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Miscellaneous - 16 FERRY STREET 4/30/2018 (2)
16 FERRY STREET 210/017.0-0001-0000.0 Date. �. . r... of"°RT"'ti TOWN OF NORTH ANDOVER to 9 PERMIT FOR PLUMBING s`4ACHU5� This certifies that...................... ............. r'.................................................... has permission to perform............ .... .....�.....Q.�.�!!`.� ............... plumbing iu-the buildings of.......... `?.. ............................................. /� �iP�' j North Andover, Mass. at............................................... 7 Fee� ".....Lic. No.�.����—. J� PLUMBING INSPECTOR Check# "" �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ 11_ MA DATE /S ( PERMIT# II JOBSITE ADDRESS n Q OWNER'S NAME ,�. 6L / �� POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL © RESIDENTIAL ---—' PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: _ PLANS SUBMITTED: YES® NO® 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 -r___ 1 DEDICATED GREASE SYSTEM .__1 __...a ___! ____I j _-._.__ --------1 DEDICATED GRAY WATER SYSTEM 1 DEDICATED WATER RECYCLE SYSTEM 1 I .._._..___( DISHWASHER DRINKING FOUNTAIN E FOOD DISPOSER - .-1 I � { � —J= _.....__ .__7_.1 _..-1 _---__! FLOOR/AREA DRAIN i __ ._._1 _____ ____ _.___,_1 I= ____.1 ._-._..._.,1' INTERCEPTOR(INTERIOR) KITCHEN SINK f _. _.I _ __. -_I __-._.I E.__( _____.. ____I -__.___j .____^i ______1 ....771 _____j -J _-___- - LAVATORY1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 J.E____1 __- _1 ___.j _1 _ _.f ____J1 URINAL — WASHING MACHINE CONNECTION _i 1 _ __ ._._�II _ _.1 ___ 1 _; WA ER HEATER ALL TYPES _. .._._.; WA ER PIPING _ ( - _-- x OTE,.ER _ __ _ I i ! --_.._.I E INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES , NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE B _CH9G4QNG THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY __i OTHER TYPE OF INDEMNITY 0I BOND Q OWNER'S INSURANCE WAIV I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Gener awl and that my signature on t i%.p.ermit application waives this requirement. CHECK ONE ONLY: OWNER &<GENT In NATURE OF OWNER OR AGENT ereby certify that all of the details and information I have submitted or entered regarding this application are true and accurst 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 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME -�i✓_., C L'�_ IILICENSE# 7 R SIGNATURE MP 0 JP CORPORATION MJ#PART SHIP P# LLC COMPANY NAME ]ADDRESS co/7f CITYn/ _- -{STATE r_I ZIP �� II TEL Dryl ^ FAX __ ( CELL��EMAIL - - --_ - - -- -- - _- ------ -- - -- - --- - - --- - ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No SS' -7114--b THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES c Date..12 ............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION C s certifies that ....]�-&4o - ..................... ........................................................................ .1........... has'permission for gas installation .....Lr�-- Loj VN^0 JI-p in the buildings of ................................................................................................................ at............ 6AW�ae-�,L, ..... .............................................. North Andover, Mass. Fee..... Lic. No. ..�3-7a ........................ ..................................................................... GAS INSPECTOR Check# I ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY n/ _ MA DATE PERMIT# 16 JOBSITE ADDRESS U.. elT � OWNER'S NAME G, OWNER ADDRESS TELF—_ ___ FAX TYPE Oil OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL F4UNT CLEARLY NEW:F-1 RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESE-1 NO Q APPLIANCES'l 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 JL= FURNACE LL GENERATOR T -n1 ----I - -GENERATOR _J1 .__- ----j GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER tHE�ATER L OTHER . INSURANCE COVERAGE have a,current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES .._ NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY K1FIG 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: OWN AGENT 01 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 andthat all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe ' provision of-the Massachusetts State Plumbing Code.and Chapter 142 of the General Laws. c PLUMBER-GASFITTER NAME :�✓ ,tpS _ LICENSE �✓'� SIGNATURE MPI MGF EjI J GF LPGI MCORPORATION[]# PART ' RSHIP El#=LLC Ej# COMPANY NAME: �/ ADDRESS STATE CITY Nc �✓ _� STATE �ZIP TEL - _ ._ _ FAX CELL EMAIL -___.w ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTI .N NOTES Yes No sSS 1 417/1 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES } The Commonwealth of Massachusetts Department of IndustrialAccidents Congress Street,Suite 100 Boston,MA 02114--2017 ' F q�r www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Flectricians/Plimbers. TO BE FELED WITH THE PERWTIANG AUTHORITY. Please Print Le 'bl A ''licant Information Name(Business/Oigariizationlfndividual)' Address- City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required); to ees(fulland/or art-time)." 7. ❑Nw'constridtion 10 I am a employer with em 2.0 I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[Noworkers'comp.insurance required.] 9. ❑Demolition 3.0 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 ensure that all contractors either have workers'compensation insurance or are sole ILEI Electrical repaiirs or additions proprietors with no employees. 12�[�Pliunbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11 Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other------ 6.n ther6.❑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 check's bbk#i must also fill out the section below showing their workers'compensation policy information, Homeowners who submit this aM&vit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached'an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 'compensation insurance for my employees. Below is thepolley and job site X am an employer that is providing-workers information. Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: date . Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration. Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation unishable by a fin e up to$1,500.00 p and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be,forwarded to the Office of Tnvestigdtions of the DIA for insurance coverage verification. lties of perjury tliat the information provided above is true and.correct .£do hereby certify under thepains and pena . • Simature: 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 Instrnctions 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 hize, express or implied,oral or written." An employer is'd'efiued as"an individual;partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferpri'se,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 xequiired." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Pleasb fill out the'workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their 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 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 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-MASSAFE Fax#617•-727-7749 Revised 02-23-15 www.mass.gov/dia 7 € ;COMMONWEALTH �OF MASSACHUSETTS ; PLUMBER>S"4ND GAS<FlTTE "` > I S;S:U.E::S::;>:: LOWING LICENS THE FOL E L I CEtNSEO'AS A J0URN'EYMAN/R.L{1F1B.ER• A1VlJREW H R I NESto 4 RAMS WAY tri. ;��';' W J 3848 � �err r / The Commonwealth of Massachusetts ! Department of jndustrialACCidents z M ry f 1 Congress Street,Sz Ite 100 Boston,MA.02114-2017 sysv www massgov/dia Workers'Compensation insurance Affidavit:Builder/Contractors/Electricians/PlumbexS. TO BE FILED WITH THE PERMTTTING AUTHORITY. ffease Print Le 'bl A ' licant Information Name(Business/Ozgabization/tndividual): -dP Address: City/State/Zip: "r/" �✓ /j Phone#: �. re you an employer?Check �ltlie appropriate box: Type of project(reeluired); 1. �am�asoje?pro employees(frill and/or part-time).' 7. ❑N6 '66nstrudtion 2. r partnership and have no employees working forme in 8. Remo deliiig any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.E]I am a homeowner doing all-work myself.[No workers'comp.insurance required.]t 10 Building addition � <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ❑ 11. Electrical xepavrs or additions � ensure that all contractors either have workers'compensation insurance or are sole 4 14 !.. proprietors with no employees. 12. PIUllTbing repairs Or additions 5.❑I am a general contracto.and I have hired the sub-contractors listed on the attached sheet. J 3; Roo£Tep airs These sub-contractors have employees and have workers'comp.insurance.t 14.El Otl1eT 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. ve rio employees:[No workers'comp.insurance required.] 152,§1(4),and ive ha ormation: *Any applicant that check's box#1 must also fill out the section below showing their workers'compensation policy inf T Homeowners who sub it•thi affidavit indicating they are doing all work and then hire outside contractors must submit a new.affidavit indicating such $Contractors that check this box must attached additional sheet showing the name of the sub contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is provzdingworkers'compensation insurance for my employees. Below is the policy and job site information. �p Insurance Company Name: T 112 e Policy#or Self-ins.Lic.#: Expiration Date; D A/ ` 0. City/State/Zip:_r.f 6. Job Site Address: own Attach a copy of the cvoxkers' compen ation po' declaration page(showing the policy number and expiration date). rage as requited under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 Failure to secure cove and/or one-year'imprisonment as ,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. information provided above's true and correct. o er•'ur at the orm p Un sins andpenalties fp J f I do hereby certify P Si afore: Date: Phone#: zcial use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License## Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date.. / ....................... TOWN OF NORTH ANDOVER I W PERMIT FOR GAS INSTALLATION CHU This certifies that .................................................................................................................... - has permission for gas installation /42,2.z.xf-A... ....... in the buildius of... 4............................ at....... ......r/....... . ....... 4.g ............................ North Andover, Mass. Fee.&O..�2.... Lic. No. o?.3.76.Z... ..................................................................... ..... ................. GASINSPECTOR Check# t—o 7. -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK lovp _ CITY C �Z- VL NMA DATE PERMIT# 63& JOBSITE ADDRESS�yte-21.. - .-� �I OWNER'S NAME GOWNER ADDRESS %-.. ct p TECg7 _ _ FAX TYPE OR � I PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL FA CLEARLY NEW:0. RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESE] NO FJJ APPLIANCES"I FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER _ CONVERSION BURNER COOK STOVE _. I � _� _ _ . - : a -. DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE _(�n1 ._ ..._ - �- - --- =---- =J�_... GENERATOR ( .f_ — 1 � _.I�V - _..__. �— _ I — GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN - POOL HEATER ROOM/SPACE HEATER _ ROOF TOP U NIT T I TEST UNIT HEATER I �� UN,VENTED ROOM HEATER WLTER HEATER - r-- OTHER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COV7CKINGGE BY THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts GeneralLaws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT _ NATURE OF OWNER OR AGENT y 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 d that all plumbing work and installations performed under the permit issued for this application will be in compliance with inent provision o Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTERNAME r��pZ� LICENSE# SIGNATURE MP ED MGF�! JP F[] LPGIj CORPORATION[]#©PARTNERSHIP 0#=LLC D# COMPANY NAME: p� h/ _ ADDRESS CITYr'�r STATE N_,N. ZIP ` TELA FAX _ CEL G3 MAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION XeTES Yes No 5 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES + e The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia ' workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE PILED WITH THE PERNIITT)NG.A,UTHORIty- .,Please Print Le 'bl A licant Information n �J Name(Business/Organization/lndividual): Address: City/State/Zip: K ` S �✓ Phone#: �06 Are you an employeri ec] t:& appropriate box: Type of project(required); CH 1. I am a e r vrr employees(full and/or part-time).