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Miscellaneous - 1511 GREAT POND ROAD 4/30/2018
1511 GREAT POND ROAD ` / 210/062.0-0020-0000.0 8790 Date/. f> f pOR7M, y. •° do TOWN OF NORTH ANDOVER of � '` ...-•. o� PERMIT FMPLU BING SSACHUS� This certifies that . . . . /4-i AJ. . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . � . . . . . . . . . . . . . . . . . . plumbing in the buildings of . .;1 /. !�: l��. ... . . . . . . . . . . . . . . . . . at . . . . . . ... . . . . North Andover, Mass. Fee. . 0 . . .Lic. No..�. .j. . . . . . . . . .L—. �:���. . . . . . . PLUMBING INSPECTOR Check # �� i i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town �40 MA. Date: Permit# Building Location: 1 S� Gly,-,4 P,9 I�c� • Owners Name: �J O Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:K Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED Z SYSTEMS z W Y O > Z V1N x Ln h p O {n 1 G' Z F Y Q N J Q W C7 G' Q�Q �. w Z W Q L,— = Z = W z < Ln 2 O ? N V1 W F 0 m Q W a Z oC = C iz Z N z u o LL J_ Q 3 W 0 O Q W W J Z 4: C O W W U H x 0.0 lx.) Z a Q LU 3 a '� z H H H Uj LU W Q a > LM a a a H O 0 > > 0 = O a a Q a F u Q oWe oae 4 a m m e oU- x ae g g oc in 1-n 3 3 3:1 0 SUB BSMT. ,BASEMENT 1ST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR ST"FLOOR 6T"FLOOR 7T"FLOOR BT"FLOOR O !� Check One Only Certificate# Installing Company Name: 1 (1 (, I ❑Corporation Address:0?0 00�- -)�F 01 City/Town: `V� State: A ❑ t y [,, 1 Partnership Business Tel: (9 1'—��� YFax: M--6j EP-36b �-� [Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner E] Agent Signature of Owner or Owner's Agent I hereby certify that all of the details and information I hav submitted(or entered)regardi g this ap catio re tru and cur to the best of my Knowledge and that all plumbing work and installations rformed under the permit iss d for thi ppli do will e i om i ce with all Pertinent provision of the Massachusetts State Plumbing ode and Chapter 142 of th eneral S. By Type of License: Title eas ftuber Ignature Lic sed Plum r Citylrownter License Num er: ����� APPROVED OFFICE USE ONLY rneyman 9927 Date.... ..^ :... f 40RTR 1 3:;•,�`' "�O� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING SS�cHusE� This certifies that .......... ........... � ...... Z�tT/d� c�T< ......................... ......................... has permission to perform ......... 665�/Ll ...................................................... wiring in the building of................( /-�i . ....................................... at..hJrll fit. !��r.�.. . 2��.................. North Andover,Mass. ..... .. ............. �. Fee ..... �. Lic.No. :S/f1.. ..................... . ..... l l E CTRICALINSPECTOR Check # Commonwealth of Massachusetts Official Use Only Department of Fire services Permit No._ g97 7i 7 BOARD OF FIRE PREVENTION REGULATIONS VOccupancy and Fee Checked [Rev. 1/071 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 ININK OR TYPE ALL INFORIAl TION) Date: City or Town of: r To the Inspector of Wires: By this application the undersi ed gives not' e of his or her intention to perform the electrical work described below. Location(Street&Number) JS J 1� r Owner or Tenant (�r.r5 V�n G Sc.✓, Telephone No. 3/1 ?bo Owner's Address t L ,,1 Is this permit in conjunction with a building permit? Yes No ❑ BLDG PERMIT# Purpose of Building rA,,c k 1�G 4,goy VX �- Utility Authorization No. Existing Service aw Amps I;LD / ao Volts Overhead ❑ Undgrd P' No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires A1-7 No.of Ceil.-Susp.(Paddle)Fans No.of Total. Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires 3 Swimming Pool Above ❑ In- Elo.o mergency ig ing rnd. rnd. BatteKy Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS� No.of Zones No.of Switches —7 No.of Gas Burners No.of Detection and Initiating Devices No. of Ranges 0 No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Nu ............. ber .Tons KW No.of Self-Contained Totals: -.. ' ' "" Detection/Alertin Devices No.of Dishwashers O Space/Area Heating KW Local❑ Municipal ❑ Other Connection No. of Dryers O Heating Appliances KW SecuritySystems:* No.of Devices or Equivalent No. of Water No.of No.of Heaters KW Signs Ballasts Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired' or as required by the Inspector of Wires. Estimated Value of Electr'cal Work: _,Z5-00 (When required by municipal policy.) Work to Start: a Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: /7 -i-k r,`� ,C/ LIC.NO.: /c�.3/ Licensee: _5-1031 C Flpa6,[ Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 011 3 7 a �Mo Address: Alt.Tel.No.: *Per M.G.L.c.147,s.57-61,security work requires Department of Pu lic Safety"S"Licen 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: $ 9855 . .2- ,c-� ,U Date... ............................ NORT" 1 °!'"`°:•�"° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHU This certifies that �U �� ............. ................................... ........................................ has permission to'perform ............ n� N�.� ...... ....................................... wiring in the building of Utt.5A.!1.D-1.............................................. at �. !... ,North Andover,Mass. ..... �..........................�. ....!� .......... Fee..3 Lic.No S1 b.3/�.... 4��E�C-T- .......OR j j Check a Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. a BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �.. [Rev. 1/071 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 PRINTININKORTYPE ALL INFO TION) Date: C'Z .— � 0 City or Town of: To the Inspector of Wires: By this application the undersi ed gives not' e ofhis or her intention to perform the electrical work described below. Location(Street&Number) i.5 I � f E'rv`� kd Owner or Tenant Ad C,M�l \J�k ,CA,n�Z)� Telephone No. Owner's Address �.� \ L'cej- �,)o n Z eL Is this permit in conjunction with a building permit? Yes ❑ No ❑ BLDG PERMIT# Purpose of Building Utility Authorization No. Existing Service ago Amps Jo, AtA 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: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires I I No.of Ceil.-Susp.(Paddle)Fans No.of Total. Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires3 Swimming Pool Above E] In- ❑ 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 Initiatin Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number .Tons• KW No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or E uivalent ^ No. of Water No.of No.of Heaters I Signs Ballasts Data Wiring: 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 E ectri al Work: oe)d (When required by municipal policy.) Work to Start: p Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RA E: 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 R" BOND ❑ OTHER ❑ (Specify:) I cert,under the pains and p enags of perjury,that the information on this application is true and complete FIRM NAME: r r r-�i� �- ��.7 iJ ry e LIC.NO.: 57-1 03 1 E Licensee: Fl ec 1 if I( [G n S' Signature LIC.NO.: (If applicable, enter "exempt"in the license number line) r Bus.Tel.No..--(,Li7 . i.�.� S P� Address: Alt.Tel.No.:1Rl:1 ��ld rx7 s *Per M.G.L. c.147,s.57-61,security work requires Department of Public Safety"S"Licen 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. $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL VG SPECTION:Failed—[ ] Re inspection required($50.00)- [ ] Inspectors' comments: (Inspectors'Signature-no initials) ~ Date 2.FINAL INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspecto s'comments: A I- EEE (Inspectors'Signature-no in' als) Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date L 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govld'ia Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectriciansfplumbers Applicant Information LL Please Print Legibly Name(Business/Organiz ation/Individual): Address: City/State/Zip:_A). Ain doyz,-- lV l �l Aone#: 7 7?00, Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. F1 Now construction ,(employees(fall and/or part-time).