNT DECLARATION r property as Owner/Authorized Agent of subject r property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 12 ND3Fw SPAN DIMENSIONS OF SILLS r' DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE y � �'1�e �ooimo�aueal!/a a�,/�Qaoaelu�aelCa BOARD OF BUILDING.REGULATIONS j License PNSTRUCTIOIrIs UPERVISOR Number CS 0274ft Bir0hdAte07/16/1953 _ I ;gxpires 07/161/2005 Tr.no: 13929 y Reg061ed ,'00 1I STEPHEN M KEISLING - 68'GLENCREST l5k, ( «p v N ANUOViER, MA 01845 1� 'Administrator -- --- — -- OT/le �omvrraaizuieall�i a�/�aaaac�euoell6 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr._0: 101846 Expiration 6%29/2006 _`.:Type Indnridual STEPHEN M.KE&AG_ i Stephen Keisling a 68 Glennerest Dr. N.Andover,MA 01845 `- Administrator I Farm DECLARATIONS PAGE 1 CONTRACTORS ADVANTAGE SPECIAL Family Casualty Insurance Company POLICY NO. 2005XO431 ® Glenmont,New York NAME OF INSURED AND MAILING ADDRESS: AGENT NO. 2591 OFFICE NO. 2591 STEPHEN KEISLING JAMES W UGONE 68 GLENCREST DR FARM FAMILY INSURANCE N ANDOVER MA 01845-1315 10 S MAIN ST STE 208 TOPSFIELD MA 01983-1832 978-887-8304 RENEWAL TRANSACTION EFFECTIVE 03/21/04 POLICY PERIOD FROM 03/21/04 TO 03/21/05 12:01 A.M. STANDARD TIME AT THE LOCATION OF THE DESCRIBED PREMISES THE NAMED INSURED IS: INDIVIDUAL BUSINESS OF THE NAMED INSURED: CARPENTRY—NOC LOCATION OF DESCRIBED 68 GLENCREST DRIVE PROTECTION CLASS IS: 04 PREMISES NO. 01: N ANDOVER MA 01845 CONSTRUCTION IS: FRAME PREMISES 01 BLDG 01 BUILDING MATERIALS / EQUIPMENT STORAGE BUSINESS PROPERTY COVERAGE: LIMITS OF, TERM ADDL/RTN INSURANCE PREMIUMS PREMIUMS BUILDING 0 0 0 BUSINESS PERSONAL PROPERTY 5,000 46 46 BUSINESS INCOME AND EXTRA ACTUAL LOSS SUSTAINED NOT EXPENSE EXCEEDING 12 MONTHS INCLUDED INCLUDED BUSINESS LIABILITY COVERAGE: BUSINESS LIABILITY - PREMIUM IS SUBJECT TO AUDIT BODILY INJURY/PROPERTY DAMAGE 500,000 PER OCCURRENCE 1,000,000 AGGREGATE 500,000 AGGREGATE FOR PRODUCTS - COMPLETED OPERATIONS HAZARD MEDICAL EXPENSE 5,000 PER PERSON FIRE LEGAL LIABILITY 50,000 PER OCCURRENCE CODE DESCRIPTION PAYROLL TERM PREM ADDL/RTN 91342AA CARPENTRY-NOC 20,000 379 379 THE LIMIT OF INSURANCE FOR THIS BUILDING SHALL BE AUTOMATICALLY INCREASED BY 5% ON AN ANNUAL BASIS DURING THE POLICY PERIOD. ACTUAL CASH VALUE (ACV) - BUILDING OPTION DOES NOT APPLY. DEDUCTIBLE: ' $250 DEDUCTIBLE APPLIES EXCEPT WHERE NOTED IN THE POLICY OR ENDORSEMENTS. COUNTERSIGNED BY: BF 30 05 01 98 INSURED COPY PROCESSED DATE: 02/18/04 f The Commonwealth of Massachusetts > Department of Industrial Accidents Ofte of Investigations Boston, Mass. .02111 Workers'Compensation Insurance Affldavit Name Please Print Name: � , -o/,sG- Location: /-5-0 P., ,e, d G' Ac l City A��10 t--e-2 /0/4 ph" 0 I am a homeowner performing all work myself. l� I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for rry employees working on this job. Compamy name: AgWr+ess City: Phone ' Insurance.Co. PoBcv 8 Company name. Address City: Phone# Insurarm Co. Policy f Falk"to secure coverage a.required under Section 25A or MGL 152 can lead to"knpositlon d aknkW pennAlea or.a Ane up to s1,sw.w anddor one yon'Imprison nent_as wd.as_dst 4mKmMn]D twhm dA.STOP VVOM OROER.and.a.floa af.