* 7. ❑Nevi'construction 2• aln a sole proprietor or partnership and have no employees Working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3•❑I am a homeowner doing all workmyself[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 airs or additions ensure that all contractors either have workers'compensation insurance or are sole rep ro+9 proprietors with no employees. 12T[]Plumbing repairs or additions 5.❑I am a general contractp+and I have hired the sub-contractors listed on the attached sheet. 110 Roof repairs These sub-contractors have employees and have workers'comp.insurauce.t 14.0 Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. M 152,§1(4),and we have rio employees.[No workers'comp.insurance required.] *Arty applicant that check's bbk 41 must also fill out the section below showing their workers'compensation policy information: indicating the are doing all work and then hire outside contractors must submit a new affidavit indicating such. tm Homeowners who submit•this affidavr g Y Tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. ensation insurance for my employees. Below is the policy and job site X am an employer that is providingworkers'comp information. r� ,p e`/ Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date D Job Site Address: 06-16 — P/rA l City/State/Zip: rJ 6. Attach a copy of the workers' compen ation po ' declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fuie up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido hereby certify under pains and penalties ofperjuryAat the information provided above',w true and correct • Date: �� Si ature: Phone#: tial use only. Do not write in this area,to he 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#: r 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 hlte, express or implied,oral or written." An employer is defied 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 oi' n 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 ofthe 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 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 iegidred." 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-insura'nc'e 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 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-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia s 3COMMONWEALTH OF MASSACHI SETTS BC3AR�:'QF PLUMBERS AND GASIF TE, ISSUES THE FOLLOWING LICENSE ` L I GENS:El7 AS J.URNEY'MAN, ,LUMBER, AhI�tREW H R I NES 4 RAMS WAY J NGSTON NH 03848 347g ' # Date.Aq�.U�I I I-D ............................. 02 TOWN OF NORTH ANDOVER 1'- PERMIT FOR GAS INSTALLATION .......... •* CV Ss HU This certifies thaQ,-I . . ................................................................................ has permission for gas installation ..... in the buildings of....MA'-6-s...................... at..........1..�...... ............................. North Andover, Mass. Fee"Zj..�.......... Lic. No. .......11Y.. . ..................................................................... GASINSPECTOR Check# 62 � 6 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK F CITY I NORTH ANDOVER MA DATE OCT.15 2015 PERMIT# 4 ` JOBSITE ADDRESS 116 FERRY ST. OWNER'S NAME NESTER MATIAS GOWNER ADDRESS NESTER MATIAS TEq 978-390-5194 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL 0 PRINT CLEARLY NEW: RENOVATION:® REPLACEMENT:EI PLANS SUBMITTED: YESE] NO® APPLIANCES Z 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 TEST -- - UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I CONNECT TO A PLUMBERS INSPECTED GAS LINE USING THE -GAS FOR.COOKI G D YER AND-HEAT INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY 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. CHECK ONE ONLY: OWNER [_—] AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b 'n mpliance with all P rtinent p inion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. -'ek PLUMBER-GASFITTER NAME I JOHN MARSHALL LICENSE# 778 SIGNATURE MP® MGF® JP[j JGF® LPGI E] CORPORATION[:]# PARTNERSHIP EI# LLC®# COMPANY NAME: EASTERN PROPANE GAS ADDRESS 131 WATER ST. CITY DANVERS STATE=ZIP 01923 TEL 1-800-322-6628 FAX CELL EMAIL �j �/y�ta-- �0� �o The Commonwealth of Massachusetts Department of Industrial Accidents > I Congress Street, Suite 100 Boston, VM 02114-2017 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING.X THORITY. Applicant Information Please Print Leoibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: ; - FAre you an employer?Check the appropriate box: Type of project(required): i.U I am a employer,with �'; employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 3.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.00ther 152,§1(4),and we have no employees.[No workers'comp.insurance required.] — 'Any applicant that checks box'f 1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 4Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: H Z Policy#or Self-ins.Lic.#: -k� L Expiration Date: 5 i I rt�: Job Site Address:L6 6 I"I2 V ry City/State/Zip:ob,'k 1`1_t v, JVV Ol s Ll Attach a cony of the workers' compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,325A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde ains and penalties of�ury that the information provided above is true and co,rect. Signature: 7 Date: .