* have hired the sub-contractors 2.Rl I am a sole proprietor or partner- listed on the attached sheet.? 7. ❑Remodeling . • ship and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its ' required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam 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: r Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,-as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pa' s andpenaldes ofperjury that the information provided above is true and correct. Si ature: Date: (, Phone#: E[Oth only. Do not write in this area,to be completed by city or town official wn: permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: f NOPRI TOWN OF NORTH ANDOVER * PERMIT FOR WIRING $s�cMus� This certifies that .................... v 4 r L .............................................�T�...................................... has permission_to perform ...............9�-S4 44 ax-t-'..................................... wiring in the building of............. P...f�.t ../ /4n/C l ........................ att �a* ' �0?7 �l� North Andover,Mass. ... ✓ 'r ...o.o.................. ......... Feti..... .'.......Lic.No. ..5..����...................... ...... n,�^ EYEC MCAL INSPEcroRY Check# r- 0 r ! JJJ Commonwealth of Massachusetts Official Use Only Department of Fire Services PermitN°. 1 � Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives no of his o er intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant /( Telephone No.(5;/7 Owner's Address Is this permit in conjunction with a building permit? Yes � No ❑ (Check Appropriate Box) Purpose of Building XL ,r Utility Authorization No. " Existing Service_— Amps _ C�/�Z50 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: „, Q f- Completion of the following table maybe waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o cy Lighting rod. grnd. Battery Units 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. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: - Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other P g Connection leo.of Dryers Heating Appliances KW Security Systems:* Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent.. OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El e tri al Work: 1,„2 pc7 (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,tinder thepains andpenalties ofperjury,that the information on this application is true and complete. FIItM NAME: . U T�/2(� LIC.NO.:, — 31 Licensee: Signature LIC.NO.: (If applicable,enter "exempt"in the license number line) -2 Bus.Tel.No.: Address: ( � 3 Z �c� Alt.Tel.No.: *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 PERMIT FEE: $ Signature Telephone No. 0 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the J Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed Y on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Ins ection Pass� Failed� Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: / SERVICE INSPECTION: Pass IN Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH SECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Co ments: El?hir3 Inspectors Signature: Date: FINAL INSPECTION: Pass IN Failed 0 Re-Inspection Required($.)❑ nspectors Comme t . Inspectors Sig ature: Date: _B WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com / 4 � The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address:2� S�— City/State/Zip: lV Cho✓e,,✓Vl l O !TS gj--Phone#: 0 /7 �l�ova Are yo"n employer?Check the appropriate box: Type of project(required): 1.RKam.a employer with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors �2. I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition �r working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 1211,Roof repairs insurance required.]i employees.[No workers' 13.0 Other 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 submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: PoliT y#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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sip-nature: Date: G 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#: v w ' 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 ofhire,• express or implied,oral or written." An employeiis defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants • Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. r Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'-permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The 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 Corr onwealth of Massachusetts Department ofzndustrlal Accidents Office of Investigations 600 Washington Street Boston,MA,02111 TO,#617-727-4900 ext 406 or 1-877:MASSAFB Revised 5-26-05 Faze#617-727-7749 --wvvw_Mass.gavfdia I rA • C MMONWEALTH OF MASSAPHUSETT-t ELECTRICIANS AS A.-REG JOURNEYMAN ISSUES THE ABOVE LICENSE TO ARTHUR J GUTHRIE • �4 PRE'SCOTT .ST AN DOVER tlA- 018 +'� IJ"ORTH. ` •. 51031: E 07/31/13 , f H�oTM 1 "�o� TOWN OF NORTH ANDOVER 0 . p PERMIT FOR WIRING ACHUSEt This certifies that ..�.�..... OGli�;1�.:�...�.i.�.�...................................... has permission to perform ..............Sv Vit, c�D 'f................................... wiring in the building of............. ..................................... .at.../St /ch� ��'''.0. North Andover,Mass. Fee...47..�.'.. Lic.No. S—/0.�/F........ .41..t. l......... / ELECTRICALINSP"- Check # ` a6 'r MO Official Use Only • �vrnrn.an.cveccC'L�i o �'!''la9sacltccseLLs �-7 �® Permit No. / o1JeL�cuLrnen.L o��ir•e�ervices Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULAI IONS (Rev. 11/99) (Icavcbkank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (M C), 527 CMR 12.00 (PLEASE PRINT IN IRrK OR T PE ALL INFORMATION) Date: City or Town of: Df- To the Inspec oro Wires: By this application the undersigned gives nooucce.orof his or her intention to perform the electrical work described below. Location(Street&Number) 1 ) ,` �1 QCA -DO41-k . Owner or Tenan[i-t(-&r�^ Ct�`r bN Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building JV evJ S,')v\- 1 t wo Utility Authorization No. Existing Service Amps Volts Overhead❑ Uadgrd❑ No. of Meters New Service Amps Volts Overhead.❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity i Location and Nature of Proposed Electrical Work:: L k I — 001SPI-1 s \f Completion of the following table mery be waived by the Inspector of Wires. No. lltt No. of Recessed Fixtures No, of Cei1.-Sus addle Fans Tra sf Total P•� ) Transformers EVA No. of Lighting Outlets No. of Hot Tubs Generators KYA AboveIn No. of Emergency Lighting No. of Lighting Fixtures Swirl ming Pool grad ❑ goad. ❑ Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No.of Gas Burners Initiating Devices Total No. of Ranges No.of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons _ __KW _ No. of Self-Contained No, of Waste Disposers Totals: Detection/Alerting Devices No, of Dishwashers S ace/Area Heating KW Local❑ Mu actionipal❑ Other t P g 1� Connection _ 4 Dryers HKW Security Systems: No. of D ry Heating Appliances g pp No. of Devices or Equivalent No. of Water No.of No.of Data Waing Heaters K-W Signs Ballasts No. of Devices or Equivalent Telecommunications Wning: No. HS,dromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent OTHER: Attach additional detail if desired, of as rewired by the Inspecror of Wires. !NTSURANCTE 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 per nit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of E ectric, Work.:: (�. ©DO (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 1 certify, under the pail and enatties of per ung, that the inforniatio on this application is true and complete. t FIRM NAME: D � �� �� LIC. NO.:S�O _ Licensee: Jature LIC.NO_: (If applicable,enter'exempt'in the license number line.) r �] Bus.Tel.No.: Address: ` / �12— 8i9_5 Alt.Tel..