(SIW MAA*agabe ma 1 understand that a copy of this staternent may be forwarded to the Offloe of InveodgWons of the DIA for coverage wNicadon. j I do hereby coil y under d w pains and pwwhY a of par/ury that the Inkrmadon provided above is true arw caned. Signature 9 Date a-2 2-o S' Print name_ -�l e d'��•� �' �'P S I Phone# 22 OftW use only do not write in this area to be completed by city or town offldsr City or Town P i QCheck X immediate response Is required 13 Building Dept Q Lkwx-V Board Q Selectman's Offke Contact person: Phone 0* Health Department Q Other Page No. of Pages STEPHEN M. kEISLING Building & Remodeling 68 Glencrest Drive NORTH ANDOVER, MASSACHUSETTS 01845 MA Lic. 027489 Home Impv. 101846 Phone 682-2072 PROPOSAL SUBMITTED TO , PHONE DATE ���_ 1 JIG✓." '? O STREET JOB NAME 1 CITY,STATE and ZIFfCODE JOB LOCATION ARCHITECT DATE OF PLANS rPHONE We hereby submit specifications and estimates for: ............................ ...... ........ . _ . a - . ... ... ............. ..................................................................... ..................................... . . . .. f- .......................... ..._ ....�...-�....... ............................. ................ .......................... ..... .... ... . ... ....... ................• .j . � ....::.............:..� :..........................................._.......................... ....................... .......................... . . .................... ^c7�� ............................................................................................................................................................................................... .................................:............ ...........................................:.................................................. ........ ✓ J............................ .................................................................................................................................................................................................................................................................... ...... ....... ...........................................w...._//�`` ......................... .................:......................�.......... ........ ...^. .........:...,{........�.L�J ......................... .............,...,.........................................r.... LrO... .... y)-'...... .......... -t-.Q- - . .. .: _ U _ - . .._� -. ................................................................... ....................................... .................................. CIV .... .. ►- ..o .. ,.. .-ri--...... ............... ...... ate a ........:................................ ..... ...................................... - - .r......................................................................_.................................................................. Pi _ , ..........._ 990........................................................................................... .. HiP PrOPOSP hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: dollars($ )• Payment to be made as follows: 6,0e All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from above specifications Si nature involving extra costs will be executed only upon written orders, and will become an extra g charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. v rices specifications ,�CCP�,1tFI1tIrP of Proposal —The above P P and conditions are satisfactory and are hereby accepted. You are authorized Signature ` to do the work as spe if' d. Payment will be made as outlined above. .Date of Acceptance:---4n-'� I la��' Signature ��r NORTH Town of over No. Sto 3Oo > Mass.,!!!!?�` o dover '�� �aS o = LA I� COCMICKEWICK V 7� 0RATED y BOARD OF HEALTH Food/Kitchen Septic System PERMIT T O L ow � d /I� 19163 BUILDING INSPECTOR THIS CERTIFIES THAT.. ......................... .../............................................................... ............................................ Foundation • �s has permission to erect...�'�!'!��!�. ....... buildings on...>/�O......�*.. ................. .1......