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HomeMy WebLinkAboutMiscellaneous - 1580 SALEM STREET 4/30/2018 J1580 SALEM STREET 210/106.6-0056-0000.0 Date........7"... .��:.. ,5....... 40RTry, O V 3r;• `:; ;•. �o� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING 'li7 0� �u�.•t1 3gAC ° CMU y' This certifies that ............. ..... 7............1.....�U. .��.. ................................... has permission to perform ........ .,�� 7 .......................... ......S..:U .� ' e.. ..........` ............................................ wiringin the building of............................................................................................................... at ..........IS�� � .......... .. ,.... North Andover,Mass. .... ..................... Fee... ........Lic.N64-3.......... .... ......�. / t.. ... .t.-a"_ ELECTRICAL INCT SPEOR Check# �2 S 12534-/ Commonwealth of Massachusetts Official Use Only '- Permit No. Department of Fire Services Occupancy and Fee Checked aM BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: 7 ci /S City or Town of. NORTH ANDOVER To the Inspector of Wires: of his or her intention to perform the electrical work described below. B this application the undersigned fives notice p Y P g g P Location(Street&Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Ys No ❑ (Check Appropriate Box) ' Purpose of Building #6 ill E _Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires / Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FM 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 Dis osers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal [:1 Other 1 P g Connection t No.of Dryers Heating Appliances KW SecN o Systems:* Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of YYires. Estimated Value of Electrical Work: �� ©O (When required by municipal policy.) Work to Start: 7-21 - 15 _21 1S 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 X BOND ❑ OTHER ❑ (Specify:) I"certify, tinder the ins andpenalties ofperjury,that the information on this application is true and complete. r4/.j 1 "Lot O V— LIC.NO.: -5'221,515 FIRM NAME: . � � � Licensee: 317.T4,1,j -Fi20$u2-t) Signature LIC.NO.: 52215 $ (If u applicable,enter "exempt"in the license ner line.) Bus.Tel.No.:— =� Ya7 Address: /may GU.4ry rJ'Zi—'% '9A1bc✓`E 1Z— Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ JAS c,® Signature Telephone No. ❑ '2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed 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. 1 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 j 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 Inspection Pass 0 ! Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: i Inspectors Signature: Date: I PARTIAL ROUGH INSPECTION: Pass I Failed Re-Inspection Required($.)❑ Inspectors Comments: k/ Inspectors Signature: Date: ROUGH INSP CTION: Pass L11 Failed Re-Inspection Required($.) ❑ Inspectors Comments: I Inspectors Signature: a&01 Date: 7- I FINAL INSPE ION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: 44, s Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com �r 1 •jhe Commonwealth of Massachusetts Department of IndustrialAceldents 1 Congress Street,Si ite 100 � d Boston,MA 02114-2017 www.mass.gov/dia I Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WjTH THE PERMITTING AUblORI'I Y. Please Print Le 'bl A Wicant Information Name(Businesslor`ganiz ation/Jndividual): y=�-'A iJ —FN '�3Q r 5 9 u/s VCR-S- l b Address: 1415 Ll-� Ci /State/Zip: h/�em ��wvE� If/iJ Phone x. . .. tS' ?Checktbe appropriate box: FTypeofproject(Tequired):Are ou an employerystruotionem to ees full and/or part-time).` �NeW'con 1.❑A�asole�'lproprietor yer with P Y ( 2, or partnership and have no employees working for me in $. Lemo delirig any capacity.[No workers'comp.insurance required] 9, ❑Demolition 3.Q lam a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4. 1 I am a homeowner and will be,hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole bin repairs or additions proprietors with no enapl6yees. 12T Plum. g p 5.Q I am a general contract o Wand T have hired the sub-contractors listed on the attached sheet. 13'.[]Ro6f repairs These sub-contractors have einployees and have workers'comp.insurance.t 14.n Other 6.C]We are a corporation and its•officers have exercised their right of exemption per MGL c. 152,§1(4),and`we have no employdes.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information i Homeowners who submitthis ai ili it indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tcontractors that cheek"box must attached'an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer'that is providing workers'compensation insurance for my employees. below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: City/State/Zip: Attach a copy of the workers' policy declaration page(showing the policy number and expiuratxon date). Job Site Address: al olation e by a fifib up to$1,500-00 Failure to secure coverage as required s well as civil ivil p25A is enaltieser MGL c. 2inthe form of aSTOPrWORK ORDER Iand fine of up to $250.00 a and/or one-year imprisonment,a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cert under tliepains and penalties of perjury that the information provided above is true and correct. Date: Signature: Phone#: Official use only. Do not write in this area,to be completed by city or town offaciaL Permit/License# City or Town: Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: i 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual;partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'ox 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 b6 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-whohas 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=contractor(s)name(s),address(es)and phone number(s)along with their certificates)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 anLLC or LLP does have employees,a policy is required. B e 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 IndustrialAccidenis. 