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Miscellaneous - 159 PRESCOTT STREET 4/30/2018
f159 PRESCOTT STREET 210/092.0-0007-0000.0 B.UlLUMNIG FILE Date7/:... .................................. OF 40Rr#f TOWN OF NORTH ANDOVER "`'= PERMIT FOR GAS INSTALLATION S3�CHU5E .. This certifies-that ..... ..PPi '.Q.'�.t� � has permission for gas installation .... . ............................................. ..... ..... in the buil ' gs of... ,�^?.p �,n .!!''��' ( j ` at A1...1- .. ..................... North Andover, Mass. FeAP..Q ...... Lic. No. .... ...Hk..................................................... GASINSPECTOR Check; -2-1%1 09916 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �l CITY MA DATEIT# ` � v W rnn G JOBSITE ADDRESS 1 S - Pre Sco z t T OWNER'S NAME OWNER ADDRESS TEI[- - - 1FAX E TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT © EDUCATIONAL [ RESIDENTIAL CLEARLY NEW:[Q RENOVATION: 1 REPLACEMENT: PLANS SUBMITTED: YES 0 NO APPLIANCES 7 FLOORS BSM 1 2� 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER �+ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR - GRILLE INFRARED HEATER LABORATORY COCKS _ �— MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT UNIT HEATER UNVE'NTED ROOM HEATER WATER HEATER OTH ER wt erP 2 INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Iwo 13 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW - LIABILITY INSURANCE POLICY Eg--' OTHER TYPE INDEMNITY ® BOND F 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 © AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc rate to th t knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn all P p ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFfTTER NAME LICENSE# 15-(.q.5 NATURE MP EaIMGF© JP ® JGF[I LPGI® CORPORATION[a� .3(,( PAR ERSHIP 0# LLC Ej#= COMPANY NAME: ADDRESS - CITY STATE' Ind ZIP Z t Z TEL G/ -ag7- o0, FAX CELL EMAIL L---- re e e O OOMMONWIALTH OF 1 • • MASSAC.. ` •B.p • HUSEn-S.. PLUMBERS Awn ISSUES SFITTE TH�� .:....: ISS .- FOLLOWING: ';I°SENSE —- L I•CENS.E'Q` AS q MASTER PLUMBER �AVID.:W GARFI EL 21 WI LL.OW SJ 1 H BROCKTON ..; 15645. ;' ��O 1 MA 02301-14g-i' b. /1,6. 226442 tj,COMMONWEALTH OF MASSACHUSETTS BOARD 01F. PLUMBERS<:`:ANb' GASF.ITTE:RS'. ISSUES THE FOLLOW I NGS'" L:bENSE,,:;< . REGISTERED AS A P..LUMB I ,COR DAVIO W GARFIELD` , Z F.'EENEY BROTHERS SERVICE, 21 WILLOW'°ST' BROCKTON :.. MA 02301 ,. 3619 05/01/1.6 ".':, ' 221413 Date.................................. '401t TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSAcmU This certifies that ......... ................................................... ............................... has permission to perform ...... ...... ................ ................... wiring in the building of............. ..................................................................... at..... ...... ........ North Andover,Ifiass. Fee.... IS Li .......... c.No. .............. Z Check # Z, 7,F 9215 �l I LI iC11111L L'AM11J1U11 MUL-1 c11111L/"a Lc J d� 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the \ permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed " on the prescribed forin.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.14*§3L. Permits shall-be limited as to the time of.ongoing construction activity,and"maybe-deemed-by-the-Inspector_of_Wires abandoned_and_invalida£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. , jThe 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 effector existence"during the qualifying period beginning on August 15,2008 and extending-through August 15,2012. ;<Rule 8—Permit/Date Closed: ZZ ***Note:Reapply for new perm' 0 Permit Extension Act—Permit/Date Closed: ` (fmmonwealg of Maseaclwaffi Official Use Only 20 arfmcnf o/�ira�arvices Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07) leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMMTIOI9 Date: �/d City or Town of: j n 6;o �-e,0 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner•or Tenant -Ppa C42 Telephone No. gQ7 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 / 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: ` G, t ' �= Sul Completion of the ollowin tablemay be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total 1 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency rg ng rnd, d. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners - o.of eteehon and Initiatine Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump umber I Tons IKWo.of elf- ontained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area HeatingMunicipal KW Local❑ Connection [1 Other No.of Dryers Heating Appliances KW Security Systems:* c No,of Water0. W. of Devices or Equivalent Heaters KW No.Si al as Data Wiring: Signs Ballasts No.of Devices or E luiyalent t No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent n Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: /- (When required by municipal policy.) Work to Start: AS 4r" 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 1X BOND ❑ OTHER ❑ (Specify:) I cert, under the pains andpenalties ofperjury,that the information.on this application is true and complete.'/ FIRM NAME: u rt Se r i • e5'' LIC.NO.: //Mi Licensee: PJy�n (�0n 9r Signature LIC.NO.: 59(oOLD (If applicable,enter "exempt"in a license number in Bus.Tel.No.•�— j _ Address: L /�!S 6SL� Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. T3eC_0-0—�7� 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:$ �� Department of PGb{ic Safety One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: Certificate of Clearance Number: SS CC 001975 Expires: 10/09/2011 Restricted To: 00 KENNY WONG 18 CLINTON DR HOLLIS, NH 03049 Tr.no: 558.0 Keep,top for receipt and change of address notification. Al u 40M-M8-DSS1JF0RMCA108212008 /k DEPARTMENT OUBLI�C S ETY/ Certificate of Clearance Number: SS CC 001975 Expires: 10/09/2011 Tr.no: 558.0 a S-License: ADT SECURITY A KENNY WONG 18 CLINTON DR HOLLIS. NH 03049 OIG SAFE CALL CENTER: (886)344-7233 C014wriICA L T H Os MiiASSSACHU-S=t t= to a OF LEC ' IA REGISTERED SYSTEO TECHNICIAN tS:�Jc&1HI5 LI�;EI:SE 1Q . KENNY R worts.' Z2 FIELDSTONE DRIVE BURLINGTON MA 018103-42.16 5966 D 07/31/1.0 284072 a i. Date. ..... . .f pOR 3j Oy. ,..o ,e 11,0E a TOWN OF NORTH ANDOVER O � D PERMIT FOR GAS INSTALLATION �9SSAGMUSESI This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installationc� .�!4. . PR in the buildings of/�S ? '.'�-. . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . .f. ". . . .Y,2? O. ... . . . . . . . . ., North An ver,;Mass. Fe . Lic. No../. 0.7`/. . . � � . . . . . . . . -AGAS INSPECTORS r Check# � 8228 Date.7J.z A . 9467 . a pf,Np RT:,M �r opt TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 ,SSACMUS� ies that / . . . . . . . . . . . . This certif has permission to perform P,. . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . ... . . . . . . at . . . . I. 5�/ . . /e?,S.c.e 7�... . . . . . . . . . . .. N rlb'ndoVer, ass. �r Fee. .4- Lic. No. � . . . .. . . .' . . . . . . .. PLUMBING IN PECTOH Check # a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY JIMA DATE PERMIT# JOBSITE ADDRESS S�- -+! G v S OWNER'S NAME OWNER ADDRESS ( TELE�'3L5,,riV.11FAXI TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL Q RESIDENTIAL PRINT CLEARLY NEW: M RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES ©I NODI FIXTURES 7 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 DEDICATED WATER RECYCLE SYSTEM DISHWASHER _I f i f ! J { .. 1 .__.-f DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN ! _..____..f J -_-_- J I ._..__J _...__.J ______f _._._.__J ._..._._._iE. ,..-j INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY _ _._I J ._.__--� ____J _____J _---__J _..-._..-1 _.__I ____i ._.-._J .:--.--..._J .___.__! _f ► _-_-.__i ROOF DRAIN SHOWER STALL SERVICE/MOP SINK __.i 1 ( _f f ------- _-.___I ._.-� .__._._! ._.-._ i __ _I .__ ( ...-__j ..___.._# i TOILET URINAL ( .......-- 3 - --f -- -J _.._.__J .._. --f ._....-- f -----I ----f .......-.._1 .... I J _ ---1 ---_....J WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ -NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND i 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 0 AGENT 10 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co lance ith all e ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LJ,v_ bl �, (l,n _. LICENSE# _gam SIGNATURE IVIP JP E-3CORPORATION Df#PARTNERSHIP D# I LLC a�j o � COMPANY NAME I PIA f` 0 Y) I'� C^1 • '0 ADDRESS - - - -- J CITY Td_h -STATE ; ZIP O -j-[�_-.