� > Phoneme t:: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ^I crf .;y ACOR '� CERTIFICATE OF LIABILITY INSURANCE I-. � 3, 3/2-.,_5 THIS CER7FiCAT= 13 133UED AS A MATTER OF INFORMATION ONLY AND CONF=ERS !i0 RIGH-13 UPON THE CERTIFICATE HOLD R. THIS CERTIFICATE DOES NOT AFFiR.1.1ATt IVELY OR NEGATIVELY A41END, EXTEND CR Ai T ER TFIE CO`iER.AGE AFFORDED B`! THE POLiOfES BELOW, THIS C=-RT!FICATE OF INSURANCE DOES NOT CONST TUT`= A CONTRAZT BETWEEN THE ISSUING !NSURER(3), :AUT'H:ORiZ_D RE?REScNTA T iV OR PRODUCER,A 1D THE CERTIFICAT=HOLDER. I;NI?ORTANT: !f the ::artificate holder is an ADOMONAL INSURED. the policy; p � , e&sr; e +agQ wrloeys / COMMONWEALTH OF MASSACHUSETTS ~� BOARD R:SM3Z;3 !w2 Gi«EITTE&; 143;::3 2>: E3:LC>� &G L ' EE\2: � LlEEN&EO 4;`14\ L7 G&; I (;T$L[;R i§ ]Orill§ F Ma;;H»EL �\ . /) 47 HOBART STREET \ D»NVERS Mi 01323- 19143 r, Date.......q.................................. OF NORTH�ti TOWN OF NORTH ANDOVER o�a * PERMIT FOR WIRING ss+CHuss j` d r This certifies that .................�tl...!...........:�....... .....`....nj '.n....................................... has permission to perform ........ ..C C.......L� r�/. ................................. wiring in the building of......IV.Qc� ��..........114P..I.u:.S....................................... at ...........IJP....... �U......... .. .North Andover,Mass. Fee.. .�.✓..........Lic. No. .. . . Xt C...... ..�----- ? ELECTRICAL INSPECTOR Check# 1r✓ Commonwealth of Massachusetts Official Use Only Department of Fire Services permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN HK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,gives FiON Owner or Tenant Telephone No. Owner's Address Sn n Is this permit in conjunction with a building permit? Yes bj--- No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. 6102!�� 1 - Existing Service /VO Amps 00/,2!/C)Volts Overhead[91' Undgrd❑ No.of Meters New Service 100� Amps J.L10 /o'?yU Volts Overhead� Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of thefollowing 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- ❑ Wbo—.-oTEmergency Lighting rnd. grud. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: . ' .....•......................... ""'•'•.•.•"......•. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Key Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent t 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*Vires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, tinder the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAM? LIC.NO.: Licensee: ySignature LIC.NO.: �— (If applicable,e ter "exempt"int is nse na�mber line.) I Bus.Tel.No.•_ Address: �� a• vt✓, — h d�Fl�� A1t.TeI.No.:��c°i y � 4 *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAVER: 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: $ 5r' 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 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. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 oe Re-Inspection Required($.) ❑ Inspectors Comments: ti 6 ------ Inspectors "`—Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ ►- Inspectors Comments: Inspectors Signature: Date: FINAL INSP CTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: 15?,Ila DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com ` y � r, The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA.02114-2017 www mass.gov/dia OSM s��y Wol;kers'Compensation Insurance Affidavit:Buildexs/Contxactoxs/Electricians/Z'lumbers. TO BE FILED WITH THE PERMITTING AUTHORU,Y. • .,Please Print Le 'bl A ' licant Information Name(Businesnns/Organization/lndividual): e J e Address: tA/ ��¢��•• � City/State/Zip: t4 Phone#: Are you an employer?Check the appropriate box: Type of project(required); 1.�am a employer with_'_L_employees(full and/or part-time).' 7. Navti construction 2.❑I am a sole proprietor or partnership and have no employees Working for me in 8. Remo deliitg any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself,.[No workers'comp.insurance required.]t 10[�Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or aze sole 1 Qq Electrical repairs or additions proprietors with no eiriployees. 12 ,2, Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11E]Ro6f repairs These sub-contractors have employees and have workers'comp.insurance.* 14.Q Other 5,11c,/c-L 6.n We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and We have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such *Contractors that check this&6'i.must attached'an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the sub-contractos have employees,they must provide their workers'comp.policy number. I am an employer that is providing compensation insurance for my employees. Below is the policy and joJi site information. Insurance Company Name: I' V-JL s Policy#or Self-ins.Lic.0.. c1 �b �- 7 y Expiration Date:. / Job Site Address: �� City/State/Zip: Attach a copy of the vvorkers ompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do Hereby cert0i under the pains and penalties ofperjury that the information provideda ov is true and.correct. Date: "7ot��s Si ature: Phone#: 8-11 y t official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Ifealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r 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 We, 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 ofthe 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 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 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(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. 