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 I Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. (Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)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. Anew affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia I g ' i I 07-24-15; 11 :28AM;BRIDGE INSURANCE ASSOCIATES ;617-964-1888 # 1/ 1 i I Ami O CERTIFICATE OF LIABILITY INSURANCE °AT 07//24/24/DD/YYYY) 2015 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(ies)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 Bridge Insurance Assoc. CONTACT 80 Langley Road PHONE (617)965-1777 FAX (617)964-1888 (AICExt)- 2nd Floor E-MAIL Newton Centre MA 02459 INSURER(Sl AFFORDING COVERAGE NAIC# INSURER A:Travelers INSURED INSURER B: Brian Froburg NSURERC: 159 Waverley Road INSURER D: North Andover MA 01845- INSURER E, 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. INSR TYPE OF INSURANCE ADDL SUER POLICYMBE POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY 680-008E474619 7/08/2015 07/08/2016 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 CLAIMS-MADE F-1 OCCUR MED EXP(Any oneperson) s 5,000 PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS (Per accident) $ UMBRELLA UABOCCUR EACH OCCURRENCE $ / EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED R T N N S $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE❑ NIA EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below I F.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION A1002163 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD S dommONwg LTH aF MASSACHUSETTs r o r BOAFLI OF EL, -TR'I C I ANS ! -'UE`, THE FOLLOWING 41 ' `.i P RE,G 7OURN7`' `` "�! ELECTR`C I Al• { d cr ROSURG OVER „MA 01845 3507 , fy y7 , t Bo6 1 79 I Liberty Mutual Insurance Mutual. New England Region Central Property Unit 75 Sylvan Street INSURANCE Danvers,MA 01923 Tel:(800)566-0323 July 1,2015 Town of North Andover Attn:Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address: 1580 Salem St,North Andover,Ma 01845 Policy Number:H3S21811808640 Underwriting Company: LM General Insurance Company Claim Number: 032030535-0001 Date of Loss:2/25/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A &B, or Mass. General Laws, Ch. 143, 5 9, or Mass. General Laws,Ch. 111,§ 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 �� Date. . 2!/.!z... .. .. NORTH TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �SSACMU`�ES 1 This certifies that . ./. . . . . . . . . . . . . . . . . . . . has permission for gas installation . !/,--I . . . . . . . . . . . . . . . . . . in the buildings of . X "S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .1'? -y,;_74 . . . . . . , Northam ndover.;`Mass. Fee 4! Lic. Nol03Cy. . . . �. . . . GAS INSPECTOR, Check# f 8303 rl MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I� CITY _ _ I. MA DATE ( '2o/& PERMIT# JOBSITE ADDRESS Q z _ $r _ OWNER'S NAME GOWNER ADDRESSTE FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:F_jj RENOVATION:El REPLACEMENT:01 PLANS SUBMITTED: YESFII NO[_I APPLIANCES'l FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _I ..-�� I. �- --- -_ ( I _ . _ CONVERSION BURNER COOK STOVE DIRECT VENT HEATER __ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE �_ —� _- — ._ LJ _ - INFRARED HEATER -- _.-- LABORATORY COCKS �—� �1—=-r.-1_.T�! �.-T-r-1 —..--I:_= MAKEUP AIR UNIT � OVEN --� ^-- - - _ _._ h- -r J I_ POOL HEATER aI L _. - 1 JJ J _ ROOM/SPACE HEATER - ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 11-- ._J - INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I[�NOE] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY El BOND E] 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. CHE LY: OWNER _(�_( AG T? SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this applicati are true and a cur e t est of y w ge and that all plumbing work and installations performed under the permit issued for this application will be in complia ent rovis' of Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTE R N G SIGN URE - - - ���---- _r. 1 LICENSE#�6sl� M MGF JP JGF LPGI CORPORATION Q# �(Y3 - PARTNERSHIP _, # LLC[.J# COMPANY N f_o�._-__-. ___ .--------- 9' --___..__I ADDRESS CITY STATE ZIP Q/b'SLS TEL � ? '` J CEa - �6 - fG EMAIL -- ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes ' No-' -- - - --THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Z FEE: $ PERMIT# PLAN REVIEW NOTES n r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ,. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: rya— Z5 City/State/Zip: Phone#: c�" �(}'�j' &2J3 Ip 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. New construction ❑ t n employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.t E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑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 & p-=7 i *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. j t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. t am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site Information. Insurance Company Name: Policy#or Self-ins.Lic..#: Expiration Date: fob Site Address:\ d�— . V-�'�� City/State/Zip: kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a :uze 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 )f up to$250.00 a day against the violator. Be add _that a copy of this statement may be forwarded to the Office of nvestig for insura ce Covera verif ation. r do It eby certify under tit p i d p n Itie pe,itry that the information provided above is true and correct. ii nature: Q Date: 'hone Official ttse 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#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." i 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the,affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit 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 iWhere a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.i dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 1 www,mass.gov/dia Date. /Z 9.548 "aRTM TOWN OF NORTH ANDOVER o� �a ° PERMIT FOR PLUMBING i � a ,SSACMUS� ' y � This certifies that . . . A �� . . . . . .. . . has permission to perform . . . . ° plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . �. . �arfth And er, Mass. r Fee ` �v.Lic. No.