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: $ IV Date...9.14.1W........... TOWN OF NORTH ANDOVER ° 9 PERMIT FOR PLUMBING « i 88•�CMUSfc � !1 � � ` Thiscertifies that........Q...............ff...__....,,..,,U.......... . -. ...................................................... ....... has permission to perform.....t:�)&..�.1., ..1 ..... �1?v 4�-�v2, plumbing in the buildings of. " T ............................................................................... at....t.�7�. ....... , A�..........N`r Q.. .........., North Andover, Mass. Fee3.9........Lic. No?.1 Q.J... Mo.................................................................... PLUMBING INSPECTOR Check# -2G4A 13 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK U CITY NORTH ANDOVER MA DATE9/4/2014 PERMIT# JOBSITE ADDRESS 1511 GREAT POND RD OWNER'S NAMEJ MARTIN POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[ EDUCATIONAL RESIDENTIAL E PRINT CLEARLY NEW:[ RENOVATION:E] REPLACEMENT: PLANS SUBMITTED: YESE] N0[ \ FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14 BATHTUB I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN E INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL m _ SERVICE/MOP SINK TOILET URINAL .. ...,....E ,....... �. ..,,�' ,1. v '' WASHING MACHINE CONNECTION F ...... 4VATER HEATER ALL TYPES WATER PIPING _ THER BACKFLOW PREVENTOR 1 3 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ej OTHER TYPE OF INDEMNITY [ BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER E] AGENT E] I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME JEFF HUTNICK LICENSE# 15212 SIGNATURE MPC JP[ CORPORATION # 3532 PARTNERSHIP[# LLC[#� COMPANY NAME CALLAHAN AC AND NTG ADDRESS 91 BELMONT ST CITY NORTH ANDOVER STATE MA ZIP 01845 TEL 978-689-9233 FAX CELL 978 423 6305 EMAIL PLUMBING CALLAHANAC COM I Date................. . .'. ...................... R r►OHr TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU This certifies that— �'I ...`T\t �-..c�IL....................................:. . . has permission for gas installation .....b .......................................... inthe buildings of....... ....................... ...................................................... at.............I.���.�...... �'. ....... ........ v°�North Andover, Mass. Fee.3 ........... Lic. Nov ...�1.1........ .....IO,. ......................................................... GAS INSPECTOR Check# a ., t1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE 9/4/2014 PERMIT# JOBSITE ADDRESS 1511 GREAT POND RD OWNER'S NAME MARTIN GOWNER ADDRESS TE FAX TYPE OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL CLEARLY NE 4) RENOVATION: REPLACEMENT:E PLANS SUBMITTED: YES NO APPLIANCES 7 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER t CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE �'� GENERATOR GRILLE INFRARED HEATERS � -- LABORATORY COCKS MAKEUP AIR UNITI ' OVEN POOL HEATER I .. ROOM/SPACE HEATERS ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATERS — - WATER HEATER I I __OTHER _-� :- x 4 A INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER L3 AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true a c rate o the best of knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compl' nc i all P ine fs y of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME JEFF HUTNICK LICENSE# 15212 SIGNAT E MPEJ MGF E JP JGF LPGI CORPORATION # 3532 PARTNERSHIP # LLC # COMPANY NAME:�CA A AN AC AND HTG ADDRESS 91 BELMONT ST CITY NORTH ANDOVER STATE MA .ZIP 01845 TEL 978-689-9233 FAX CELL 978 423-6305EMAIL PLUMBING@CALLAHANAC.COM i COMMONWEALTH OF MASSACHUSETTS li • • - • A Isl BOARD Q ti PLUMBERS ANb"GASf1TTERS` ISSUES THE FOLLOWING>-L_10ENSE LICENSEa} AS'A JOURNEYMAN PLUMBER JEfFR.EY P HUTNICK � 60 PLYMOUTH ST _ I ::MET UEN MA 01844-4256 zt88r; 05101/.. 6 204053 i".-comm ONMEALTH OF MASSACHUSETTS Rifelmejou wisig lei BOARD OF.. PLUMBERS .AND'GASFI.TTERS: i ISSUES THE FOLLOWING. LPCENSE REG tSTEREb AS A ..PLUMBING CORP JEFFREY HUTNICK., CALLAHAN A:/C ANb HEATING SERVICEy 60 PLYMOUTH ST W METHUENMk 01844-4256 3532 05101/1;;6 204054 COMMONWEALTH OF MASSACHUSETTS BOARD OF PLUMBERS AND GASFITT ER,S ISSUES THE FOLLOWING LICENSE ;;: LICENSEI AS A MASTER PLUMBER :: JEFFREY P HUTNECK 60 PLYMOUTH ST :IIETRUEN MA 01844 4256 152 2 05/01/16 1-9305' r II-Contact.Per_Son. '' CERTIFICATE OF LIABILITYDATE(MWDDIDIYYYYIPS INSURANCE 11/01/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone:978-686-2266 CONTACT q_M% North Andover insurance Agency Fax 978-686-6410 PHONE FAx M.J.Foster Insurance Services AIX No 163 Main SL E fNUL North Andover,MA 01845 ADD • Stephen Sullivan PRODUCER CUSTOMER ID IP CALLA-1 wSUR 5 AFFORDING COVERAOE I NAIC 0 INSURED Callahan A C and Heating INSURER A:PEERLESS INSURANCE COMPANY Services,Inc. Callahan Air Conditioning and INSURER B:GUARD INSURANCE COMPANY Heating,Inc. INSURER C: 91 Belmont Street INSURER D: North Andover,MA 01845 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCEMP0CY EFF MPEOAID�EXP LIMITS POLICY NUMBER GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CBP4016154 09/25/2013 09/25/2014 pR MIS a ocaarencol s 100,00 CLAIMS-MADE IT OCCUR MED EXP(Any cne porson) $ 5,00 CONTRACTUAL LIAB PERSONAL&ADV INJURY s 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY FX1 PRO--IFrTLOC $ AUTOMOBILE LIABIUTY COMBINED SINGLE LIMIT $ 1,000,00 A 7 ANY AUTO BA4544035 09/2512013 09/2512014 (Ea accident) X ALL 04YlIED AUTOS BODILY INJURY(Per parson) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE X HIRED AUTOS (per accident) $ X NON-OWNED AUTOS !! $ I I$ X UMBRELLA UAB X OCCUREACH OCCURRENCE Is 61000,00 EXCESS LIAB CLAM-MADE A CU8809334 09125/2013 09/2512014 AGGREGATE Is 5,000,00 DEDUCTIBLE $ RETENTION I$ WORKERS COMPENSATION WCSTATU• X DTH• AND EMPLOYERS'LIABILITY B ANY OFFICER/MEMBER EEXCLUDED7 Q NIA CUTtvE YIN CAWC471731 09/2512013 09/2512014 E.I.EACH ACCIDENT $ 600100 (Mandatory sa In NH) E.L.DISEASE•EA EMPLOYEE $ 500100 U ea,dosaib;under `DESCRIPTION OF OPERATIONS below I E.L.DISEASE•POLICY LIMIT S 500,00 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 107,AdMdonal Remarks SchWulo,Ir mora spat;is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. fax#978 688-9542 BLDG.INSPECTOR AUTHORRED REPRESENTATIVE 1600 OSGOOD STREET NORTH ANDOVER, A 01845 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Location No. ao DateL cc 7 CL Of 0TTOWN OF NORTH ANDOVER- p Certificate of Occupancy $ Building/Frame Permit Fee $ cFoundation Permit Fee $ swcMusE Other Permit Feealo $ Sewer Connection Fee $ k CU Water Connection Fee $ TOTAL $ dc aLl IC) Building Inspector 7924 Div. Public Works PEWMIT NO. ��l�J APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE 'ZONE I SUB DIV. LOT NO. LOCATION 1s�l ��o�f' �j A.)(> PURPOSE GSC' a r1a 3..,AAr. ? �zx OWNER'S NAME NO. OF STORIES SIZE oyr e / � _ WNER'S ADDRESS /` // /)��1/1 dgz>,u D (J_►/ BASEMENT OR SLAB -- ARCHITECT'S NAME (, �,T �C G1' SIZE OF FLOOR TIMBERS IST 2ND 3RD v .,/BUILDER'S NAME _ C'e�� SPAN -- DISTANCE TO NEAREESST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "" POSTS ISTANCE FROM LOT LINES-SID " REAR 7 GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS BUILDING NEW `-5 SIZE OF FOOTING X IS BUILDING ADDITION _( MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER ,,_,,IOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER ��. i ' ••7 1 IS BUILDING CONNECTED TO NATURAL GAS LINE 1 �0 INS CTIONS 3 PROPERTY INFORMATION YY LAND COST SEE BOTH SIDES ST. BLDG. COST OJ1 O PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 1 /PLANS MUST BE FILED AND /APPROVED BY BUILDING INSPECTOR v D E FILED Ir SU ILDI NO 1 NSPSCTOR SI NA URE OF OWNER AUTTI QBJSED AGENT ' 'F /E "`� OWNER TEL.