-� TEL FAX ( CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT F-11; t FEE: $ PERMIT# PLAN REVIEW NOTES 1 � The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston,MA 02111 Uf www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): JUk_L, `1 c Address: I ' y ix Ml ra City/State/ZiPhone#: 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 employees(full and/or part-time).* have hired the sub-contractors 2.% 1 am a sole proprietor or partner- listed on the attached sheet. �• FJ Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition J [No workers'comp.insurance 5. ❑ We are a corporation and its 1011 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[1 Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *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 aie 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 thepolicy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 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 DTA for insurance coverage verification. Ido hereby cerfifyunde thepai s anapenalties ofperjury that the information provided above is true and correct. Si afore: 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#: 4`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." 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 nedessary,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. 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.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax##617-727-7749 w .TnaSS,�QF/411a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY - � MA DATE :Z� �� PERMIT# JOBSITE ADDRESSfCl G ._ OWNER'S NAME _RG . _ c t 0._{� OWNER ADDRESS C( Yy, TE 12 _01 AX � TYPE O OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL RESIDENTIALPRIN CLEARLY NEW:D RENOVATION:©1 REPLACEMENT: PLANS SUBMITTED: YES 0 NOD APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - _ _I 1::j J_ ( —s Il_ _ { I rt_a__I1 1 . . BOOSTER CONVERSION BURNER COOK STOVE h- r _. - f l DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR _J GRILLE IL i INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT _ TEST UNIT HEATER UNVENTED ROOM HEATER —(I__ _ 1 t WATER HEATER OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 cYES 1�.NO 1 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. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 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 Pe ine t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME LICENSE#- 0 S GNATURE - - MP Q&MGF JP n JGF LPGI© CORPORATION F PARTNERSHIP©# �LLC[�]# _- COMPANY NAME: j 'ADDRESS CITY 01rC G,�yL STATE 2ZIP TEL __Y3FAX CELL Sr'1 �S'' EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ + } /� FEE: $ PERMIT# PLAN REVIEW NOTES 1, t NORTH 1 TOWN OF NORTH ANDOVER o p PERMIT FOR WIRING ,SSACMUSE� This certifies that .......�t'.............. ...... ........................................... has permission to perform / ....................................... wiring in the building of..... ............................................. at. ...........................:.pp: -! ..................... ,North Andover,Mass. 1 Fee!;..!;;!. �f.`..... Lic.No !1 -�7... r } .... ...... ELEcmicAL INSPP&ORR Check # 7170 Commonwealth of Massachusetts Permit No. Official Use Only Department of Fire Services Occupancy and Fee Checked C � BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: %—/Y--z07 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) � cow-- Owner Owner or Tenantrt�r7 f fGl.rylTelephone No. 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 / 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: �`^� /wo �2��_ s�✓4SDi/e �4r Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o. o mergency ig ing rnd. grnd. 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 InitiatingTotaDevices No.of Ranges No.of Air Cond. Tons l No.of Alerting Devices No.of Waste Disposers Heat Pump I Number. I Tons I KW No.of Sel - ontained Totals: IDetection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection ' No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water K`,,, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent ' No. Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: ZBQ (When required by municipal policy.) Work to Start:�1-2�,a-zV 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 covera e 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: `lam G LIC. NO.: 7 Licensee: r` �`��� Signature LIC. NO.: _ (If applicable, enter "exempt"in the license number line.) Bus.Tel. No. Z�`wT'��SBY Address: o �.�.'1�I� 5! ���,�2r��T� Q �L� 7 Alt.Tel. No. B-y-41-6�f��Z *Security System Contractor License required for this work; if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: Signature Telephone No. f t °} i 10 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT. TO DO PLUMBING (Print or Type) Y- Mass. Date 19 Permit # y Y M ti a Building Location 5 f f Owner's Name .)a for- Go 12!E. Type of Occupancy �c?5 New Renovation ❑ Replacement Plans Submitted: Yes ❑ No-d FIXTURES r z Z c " �• ~ H VZ VfZ W Z Z o 96 0 (,� to OC 09 rel Z Q IY = 4 Z . OVf W fA = H WCL C W CL 3SmvziCC53 = � 0 � ca7 � G < 3o0em0 I SUB-BSMT. BASEMENT 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name S.,S Check one: .Certificate Address _ 1 �- El Corporation an ;L 6 VPartnersh i p Business Telephone ❑ Name of Licensed Plumber INSURANCE COVERAGE: I have a curre9t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Q No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policyv Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent❑ Signature of Owner or Owner's Agent I I hereby certify that all of the details and information I have submitted(or entered)in the above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp lian ith all pertinent provisions the Mass setts State Plumbing Code and Chapter 142 of the General Laws. I By Signature of Lic Plumber Title Type of License:Masters 1ourneyman Ll City/Town License Number L�(j APPROVED(OFFICE USE ONLY) r f I t r s FINAL INSPECTION SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED Date 19 U.G. Insp. Rough Insp. Final Insp. Plumbing inspector Date. NORTH TOWN OF NORTH ANDOVER O�t,�•c y1�'O PERMIT FOR PLUMBING ,SSACMUS� / This certifies that . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . n plumbing in the buildings of . .�.Cc.. . ,c.�.4-... . . . . . . . . . . . . . . . . at. ./. .s �1. ,��� s�„�--��'-. . . . . . . . . , North Andover, Mass. Fee..,?;.,. 77. .Lic. No./U`/G R' . . . . . PLUMBING INS-4-1117>--1 ECITOR 11/23/95 14:59 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File � 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING �. (Print or Type) , Mass. Date _'7l '/ 19-22— Permit: # Building Location Owner's Name Type of Occupancy. New ❑ Renovation Replacement ❑ Plans Submitted: Yes❑ No (2l' N Q N W N Y Z I= N N N U to Q N Q O N f� z o u a a a 77, r a m vs F- y Lu O c < N rt N O V W N < cc O d > uJ W w � .1 Z < = UA s O ¢ W r' �++ F. = Hcc C7 F- Z ~ UJI E" F- r N 0 Z O Z O t~A = z < > < c. m 4 W > Lu z. < < < O O W Q O w P '= O C7 Y u. n O J U C Y a a M- O SUB-2SMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR ATH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name ill�Q ,�r3�2� Check one: Certificate Address ❑ Corporation Partnership Business Telephone .�7�/'�zs.3� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter (TrnFS INSURANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checked Les. please indicate the type coverage by checking the appropriate box. A liability insurance policy LTJ Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. 'Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the eral Laws. By TELurneyman License: mbergnature of Licensed umber or Gas Fitter Title fitter terlicense NumberGty/Town APPROVED(O IC U NL BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION FINAL INSPECTION SKETCHES FEE. NO. - APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF DUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE ---19 GASINSPECTOR r Date. �f!/��..%.� ....... MORTH TOWN OF NORTH ANDOVER 3= '� PERMIT FOR SAS INSTALLATION o � 1SSACMU`�ES This certifies that . .�. .0 i'. �.� . . . . !:. . . . . . . has permission for gas installation . . . . ... . . . in the buildings of . . .. . . . . . . . . . . . . . . . . . . . . . at . . . . .`. . .. . . . . . . . . . . . . . . . North Andover, Mass. Fee. .,. >. .: . . Lic. No..&. ,-/ �-.`%. . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print norType) ;0 Mass. Date 19 _ Permit # W Building Location Owner's Name ` AUT, Type of Occupancy -� New ❑ Renovation ❑ Replacement Plans Submitted: Yes ❑ No [P� }} FIXTURES h W UF- tri ov't e`nt 0 t P_ = 1�— ly W LU t„ oe O v m Z X =u to m y h III oe W= W 0 a 00 W Z > Z long wo WWy ; �r NO FINAL INSPECTIONS SKETCHES BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS FEE. NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME & TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT.GRANTED Date 19 Gas Merc. Final Insp. Gas Inspector r �� Date.fi� '. �..r. ....... . I f NORTM TOWN OF NORTH ANDOVER 0 a `p PERMIT FOR GAS INSTALLATION ♦ i � r l ,SSA�MUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas-installation . . . « . . . . . . . . . . . . . . . . . . . in the buildings of . ... . . . . . . . . . . . . . . . . . . . . . at . . . . . . ., No Andover, Mass. 155 1; INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File `' C� 63(Z Rough Service Final At TiltntnonWCH10 of majosnc4usetts Office Use Only Department of Public Safety Permit No.020019- BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy 6 Fee Checked 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 1 (PLEASE PRINT IN INK OR TYPE.ALL INFORMATION) Date ��t:LL City or Town of 0021"A- To the Inspector of Wiress The undersigned,applies for a permit to perform the electrical work described below. Location (Street & Number) _151 C 2 @S co -t- S'Q`L- Er Owner or Tenant 2 y`^2 C, G 1.( L`-LP Owner's Address C,..--t Is this permit in conjunction with a building permit: Yes 11 No F (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work TOTAL No. of Lighting Outlets No. of Hot Tubs No. of Transformers KVA AboveIn- No. of Lighting Fixtures Swimming Pool grnd. grnd. ❑ Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and N_o.of Ranges No.of Air Conditioners Tons Initiating Devices Heat TotalTotalNo. of Sounding Devices. No. of Disposals No. of Pumps Tons KW No. of Self Contained Detection/Sounding Devices No. of Dishwashers Space/Area Heating KWMunicipal No. of D Heating Devices KW Dryers Local❑* Connection ❑Other No.of No. of Low Voltage No.of Water Heaters KW Signs Ballasts Wirin it No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES WINO O 1 have submitted valid proof of same to this office. YES O NO IJ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE RBOND ❑ OTHER❑ (Please Specify) Estimated Value of Electrical Works_ 7S (Expiration Date) Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME UC. NO. f2t?677 Licensee ua e-L Signature LIC. NO. <200? ? Address _R6 C2.r_,/cr4( 1ARk"-11, '(1 d`'lA- 0032 Bus. Tel. No. 37a 8a0q' Alt. Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the Licensee 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) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) •� Date. 2808 f 4oRTH 1 r�`- "�0 TOWN OF NORTH ANDOVER to p PERMIT FOR WIRING ,SSACMUS� This certifies that .......RA.-.(... .............. has permission to perform .� !.! h?.........................� I-v;L.G ... wiring in the building of....... ........................... at �x./lZ "5t`a.l.........`� .�.-.-....... ,North Andover,Mass. FAf ........ Lic.NoF!7l?71............................................................... ELECTRICAL INSPECTOR XLL Ck�/iL�- 011121% 15:46 15.00pQTTppWHITE:ApplicantCANARY: Building Dept. PINK:Treasurer MR: File Location No. �1 / Date =, MOR, TOWN OF NORTH ANDOVER i 0 •' • C9 + i Certificate of Occupancy $ ,SSAC►WSEt�'' Building/Frame Permit Fee $ _ - �' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ U Check # 16220 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING OChAS.for Offs;"' "U" SC I - 5_ nrn BUILDING PERMIT NUMBER: /�� DATE ISSUED 3_!a X SIGNATURE: Building CommissiAedins=tor of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Cl CP- 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 Required Provided v 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner f Record Name(Print) Address for Service Telephone qr 2.2 Owner of Record: Name Print Address for Service: O Z Signature Telephone rn SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number mn Address -4 }' Expiration Date Signature s Telephone r 3.2 Registered Home Improvement Contac r Not Applicable ❑ v �- V� Z Company Name rn �© D/,�--Z Address Regi tion Number r z (Ii'/ �� r 6/F wry y E raft ate ^� Si nature Tele hone �+, � w SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit ust be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildiOpermit. Signed affidavit Attached Yes....... NO.