�d3Q . . . �d'l. . .. ..i . . . . . . . . PLUMBING INSPECTOR Check h �PP MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ _ MA DATE _� / ( PERMIT# U JOBSITE ADDRESS — >°bk "i� OWNER'S NAME ��O/Sz° Y orl"i POWNER ADDRESS 7j TEL I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 01 EDUCATIONAL LI RESIDENTIAL.' PRINT CLEARLY NEW: Ell RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES® NO© FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _._ DEDICATED GRAY WATER SYSTEM ( _.- ( I I f J DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL _I .._._I .—_.� ._-( SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES� NO OF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND Q 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 th7quire t.0)NE WNER Q VNT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicaboZare true an ac r e thg best of Qo edge and that all plumbing work and installations performed under the permit issued for this application will be in w' all erti ent pr si of e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ��0I SIGN URE MPa JPQ CORPORATION D# 3_-j PARTNERSHIP®# LLCU COMPANY NAM L(Ut b= _ ADDRESS CITY r= A—_cn,�r - - STATE !t.(0 ZIPo ,J,J y` 5� 11 TEL CEL ���EMAI ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES -- - - ---- -_ --_ ---- Yes NoTHIS APPLICATION SERVES AS THE PERMIT ❑ ' ❑ t ZZi `Z FEE: $ PERMIT# PLAN REVIEW NOTES r I J The Commonwealth of Massachusetts Department of IndustrialAccidihts Office of Investigations 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: ��- City/State/Zip: Phone Are,yo employer?Check the appropriate box: Type of project(required): 1 I am a employer with 4. El am a general contractor and I 6. E]New construction employees(fall and/or part-time).* have hired the sub contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. F1 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition p comp.working for me in any capacity. workers' •insurance. 9. E]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 I L❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof epairs insurance required.]t employees.[No workers' 1 Other t�f7 comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they a're 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. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. f^ Insurance Company Name:. "( Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address-_Al (M,sr 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 requiredunder 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 imprisonmenraswas civil penalties in the form of a STOP WORK ORDER and a fine of up to against the violator. Be adva copy of this statement may be forwarded to the Ofce of Inv igations of the D or insuran coverage vn. I do i i under t d ena ties of per z the information provided above is true and correct. Si a e: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." I 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#61.7-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 l{aY,#617-727-7749 wwwmass.govldia 9695 Date + t NOR7M 1 4,oma TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING SSACkUSE� . This certifies that ..... ... has permission to perform .`�.4%ztlzl�...!`—A.....`'7//;-, wiring in the building of...�!'!.�/ ............5t f(�.e...5...:....................... at.. /ma�y �U F:7........f. ............ . orth Andover,Mass. FeO.!?.!............ Lic.No.422 tf,;V............... E cmicAL IMPECrdk Check tt �Z U � Commonwealth Of Massachusetts Official Use only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. t/07J !rave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be nc;rtormed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) pate; City or Town of: NORTH ANDOVER To the Inspector H o W' By this application the undersr Heti P f fres: g gives notice of his or her intention to perforin the electrical work described below. Location(Street& Number) f>_del r- sf-- Owner or Tenant �Gv Eq Telephone No. Owner's Address Is this permit in conjunction with a building permit? ye ❑ No Purpose of Building ❑ (Cheek Appropriate Box) Utility Authorization No. Existing Service 2P/y Amps /2 v_ 1,7 y, Volts Overhead ❑ Undgrd P— No.of Meters _Z � New Service _ Amps 1 Volts Overhead ❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a"a ion Com letian o the olloH in table ma he waived b:the Inspector of Wire. No.of Recessed Luminaires No.of °. Ceti.-Susp.(Paddle)Fans of ota No.of Luminaire OutletsTransformers "ANo.of Nat Tubs Generators KVA No.of Luminaires Swimming Pool ove ❑ mergeacy ig ng P.M. rud. ❑ Batte Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners ©-o etechon an InitiatingDevices No.of Ranges No,of Air Cond. Tota Tons No.of Alerting Devices No.of Waste Disposers eat ump um er ons o.o e ontain Totals: DetectionlAlertin Devices No.of Dishwashers Space/Area Heating KW Localunicipa Other ❑ Connection ❑ No.of Dryers Heating Appliances KW 9;7u_Rty ystems: o.RAI ©.o No.of Devices or E uivalent KW ` Heaters o.° Data Wiring: Signs Ballasts No.of Devices or Euivalent t No.of Motors Total HP a ec I of 1Iicahons Wiring: No. Hydromassage Bathtubs : No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the lnspector of Wire. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:fO /z -/l/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.COVERAGE: Unle;wc waived b the owner,no permit for the performance of electrical work may issue unle the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. Theme undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. C14ECK ONE: INSURANCE OND ❑ OTHER (Specify.) I certify,under the pains and penalties u IPeJ �'r u .that the information on this application is true and complete. FIRM NAME: /i? i.icensee: LIC. NO.:. �y 3'S �� � / Signature tIJ ul�l,}icuhle, rrt r "'r.rrmpt it,the lirenxe number line_} T LIC. NO.: p Sa 3 Address: S c Bus. *Per M.C;.t.c. 147,s. 5 -bl, security work requires Departm of Public Safety"S" License: LicAlt.Tel.No.INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. fly my signature below, i hereby waive this requirement. I am the(checkfne)❑owner own is agent. Owner/Agent Signature Telephone No. E!RMl FEE- �/ I 1 I I Y III I � t I I ,I I I r f Date.../ / NORTF� °f,�`` TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSAGNUS� This certifies that ....... rev. has permission to perform � wiring in the building 9r /f_.a of, _ ..., -...........................r......................... Ll at.1�re.f f�J � ...d,.................................North Andover,Mass. Fee..../Ki.""