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 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 wwwmass.gov/dia c ' I ' vOMMONWEALTH OF MASSACHUSETTS I C • - • ® i ' BOARq'O� I ELECTRICIANS THE FOLLOWING LICENSE 1SSUES ELECTRICIAN AS A REG JOURNEYMAN ; z V N. W ADDIN y G..TON - z : KE �W , r v 1 J 196 SUMMER 57 UNIT'..2. MA 01830-61301 I HAVERHILL , Location —A rerR Y -F- No. ]No. Date NORTIy Of x, TOWN OF NORTH ANDOVER „ Certificate of Occupancy $ # Building/Frame Permit Fee cHus CHU Eta' Foundation Permit Fee $ s� Other Permit Fee PwL--- $ .35 �J Sewer Connection Fee $ Water Connection Fee $ TOTAL $ //• l Building Inspector .. v, 7484 Div. Public Works PERMITA. -9�� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP h40. I LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION S+rcee-}" PURPOSE OF BUILDING O�©je 15 OWNER'S NAME (p y� c��e- ���� NO. OF STORIES SIZ OWNER'S ADDRESS ' ,(D K l ( l BASEMENT OR SLAB ARCHITECT'S NAME Mpaig _ SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAMEVi 7) ;W� , `� ^ AIN.SPAN DISTANCE TO NEAREST BUILDIN DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR n © `'L "' "" GIRDERS AREA OF LOT / FRONTAGE T HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW C SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE `p� 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 0 �o PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM AERSIPW PERMIT NO. /76"Z; ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY t ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED U a cl 1 1:2 e BOARD OF HEALTH SI NATURE OF OWNER OR AUTHORIZED AGENT 4 F E E PLANNING BOARD PERMIT GRANTED( / of 19 _ BOARD OF SELECTMEN J U L C BUILDING INSPECTOR DEPAII - _ � 7 BUILDING RECORD 1 OCCUPANCY 12 S!NGLE FAMILY s;ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I IRAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY VJALL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ '/. 1/1 1/ FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 22 J 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH __------111_ ASPHALT SIDING HARDWD _ 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 _ SUPERIOR OOR ADEQUAATE I-i NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) GAMBREL MANSARD TOILET RM. 12 FIX.1 _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR A TILE DADO t s 6 FRAMING II 11 HEATING f WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W T OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 3rdNOI NO HEATING NORTH Town of 4Andover No. 3151 - .:r,<<. :.': �^ o _ ori dover, Mass., A�t4 - COCHICHEWICK �tG, �AoRATED PPa\�`\_J �S` L BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 6 BUILDING INSPECTOR THIS CERTIFIES THAT . �H�E �Ic� ...................................................�..........�`...................................................... Foundation has permission to erect.......'.................�.......... on �.. ........ ......... .... T1.............. Rough to be occupied as.......�.Z...X oZ .... ......... ! �.... IV.... ............. chimney provided that the person accepting this permit s all 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 ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS_ Rough • ..1 � ........................... t`� ........................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL street No. Smoke Det. LFIII/FR /IAIl1TFR FINAI DRIVEWAY FNTRY PERMIT__ _ . Ke /✓orE: �,eoPE,ery G/.vEs .�.eory row.✓ mss E.sso,es �A� " /7 � A.c/O A.2E APP.Eo.�/�A rE SEE DE_.EL7 �iC 2G lv 3 PG zG Z •� ,` i Q� w y AP' ro , F 13 o'` o Y� Ic 13yzq x 22 7 - 1 \ JUL 1 //c'.rEBY CECT/FY TO TyE T/TGE/,�/SU•PD,�ANO �L Q T T1J Tf/E B.4N.r TygT T//EOti-ECG/.u6/S LOCATE'O O.V Tile LOT qS S.5[�iY.V ANO T//qT/T OGLES CO.!/FGt?iYI �N 1Y/T/1 T.S/E7'Ou/,✓oFiY4 A.�/�i��20N/NG .CE6vLAT,4J.t/,S' � /l �cG�I.eO/NG SETJAC�t'S FEOiIf ST�PEET,S f LOT L�.✓ES."' �D ��QO�E/�.� ��1. 1 F/ir75s�E.c CE.�T/FY T//.4T T.�.'/,S OA►�crCL/N6 /S LOG9TE0 /,t/ THE F 000 �i'gZq�O APE.4. Ae,4 5V �Q,P SyyewN O,SI Ff � ,g�Y P•4�vGL '� 9EP • S � r STAP �3'TEP//E ,PL.S. OgTE BOU.vO.PS�OETE.P,Y!/Ni9T/Or(/ Bo�,vv.v ey�,v,�o,P,N- /�lE,P,P/� .44,r -,�GivEE.P�.ti6 SE•PI�/CES u�uo A.1/OOf�E.P, AIWXS,gCs/!/SETTS MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date /C21 building Location Permit IIo73� 2�C I ; ry f lA -4,1do f r', M 55• Owners Name New 77 Renovation D ReplacementPlans Submitted FIXTUPFS frl W 01 03 x y z cc o� N = a yr O V to f' s of o W i" Q a x O z W d 0 H N W W O O a W !– cant s t- to O > A w o W Z a z a °" W 4 a a•- ° t- x cc us 0 i- 2 j F. 2 l.. W W d 0 > NL h V 1 FO- W z 4 W G Cr Ct O 2 0 N x Q ,tr > W O 2 Q Q 4 .� O O W — O W Q = O 0 Y W O 3 A O -A v � > Q o. t•- o SU11-6SOMT. BASEMEMT IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH. FLOOR ! I STH FLOOR (Print or Type) Check one: Certificate Installing Company itlame "�Itl Q Corp. Address— d Q Dky raA Goo(2.—' � Partner. Ma,Vol Ea /46� i:L/ /Y#a Firm/Co. Business Telephone: _'5*0 Name of Licensed Plumber or Gas Fitter �Tz` �/� L N��y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy E� Other type of indemnity Q Bond Ej Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application nn[� does not have any one of the above three insurance coverages. �tgnature f+ d owner/agent of property Owner Agent 1 hereby certify that all of the details and information I have submitted (or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under'Permit W-4 for this application will-be In compliance with all pertinent provisions of tho Massachusetts State Cas Coda and Chapter 142 of the General L►ws. By TYPE LICENSE: Plumber Title Gasfitter Signature of License City/Town: Master Plumber or Gasfitter APPROVED (OFFICE use ONLY) Journeyman /0 72 License Number T� 4 Date... ......12........-9 _ . 2393 f HpRTM TOWN OF NORTH ANDOVER p 0 � pp PERMIT FOR GAS INSTALLATION • o� a C7 SACHUSEtA`i O This certifies that . . . . . f. . . . has permission for gas installation in the buildings of . . . . . . . . at . . /.E?.. . . . '.. . . . . . . . ., North Andover, Mass Fee. ` `""Lim<l .!