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify 1 Brief Descrip ' n of Pro osed Work: NJ 31 621w-f SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAI:USE,C3NLY Completed by permit applicant - 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of O Construction 3 Plumbing Building Permit fee(e) X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZE A ENT DECLARATION I, Zas Owner/Authorized Agent of subject property Hereby declare that the statem is and to ation on the foregoing application are true and accurate,to the best of my knowledge and b-lief Ni t Si at weer/ ent Dat NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 j SPAN DIWNSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATEPJAL OF CHIMNEY IS BMDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE j I -7 '-VO!IY!/I3LO�lLIIlP,2LC/L;.•`V TINT i i.%6udoaCJX.�LC66P.t�s � �r, '+ �parc�,of Bu�►ding�egu►shous+an�1 S�irtnd�rds'� ;• ,.+ le HOME&PROVE SIT Registrat7ion P2426 � ; P",. # x F�cp�raii'bri 2003 a." k ype=dn p.i ual Al�m '� 18 CARLISLE ST # �> 01852 '�' Z �'=~�Admiof3tfatoi�� 1� WThe Commonwealth of Massachusetts d Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 °'�,M 5�•'' Workers'Compensation Insurance Affidavit Name Please Print Na Location: Ci l Phone .# b/ Z�/ I am a homeowndf performing all work myseI . I am a sole proprietor and have no one working in any capacity �am an employer providing workers' compen on for my ployees working on this job. Com an name: Address ` p Ci 46 U7& Ql Phone* q0/l C Insurance.Co. Poligy# T y jSZ D Company name: Address City: 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 vrelLas_civjl penattiesin-theSamrAaSTOP]I.V.ORK_ORDFf2..and_afine_ct..(,$11ZO.flD)_ariay against me I understand that a copy of this statement forwarded to the Office of Investigations of the DIA for coverage verification. j do hereby certify under e p . an /ties of pe that the information provided above is true and correct. Signature Date Print name , L Phone.# 6/r frd ' Official use only do not write in this area to be completed b +, Y P Y city or town official' 1 City or Town Permit/Licensing. Building Dept ❑Check Y immediate response is required [] Licensing Board E] Selectman's Office 'i Contact person: Phone#. E] Health Department Ei Other 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 c 11, S 150 A.. The debris will be disposed of i . 4 (Location of cili Signat 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 I i i t '__t= 1c Y;`'-+.: '1:1;�i .�.—� i� -I' • �•` �- --t..:i-'F• �'li'.,,.,- - _ .r_-i�-1r - ---�- _ ti. CERTIFICATE F' LIABILITY INSURANCE _ �� � /2002 T14 CER MOW If 1PEUl.t1 iU A AT T5 OF INFORt T10 ONLY AND cONFERS No iiOMS UPON THE CER1nFICATS E 2alEi2iE.Ltr ' ti�,tY. f'taTtl +6iP,`j ItJ8Tl cL27cF Agency, IY1G. Wl`1I DER. THIS CFR'wr1FiCA% DOES NOT AMEND, EXTEND OR ALTS€ T`r3rm COV5RAGE AFFCR001 BY ME POLICIES BELOW.— .1. WSURERS AFFORDING COV�GIo 1kv.4 4�� se:rn�.sti� !�'3s 32324- f lP<cR A �F3 Tam 3Gkv'r@'1Tire 2li Yc 1 LCr[t" .�..r, VA lT-}.�1{,,..,m.�.„.r.,.......�...�,.^.._.............._.. ,H�u4EFi£,,.o. .y...�:,,..�......�- - �.n..,..-...-------.....+�..�..o.. C„L;/'�x^{�57�;'C.�.n,.. w•.ww.•...-...+«.�.^�..,��--.-._a:.ew,..�.._r..�Q.n.ti.,....Y...a,.,��w.�,.,e.�.....b.+..»..-.••-... .oww�.rr,+ fi�F INS.:tRAgCZ R.! T40 6ELW;,f PAv5�-EEN ISac(SQ M THE INSURED P.G=r iED n39Cvc FOR THC-P,:,Jr Y PERIG7 iNOICATED.NyTWTKST,AhTNNGi XY 1'rt31J: EAi; �r,TF1,11A Qa CONE:MON OF A4Y CONTRACTOR CTHFR CJOCVM1 'H: ECT?CT�YP(1C,??T7f'CEvnT-I:.A 'E MAY FE 1SSUE0 CR MAY PERT,•UN, t:li ;':1�:•'�=:tc «"=':@rl=� fTY qME t'C7L'Ciirs OESCRSEC ;iEPitiN !S SLI�JECY<' ~ t "i•%< '1Tk'1s. (EXCLUSIONS t,,ic CCk1L.wrv4S of SLr�t P alic 6S. Umrls Will ;7rv�'OF iP wJ+ilfi." €' MLICY N6 f6l".t+_ }I��nit'ld.t' r_ _ Jcrn a.e 3r3+cw�65dA�lwl7'r"� � K•• � / tt EACHC%tiiJRREh'C� 5_ OC,CC �_� i�►fSiF37C k:r:E't �i,LI-Alk!'Y j i FERE pA�AP.KiE ?