... Lic.No..,.. ...... ..e4......... ;,.._..; ELECTRICAL INSPECTOR Check # 5471 Official Use Only MASSACHUSETTS, Permit No. L5 / THE COMMONWEALTH OF Department of Public Safety � BOARD OF FIRE PREVENTION REGULATIONS 5 CMR 12:00 Occupancy&Fee Che6kbd L APPLICATION FOR PERMIT TO PERFO, M ELECTRICAL WORK All work to be performed in accordance with the MassachNfsetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a per mit to perform the electrical work described,(below.4i Location(Street&Numberer� 1 6 8 0 V iql e m �f ke k-J Owner or Tenant �d;o �� Szq1Y Owner's Address SAM if Is this permit in conjunction with a building permit Yes No (Check Appropriate Box) Purpose of Building L(�Qi�/dY Utility Authorization No. Existing Service Amps Voits Overhead • Undgmd • No.of Meters New Service Amps Voits Overhead • Undgmd • No.of Meters Number of Feeders and Ampacity //�) �� / /�/ 1 J Location and Nature of Proposed Electrical Work Id/Re SC1171 G 10UMe (AJ 1 A 'f"7U AT.S a tid glaviV1 P�Ne l Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above In No.of Lighting Fixtures i Swimming Pool gmd grnd Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di oral No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices • Municipal Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Si ns Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP 116 ti OTHER: INS RANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy includin ompleted Operations Coverage or its substantial equivalent YES= NO = tted valid proof of same to the OfficQES 6 NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE)= BOND = OTHER = (Please Specify) (Expiration Date) Estimated Valu gf Electrical V�lorkS /y Work to Start /1—hr o¢ Inspection Date Resquested Rough Final t.4-lid PA Signed under-the PenaLlti FIRM NAME 1 v $of L 1�r'm �jA �•��> QP 1/I LIC.NO. 1f 6 A Licensee AM e Signature CJ//.UIHu(/ Q // � t(/ / LIC.NO. l d�t/Ylf✓ {/R.�✓z° l�0 � M J Bus.Tel No. Address er 1 y' Alt Tel.No. �S 35 O� OWNER'S INSURANCE WAIVER:A am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) c Telephone No. PERMIT FEE $ (Signature of Owner or Agent) i .1r, Location No. Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ Eta Building/Frame Permit Fee $ SACNus Foundation Permit Fee $ Other Permit Fee $ P� TOTAL Check # y-//,/ 16789 �/ Building Inspect t TOWN OF NORTH ANDOVER - BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 'y .. 3 for tci1 Use't g , _ r x .._ z V BUILDING PERMIT NUMBER. DATE ISSUED. —�f� rn SIGNATURE: Building Commissioner/Inspector of Buildings Dae z SECTION i-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ` AW -12 C L- � JJ Number Parcel Number 1.3 Zoning Information: I A Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.GLC.40. 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zane Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT F M 2.1 Owner of Record S C=7�lZ f b' a S/�/C-M s Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: O Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction )l Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 0 b L O License Number Address / a 9 S �� / Expiration Date Signatu Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ v fill tI�O��'I 0n c- /3 9 b S� Company Name rn � �L l `pLc- �� ��_ y L f� � Registration Number Address Expiration Date Si nat a Telephone • r SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) ' 'i 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 a ticable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify t . Brief Descriptionof Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be C3F+`ICIAL�USEONL3t e Completed by permit applicant 1. Building (a) Building Permit Fee d t Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)X(b) 4 Mechanical HVAC c 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT PJR CONJRACTOR APPLIES FOR BUILDING PERMIT I II, as Owner/Authorized Agent of subject property Hereby0horize Ao act on My behalf;in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION r t I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief i 1 Print Name Si atureof Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST2ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS f1EIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL,OF CHIMNEY 1 IS BUILDING ON SOLID OR FILLED LAND 71S BUILDING CONNECTED TO NATURAL GAS LINE L10RTH Town of over 0 ' . No. j� S '' _ _ F 70 C% 0 dover, Mass., 0 ATED C5 H BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 14JA BUILDING INSPECTOR THIS CERTIFIES THAT........... "W .......................................................... ...... ......................... ... Foundation .. ............ buildings an ............. ....0 . .............. has permission to erect.................. ....... ... Rough tobe occupied as.. .................. ....................................................................................................................................... Chimney provided that the rpersion accepting his 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 EXPIRES IN .6 MONTHS Final UNLESS CONSTRUCTION S ELECTRICAL INSPECTOR Rough Service ................................................................................................................. BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street NO. SEE REVERSE SIDE Smoke Det. ✓lie,-�anv�no,r�,�eca/l/ a� �ze�z,c/utaeCt BOARD OF.BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR Number C$` 069120 I + :.