�0� Rough to be occupied as........K4.40 .4bAoP �. ..... �y� �.f/Q� Chimney ..... .......... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 6 13( PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMEXPIRES IN 6 MONTHS Final IT - UNLESS CONSTRUCTT N T TS ELECTRICAL INSPECTOR' Rough C (001111111011100011 6111's� .. ... .. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building I 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. Burnet Street No. SEE REVERSE SIDE Smoke Det. North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: 2 L (Location of Facility) r Signature of Perm it-Applicant �? o Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the office of the Building Inspector — 574" o t 125" 77i" 28" 18" 2}" 17s" 27" 9 135; 4i" 37a 32P' , 3 '��` r �-2 } "�17 36". . IF ...__........ . ... ........ .... 225 283015 I If W1842L a 174212WCO27274 2 V „ 24:DISISF01: SF lCtS COM BCC3 rn ......_ T — .... _.... ap i 0 w Ln J V I � a � BOV333424 BF 2 L o>' CA : m m 71. N w w CO rn P23S34.5 C DP 8S34. —33 24 O s W w w CO N A "I' mlN n I V I W —___ _._ __.L_.I :...:. ... __.:::.._ -_.. ___._._..__..___.....___.........._ _ T199618li n S BF G g ,. 24 24- BF IDG' 434. i90625R B1PBM353424R N CI w j W361225C SF 3 74215 WOR303612 W2742 i W332612 144212E A I N nu 2 3 'r” 2 19i" 3 19r' S" 36" a 27" 30" 27" 7T" All dimensions _size designations given are j""� This is an original design and must not be Designed: 12/13/2004 subject to verification on job site and TECHNOLOGIES released or copied unless applicable fee has Printed: 12/13/2004 adjustment to fit job conditions. been paid or job order placed. DIA 't All Drawing #: 1 I 11M I UIVIAlulY YIGt1LJ n Ur 1V"1 Lae 1%-"VLU.M 10 DEPAR 1ETOFPUBIICS MY permit No. BOARDOFFREPREVF1MONREGULAT70N55VOR12ib Occupancy&Fees Checked APPLICATIONFOR PERA41TTO PERFORMELEC'TRICAL WO 0pj� ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: "Ceation undersigned applies for a permit to perform the electrical work described below. (Street&Number) �j(� (�j t � ? ";► �e Ler or Tenant 't ` ner's Address \� his permit in conjunction with a building permit: Yes No a (Check Appropriate-'Box)' se of Building Utility Authorization No. ting Service Amps 'Volts Overhead Underground M No.of Meters Service Amps� Volts Overhead Underground Im No.of Meters ber of Feeders and Ampacity tion and Nature of Proposed Electrical Work 7�7 7t i 77" f Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA f Lighting Fixtures Swimming Pool Above Below Generators KVA round and Receptacle Outlets No.of Oil Burners No.of Emergency lighting Battery Units Switch Outlets No.of Gas Burners Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons O sposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Device s ishwashers Space Arca Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices ye, Heating Devices KW LocalMunicipal Other If M Connections ater Heaters KW No.of No.of Signs Bailasis b Massage Tubs No.of Motors Total HP 2d C ileC v b%E3=C0VW4r.P=AltlDftWgll¢WXMb GataalIaws IhneaanatliabtliyL�tarel�TicYirrYldrlgCm>p>e� COQ' crk5wbdMalagtrivalat YES9- te NO El lhavesubmedvardproof bdEO�ca YES 1� �Aws YES, typeef by INSURdzddrthe BOND Orlm 1. q � ( , INS<.1RANcE o o ��) EsWrMdVaileafEkcftEd WC&$ WadcbStat klspacdmD&Fqjes1ed Rao Fmd RRMNAME R 0fpqI :F G ?( Lao .Na 14 �11 L-oa90g 514L,�, M 11'/0/lL( Sigrmw ldaa>seNo -'� Btsk=TeLNa 17k f3-266731 AkTdNa �,!!WSINSUW4MWAIVER;Ivetheir>sualoeoomWtritsakftM gtdv inastagzedbyM=cWmGataallaws arcl drat my si®rlahue m this pealit aQpGca4iort waves dic legtmernat (Please check one) Owner Agent Telephone No. PERMIT FEE$ signature or Owner or Agent