� 1� . . N GASINSPECTOR N WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD:File Location No. Date 2 %�Ift3 s °RTI TOWN OF NORTH ANDOVER Certificate of Occupancy $ 41 Building/Frame Permit Fee $ cHus t� Foundation Permit Fee $ c Other-Permit Fee $ T Sewer Connection Fee $ Water Connection Fee $ TOTAL $ ►FEB 2, 1 7990 AAt,Q_.yj-- -_. Building ihspector A Div. Public Works PERMIT NO. \ 1y -S APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAG>; 1 MAP 640. LOT NO. 2 RECORD OF OWNERSHIP DATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. LOCATION 01 PURPOSE OF BUILDING OWNER'S NAMENO. OF STORIES SIZE OWNER'S ADDRESS , J Afr,`y S� �, .A� �`O� BASEMENT OR SLAB -- ARCHITECT'S NAME (s 17� Jam' SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 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 BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM r 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 APPROVE BY BUILDING INSPECTOR DATE L F I A .1o7 A� ,.� BOARD OF HEALTH SIGNATURE OF OWNER OR U IZ%D AGENT FEE PLANNING BOARD PERMIT GRANTED 19 BOARD OF SELECTMEN BUILDING INSPECTOR WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY StCRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WALL UNFIN 3 BASEMENT AREA FULL FIN. B M'TAREA _ '/, '/_ '/ FIN. ATTIC AREA _ NO BMT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS II 9 1 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW'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 _ SUPERIOR II POOR ADEQUATE l NONE 5 ROOF 10 PLUMBING GABLE I I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. Of ROOMS GASOI L B•M'T 2nd _ ELECTRIC 1st 13rd NO HEATING •- 1 )'L1tt�IT N0: WOOD STOVE INSTALLATION CHECKLIST ley -S ; Permit A building permit is required for the installation of any solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A. New B. ,Type/radiant C. Manufacturer Ikk-n c k S-Zle roc 12,E Lab. No. I L K D- Name/Model No. �N).04-cL 911�0 Collar size 'Dimensions/Height `3� tt Length 16 ' 1 Width 26 Chimney New_ Existing B. Size(flue area) G rr C. Other appliances attached to flue(Number and flue size) D. Prefab(Manufacturer—name and type) E. Masonry/Lined Flue liner P Unlined (type b manufacturer) F. Height(refer to diagrams) CPZ T C EF 2201 cap S th �rpvy� STo U� TO C\e.hhy OVER Ict I 10"ER IQ' I 12') MIN. 2I MIN. 2 Miri. ,3t MIK `{io' lo'I 3 MIN. IZ ,MIN. 18if MIN. (FUEL/d5H .4GGE5y StC� HEARTH CHIMNEY HEIGHT Hearth(non-combustible) ; A. Materials B: Sub-floor construction 4'1`)woo C. Minimum dimensions(refer to diagram) Clearances and Wall Protection(see stove installation clearances chart) A. Type of wall protection provided B. Clearances(refer to diagrams) Fit ov,T — I6 JNW A 1 FIREPLACE CORNER WALL/CENTER 13 4 s - Town of North,Andoverof 40 oT a 11 OFFICE OF c� y` o COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street' North Andover, Massachusetts 01845 �9SsgcHuS�`t�� WILLIAM J. SCOTT Director (978)688-9531 Fax(978)688-9542 r Mr. Michael Clark 16 Ferry St. I� North Andover MA 01845 N dg 1 March 23, 2000 Dear Mr. Clark: Please be advised that upon an inspection on the above-mentioned date in regards to your concern the following was observed. 1} Mr. Finocchiaro has applied for and received a driveway entrance permit from the Department of Public Works. 2) Attached you will find a copy of the Town's zoning map showing that all of Ferry St. is in the Industrial S district and as such the contractor's yard is allowed. 3) The parking and or exiting of commercial vehicles at this location is allowed.-- 4) 1 have spoken to Mr. Jim Rand the Town's Engineer in regards to the amount of soil being deposited on the roadway and he has addressed this with the contractor on site and was told it will be cleaned. 5) The parking of motor vehicles on the street is allowed as it is a public way unless it is posted otherwise. I hope that this will satisfy your concerns in regards to the situation at this location and if I may be of further assistance please do not hesitate to contact me at 688-9545. Respectfully, � r W Michael McGuire Local Building Inspector L G gy Attachment Cc Terri Ackerman, Town Manager William J. Scott, Director CDS D.Robert Nicceta, Building Commissioner Rosario Finocchiaro File 6,111 -- BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 r k i t MEMORANDUM TO: D. Robert Nicetta, Building Commissioner FROM: Donna Mae D'Agata,Adm.Asst.to the Director RE: 16 Ferry Street DATE: March 21,2000 Mr. Michael Clark, 16 Ferry Street called the Director's office today at 12:44 P.M. Mr. Clark was referred by the Town Manager's Office. Mr. Clark contends he purchased his home in 1993. He contends his home is in the residential area. A year or so ago,his neighbor put up a fence—cut down trees and leases the back yard to big construction trucks/equipment. The neighbor's yard(Ray Finochiarro)is also on No.Main Street. The trucker today could not make the swing out of the fence onto Ferry Street. Mr. Clark is losing the parking on Ferry Street to construction trucks. 'Mr. Clark's question is: Was there a Driveway Permit? Are construction trucks allowed to exit that fence onto Ferry Street? ---_- 3 Mr. Clark would be happy to meet with anyone at his residence to show what he is speaking of. His phone number is 687-1429. t Please provide this office with your response to Mr. Clark's inquiry. Thank you for your continued cooperation. pe TO o� l,� \ t 23 AARP o ,g oop N 3.77.u -4 i uR qCY Pla"round. TF H O2• N METWuEN 'a _� rte.- �,00 2'4 AvE' 4 •1 4 Y Opp _ wtttQu I '� 12-4RI 4T w V � roa oo� 4`, No"1 SrV MPS C f� C5 e y a OF v+P R R•4 a-4 ,✓ 0-1 � / 1 �♦ �00 ♦ goo .� INS MS, G � bo is 1 B 8 ti (Z-4 � sir�44 Maio otsop#.* R 5 d Q 4 `�y1•rMAP`� �' � � .� ti a �� P4T12tsT s (�0 •Z Q h •S,. �_� � 'O GB_ D S Tt P M 1 1 J Z /� •OC Ery v"\ CIA \ R-4 O 0 y � CA vow IL ISL' v O .V Location A, No. L Z, Date R NORT1y TOWN OF NORTH ANDOVER ' 0 Certificate of Occupancy $ Building/Frame Permit Fee $ rigs'cNusE ,CHU Foundation Permit Fee $ s� Other Permit Fee $ Sewer Connection Fee $ u� Water Connection Fee $ TOTAL $ 9� uilding Inspector 9755 / Div. Public Works PEa31IT No. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE MAP 4-40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE — ZONE I SUB DIV. LOT NO. I LOCATION �O LSA /� �����,� / PURPOSE OF BUILDING d- C� tie c'� �7 ,'ln iC /T iJi y 3 2 OWNERS NAME NO OF STORIES SIZE OWNERS ADDRESS `c` �p�.0 t�� f BASEMENT OR SLAB ARCHITECT'S NAME l' •J SIZE OF FLOOR TIMBERS IST 0 2ND 3RD BUILDER'S NAME p� I G� t U +' SPAN /7 DISTANCE TO NEAREST BUILDING C 14 a, 0,e 10 `l DIMENSIONS OF SILLS C s_.�_ -- DISTANCE FROM STREET - POSTS DISTANCE FROM LOT LINES—S16ESOV REAR GIRDERS C� AREA OF LOT FRONTAGE /Ov _/ HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW eeee....tttt /`/ T' SIZE OF FOOTING O % IS BUILDING ADDITION A MATERIAL OF CHIMNEY IS BUILDING ALTERATION 'J L IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE `/eS 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 C' O s PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. - PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 1 PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SUILDING INii;w'a. SIGNATURE OF OWNER OR AUTHORIZED AGENT F E E col< OWNER TEL.# _ PERMIT GRANTED CONTR.TEL.# �J 19 CONTR.LIC.# _. H.I.C.# I f BUILDING RECORD 1 OCCUPANCY 12 ._ SINGLE FAMILY S.ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- ' - - - _ APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE d 2 13 CONCRETE BL'K. PINE BRICK OR STONEHARDWO PPLAS IERS TER _ DRY WALL _ UNFIN. i 3 BASEMENT AREA FULL FIN. B M AREA _ Y/ 1/1 l/ FIN. ATTIC AREA _ N_O B M-T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDNrJ'D _ ASBESTOS SIDING COMMON VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME -- .- - BRICK N MASON Y ATTIC STRS. 3 FLOOR .. .- .-. _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR ADEQUATE ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM- (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &_COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING ,. RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS -_ OIL _B'M'T 2nd 1 ELECTRIC 131 13rd I NO HEATING a Tc)NN-rn_ ® A. ndover No. d 12 _ North Andover, Mass.,_ S— �- 19 wpm BOARD OF HEALTH T TO pi:�; UILD Food/Kitchen Septic System /` � THIS CERTIFIES THAT ....... .......................... BUILDING INSPECTOR.�►..�.�h..�.�........... ..� ;�.�,..1��................................................. Foundation has permission to erectc�.....1�. C.K. buildings on .......... % .....� G .12. ........ ...1.A..................... Rough tobe occupied as ......................................................��. ................... .. ........................................................................ Chimney. provided that the person accepting this permit shall in every respect c ni to the terms of the application on file in Final this office, and to the provisicns of the Codes and By-Laws relating to ► ;,, iiist�action, Alteration and Construction of 3uildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION o; thF Zoning or 1wui ding Regulations Voids this Permit. Rough Final ELECTRICAL INSPECTOR Rough ........................................................... Service BUILDING INSPECTOR Final GAS INSPECTOR Div,�sy in C�o �spil �.icius Fie �- Rough Ci ce on the P Do Not Remove _ Final No Lathing or Dry Wall T ij w1)one FIRE DEPARTMENT Until Inspected and Approved by t� f_- ,ig Inspector. Burner Street No. Smoke Det. :, { IM C) i LOT 9 , a Ct '17� Sid , S deck 1STY. c WOOD t5 LOT 7 deck,(, 2 STORY f / WOOD �`•OJ} 6'+/�� (100 ,g.3 z 43,4 f s" iTp=D� FERRY STR: EE"T tin C) woo In 9 G� �Q� o z FORM U - VERIFICATION FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: ^,. �. G� Gl P_ a m< Phone 8 -( -773 LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street b f'elLIL Vl St. Number ************************Official Use Only**********•************** RECOMMENDATIONS O TOWN AGENTS: Date Approved Z2119VA� Cons rvation dministrator Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date !\Y1 I RE C L, A. R`1� - Cel (ct 2 e1'al(zs'" v -7 - L/ a 9 w T oix F /4� r��- i ' I t 1. -77777777r ____ ~:��. :��.- `�=% Ue_it�- :_�;t1__ r oo I � , F r i s t- zy tA .r. � f � Location_A No. Date L-/U pf "��o NORTH TOWN OF NORTH ANDOVER t ,�,'�'O A Certificate of Occupancy $ * i ; • Building/Frame Permit Fee $ U scNus"C e'�_ c Foundation Permit Fee $ � 1 t Other Permit Fee $ Sewer Connection Fee $ MAY _ �Wr Connection Fee $ 8 TOTAL $ �Sy r � G� Building inspector v_ 12Div. Public Works Pr-AI tl'l��. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. ZG E 1 MAP K40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK PAGE Zs'3NE SUB DIV. LOT NO. LOCATION i1 PURPOSE OF BUILDING Q�P(a� r�1 C�Q� CQS��K� OWNER'S NAME r /c A ( NO. OF STORIES 11 SIZE 'T 6OWNER'S ADDRESS ` -rp �� �nl` BASEMENT OR SLAB AR HITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME tM ;C `>R - ,,vt if 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 BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. a ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS t PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR TE f T'� BOARD OF HEALTH SIGNATURE OF OWNER OR AUTHORIZM AGENT FEE c a 714 OWNER TEL.# _ PLANNINGBOARD PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# BOARD OF SELECTMEN BUILDING INSPECTOR f' BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY _ STORIES I THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE E 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ DRY WAIL UNFIN. 3 BASEMENT 11 AREA FULL FIN. B M AREA _ '/ 1/2 1/ FIN. ATTIC AREA _ NO B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 —2—f 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDI!I'0 _ ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE —{I_ STUCCO ON MASONRY J_ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I- I POOR ADEQUATE NONE L 5 ROOF 10 PLUMBING GABLE I HIP BATH f3 FIX.) ) GAMBRELMANSARD TOILET RM. 12 FIX.) P FLAT 11 SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ l ELECTRIC 1 1st 13rd NO HEATING CERTIFICATE OF USE & OCCUPANCY . Town of North Andover Building Permit Number 189 (1993) Date JUIN 9, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 16 FERRY STREET MAY BE OCCUPIED AS remodel kitchen/single family dwelludN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO _Michael B. Clam, 16 Ferry St. ADDRESS North Andover, MA ��`""i Buibdink Inspector • 0TH Town Of over No. 18 C' 7`» O v dower, Mass., "Ov 19 COC HIGH WICOY. _' AORATED PPS\ �� '9S� �H � a : ® BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..../7..