� Birthdate 04/03/Y959 Ezoires 04/03/2005 Tr.n9: 10040 Restncted 00- JOHN W LANZAFAME � � ' 30 TEMPLE DR .METHUEN, !MA 0'1844. > Administrator it i I I 1 ` 3C0G�'OC7� o da RID ori 0oo[F Residential & olmmercial Roofing All Types Of Chia>aran�ys Work Siding CHIMNEYS POINTED-REBUILT-CAPPED Expert Masonry Roof Leaks Experts Licensed & Insured Mass Toll t=ree �""" License#034200 Year Mound T-4- Gocatly Owned I-80®- AI8c Operated Srrce 1976 _ {824-8487) IKO® 'ylo�m o¢,Flaw We Work r - . Proposal Submitted To Phone e? 9/a/Q.3 f-Z Job Name Street City,State&Zip Code lob Location lob Phone /lJ /4.r,o6 cd� '4agVS We Propose hereby to furnish and labor in ilk ,peeffications below,for the sutra of: ©n -q a f} Dollars (S ` •cX�©, ®t� ). e4 9411&x _Q All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized. AP 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 extra charge over and above the estimate.All agreements contingent upon strikes,accidents NOTE:This proposal may be �q or delays beyond our control,Owner to carry fire,tornado and other necessary insurance. withdrawn by us if not accepted within�8" days. Our workers are fully covered by workmen's Compensation Insurance. We hereby submit specifications and estimates for: slmo 4 �/n�stall 3 feet of special "Save Seal" ice and water barrier protection along all bottom edges of roof and top to bottom in each galley. If roof is stripped, we will apply conventional ice and water shield ( 3 )ft. high in the same locations previously described and tar paper will cover the remaining bare wood. Any r% d or damaged boards will be replaced at ( 2,5-a ) per linear ft. or per sheet of plywood. Ld°lnstall heavy gauge aluminum drip edges along every edge surface of each roofline. Q Cover entire roof (s) with IKO 25 year all asphalt, non-fiberglass, premium grade shingles (Color of choice). Replace all pipe boots where possible. "Seal all flashings with clear Geo-Cel sealant. No black tar unless previously applied. &Remove all work-related debris. E"Contractor warrants roof against all leaks Oie to defects in his workmanship for 12 years under normal circumstances. I Local current references and proof of workman's compensation insurance gladly given. JRemarks: %",f)7,,/r f "14T4-7C Sg.,z -c2 C.) !G GA14C t_ ©n k�f a h C' 6&"J�r e6,5144 LJ -17 Acceptance of Proposal- The above prices, specifications and conditions are satisfactory and are hereby accepted. (1 You are authorized to do the work as specified. Payment Signature: -- will be made as outlined above.. Date of Acceptance: Y�r-� `Z Signature: The Commonwealth of Massachusetts / ., Department of Industrial Accidents \ r offfts of l®inisliffaff®®s I 600 Washington Street, 7` Floor;Boston,Mass. 02111 Workers'Compensation Insurance Affidavit Anuhcantanformabon name: location: D 511/arm Si city f7 c) ( i l ohone1 ❑ I am a homeowner performing all work myself. ❑ Ia�� ole proprietor and have no one working m any capactty ».���.-^bt '�..'-'z5- a „� -.,1'^' -,+^s,�,: "�T �"xf ., ,n.• e' r` Y3'... - ....,.".,...; ,.'-�_.'..'i. ._"�"` "; . .�-- �=��`" Kkau�.sa,. s• "" �,..s.- �.w_..�:.t r�..,rh......i" �'^.,,�,.,.!•z..t_...-.. I am an employer providing workers'compensation for my employees working on this job. comnanv name. U 7�L (J,24 V6 address. ✓ �G����-�� y/yC i�L /- y it G city C= f � /�'3s lion /.yr�� ? )nsur_nce co Pi nolic .:nr •wyv x- c ;.-„,y.� � -.'`�`,.�,."`:” ,� �.t'�r�'�. '�-� ,.�•,y�,..R.. �. ,.,n -��,`: �'"�r'' e�:.H= '"• ��' y rw I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have i, the following workers'compensation polices: comuanwname - - • address* city nhone#. insurance co. uollcv=# �sr .w,- r c comoanv name.- - address. city: nhone#^ insurance co. #- D t�tt8.e t`ili3'o 8 ChB HCEsSar .r±,+�'.,...,x.• _ wY'�..: -s:.•., �...1� ..�ui''K�a�r '�� -'�.��...: Su"....r..,..w.' Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 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 hereby certify u der the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name U C, c Z•1-7,r-J /qw G Phone# �'Od -73-31 official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑ check if immediate res onse is re wired ❑Licensing Board P q ❑Selectmen's Office []Health Department Jcontact erson: vhone#: Other (revised 9/95 P1A) Information and Instructions I , Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An' employer is defined as an individual,partnership, association,corporation or other legal entity, or an two or rP g tY, y 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 section 25 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 in coverage required Additionally, 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. ^ :.:'. '"4 ....,Y 3 crC :5.... ..,.... ' . �xun-NMR; n,2 .=*3rS •.y'r' " Applicants Pliease fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. i _ u � z � � : . City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitilicense number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Te Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. ,vc., The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Ivoestilatises 600 Washington Street,7t' Floor Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 ,I North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that.the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A.' The debris will be disposed of in: 1 Z c- Sr+L-� ,?v /� /f sy s/i-- sr (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 t , Location __ No.� Date L777 E E` TOWN OF NORTH ANDOVER 09 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ T' s�C" r Other Permit Fee $ �) Y Sewer Connection Fee $ Water Connection Fee $ 4 TOTAL , a 304304/13/99 13:38 25.00 PAID Building Inspector Div. Public Works f PERMIT NO. APPLICATION FOR PERMIT TO BUILD'/*****NORTH ANDOVER, MA AI\1,No . %Q / LOI.NO. 60S / 2. RECORD OFOWNLRS1111' DATE BOOK PAGE /ONE L' SUB hIV. 1.01*No . Ca 1.0( .41ION tJ+� 1'11RPOSE.Of BIJll DING `L'V /s p S'i�l ST/1 PP OWNER'S NAME Geo /�A�3"o.e/e SeJ4i2$ No .(N:sroRiLs SIZE t)\VNER'S ADDI(ESS �s Of-U Sf�C".