� ona rrol t 50,00 07.6 399 ; lCF f rr 9-A i i�c �C p� .Pa:JQ�i M( F i;�^Y orni cSltsrni—_ 'ti,,,,,,.., __I� G4 300 00 1 _.�. .___._....,,......,��-.._.._"""""` r' � J 'i � � t3F'dFF2.h:faG,?.'�G1T Y ��_.-.•_•__•_•spa CQ T 600. a G FL R4C�iEakTE li 0 pouaf r' e-r L.,.,C VX8NSO SINOLEUP' -NNY At3T0 — I 111 41A1SLC ki.1T%s 9JU.L.ttJ6R. l $Giii t7ilLFr ktJ;tJS 1(Per P»a+) }-(RED AUTO$ r 1 J' f i � � �ROGIi'rINJVW I t40r4-dWj%0AO C3 i I 1i btrtiatust!) _ �S - .— S'ZQPSF'TY DAMAGE _'ACCAGI t.iis6'Ldf f AU"t?QNLY,^FAAf7 MENT S ••� 1 J t - + ..-.-_..___�.�....— _ griv Wl a L , , t OfHUR Tt•tM EA f..Gxs ___ �...-......d�.., .. r......,.,�._. j !! 1l I EluIs �14 LK..i-�S�R_TiCF. C:_l't1F i tw.,+,DE SL i 4NONAW11 .,..,..,,�-.'1 RP��...,�,��k-; €E-SdRi.�Yt'x.5`i.iAEtlJYtt I � ! !�-- III € IE'1. abACCIC wT_ _ 5 14Q,G! I I , I ' +,'.�f;Ff'tiVt't'4�?IGlPt1F'��'t�!ik-7N�i'1..t.`^`-i;T.�1JS�tFHi;:'sE':y'e-`.1`+",F��J`slit°.k2CcC1F}"rE*J�]GR3'�Ni:I�;T!`_;.^��I:,A:'.��°S'QN'd -,••� 6 - C:Es?4ir€€t.tE�cir4t7�i,?-E�; r,t'LP ANY 0;: TKA AMA-C, t CX;'i18EV PULC+•toS IK CR.eiL?16.€” fiwARP Tr EXi JRI+T'!ak y Tfl r#ti�RC-!'iF, -`iti f3C11OVAYOR TO MAI _ C14yS W6d'J'f'SW K0!V^1 TO+aiE;.'EITTIMATK"OLDER PIN NM TO TMP,Ur,DL FA;VL All r,•L10,1Y)NVALL IMPQ,G NO M ipS-TJ7N U:-^.J A13t.1TY OF ANY X NA P–P�+t 71 Y :h,URM'I'�' 47fI.,,':a OR�ic5•YiE.SF�tT'AT'It�r Y. �^®m- .o.e. 1 I ALJTRQ�f.�ED R�FJi��r�P."� (T'�,5•w' sem" �-::,. .,�.....�. ----..-..<__..n.^>,:,+.,.,�.�.,._.. .....yam -e �.•,., ..._.�._ ....�.Q.t�-..a., "'^��.,.��...�....,M:.-"nW �� j rx':S i$1{71y7�1 �€�At, C�R411GRaTIC N1 i r. .11ti�iid�$-`.S(f:»U q, `-'sem-r�;,,3�;- ..t•;.`_$.•:.Z �t`,�. tE,�.Q;'.'•ir5rtii T '. NvR � r1 Town of Andover No. jC, O - LA `. dover, Mass., .� COC HIC W ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... .......... .. ...!�. L'!_ Foundation has permission to erectStq buildings on ...... ?1NrVr0* ......................... Rough to be occupied as.... ..R!1 t 00.................��t� /........................................:................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By- ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. �a �� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI N S 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 Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT i Street No. SEE REVERSE SIDE Smoke Det. Location �Jc I Pf pS( cam S No. Date f S y�io-b3 � i a NORTH TOWN OF NORTH ANDOVER N A 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ 3 s.KMust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 p r Check #_ IR 0 16295 � + C -- Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. a O0 3 ic_ SIGNATURE: / "�C( Building Commissioner/Inspector of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I q FRESCO 9 a \ , ^ /�p „^ /� O��,. / ` 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 Required Provided v 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zane Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1pOwner ofReccorrdd - D 7T1 C Name nt) Address for Service ///-;� 8 jigdature Telephone 2.2 Owner of Record: l� L,Rl 67 R I S O a tint 1 Address for Service: 005 M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Constn.aion Supervisor: O License Number Address Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name m Registration Number r Address r Z Expiration Date ^ Signature Telephone YI SECTION 4-WORKERS COMPENSATION(NLG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ TAddition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: NG- -_ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIALUSE ONLY Completed bypermit applicant " 1. Building (a) Building Permit Fee JSOO. 0 0 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(8)X(b) 4 Mechanical HVAC ' 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH DING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; " 11 matters relati o wor uthorized by this building pennit application. g/-2Y�3 Si natu Owner Date SECTION 7b OWNERIAUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDvIBERS 1 2ND 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 FORM U - LOT RELEASE FORM C" INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANTp�a_PHONEj,?6-6k,.5—oo9fL LOCATION: Assessor's Map Number PARCEL / SUBDIVISION LOT(S) �S STREET t ST. NUMBER ************************************OFFICIAL USE ONLY****************** ***** **** RECO ENDATIONS WN AGENTS: C SERVATION ADMINISTRAT DATE APPROVED 3 12 J 103 DATE REJECTED COMMENTS W S ��oSS �l �- I66 i caw TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE --_ Revised 9\97 jm NOV-08-01 12 :01 PM E K SURVEY 9784697046 P. 05 E K SURVEY INC #HAVERHILL,MA 4 Phone 979-489-1gg5 1 F@X 879-49D.70* i MORTGAGOR 'Klt:lIPL DEED REF, y�{/(/ PG. ADDRESS OF PRINCCIPLE BUILpI a PLAN REF. iT _�E�J�✓QIP. /1�A DATE OF INSPECTION p+ � SCALE'S"le f r3 3q I o � I i 6 sco rf � i hdrd �� I iT. CERTIFICgnAUbELoN TO: (l r' 7n n �p No.36MM This MORgage Plot Plan was prepared speeifiemly for ,� The location or the principle structurals �goos purposes only and it is not intended or represented $ nfCISI L � to be a property line or land survey.This plan Is not to be used Opu t,AMa S with the local zoning bylaws In effect when ConStrmlod b establish any Of the property lines for any purpose.No andl or is exempt from violation enroreemnent ►esilonBIWIty Is extended to the land owner or oeoupant. action under Mass B.L. Title VII,chap.4CIA,84c.7, Thio unification 19 bused on the location of survey marker OubJeot bullaing Is not In a Fkwa Hazard Area. bt Otilefs, O Subject Wilding la In a Flood Harard Area. Frond Himard determined tram the FIRM map# Outod i fi-- - 1 _1 t 115 I I 1, 6 I I I I - -I I 1 tt 1 I ' - t t r T + , + + { t f + t t + t Y ? 1 1 T i f t T t t t T t T t T t t t t + T t t f I I I i + t t 7 � -� t t t + � t I i I E I I tf I Ilk4 r ! I ! I ! 1 + I f _ +fit t t- _ f t -- - - - fi _ , T t�J}I Q u, I I f L 1 - - - - - t t + I I ! t t i + - t + - f t- { NORTH TownE _ /1 .,,., Andover 1459 z o * dower, Mass., JV- - and 3 A0"SATED OPte\ �C 4 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT...R.<<...... .a reh ...5 .......................... ...................... .. Foundation has permission to erect....�Z�. .�.8..�...... buildings on ...t...S ......P re t O ............. ..... Rough to be occupied as..O..P.I.&+....MC.K.....0.04 StdC......W.C.....'Af%t 4r.A#C..+t.......... 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. / �0 �..� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION T TS ELECTRICAL INSPECTOR A C 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. Date. . . .. �`�. ��.. .... T1y Of of � TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a s h �9SSACMUSEtt This certifies that . .i L . . . . . . . . . . . . . has permission for gas installation `:::: 'p:. . . . . . . . . . . . . . in the buildings of-�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . ? ' . . .��.1. ' -� North Andover, Mass. Fee.:`'. . . . . . Lic. No.5 ?:�-- . . . . f. . . . . . . . . . . . . . . . GAS� OR Check# 4, 3 6 � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) /V. U e.✓' , Mass. Date 2co Permit Building Location til�S 4 Owner's Name/^. N. A 0 c r Ma Type of Occupancy, iR ESI i P N 71 r- New ❑ Renovation ❑ Replacement 2 Plans Submitted: Yes❑ No ❑ N N W N _. Z ¢ N N V H ¢ df ¢ O15 cc N = t- W J_ O W Z O W i ¢ ¢30. Q O C r W _ 4K CC a ~ H O ¢ W Wz r7 1- _ .9 = 1- ♦- N m Z O Z W O N S Z < W ¢ W O =. < ¢ < < O O W O SUB—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company NameCjAeT A . `Am MA TA�0 Check one: Certificate Address 3L ❑ Corporation M E 7 H U e r\) r11 A 0 k g y ❑ Partnership Business Telephone /a�92 —(t 9"7 r perm/Co. Name of Licensed Plumber or Gas f=itter "RO A E P T 1 5 A M r)'1 t9 7d>E?r� INSURANCE COVERAGE: I have a current pf bility insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you have checkedrtes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ' Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General I$ws, and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed underthe pe i ed for this application be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of ner laws. By T of License: G� Plumber n ure of n u or atter Title tter er License Number X333 City/Town O NL Journeyman I - r BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING I I NAME S TYPE OF BUILDING LOCATION OF BUILDING . PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 GASINSPECTOR 1 tE ,