�.�i� L.... et"k�..... ................................................................. Foundation has permission to erect..*W.I.01t.... buildings-on ....I...�.. �........ ... .....�. ....................•••••• Rough � d Ir* to be occupied as...0&IV.�.. ji►.... .�.. . ..�' .+/ .. +�. ..� .... Chlm ` ne provided that the person accepting this permit shall in every respect conform to the terms of the application on a In Final , i/ this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of b` Buildings in the Town of North Andover. PLUMBIN I WECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Roi al G PERMIT EXPIRES IN 6 MONTHS P�/ UNLESS CONSTRUCTION STARTS ELECTRI AL INSPECTOR Rough �y.. .... ..... ......Cf ....... ... AWA.. .. ......................... Service BUILDING INSPECTOR Final Occupant.-' Per-riiit I?egzA17-cd to OCcii j)y I ittld[71g GAS INSPECTOR Place on the Premises — Do Not Remove �F_ h ' C Display in a Conspicuous i No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE ]APARTMENT Burner PLANNING FINAL dj,,g a�I CONSERVATION FINAL Street No. Smoke Det. cnn►ED /AAIATCR FI�IQI I`. r« DRIVFWAY FNTRY PERMIT_.__ -4AS'sACHUSETTS-UNIFORM APPLICATION FOR PERMIT TO OO GASFITTING (Print or Type) NORTH ANDOVER Mass. Date -L 9, ._ Building Location Permit Owners. Name (74 • :' New '"1 Renovation Replacement Plans Submitted FIXTURES N � Y W N z d as m a as a .o i tom-• W LU m o v m r s ai o r tmrr `a m m N W w o a a°c W r 4 WIt N a Ut x W usr t•- N O > W W 0 W z Q = a Q a Q W .11 W V S t9 Q O ~ Z Z O 2 W O N S Z• Q W G a r R 'X O C7 Y tL Q t9 V tr > G a t- O SUB-13SIAT. BASEMENT j IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR (Print or Type) Check one: Certificate Installing Company Name It �+ -�-c, Q Corp. Address p �--, = Partner. FzFirm/Co. Business Telephone: ( o��— (p Name of Licensed Plumber or Gas Fitter--,I lit, Insurance Coverage: Indicate the type of insurancc coverage by checking the appropriate box: Liability insurance policy 2!! Other type of indemnity Q Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner U Agent I hereby certify that all of the devils and information I have submitted(or entered)in above applicat' are a and accurate to the best of my knowtedge and that all plumbing work and lnsallations performed under Permit ittced for this aP C. n will be compliance with aA Per provisions of tho Massachusetts Slate Cas Code and Chapter 142 of the General Laws. By TYPE LICENSq. - Plumber Title Gasfitter Signa re f Licensed . Master P r r Gasfitter City/Town: Journeyman (o), APPROVED (OFFICE USE ONLY) License Number y � Date. . . . . .. .... . . . . .... NpRTN TOWN OF NORTH ANDOVER pF i��ao ,".1ti0 �--PEMIT FOR GAS INSTALLATION 49 SACMUSEt This certifies that . . . . . . k. ... . . . . . .�. . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . ... . . . ?F. . . . . . . . . . . , North Andover, Mass. Fee. . :. . . . . . Lic. No.. . . . . . :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Ddpt. PINK:Treasurer GOLD: File w MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING ✓'` (Pri nt or TT�.y�p}e)(� Mass. Date 197-3 Permit # 2 V t Building Location l�f`f: Y -S- Owner's Name_ ¢�(°f� l fZ-' (o a014 Type of Occupancy RESIDENTIAL New K Renovation ❑ Replacement ❑ Plans Submitted: Yes[] No ❑ (n W Vl Y Z s N 2 N � UO j N = x 0 J N W o V m ~ 2 2 O W F Q Z = O >- W Q m N r- a O O z N S N 0 W Q(j W = Z f., of a0 � > w W W W j Z Q x ¢ Z W ¢ W F- W F- 2 z Q W J Q = ~ H W O O > 0 t- U J y a w > X W o z. Q a < o o w a o �u 'x o c� Y u. 3 o tl J v y e a 1- o SUB—BSMT. BASEMENT IST FLOOR 2NDFLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH r'LOOR Installing Company Name BAY STATE GAS COMPANY # Address 55 MARSTON STREET Check one: Certificate R7 LAWRENCE, MA 01840 Corporation 6 4 C Business Telephone_ 508-687-1105 [1 Partnership - ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes I$ No ❑ If you have checked Yes, please Indicate the type coverage by checking the appropriate box. A liability insurance policy ® Other type of Indemnity❑ Bond O 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: i�nature of Owner or Owner's Agent Owner❑ Agent ❑ ereby 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 VII-Int and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Anent provisions of the Massachusetts State Gas Code and Chapter 142 of the G ` Plumber Signature of Licensed Plumber or Gas Fitter ------------ Gasfitter 'own - Master License Number M-429 LVED (Uf fICE Uf C)!JI YI Journeyman BELOW FOR OFFICE USE ONLY -14AL INSPECTION SKETCHES PROGRESS INSP_C7lON FEE N0. APPLICATION FOR PERMIT TO DO GASFITTING NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC, NO, PERMIT GRANTED DATE_..__�19 GAS INSPECTOR , i �M Fn d Date. :.. .. . . .. . . .. .. .. of HO oT"�ti y TOWN OF NORTH ANDOVER PERWT _4OR GAS INSTALLATION �4SS'q uSES 1111 r This certifies that . . . .. .'. . . . . . . '. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . .I. . . . . . . . . . . . . ., North Andover, Mass. Fee. ... . . . . . Lic. No:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GASINSPECTOR WHITE:Applicant CANARY: Building Ddpt. PINK:Treasurer GOLD: File Y` Bay State Gas Company 698016 698016 MARK 5123/93 052893 PERMIT APP! 15.00 1 .5.00 - .-'z1ytR•..,3i _ J..,. 1 lr:...,;ln..w7.,...:1r.-., .-+...;Jn..17"..,� �,,....j�....�.7�•..;(... 1J,"•-.:, ...:;J�` tJ,_.,�,7�,-� :7c•.,z.7�..._ �-.i,7 ...y�."..,r�lo..7yl�-..r,.�,.._ }.c%4"':`�C:�.�.a: a �:�� ,'C,,�?C`.a �4:C�* Jf�:C 4 f 4 C 4-:f u , •x �(4 �}.,f� ( } f a.,(.,}. (.v �(,}.,�a. 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