�; ST2PC BASEhIENr OR SLAB ARCI III ECCS NAME / SIZE OF I I COR IIMBERS I 2 ND 3 RD BI III DER'S NAME see1c e C/ a+ (� SPAN DIS TANCE*1oNEARESIBUII_OING DIMENSIONS 01:SILLS DIS I ANLL I ROM S REF r DIMENSIONS Ol POS IS DIS I ANCE FROM 1.01'LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FROM AGE I IEIGI IT c l:FOIINDATI(NN THICKNESS IS BUILDING NEW SIZE OF I(XII ING a X IS W IILDING ADDIIION MAI ERI AI.OF CI IIMNEY IS BUILDING ALTERATION C S IS BUILDING ON SOLID Clall LED LAND WILL BUILDING CONFORM TO Rli(�JIREMENI'S OF CODE IS BUILDING CONNECT ED TO TOWN WATER BOAAD OF APPEALS ACTION, IF ANY IS BUILDING CONNECT1:1)TO TOWN SEWER IS BUILDING CONNECTED TO NA I URAL GAS LINE INS11 N('TIONS 3. NIiOI'k R'11'1NFnRN1.1'1'IDN — 3 LAND COS F EST. Bl.fx;.COST 1'.4GE I FII.I.OIrrSEC`TIONS 1-3 �� EST. BLDG.C()SI PERS(.FT. ilk EST. BI DO.COSI PERROOM EI ECTRIC NIE'l URS MUST BE ON OUTSIDE OF BUILDING SEPI IC FERMI I NO. AI'IACIIEDGAI2A(;ESMl1STC(NNFoRm rOsrAIEFIRE-REOULA11(NNS a. APPROVED BY: PLANS MUST BE FII.ED AND APPROVED BY BUILDING INSPECroR BUILDING INSPECTOR DAII:FILED 3 t 1 ! ! ( OWNERS EIA CON I'RAEl (p�Z-2U 7Z CON Iit.I.ICII �. � �� � 3 ! V ti NAIIIREtNUWNI:Rt)RAUlHoRIZI:DAGIfNI' Q Ga MAR [ t(IL GILL 111 101111(MAN 111) 19 Brockway-Smith Company Andersen Brosco Architectural Group C. Windowalls* Serving Greater Northeast Architects since 1890 Office and Exhibit Area: 146 DASCOMB ROAD (Route 93-Exit 42) 800-225-7912 ANDOVER,MA 01810 FAX (24 hours) 800-242-4533 COMMERCIAL - RESIDENTIAL DATE JOB 3 f I a I t t � 1 ------------ 1 — - --* _F4 s i { � R .tee._._ �,.........,_.�• __.}_..._-�- t .F- � '.f'_""—f.` .�. i ��^ � «¢......_...E3�».� � _ _ { 4 �♦ l ( � m t } { t { 3 _.. __..✓�luaila6fe-f6_serueyouu .well_ udyel Jrlces,— Indoru_1�elaii-myf.answoC-1brifiny 1 ENTRY DOOR SYSTEM Andersen "Rain Sensitized" 1 I I Wood and Steel Automatic Closing Hinged French Patio Doors ROOF WINDOWS 0R TH 0VM Of I — dover No. 76 vt `�- dower, Mass. 'AAOcoctli'.IE J P RATED F BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... Foundation .O.N f.to....Y....INA.. �� .............. �".... ............. has permission to erect../Ao.04..... ......... buildings on ....� ... �.........S.�,.,��. .......,$..;�..... Rough to be occupied as..,NV ....W!V,0#40., *.... I.�P'�/aftChimney .. . . . ................ 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 tZ�e PERMIT L.[VIRES IN 6 MONTHS Final 13043 UNLESS C N SI�.t .UCP ' �� ��^ T ELECTRICAL INSPECTOR Rough . ..................6 Servtce BUILDING INSPECTOR Final Occupancy Permit Required to Occ.uj:y Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final 4 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. DelleChiaie, Pamela From: Andrew McBrearty[amcbrearty@millriverconsulting.com] Sent: Thursday, June 10, 2004 9:15 AM To: Susan Sawyer; 'Pamela Dellechiaie' Subject: NEES Soil test cancellations Hi Sue& Pam, Just wanted to let you know that Ben called, and had to cancel his two soil tests scheduled today for 1094& 1580 Salem Street. We rescheduled 1580(or was that 1094?)from Monday so that Ben could get DigSafe in to mark some gas lines. His backhoe operator had a death in the family, and Ben could not get another on short notice. We will reschedule, and let you know when they are. thanks, -andy �'�' �� S Sf Location G /� No. 4 Date NORTH TOWN OF NORTH ANDOVER O? • � -•• OOLiw n Certificate of Occupancy $ • ; , Building/Frame Permit Fee $ S 0 tJ �'s'•^e'E<�' Foundation Permit Fee $ s�cMus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building In pector 05:56 25.00 PAID Div. Public Works 'Location r No. Date NORTp TOWN OF NORTH ANDOVER ?O•`t`•O '•,�O 9 Certificate of Occupancy $ 41 Building/Frame Permit Fee $ l Foundation Permit Fee $ swcHust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL # +Building Inspector 10/19/98 08:55 25•� � ii�Div. Public Works rr rr1'IFRM1T NO. ' ' TION FOR PERMITTO IIUIL,D* v ****NORTH ANDOVER, MA `TS AI1L,ICA 2. H!(OKI)Ot o %%'N1 H5I111 nATF� BOOK PACE F()WNU*R'SNAJ\1E St" 1)IV. 1.!)LN(1./5S �tc' P11K1'OSE()FdI111DING Rep(Ace /2' ?(/z� &jic-e 1,ee k ujI' NC'r.J �Oo�/,v SNO.OF S FORIESSIZE J�IL GCA�DKESS C7�� S`/� PIyStLBe d/tSFMENTORSTAB SIZE OF FLOOR TIMBERS 1 2 ND 3 NAMEAME SPAN DIJIANCElONEARES'1 BUI1.1)ING DIMENSIONSOFSILLS DIS I ANCI 1'HOM STHEEI DIMENSIONS()I:POSTS DIS I ANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE IIEIGI IT OF FOUNDATION THICKNESS SIZE OF FOOTI NG X IS BIJILDING NEW IS dUIIDING ADDITION MATERIAL.OF CI IIMNEY IS BUII.DING ALTERATION IS BUIIDING ON SOLID OR FILLED LAND WII.I.BUILDING CONFORM TO RE(,?t)1REMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEAIS ACTION,IF ANY IS BUILDING CONNECTED TOTOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INJIUCTIONS 3. PROPERTY INFORMATION I.ANDCOST EST. Bl.lx;.COST 33 QD. *PAGE 1 Flt I.cx TT SECTIONS 1-3 EST. BI.IX;.COST PER SQ.FT. EST. BLIx i.C(WI"PER HOC" ELECTRIC METERS MUST BE ON(NITSIDE OF BUII.DING SEPTIC PERMIT NO. Al-TACIIED GARAGES MUST CONFORMTOSTATE FIRL'REGUI.ATIONS $. APPROVED BY: PIANS MUST BE FILED AND APPROVED BY BUII.DING INSPECTOR BUILDING INSPE OR OWNERS'LELDAIEHIED N C(N"I'R.TLI N �PZ- LO 7 Z a SIGNA I I IKI. 1:OWNLI(t M Atli I N IIH)AG KI ¢ 111 � _�^.. V � I5F"I ud•.•_ t. ,. .. .y..,..I 'I! I'1It(.111 GItANTH) � ---- i NoRrh 0 Of over rn No. .r, .0 * - dover, Mass., 19 w �9A:coCH cHc Icx '9 �q�T E D►PP�y ,t� S E ` BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System // BUILDING INSPECTOR THIS CERTIFIES THAT............V-.'�,.d.MCy R�.S..........................................................................:............ /� nne.••••••••••S•�c.•�•• Foundation has permission to erect...kt.f 1.kNe.....�.. ildings on.......L.611...k[A .......IR.etla..!� '........ Rough to be occupied a3 , �..... Chimney y �/ Ch' e provided that the person accepting this permit shall in Every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ARTS / Rough j .. ......... .. Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Finalh No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. `a Yq4 Smoke Det. V APPIACATION FOR PERMIT TOB ANDOVER, MA 1'1.12MIT NO. �� 1%F NO. n (n LOI.NO. 2. RE('ORU OF owNL:RSIIIP DATE BOOK PAGE ZINE (� SUB DIV. 1(YI"NO. L(uArR)N13-e0 S" 4,,4* ���� Pl1RPOSE(7Fdi1111)ING Pe-p(Ace 124 )0Z 8,14 C, ��c /� UJ I JQ 0 o�iivAS' OWNER'S NAME CQ'®A 6!"