# `�1� 1 PERMIT GRANTED CONTR.TEL.# 19 G4�� ��. CONTR.LIC.#. H.I.C.# PERMIT NO. ® APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE "ZONE I SUB DIV. LOT NO. LOCATION /`S�� I�E�T A)p PURPOSE oa YT.d�o sr /��^ ��l� ;`V s`1a3� OWNER'S NAME NO. OF STORIES SIZE • WNER'S ADDRESS �/ •�-drl>,u p BASEMENT OR SLAB -- ARCHITECT'S NAME / SIZE OF FLOOR TIMBERS IST 2ND 3RD V,IBUILDER'S NAME seg►/= SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET •' POSTS (STANCE FROM LOT LINES-SID " REAR 7 GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS UILDING NEW `OS SIZE OF FOOTING X ' IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER .1-18i:,ARD OF APPEALS ACTION. IF ANY c�` IS BUILDING CONNECTED TO TOWN SEWER .•.•77 l IS BUILDING CONNECTED TO NATURAL GAS LINE •U 4!�—INN;MJCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDESL�,-��ST. BLDG. COST Oo i O PAGE t 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 1 /PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR v D E FILED �C.. l� 62h SUILDINO INSPECTOR SI NA URE OF OWNER AUTF�I4Z*B AGENT ` —'2-F E , -� OWNER TEL.# � PERMIT GRANTED CONTR.TEL.# 19 G4�� CONTR.LIC.# H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _- LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. . CONSTRUCTION a 2 FOUNDATION —I 8 INTERIOR FINISH t . CONCRETE B 2 13 CONCRETE PINE BRICK OR STONE HARDW D PIERS — PLASTER DRY WALL t . r�� (� 3 BASEMENT UNFINU3 C:30 AREA FULL FIN. B M'TAREA 14 1/1 l/. FIN. ATTIC AREA ` NO B M FIRE PLACES _ _ �a�1t � cot HEAD ROOM _ MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 -_ DROP SIDING CONCRETE �_ J I ' WOOD SHINGLES EARTH _ _' {rf- ASPHALT SIDING HARDw D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY 77 U/4 STUCCO ON"FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR OJJJ_ `^ (C.J /�« � BRICK ON FRAME CONC. OR CINDER BLK. (Q STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE _ ADEQUATE NONE w (f-1 5 ROOF 10 PLUMBING �4`-F`f'1 �lJ GABLEHIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY - WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWEREo ROLL ROOFING MODERN FIXTURES U�.� 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 GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd NO HEATING ToVM of over 0 )h �. ort ' M dover, Mass., ag&__Y 19 g S O L A K E C CIC MIC ME WICK nh•�IED BUILD BOARD OF HEALTH Food/Kitchen PERM IT TO Septic System --� BUILDING INSPECTOR .THIS CERTIFIES THAT.. .................................................................................................................. Foundation has permission to erect...UPPICD.... 11.1 ,. buildings on ...�.S'. .....,c T.. �.... '�...................... Rough tobe occupied as.... .......�E...... 4Z........................................................................................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXP MONTHSFinal ELECTRICAL INSPECTOR UNLESS CONS FRt 1C I I AQUIEU; Rough f.%SIL ......... . . . ...... . ... . . Service ING INS TOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RouFinagh No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT Registry of Deeds Northern District of Essex County Lawrence, MA 01840 02/16/95 JAMES TO'iE CI # 77 Rec:time 1149 Type NOTC 10.O() Postage fir,r=,4 # 78 Rec:time 1150 Type NOTC 10.00 Total r'''�•�4 # 39 Payment Cash 20,64 THANE; YOU' Thomas J. Burke Reuister of Deeds JOYCE L:RXS ',tiyW . - • 1.. AlwltI" i30 TOWN CL i tK 1855 . NORTH AtibovER Any appeal shall be filedf�ss.CHU-- 04 within (20) days after the ►.�� vv��. R /nS' 155 date of filing of this TOWN OF NORTH ANDOVER Notice in the Office MASSACHUSEZTS AMENDMENT TO NOTICE OF of the Town Clerk. DECISION TIME STAMPED IN THE TOWN CLERK'S OFFICE BOARD OF APPEALS January 17, 1995 at 4:12 PM NOTICE OF DECISION Januar is to certify that twenty(2C;days Date . . . . . . . . . . . .y. . . . . . . . . . . . . . . 20, 1995 a elapsed from data of decision filed ....1061 filing of.1n Date�f iPU�l2 y /G,/99� Petition No.. . . . . . . . . . . . . . Joyce A.Bradshaw Town-.^•Iwk v Date of Hearing January. .1.0. .1995. Petition of . . . . . . .JOYCE .TOYF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . . . . Premises affected . 151.1. .GR> AT. FOND.ROAD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Referring to the above petition for a variation from the requirements of 3" .Section .7., . . . . . Paragraph. 7.3. and.Table .2 .of. the Zoning. Bylaw. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so as to permit .a f.r.ont and. .side . setback.of. 25. .feet. .(t.o .allow. the .construction. . . I . . . . .of. a. .1.2'. .X. 12.1. .wooden. .shed.to. b.e .5 .feet. .from. the. .front. and. .side. lo.t .lines). After a public hearing given on the above date, the Board of Appeals voted to . . GST. . . . the VARIANCE and hereby authorize the Building Inspector to issue a permit to JOYCE TOYS . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I for the construction of the above work, based upon the following conditions: The existing fence shall extend three sections or 24 feet behind the shed as requested in a letter by Mr. Gary Wilkinson dated January 4, 1995. The Board finds that the Signed petitioner has satisfied the 01 provisions of Section 10, Paragraph 10.4 of the Zoning Wa ear � cAing�, hairman I Raymond Vivenzio Bylaw and that this Variance may be granted without substantial John Pallone detriment to the public good and Scott Karpinski Joseph Faris derogating from the intent or purpose of the Zoning Bylaw. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . Board of Appeals RECI_tY,F V 9 d N JOYCE BRADS!SAW TOWN CLERK NORTH ANDOVER JAN _ 9 19�� Ga Wilkinson JAN �O 36 APA reat Pond Road North Andover, MA 01845 (508)683-6116 1130ARD OF APPEALS January 4, 1995 q x Z C- �, Quo William J. Sullivan x� m� C-0n171Chairman - Board of Appeals w a r- -7. Town of North Andover „ 120 Main Street n g North Andover, MA 01845 L'' to Dear Mr. Sullivan: I sent you a letter dated December 27, 1994 regarding the location of a wooden shed at 1511 Great Pond Road. In that letter I stated that I was not in favor of having the shed located directly behind our house. Since that time I was contacted by Jay Toye to discuss the size and height of the shed. I would now not object to the location of the shed as long as the existing fence is extended three sections or 24 feet behind the shed (perpendicular to the current end of the existing fence). Please call me if you have any questions as I will not be attending the meeting. Best Rega , cc: Joyce Toye NaRTN ANCs�dEP. Any appeal shall be filed s within (20) days after the ti•;;;°��' date of filing of this TOWN OF NORTH ANDOVER Notice in the Office MASSACHUSETTS of the Town Clerk. BOARD OF APPEALS spm NOTICE OF DECISION -sem Zoo , "'� Date January. 17, 1995 A� .sed from data o:decision filed . . . . . " " " . . . . " " " ' cp t....: .:filing of meppeal. X6001-95 � Date_Ffdt'�i �ly /l9� Petition No.. . . . . . . . . . . . . . . . . . . . . . Joyce A.BmdWWX TOR Oak January 10, 1995 a Date of Hearing. . . . . . . . . . . . . . . . . . . Petition of . . . Joyce. Toy.e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Premises affected 1511. Great. Pond ,Road. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Referring to the above petition for a variation from the requirements of tw. . . .Section .7, . . Paragraph 7.3 and Table 2 of the Zoning Bylaw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so as to permit a front and side setback of 25 feet for the construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of a wooden sheds 12 feet .by. 12, .feet.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . After a public hearing given on the above date, the Board of Appeals voted to .GST. . . . . . the variance and hereby authorize the Building Inspector to issue a permit to Joyce Toye. . . . . . . for the construction of the above work, based upon the following conditions: The existing fence shall extend three sections or 24 feet behind the shed as requested in a letter by Mr. Gary Wilkinson dated January 4, 1995. Signed The Board finds that the petitioner f�/ ./ ;�'� has satisfied the provisions of Walter Soule, Chairman. . 1Xq Section 10, Paragraph 10.4 of the John Pallone Zoning Bylaw and that this variance may be granted without substantial detriment to the public good and Scott. . . Karpinski . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . without nullifying or substantially Raymond Vivenzio derogating from the intent or purpose of the Zoning Bylaw. Joseph Faris . . . . . . . . . . . . . . . . . . . . . . . . . Board of Appeals OF NOR7N 9� 11 OWN i1J'LL.R tt Eo a MGM ANDOVER ' oc 401 A JAN 17 4 12 Pty { r, YS SSACHUSES TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS ****************************** * Joyce Toye * DECISION 1511 Great Pond Road * Petition #001-95 North Andover, MA 01845 ****************************** The. Board of Appeals held a regular meeting on Tuesday evening January 10, 1995 upon the application of Joyce Toye requesting a variance of Section 7, Paragraph 7. 3 and Table 2 of the Zoning Bylaw to permit a front and side setback of 25 feet for the construction of a 12 ' by 12 ' wooden shed on the premises located at 1511 Great Pond Road. The following members were present and voting: Mr. Soule, Mr. Karpinski, Mr. Pallone, Mr. Vivenzio and Mr. Faris. Mr. Sullivan was present but not voting. The hearing was advertised in the North Andover Citizen on December 21 and 28, 1994 and all abutters were notified by regular mail. Upon a motion by Scott Karpinski and seconded by Raymond Vivenzio, the Board voted unanimously to GRANT the variances as requested with the following condition: The existing fence shall extend three sections or 24 feet behind the shed as requested in a letter by Mr. Gary Wilkinson dated January 4, 1995. (Letter attatched) The Board finds that the petitioner has satisfied the provisions of Section 10, Paragraph 10.4 of the Zoning Bylaw and that this variance may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Zoning Bylaw. Dated this 17th day of January, 1995. BOARD OF APPEALS, Walter Soule,- Chair?apf iVLU J�YGE RAMHAw Tawx CLERK p %OfMi ANDCYER t� Gary Wilkinson - 919 JAN17 7 � i3 1521 Great Pond Road North Andover, MA 01845 (508)683-6116 IBOARD OF APPEALS January 4, 1995 William J. Sullivan Chairman - Board of Appeals Town of North Andover 120 Main Street North Andover, MA 01845 Dear Mr. Sullivan: I sent you a letter dated December 27, 1994 regarding the location of a wooden shed at 1511 Great Pond Road. In that letter I stated that I was not in favor of having the shed located directly behind our house. Since that time I was contacted by Jay Toye to discuss the size and height of the shed. I would now not object to the location of the shed as long as the existing fence is extended three sections or 24 feet behind the shed (perpendicular to the current end of the existing fence). Please call me if you have any questions as I will not be attending the meeting. Best Re2a , r cc: Joyce Toye Date....'..!/.....Z"Z.'....®:/ f NORTI�, :;.';e`"-:'�.."�o� TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING ��SSAtNUSEt a This certifies that ................................. ................. .............................. lal� .? �m .11 has permission to perform ..... ...........�.`.......,..�...........!"�......................... wiring in the building of 6-17-X C....... Sr'u 41. ............ . ................... at........lAt.......����7.....i A/VTl7....... .: ,North Andover,Mass. � `- Fee... .-fir. ..... Lic.No.... . .3.......... ill, :"*................................ ELECTRICAL INSPECTOR Check # 51.1-0/ 6 (Rev.11/99) For Wce Use Only c�sfaa 1J ".1d a/5-M S Permit Number. �+vica� ` BOARD OF FIRE PREVENTION REGULATION OccupancyFee c'h il IP To APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (ALL WORK TO HE PMWORMED WrrH nM MASS�k(HUSL-ng=CMCpy CODE 527 CMR 12:00) PLEASE PRINT IN IN OR TYPE ALL INFORMATION Date: 17— — 2-2— City City ar Town of: Al- v., To the Inspectorof Wires: By this application the undersigned gives notice of his or her int n'on to perform the electrical work described below. Location: (Street&Number) ` S Owner or Tenant: Owners Address:_ Is this permit in conjunction with a Building Permit? Yes C,--N-o`--c3 (Check Appropriate Box) Purpose of Building:- a Utility Authorization#: Existing Service: ZLf'Amps / Volts Overhead 0 Underground.❑. #of Meters New Servicer Amps / VOlts Overhead ❑ Underground.❑ #of Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: !i✓ No,of Recessed Futures '- No.of Ceil:Susp.(Peddle)Fans No. of Transformers Total KVA No.Of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Y Swimming Pool: Above ground o In Ground o #of Emergency Lighting Battery Units �[ No.of Receptacle Outlets No. of Oil Burners Fire Alarms #of Zones ! #of Detection&Initiating Devices No,of Switches ,/ —— No.of Gas Burners #of Sounding Devices: #of Self Contained No,of Ranges No. of Air Conditioners TOTAL TONS: Detection/Sounding Devices Local o Municipal Connection o Other c No. of Waste Disposals Heat Pump Totals: No. of Number. TONS: KW: Nf D Systems: No. Devices or Equivalent No.of Dishwashers Space/Area Heating: KW Data Wiring,No..of Devices or Equivalent No.of Dryers Healing Appliances KW Telecommunications wiring:No of Devices or Equivalent: No. of Water Heaters KW I.No. of Signs: #of Ballasts: OTHER; #of Hydro Massage Tubs No. of Motors Total HP 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 substantlal equivalent. �e undersigned certifies that such coverage is In force,and has exhibited proof of same to the permit Issuing office, CHECK ONE. INSURANCE BOND a OTHER O Pleases specify: rfy: Estimated Value of Electrical Work$ (When required by municipal policy) Work to Start: y Z '�2 — (/of Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the Information on this application is true and complete. Firm Name: - Zo LIC.# Licensee: S �. o S/�-i Signature: �� (If applicable,enter LIC.# _ the Acense er line) Address: t Te�#k 12 Alt.Tel.# 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 o OR Agent o Signature of Owner/Agent: Telephone# — P—MWT NEE:S (—vmA nwaaa o` aa�cs�t�aff� For ce Use Only (Rev.11199) Permit Number. ' .1Jspatman�a�,fisa S'arvicad �� Occupancy&Fee t:�t BOARD OF FIRE PREVENTION REGULATION APPLICATION FOR PERMIT T PERFORM' ELECTRICAL WORK (ALL WORK TO EE PWOMVMD WITH Tf>E ELECTRICAL CODE S27 Cruet 12.00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION1 z — i-Z- -- y Date•• City or Town•of: To the Inspector of Wires: By this application the undersigned gives notice of his or her int niton to perform the electrical work described below. Location: (Street&Number) S G'/"c4 el Owner or Tenant: A, Owners Address: Is this permit in conjunction with a Building Permit? Yes No o (Check Appropriate Box) Purpose of Building: Utility Authorization# r Fxlsting Service: Z�r Amps 1 Volts Overhead p Underground.C1 #of Meters Servicer Amps / Volts Overhead O Underground.0 #of Meters: ber of Feeders and Ampacity: tion and Nature of Pmpoged Electrical Work: of Recessed Fbdures No.of Cell:Susp.