_ �`���� NO.OF STORIES SIZE OWNER'S ADDRESS �`J�U S!fi�P{yj S'%PEe / BASEMENT OR SLAB ARCI III-F.CI'S NAME I j SZE OF FLOOR TIMBERS I 2 3 dl ill DER'S NAME � SPAN DIS I'ANCF 10NEARES'L BUILDING DIMENSIONS OF SHL-S DIS IANC L-'I-Rom STREET DIMENSI(NNS Of I'OST S DIS I'ANCE FROM 1..OT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF I-OT FRONTAGE I1EIGIIT OF FOUNDATION THICKNESS IS BU1I.DING NEW SITE OF FO()TING X IS B011.13ING ADDITION MATERIAL.OFCIIIMNEY IS BUII.DING ALTERATION IS BUILDING ON SOLID OR FIL.LED LAND WILT.Bl11LDING CONFORM TO RECK 11REMENTS OF CODE IS BUII.DING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSVOCTIONS 3. PROPERTY INFORMA'FION I.AND COST EST.BLD(;.COST 33 00, PAG: I FILL.Ol1'TSECTIONS 1-3 EST. BLT(;.COST PER SQ.FT. EST. B1.D(;.COST PER ROOM EI ECTRIC METERS MUST BE ON OUTSIDE OF BUII.DING SEPTIC PERMIT NO. AI-]ACHED GARAGES MUST CONFORM TOSTATE FIREREGUI.A'TI(NNS 4. APPROVED BY: PLANS MUST BE FILED AND APPROVE=D BY F101l.DING INSPECTOR BUII.DING INSPEC OR OWNERS TEEM a V I `4 t1t' F �1 2 DALE FIIL:D I. J9/gy U . S l? r CONTRA 1:1.4 Z- LO 7 Z CONTR.I.I('M i � �',I(;NA I I IRI. N'OWNER t IR At I I It 1/1:1)AF ^_ Lt ;a 19 �KQl I'IkMI-I (�IlANlll) 1 MORTGAGE INSPECTION PLAN AT /580 SALEM STREE l NORTH ANDOVER, MA. N0. ESSEX REG/STRY OF DEEDS.' BK. 10702 PG. 97 PLAN.' N0. 6 066 CERTIFIED TO.'L A WRENCE SAV/NGS BAND SCALE.' /= 60' DATE' NOVEMBER 23, /993 I 319.08' LOT 5 00 STOR 45 I00 S.Ff h coo `J� 7 WOOD p n i D t FRAME p ,DWELL !. h 314.11 I , NOTES.' �H of /) DO NOT USE OFFSETS TO ESTABLISH PROPERTY LINES OR TO ERECT ANY STRUCTURE. 2)PROPERTY LINES ARE DETERMINED FROM COMP/LED INFORMATION TO BE USED FOR MORTGAGE PURPOSES ONLY. ss+o�o�, 0 SURV� CERTIFICATIONS: BASED ON MY KNOWLEDGE, INFORMATION AND BELIEF, I HEREBY CERTIFY THAT THE PERMANENT STRUCTURES INDICATED ARE LOCATED ON THE GROUND APPROXIMATELY AS SHOWN AND ARE CONFORMING TO THE ZONING SETBACK RECUIREMENTS OF THE TOWN OF N0.ANDOVER WHEN CONSTRUC TED AND THAT THE STRUCTURE SHOWN Is NOT LOCATED /N A FLOOD HAZARD ZONE AS PER FE.M.A. MAP, COMMUNITY NO. 250098 9C EFFECTIVE DATE.' 06-02-93 ZONE.'X JOHN ABAGIS B ASSOCIATES, PROFESSIONAL LAND SURVEYORS I37 CHANDLER ROAD, ANDOVER, MA. (508)•688-4699 AFPL/CANT.'SEARS NO. P I,696 Brockway-Smith Company C Andersen' u Brosco Architectural Group Windowalls' Serving Greater Northeast Architects since 1890 NWZI Office and Exhibit Area: 146 DASCOMB ROAD _ (Route 93-Exit 42) 800-225-7912 ANDOVER,MA 01810 FAX (24 hours) 800-242-4533 COMMERCIAL - RESIDENTIAL DATE JOB j { , 711 f 1 6fe_.lo_seroe_ ou .wild_} �rrces.w. ir.o�o.rrw_J�elaif' . ano�c� ec auaq of�J _ ' inrlfln9 ml I I 1 1 91 9 ! p I I I ENTRY DOOR SYSTEM Andersen "Rain Sensitized" Wood and Steel Automatic Closing Hinged French Patio Doors ROOF WINDOWS Brockway-Smith Company AWindowalls'nderse . Brosco Architectural Group C' Serving Greater Northeast Architects since 1890 Office and Exhibit Area: 146 SCOMB ROAD n - (Route 93-Exit 42) 800-225-7912 .. ANDOVER,MA 01810 FAX (24 hours) 800-242-4533 COMMERCIAL - RESIDENTIAL DATE JOB (114 ! i d , _Y , i = � I 1 * it Eualfa.6je_1o_ser_ue__ .=ou -rr�yl�i_ /` uo�_el_J�r:ces� ln,o�o°w 17elailn. __a1 . _ �cn I 1 1 1 ! 1 1 1 1 91 1 i I' I 1 I 1 I 1 9! ' PI I 19 i I ENTRY DOOR SYSTEM Andersen "Rain Sensitized" I MiWood and Steel Automatic Closing Hinged French Patio Doors ROOF WINDOWS r • �le�oam�rruax�uea�x 0�..2�raurc✓ucael�a J' DEPARTLIENT OF PUBLIC SAFETY CONSTRUION�SUPERVISOR LICENSE Expires: Birthdate: �. -- 116(1999 07/161953 Gna►'h' � _ IS ING i 68 GLENCREST DR ` N ANDOVER, MA 81845 ------------- p� Elul v/'/ff� i. !. :HOME IMPROVEMENT::CONTRACTOR -- ;Regrstration 101846 Type "INDIVIDUAL E'zpiration r"..06129100'%. a , TEP HEN KEI$LI G F M68 Glennuest Dr. pf�Andover MA;01845 - ADMINISTRATOR I y N2 2 1 40 Date..... A9': 40RT#j TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SACHUS This certifies that ......6 ........ ...................................... has permission to perform ..........k"J..;kZ wiring in the building of.....!�J.c ...(.ft4..k......................................................... at.... ......4S�i�............ .North Andover,Mass. AA:.. ............................................................... Fee.. .....0... Lic.No. ELECTRICAL NspEcrOR 11/18198 08:52 15.00 PAID WHITE Applicant CANARY: Building Dept. PINK:Treasurer THEOfscUy/(�J DEPARTMFVTOFPUBLICS4FETY� Permit No. C V BOARD 0FFMPREVEIV170N A0ANV7CMR120 Occupancy&Fees Checked APPUCATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) S Owner or Tenant Le— p_ Owner's Address _S'fi�-V Is this permit in conjunction with a building permit: Yes m No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps!/ Volts Overhead Underground No.of Meters New Service Amps Volts Overhead Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work u r 4 ►^ u 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 No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets 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 Local a Municipal Other _f Connections 'No.of Water Heaters KW No.of No.of Bailasis JVo.Hydro Massage Tubs No.of Motors Total HP OTHER hlst==Covw�R=artlothereWwYo sdMm&hsefisCtataWLaws IhaN,eawffutLabibtyhisw&=PcbcymdudmgConpideOpembamCovmgcrtsakstttdoWalat YES F1 NO ]haNest# naDdvdMPIUOfofMMIDtheOffM YES M NO IfyuhmeduiWYES,pk%eirdic*thvNxo w&aWby gthe dFpcpi INSURANCE Q BOND F-1 OTI&R Spey) ExpiefenD* Esti�Value ical Wcdc$ WcdcioSwt hpaaiwDakRequesWd Ra# Fatal SigttedunderlieR taltiesofpajtey: FIRM NAME LiodwNa L+oa�see Signalise Li=lseNo BtsmessTel.Na AiTeLNa OWNER'S INSURANCE WAIVER;1amawarethattheLioense thertstratneoow trilssibstar>dalagtrivalattasregt8edbyMassadt�lcs and that my s�taeon ibis pamit wait this tegtrQariad. (Plea eck one) Own ®� Agent ��o Telephone No. PERMIT FEE$ (J 1, T - �-� Location A, No. Date TOWN OF NORTH ANDOVER It Certificate of Occupancy $ i Building/Frame Permit Fee $ 'SsAcMusE` Foundation Permit Fee $ Other Permit Fee $ . Sewer Connection Fee $ Water Connection Fee $ ' - TOTAL $ .� Building Inspector a 07I f7j J•all PAID Div. Public Works �isPEIR111T f�O. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. ✓ PAGE 1 MAP +40. 12 RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. LOCATIONlJ!�'rJ1l� p�^ PURPOSE OF BUILDING OWNER'S NAME FT> lSL 3 NO. OF STORIES SIZE O OWNER'S ADDRESS 15- _I BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAMEy SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES—SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILD ALTERAT OT N"'�� la�1 1� IS BUILDING ON SOLID OR FILLED LAND WILL BUIL NG CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 ' EST. BLDG. COST PER Q. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS i - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED +.., BUILDING INGFRCTOR SIGNATURE OF OWNER bR AUTHORIZED AGENT F E E �/ OWNER TEL.# �� PERMIT GRANTED CONTR.TEL.# 37aBj f- d 7 y �Iy CONTR.LIC.# .��6 2 1 H.I.C.# BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY• I I STORIESTHIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES �_ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL K.1 PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL N. B M"T' AREA _ '/ 1/2 �/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 _-2_f 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDINGI HARD"J'D ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ 1__SIPEIIORII-1 POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING ) d 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 GASOI L B'M'T 2nd _ ELECTRIC 1st ( 3rd 1 NO HEATING AUKIH Town of0 Andover 0 �, No. 33.3 r. w �;;; : ,.,.M, er, Mass. 1 qei COCIII�Mr WICK qOR P���. SS F L 0 BOARD OF HEALTH P ERMI THIS CERTIFIES THAT.......................(OJO'ec--E........�EW-",5..................... � �� J BUILDING INSPECTOR has permission to erm-..kd [:.............. buildings on .... .. ......2, ....... Rough U�............... Chimney tobe occupied as...............................G% ........... ..•`S. .. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTRUCTION Service Final ................. . ... . . . . ...................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector . Date. . .1.1...U.?. . . . . Of p0 oT/y °p TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION 9 9 ��SSACHUSEt4 This certifies that . . . . . . . . . . . . . . . . . . . . . has permission for gas installation .I. . . . . . . . . . . . . . . . in the buildings of . . . r9/z t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at 01:.f c . . . . . . . .; North Andover, Mass. Fee ? . . . . . Lic. No..- �. %�. . . . .-. . . .l ,GAS INSPECTOR 1 Check# 4012 MASSACHUSETTS UNIFORM APPLICATON FOR PERMiT TO DO GAS FITTING (Type or print) Date L t 4 O NORTH ANDOVEy-R�,�MASSACHUSETTS Building Locations �. 0 �- L(1 Permit# v Amount$ A Owner's Name New Renovation ❑ Replacement Plans Submitted �a ` N z c SUB-BASEM ENT BASEMENT rt 1!1ST. FLOOR 2ND. FLOOR 43RD. FLOOR 4TH. FLOOR 15TH. FLOOR 6TH. FLOOR 7TH FLOOR 8TH. FLOOR (Print or type) one: Certificate Installing Company Name Corp. Address S7Z (34).x AaA Partner. 7-11 U Business Telephone Ake= �1--d aFirm/Co. Name of Licensed Plumber or Gas Fitter {A INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ©- Noo If you have checked�,.please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑.-- Other type of indemnity ❑ Bond ❑ ,. V Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all phunbing work and installations=formed under Permit Issued this applicati will be in compliance with all pertinent provisions of the Massachus a ode and C ter 142 of a General . Signature of Licensed ber Or Gas Fitter By: Q" Title Plumber /f7L City/Town rl Gas Fitter License Numwr r-71-Master APPROVED(OFFICE USE ONLY) ❑ Journeyman Official Use Only THE COMMONWEALTH OFMAS5ACHUSETTS Permit No. Department of Public 5afety BOARD OF FIRE PREVENTION REGULATIONS 5 CMR 12:00 Occupancy&Fee CheEk ` APPLICATION FOR PERMIT TO PERFOr M ELECTRICAL WORK All work to be performed in accordance with the Massac setts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) f Data "d To the Inspector of Wires: Town of North Andover 41�;.. The undersigned applies for a permit to perform the(electrical work described beloviv Location(Street&Number /58� File Stt2�Pf k t, 'Owner or Tenant E©i2 •Z Owner's Address bAM e ` Is this permit in conjunction with a building permit Yes (Check Appropriate Box) Purpose of Building D J P/ /N � / � Utility Authorization No. Existing Service Amps Voits Overhead • Undgmd • No.of Meters New Service Amps Voits Overhead • Undgmd • No.of Meters Number of Feeders and Ampacity I 1 Location and Nature of Proposed Electrical Work �.Vi`0 ' JlePT i C, IOU M 191,Ale/ Total No.of Li.ghting Outlets No.of Hot fuse No.of Transformers KVA Above In �I o.of Lighting Fixtures Swimming Pool q rnd qmd Generators KVA No.of Receptacles Outlets No.of Emergency Lighting No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osal No. Pumps Tons KW No.of Sounding Devices 5 - - No./of Self Contained washers Space/Area HeatingKW Detection/Sounding Devices • Municipal Other Is Heatinq Devices KW Local Connection No.of No.of Low Voltage er Heaters KW Signs Bailases Wiring assa a Tuds No.of Motors Total HP � I E COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws rent Liability Insurance Policy includID&Zompleted Operations Coverage or its substantial equivalent YES= NO = [ectAp d valid proof of same to the Offs YES NO = If you have checked YES please indicate the type of coverage by checking the appropriate box. OND = OTHER = (Please Specify) u f Electrical orkE (Expiration Date) o - jr-0 Inspection Date Resquested /Rough Final W%!rel Penalties of perj J ATV l cam• �,I C P�i<e lil LIC.NO. X j��(C! A ' / / Signature �//,/ �A_ LIC.NO. t f�� "De-/lie Bus.E�0 ftp Bus.Tel No. T�'.53:Q Alt Tel.No.-A4 535 Ccsa=) NSURANCE WAIVER: am aware that the Licenses oes not have the in overage or its substantial equivalent as required by Massachusetts And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ nature of Owner or Agent) . �Fi�7%c w.r P it i ' I 1 I i j I I