(Paddle)Fens No. of Transformers Total KVA Of Lighting Outlets No. of Hot Tubs Generators KVq of Lighting Fixtures y Swimming Pool: Above ground o In Ground o #of Emergency Lighting Battery Units of Receptacle Outlets No. of Oil Bumets Fire Alarms #of Zones #of Detection&Initiating Devices of Switches No.of Gas Burners. #of Sounding Devices: #of Self Contained o.of Ran Detection/Sounding Devices 9 No, of Air Conditioners TOTAL TONS: Local o Municipal Connection o Other o D. of Waste Disposals Heat Pump Totals: Security Systems: Number. TONS:T_ KW: No.of Devices or Equivalent of Dishwashers Space/Area Heating: KW Data Wiring,No.of Devices or Equivalent: of Dryers Heating Appliances KW Telecommunications Wiring:No of Devices or Equivalent: of Water Heaters KW No. of Signs*_#of Ballasts: OTHER; f Hydro Massage Tubs No. of Motors Total HP o iURANCE 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,equlvalent a undersigned certifies that such coverage is In force,and has exhibited proof of same to the permit Issuing office. CHECK ONE: INSURANCE 6— BOND O OTHER O Please specify: Estimated Value of Electrical Work$ (When required by municipal policy) Work to StartZ Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the Information on this application is true and complete. Firm Name: j' LIC.# / [ Licensee: S _ !ti Signature: fill LIC.#��9�� (If applicable,antept",&the liicaonsa er line) Address: a i f us.Tel. (i Alt.Tel.# 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 em the(check one) Owner o OR Agent o Signature of Owner/Agent: Telephone PERMIT FEE:S �/� Date.,l' 40RTPI TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACMUS� This certifies that . t;�7 !!?r .<}h-<�. . .1��. l . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . ... ... . . . . . . . . . . . . . . plumbing in the buildings of . 5-c -.( .(.>,f. . . . . . . . . . . . . . . . . . . . . . at . f. .�. . . . . . , North Andover, Mass. Fee. 40. . . .Lic. No./0.7.c' ... . . . . . . )PLUMBING INSPEC;TOF Check # 4<7 !� 6296 i V MASSACHUSETTS UNIFORZAP ICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS l/� DateBuilding Location J1 `-r i t Owners Naf((j( `G�,I Permit# < ?&-j-"/'—,z—'-'/ Amount -� Type of ccu nc New Renovations Replaceme t Plans Submitted Yes No FIXTURES d x H H a a w U a Un x x a a. w x C) � a SMRM RASEMENT M)H-CM z"Hfm 3M FUXR 4IH 1EIDOR 5M FIOOR 6M FU)UZ 7IH HBM 9M FLOOR (Print or type) /,� Check one: Certificate Installing Company Name `�t PkG�h �J ,14�+'c ❑ Corp. .�+ Address ,: f 'r f �^ Partner. U6. Business Telephone '�h , 17 — S Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the ty e 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 "''Mner Agent 1 I hereby certify that all of the details and in rmation I have sub 'tted(or enter•)in above ap �catio a true and accurate to the best of my knowledge and that all plumbing,work and ins,\allat' ns performed/ad e t I ued r't�s application will be in compliance with all pertinent provisions of the Massachuse State plumb' `C e and Chapler Alf the General Laws. By: re o Wense m er Type of Plumbin License,,'' Title r'rsG i City/Town icense m uer Master � Journeyman ❑ APPROVED(OFFICE USE ONLY No 2 r 8 f NORTH 1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING i6 ,SSACHUS� " J This certifies that ....... ., .............;.4..� �J�f+. .......!... ;41..................... has permission to perform / 1 ............. wiring in the building ofl ............:..;t ............................................................ atZ ................ r ,North Andover,Mass. f 5"a Fee-.:. .....:......... Lic.Na. 7 7? ......_....;.................ct�r. .................. CELECTRICAL INSPECTOR Check # WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TI&00MMONWE9LTHOFM. 4S"CHUSETTS Office Use only DEPARTMF1VfOFPUBLICSAFM Permit No. 6'D BOARD OFMEPREVF.W0NRWUL4TI0AS527CMR 12.00 n Occupancy&Fees Checked APPLICATION PERMIT TO PERFORM ELECTRICAL WORK AK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat7"" '/Ln I Town of North Andover To the I spector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) ��'�� �' �j�-�-pt)A RCA Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service_ Amps/CVD/ d Volts Overhead r ' ndergroundNo.of Meters �^ New Service Amps 1 Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA and ground No.of Receptacle Outlets i� No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets Com/ No.of Gas Bumers No.of Ranges 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 Locala Municipal Other Connections No.of Water Heaters KW No.of No.of _ Signs Bailasis Nf.Hydro Massage Tubs No.of Motors Total HP OTHER- InSIVMWCoKaage PtastralY9�theragttitartattsofivlassad GalaalLaws Iha-,eaametLmbkhEwa=PdiLyffdudmgCtnTideOpffafimCDmaWcritsstistorMoVivalmt YES a NO IhawabnittedvaMpvofofsaznekothe0>lim YES I NO lf}cuhaecheckedYES,*asetrdc*thetypeofw&aWbyd>Jtgthe INSURANCE M BOND M 0T[*R r--J (lawSpa*) EViationD* Estin*dVakXdEkdnCal Work$ WotktDStalt D hq)ectionD*RegtresW Rough Fatal Signed underlie FIRM NAME Lioa>seNa � �`1>2 I Licasee "r Si�iat<ae LioaseNo Bt TeLNay �q J 3 8 Aftes-,- LIZ &/ L1201Alt TeL Na OWNER'S INSURANCE WAIVER,lam awa¢e*Atheliwse not theicstranilssubsitial Cataaliaws anddietmysigriattaecxithispemitWpkafimwaitf fttegt.titunent (Please check one) Owner Agent 6r-,Telephone No. PERMIT FEE$ c�}u Location i�L f� `""J' ' �2' No. Date &ORTM TOWN OF NORTH ANDOVER 16. ' Certificate of Occupancy $ T1s'••.°•E<� Building/Frame Permit Fee $ s�cHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ •���• r Check # l�?� I J Building Inspector' x TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: Q SIGNATURE: 1/f av6f ,0Wa440s4- BuildingCommissioner/I for of Buildings Date . . a& Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number L 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided RegWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record Name(Print) Address for Service Signa Telephone 2.2 Owner of Record: Name PrintAddress for Service: O Z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ ll 4 Licensed Construction Supervisor: ?v O 176P ��- f� �� �l �� License Number mn Address / Expirationate ic� Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name ' M 5�G,y/ Registration Number ra Address _r 1r Gti7j Z �— Expire on Date ^ Signature Telephone MI r i 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.......❑ SECTION 5 Description of Proposed Work check an applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) , ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of �� pa Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC ( {� 5 Fire Protection �t7` 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 I, as Owner/Authorized Agent of subject property lk 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/AUTJIORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief c Print N Si mat weer/A ent Date 10 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TEv1BERS iST2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH own Of I,_ over p ...,.w M. No. .0c) SJ3 O L�- A o dover, Mass., COC MIC ME WICK V �i BOARD OF HEALTH Food/Kitchen PE T I Septic System BUILDING INSPECTOR ............. THIS CERTIFIES THAT... ...... ....... ........ ...... ......................`.�........... ..... ................. Foundation :::: • ........ uildin s on A Rough has permission to ere .. . g .. ................... ...... ............................ to be occupied as . ..,�► Chimney . .. ... . .................................................................................................... provided that the person accepti this permit shall i very respect conform to the terms of the application on file in Final this office, and to the provisions f the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T C Rough ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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 I Street No. SEE REVERSE SIDE Smoke Det. AWN 4. AD U"dor OM P'46 O~ !.p Ms � MA 0" 4tRtr'�'�b1A.04� �� IDCCi COdt+!it.• 34TH Rts1t iQ NO.: t 74lMR fEp m NwMNt: oOaiDgM •a 2 ftws AAOd•t 1MMIN Id I imam S2m sm afta t-d wo Of MO raw"*111rt Mfa addrOM. 3A. wor«WS cW 00 WSdaP,bWAWA&f O OM of IO POM&30+r m V*WOiDOrt CMMPW M "taw W*4 WN oMrltliww�iMaM wtr d.dtarhAAMr I�Md>laaK � 38. 19 pMss oil UMft%%MOW*& Pat TOO Of!f09M1yt 2ef 1a GffVWf s~"tM�MOtwa+�.roelt fR erah sago W"in IIS W "*UWM oft tMltWSW. oo*"Wfv by Dwm silts 90 Ei W;0l13Ont 3C Ott W ow"NfotNOr": Paft 7%f"d"Imo►SPOW tot* tfMI I. A ani.ltg4d Wont. Aa rmn am"t NV.tea OM,wA6VWV.WY and Gotta desIPMA td in MM 3A c t Me Mftwmaiien POGO. 30. Tft*oft wi&Aw MNM fNQomim1i Ond SWOMYMO: :M Ml rM Ot.Rt"61g. 4. The PM M%Mn►ftr Oft pMip r WM 60 ft%P *W OV OW 1MOn4 M of O Ntt.dODO�CNtbns.�. Ortel Mlt Irq P�M. AP kft4nebm Ww s su%w b we'OtM'in OW dWi a,am" A46*bftd d WWVWM OW In MMO!$t P"b~ fNbr ' _ even of or«ID�er+.- a..aMe�fod„et�„r qEMe�.ca�wnt TOIO E:SOMWd Mwwi Ply cer�w.�Law- alex CauntOrOired 11124/19ft -'--�- mon POM wm Ift MYOmn COil tOtisw!=rO M&Pony.ww"to%M O Ow tl+OtMf Ott gfO� *fnv+w Pak, ants r �. Owr 01 IMS. t•/Otit/t900 WC 00 00 01 Ov(tyM: t0 ., arse. va tu x lod �a+t >�t � n s t wnw.-•w.ti. .a `aer��a� cla1�0°f �es Licensed&Insured Ih L o o g a t g • Roof Leak Experts • (978) 794-3883 • 1-800-WAIT-4-US "PProlposalitted To Phone {�. Date Street Job Name e7 —A City,State&Zip Code Job Location Job Phone We Propose hereby to furnish andIabor in accordance with specifications below, for the sum of: r'!. *6p /./ /,/ Dollars ($ <?c5ZdZi ). 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 specifications be- Signature: ., low involving extra costs will be executed only upon written orders, and will become an Vw extra charge over and above the estimate.All agreements contingent upon strikes,accidents !� s beyond our control, Owner to c .fire tornado and other necessary NOTE:This prop1 may be or dela # Y Y arty ary insurance. � Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: S G .�.� � l''�2� •C C 7— ,/✓'lei F'�. 5 c� �T ,� C .s� r►��ss�' t'!/ /c .s�t" �',.�" - h ' �•r�.s°�•?/ �'_' �-- ��.' G°� �__f" ,�" s_-J" c.+�Cls .�' . �l Acceptance of Proposal - The above prices, specifications and conditions are satisfactory and are hereby;accepted. You are authorized to do the work as specified. Payment Signature: will be made as outlined above. Date of Acceptance: Signature: Location G rl ',d JV No. Date Ia--8 No�,M TOWN OF NORTH ANDOVER 3? � SOL Certificate of Occupancy $ _ * ;�a •E<�' cMBuilding/Frame Permit Fee $ s� us Foundation Permit Fee $ Other Permit Fee $ _ TOTAL $ Check # Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVryAeTE,,, OR DEMOLISH A}ONE OR TWO FAMILY DWELLING �. 7. .._:- 1 _��� h ..;:t 11 �,..� �i, IYJ '/ S S Y�.:.�Y4 ,.,,; F .:$ 1; uy- la i'; .v x BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: /►�l C Building Commissionerfl for of Buildings Date z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot.Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required —+ Provided Re red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record J-01 V C C �a mac. S 1 �v cel poJ Name(Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z M Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: ii R License Number 1j ICI 8 o64 ,1 ekvein M Address n I 19 / C) D ic&A liz 0p C b e?' -7 g d-3 Expiration Date Signature h Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ kl. mulbtI7 Company Name M J ✓C g Re istration Number rM'^ Addss Gomm X -7 O `C b b ` -7�0-3 Expiration Date Si nature Telephone 1 » SECTION 4-WORKERS COMPENSATION(nG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction 0 Existing Building ❑ Repair(s) ❑ Alterations(s) 0 71tion ❑ Accessory Bldg. 0 Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: U X r'Z C 1��. I �_ �JC�IJ n ( ��i��i 1. � �. � ✓�� �C'GX 4}✓ ` �CP/•i[:")�[X j,,Jr, idy L Lola SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be ©FICIAI.USE t)NI:Y i Completed by permit applicant I. Building (a) Building Permit Fee -60 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 S O b Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act oil 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/ uthorized Agent of ubjecf property ...... Hereby declare that t''/St rt,and information on the foregoing application are true and accurate, e best of my knowledge and belief Print Name Signature of Owner/A ent Date a, NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MA"IERIAL OF CHDv NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE l 11C liVllll/!V!/VVCdII/1 V/ /Y/dJJdl,//UJCILJ ' Department of Industrial Accidents Office of Investigations ` Boston, Mass. 62191 Workers'Compensation Insurance Affidavit Please Print Name: _ Location: I S 1 I r G g P0, City m, U4.� AI,Jovcf - H -Phone 7-7 G<1 4f - -7V D 3 am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity QI am an employer providing workers'compensation for my employees working on this job. Company name. Address Ci- Phone#: Insurance Co. - Policy# Company name: Address Ci • Phone# Insurance Co Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signatures Date 2 6 Print name �-"' Phone# 7 °(-a T�U-3 Official use only do not write in this area to be completed by city or town official' � Building Dept []Check if immediate response is required Building Dept p Licensing Board p Selectman's Office Contact person:_ Phone#: Health Department 0 Other FORM WORKMAN'S COMPENSATION %,MOO uAsaaS (7 -21 x p Wo 0 1 ')J jnoC dla �T10SUI ? 1 i H 16 t Jd00 ot (b %Az �,k t skis ;�5 Ronr x Ll Top PI Ce-=IiH� 3 z � b�►-Slq s s 21,x�" pI w©d IG 0. C. Y Is t PPV1C G S V1C��hl,►1J $-6 J_l\tCr iby vd 2 -O'PC tG�410tJCcr� Sj� ' (oar `Z'X�It S�GG A� A a �►, 4ko C kisliP�cJ can C_Ir 4 � r icif"ro Un V/01 p b �C x�S��,n5 �U✓►C rc'�'C n r a e, ►. �Z-o X 12-0 3 SCci3Utn Roc), U31' Xl ��:b•� FoL)0 +�ioti, - S IRL. V(yU(- Scudc 1 "z � -Q — Y B f;ctn ML),•pk7 ITQI?I< royc Isar Gv .Poo� Ked • r f ✓lie {�Jornmanu.erzllfi a�.. lla�uc�iuse�J i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR i Number: CS 033676 ({ Birthdate: 01/19/1958 Expires: 01/19/2002 Tr.no:JA 13431 M Ftestrlcted To: 00 r BRIAN J MURPHY 59 BOOTH RD (�"'• METHUEN, MA 01844 Administrator i I I NORTH Town , of _ Andover 57. No. G G = _== L A ori dower, Mass., is COCMICKEWICK V AORATED PC7 S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... 0. ..1 .��........�1 . .... .......................................................................W ........ Foundation has permission to erect.....,�........ .O.e,..f.... buildings on ........I47� .0�� � � ....... Rough .... ............... ................. ................................. to be occupied as........................... R ,�V �0 0�....................................................... Chimney t .... ................................................. .......... provided that the person accepting is 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? 6 d;� p PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EMPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T S Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. • SEE REVERSE SIDE Smoke Det. Location No. Date �oRTM TOWN OF NORTH ANDOVER so 0 9 • i : ; Certificate of Occupancy $ cMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U Check # 'i 7 6 u `� Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATY2 O O�LISHAO�NEO TWO FAMILY DWELLING BUILDING PERMIT NUMBER. a s 's DATE ISSUED: �j � SIGNATURE: WW Building Commissiorie—rApsRector of Buildings Date SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I i I l �`P cZ� cyLA �C� L�� 2'0 Map Number Parcel Number (t ll 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fromm e ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water S° M.G.L.C.4tl. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public CI Private ❑ Zone Outside Flood Zone ❑ Municipal 2-11 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT HIS toric District: I'1'1 Yes 2.1 Owner of Record Name(Print) Address for Service V�l 0 %J SignTelephone ( 7 S D C� 2.2 Owner of Record: t Name Print Address for Service: Si natur Telephone SECTION 3�"CONS1`R O SkRVIC S 1 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address t `( 2g �v C /s�� C) � l� `���\(=�Q — ,� J ����/ Expiration Date ic s Signatute Telephone 7Y,(`3.2R 'isom tered e mprovemen Contractor Not Applicable ❑ 7 v �� AUC . fG� 1v5� j'v Company Name k `�P S�Vk ` Registration Number r Address :)�-n , � , -, \\,-) (�- Q 0 :2 1 Expiration Date ^� Si nature 1,-Tele hone tl' 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 building permit. Signed affidavit Attach Yes....... No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Ef Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: (1 SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building q c>Go C'c' (a) Building Permit Fee o Multiplier 2 Electrical I V (b) Estimated Total Cost of Construction 3 Plumbina 0C - Cdcl Building Permit fee(a)X (b) 4 Mechanical HVAC Q 5 Fire Protection 6 Total 1+2+3+4+5) U<j 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 l���e 2SLc�e� (`�c�e to act on MyIf,in all m er ative t work authorizedby this building permit application. C. ' Z c , Si at e o er Date SECTION 7b OWNER/AUT11HOR)!ZE AGENT DECLARATION g j T, .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 FV qq I Print N ,at - A -71 ,-.q Si ature o Own r/A Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS iST2ND 3RD " . SPAN DIN ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHINMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. i The debris will be disposed of in: 1 QS Y) A C, (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of.North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 - ' Workers'Compensation Insurance Affidavit Name Please Print Name: Location: CC , C S S Phone l ? 7C7 I am a homeowner performing all work myself. 0 I am a sole proprietor and have no one working in any capacity I am an empler providing workers'co pensati n for my ployees working on this job. Com name: C.1c � ' CC Add � � c C c C �� c��Q c�sS. P # 7 72)`T 314-' 11 insurance (Cao >s Yi4-�((4iEL.l PollcV a cc 92 O Comoanv name: Address Clty: Phone# I suranca�• Policy# Failure to secure coverage as required under section 25A or MGL 152 can lead to the Imposition of crirninal penalties d,a flne up to 51,500.00 and/or one years'imprisonmeM_as wau.n-cb l pwakimJnibefmn dA ST.QP YVDW.ORDERAnd.a.No d_($1W.00)A day apslnst.mL I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. 1 do hereby cerbXunder the pains andpeRa erjury that the information provided above 1s true and correct. V� - \ Date—_ -1 G Z fi Print name Phone# Official use drily do not write in this area to be completed 7Y7 or town NOW. City or Town Pem*Licensino ❑ []Check if immediate response Is required Building Dept❑ Licensing Board ❑ Selectman's Office Contact person: Phone#. ❑ Health Department ❑ Other Michael Rodden Builder- Contractor 47 Prescott Street North Andover,Massachusetts 01845 (978)687-2934 License Number 028538 PROPOSAL SUBMITTED TO:Jen and Patrick Scully DATE: 7/28/04 ADDRESS: 1511 Great Pond Rd.N. Andover Ma,01845 JOB NAME: PHONE:478 685 2000 ARCHITECT: 5U,MRY: We propose hereby to furnish material and labor,complete in accordance with the specifications below,for the sum of 21,000.00 . Payment to be made as follows: 10,000.00 start, 7,000.00 piaster, 4,000.00 completion_ Note that this proposal may be withdrawn by us if not accepted within 10 days. AS;CEPT&KE OF PROPOS • The ,below specifications,and conditions are satisfactory and are hereby accepted. are tho ' o do the work as specified a wit!be made as outlined. Authorized Signature. Date: SEECIFICA=S: Totally gut master bathroom including all wails,ceiling and floor.Relocate shower and toilet areas.New shower area to be approximately.3' x 4' and will have two walls of the and two walls of frameless glass. Supply and ieastslt toespace It ath vanity..New-tub to.be g.ty wixh short.w81t shower side.Electrical will include lighting, switching and a new ceiling fan. Floor area to be the with new plywood underlayment.Tile areas in shower to be applied over masonry board.New ceilings and walls to be blueboard and plaster skimcoat.No painting is included.All job debris will be removed. All necessary permits are included. Allowances are as follows: Plumbing fixtures at retail including shower valve,hand held, shower head,toilet,tub and faucets,vanity, vanity top,sinks and faucets,glass shower,enclosure and any other accessories. 6,000,00 Electrical including all materials and labor 1,500.00 Tile including all materials and labor 2,000.00 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from specifications involving extra costs will be executed upon written orders,and wilt become an exon charge over and above the estimate. All agreements contingent upon strikes, accidents,or delayi beyond our control. Owner to carry fare, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE 12/07/2004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NORTH ANDOVER INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 WAVERLY ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NORTH ANDOVER MA 01845-2415 INSURED INSURER A:NATIONAL GRANGE MUTUAL Michael Rodden INSURER B:AMERICAN INTERNATIONAL 47 Prescott Street INSURER C: INSURER D: North Andover MA 01845— INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 11:011 MERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 500,000 CLAIMS MADE a OCCUR MPP37395 02/01/2004 02/01/2005 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY ECT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY / / / / EACH OCCURRENCE _$ OCCUR EICLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ WORKERS COMPENSATION AND / / / / X TORY LIMITS OER EMPLOYERS,LIABILITY E.L.EACH ACCIDENT $ 100,000 $ TBA 01/01/2004 01/01/2005 E.L.DISEASE-EA EMPLOYEE$ 100,000 E.L.DISEASE-POLICY LIMIT Is 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION 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 TOWN OF NORTH ANDOVER FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845- ACORD 25-S(7197) 000,001 AC CORPORATION 1988 T,INS025S(gsfo).ot ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 � NvniH Town of 4Andover w , : ,. VO Noz 'r - 2dover, Mass., /6) ` 7 o0 LA COCMICMEWICK 7�A0RATEO J.? BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT AW r�.�.................fS.......C.`........... ....................................................................... FoundationBUIL has permission to erect.... O.. f .. buildings on /S .......�t �.... .... Rough ...................... .............. to be occupied as ^4 1+944.... AB.A. .......Z�✓....... .�. �!�/� �`............ 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. /Z 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 C ugh ......... .............................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.