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HomeMy WebLinkAboutMiscellaneous - 16 PUTNAM ROAD 4/30/2018 _ 16 PUTNAM ROAD 210/021.0-0009-0000.0 1 I I„ ` Date.. ZZ................. t f NORTI� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING o VSs^CHus� This certifies that ................ ..................... has permission to perform .......... .4-(.fm T .. /........... ........ .. wiring in the building of. ate.. ............ ... ...... ......�l1/L 7-� ' t-*/" �T at........ ........... ......................................�................ , orth Andover,Mass. Z Fee...3 .......... Lic.No.....&Y ...1..!! .... ....... . . .... .......... ...... .... �i/� ELE ICAL INSPECTOR Check # �ry F 8107 Commonwealth of Massachusetts official use only Department of Fire Services Permit No. g 1 d 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigns gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 61 TA, A M Owner or Tenant J o A A/ R y-` --\/ a` Telephone No. 5 8;�gl Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building p W,—I i& ./& C, Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d �' ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: IPePGAC,p�57A/yb ER 4 R G f�A/V a- ff S 6- L!G H 7'5t o Po /T pAAi n G Completion of the ollowin 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 Lighting nd, rnd. Batts Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of ZonesNo.of Switches No. of Gas Burners No.of Detection and Initiatin Devices 1 No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No,of Self-Contained Totals: _.�.....__........_......__.._.... .._._. .. ........... Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local[I Loc Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: S.,—. Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications icing: q OTHER: No.of Devices or Equivalent r Attach additional detail if desired, or as required by the Inspector of Wires. 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 ❑ (Spec I certify,under the pains and enalhes o ) P ofperjury,that the information on this application is true and comple FIRM NAME: AA E N IQ/AA 4 C A C LIC.NO.: Licensee: R)e HA R p M I}/ !/)( Signature (If applicable, enter "exempt"in the license number line.) LIC.NO.: Al PS Address: Bus.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt L cl.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:S =ti The Commonwealth of Massachusetts k� ! Department of Industrial Accidents Office of Investigations �i�: 600 l 1 Washington Street Boston, MA 02111 www mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�bly Name(Business/Organization/Individual), 66 CA %/K,4c�_ /�} G J�lc,t�/�/Q D M A/L(io!/X Address'- q X7`0' P E (Y City/state/Zip: �f}-EIIA 111 f-f Phone#: .405 �7- l a-75;--, Are you an employer?Check the appropriate box: 1-9 I am a employer with—�— 4. ❑ I am a general contractor and IFE] oject(require[): employees(full and/or part-time).* have hired the sub-contractors pro'construction 2.❑ I am.a sole proprietor.or partner- listed on the attached sheet.t odeling ship and have no employees These subcontractors have olitionworking for me.in any capacity, workers' comp. insurance.[T10 workers'com .insurance 5. ing addition p ❑ We are a corporation andifs�mred.) officers have exercised their trical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL bing repairs or additions myself,[No-workers'comp. c. 152, §1(4),'and we have no 12.❑Roof repairs t insurance required.]t employees, [No workers' ❑ comp. insurance required..] 13. .Other 'Any applicant that checks box'#I must also fill out the section below showing their workers'compensation policy infonnstion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contrtors that check this box must attached an additional sheet showing the name of the sub,contraetors acand their workers'ramp.policy information. I ant an employer that.is.providing workers'compensation insurance for W.employees. Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address; �6 f //I�/�M S ]— City/StateZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penaities 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 !l of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby early under the pains and penalties of perjury that the information provided above is true and correct Si tore: Date. �. Phone#: Li 4 iL3'/ 7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Lieease# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Otber Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee,of an individual,partnership,association or other legal entity,employing employees. 'However the owner.of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shaU 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 evidenceat compliance with the insurance coverage required." Additionally, MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the , members or partners,are not required to carry workers'compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage.. Also be sure to sign.and date the affidavit. The affidavit should, • be returned to the city or town that the application for the permit or license is being requested,not'the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self.-insured companies should enter their self insurance'license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. 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.When 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. a The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, r 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.# 617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov/dia TOWN OF NORTH ANDOVER Fire Department Fire Prevention Office Central Fire Headquarters 124 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 William Martineau Telephone(978) 688-9593 Chief ofDepartinent FAX(978) 688-9594 �_. Michael Beir►1e ` tineau@bTownofNorthAndoyer.comwmar e Chief Iir m.beirne��Town.ofNorthAndover com Lt. Andrew Melnikas amelnikas(a)TownofNortliAindover com Fire Prevention Officer On Wednesday, April 9a'I went to 16 Putnam Rd. in order to check the property for the proper amount of smoke and carbon monoxide detectors. I found everything to be in good working order. Please call me should you have any further questions. Lt Andrew Melnikas N2 2463 Date...2../.y....... '... � t NOR7M 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �SSAcmUSE� This certifies that � --�� ' �-.-� ...................... .................................................................. has permission to perform .'.-� 4...... .............................................................. wiring in the building of.... .. ..... at ��......>._...� :..- -� - `'-� �.�. ................... .North Andover,Mass. i Fee`-5..... ....... Lic.No!:?//.zr.. .... ...........%.'........................................ V ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer TBFC0W0NWE4LTH0FAf4MCY1USE77S Office Use only ff DEPARTAf ENTOFPUBLIC&FETY Permit No. CD� BOARD OFFIREPREVENTIONREGMTI0NN5270212:00 Occupancy&Fees Checked APPLICATION.FOR PERAIT TO PERFORM p ,ECI CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dater- Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant e • , Owner's Address 0a 1 2 , )�A ,Y,,, ,e-( . 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 Underground F-1 No.of Meters New Service Amps Volts Overhead ® Underground ® No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.ofTransfotmers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground El ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal ® Other p Connections No.of Water Heaters KW No.of No.of I Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER- f i It�slyditoeCoraagc Ptxsua�9�thetacgmantuse�CalLaws IhaneaumatLiabk r PbhyirtduchrgCm#gte C',vvaaWcrgs%kg3ttialegz4erg YES 4L;:J NO IhawaftnftdvaEidptooffofsmxiDtheOffi=YES F-1 If}Doha%edKxiWYES,pleaseirdi IC#EtMMCfWArdWbyt gthe box nvsL>RANCE ®' BOND [� OTR ® ftm )_ _ Z e9 WctklDStnt hnspactionDWeR que ted Rao Eom&d ValuedEimbial WcdcFm 7 Signed tmder�iePF�>a)ties� FIRMNAME f;/M/YtL Lioa>,see � ot, .,r,.; �— BuixssTel.Na Alt Tel Na OWNER'S ML ANCEWAIVER;IamawaaethattheLio= not theinsuratme o�ssu�C>tralegvnale�tascagt>BadbyMa�SselcsGatr3a►Iaws ar3d�atmysgtmhaea��tsp�nitonwm�sihis Wig, (Please check one) Owner ® Agent 17 Telephone No. PERMIT FEE��i Location I&I No. 3 Date NORTH TOWN OF NORTH ANDOVER # s Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ p s�cNust 9 Foundation Permit Fee $ _ J Other Permit Fee Poo � $ TOTAL $ ,- Check # �N (� t 4 .• Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING r BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/I t of Buildings Date Z SECTION 1-SITE INFORMATION 1. Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number V 1.3 Zoning Information: 1.4 Property Dimensions: Zon d Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R rd Provided 1.7 Water Supply M.G.L.C.40.1 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record ame(Print Address for Service Signa Telephone 911 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Mn Address Expiration Date Signature Telephone '... 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number M Address 0 Expiration Date ^ Signature Telephone V ' Y . SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work(check ali applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: .4 0'-Ad 1 fir, ai 1ho �rvv w� �oc�L. ►�� > 33 ' SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building _ (a) Building Permit Fee -� 5 0, Ob Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X tbl 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 ?j 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 autho a to act on My be alt,in all matters relative to work au riz y this building permit application. Si na re of Outer Date SEC ON 7b OWNER/AUTHO IZED AGENT DECLARATION I, 1AQ,CAI L4 as Owner/Authorized Agent of subject property Hereby declare that the statements and info ion on the foregoing application are true and accurate,to the best of my knowledge at d belief Print e Si e of Owner/A ent Dr NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T MBERS 1 2ND 3RD SPAN DEV ENSIONS OF SILLS DRvIENSIONS 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 �.. CERTIFICATE OF.C'"LITY INSURANCE 2 ao P"couc" TMIS CERTIFICATE 18 ISSULO A8 A MATTER OF INFORMATION .SIM O'CONNELL INS. AGMY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CWPICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND FXTENO OR t311a88RRY 4 CONI.IN INS. AGEIICY, LYC. ALTER Ilii COVE.J"E AFFORDED BY THE VOL �CIEB !/FLOW. 554 PLEASANT ST. I PWRERO A"ORDMG COVM46 WORCESTER, MA 01502 _ usum Pdeu"tR� UTICA.MUTUAL INS. CO. FREDERICK ABASCIANO DBA: �w—au-R-are: ZURICK-AMERICAN INS. PIECE OF THE BEACH !otsumm 0- 10 VANCROFT AVE. rWUA6RC: SH,kEWSBURY MA 01545 IMsuRsaac: COMAGE8 THE POUCIEB OF M15UAANCE US'.EO BELOW HAVE BEEN ISSUED TO THE PASVFE0 NAMED AWVE FOR TW-KtUCr PEROO INDICATED.NOTw(THSTANDING ANY RMIRENW.TEAM OR COW)MON OR ANY CONTRACT OR OTHEA DOCUMENT WITH FIESPECT TO WHICH THIS CEATIRICATE MAY RE MW OR MAY PERTAIN.THE INSURANCE Ar-+ORDEO 9V THE POLICIES OESCRISED HEREIN IS SUBJECT TO ALL ThE TERMS.EXCLUSKNS AND CONOITION.S OF SUC.i PO"198.AGOREOATE LIMITS SHOWN MAY MAVE SEEN AEDUCED dY PAID CLAIMS. TTPE OF 10MRAMN Pou"MU11llR I wm o UA6LrfT I EA:H0=MEN= ^ ,&.500 000. A COMMEta,4LGeNEPIALUABILM CC=1602984 il/S199 11/,5/00 {rnE-Aw we s 5Q 000. Cu►IMa WCCUR o6 OMR)IDV(Rey*" S exci P♦�t]oWLAA s NURY 00 000. _ GENERAL AGC.Q=4TC s 000.000. ML AeopoluTs WT.PPu"Ptk ol10ou %-COIAP,DP AGG 61 000 000. Pa.•G,7P1O wa ANTOYDIRRUAMUff coaeINED81N4auw j AYY AYTO I(ft acww) : ALL OWNED AUTOe !^ y elOLra..Antr s tdIEOUiAD AUTOft wr.�r.on1 - /IDM ptiM+Ap AUToe j(pw wcldwu) i PROPERTY DNMGe f (Por doo"At) eAwAOE LUIe1lfTT ANTO O+wY-e4 AOCloam 11 AN r Aura EA ACC S OTN9ITHAN AUTO Dir` -too ✓I FtxCtee UAa[!TY 'BACH OOCURRENCE 'b occum El CLAMIDMID[ ppReoa !a 'i DwuVIe1.0 ;s "6TOMr04 1 tpORKtRecOnPtMNnoN.Ip '"� wCSRATtY VAPLOWM'LAIL" *SEE ROTE BELOW* 4/30/99 4130/00 E.L EACH POMENT s I QL DIi'EASS-GA 6MkOVE i E.►.016""-Poucy UOPT S OTN6A I I 1 _ I 9ElORIIIIOR�OPl11AT10NefL.OCATA'>t1ilVEMIgpIQCWMONeRODEOIY 1Pt10YNIlONe *WORKERS COMPENSATION INSURANCE IS IN FORCE. CERTIFICATES OF INSURANCE DISI' BE ISSUED DIRECTLY F= ZURICH-AMERICAN BY AGENT, AND ARE AVAILABLE UPON,EIEQUEST.* CQRTIRCATE MOLDER •oww.%L IOmmw e1/ma L.tme: CANC%LATM —V..----•— sMotn.P N.Y os Twt 4!!OR aoeA.ato�e_�aGAMGttAlO t�vni TM6 E�PIRntrON FOR INSURED'S RECORDS 0419 TI(sReos.TIIIt,eRuwo MMUIE"*ILL FMIXAVOR To 1141` xa DA`s WWI" wma To T41 CORT110 ATE RoLO@R NAMED TO TNs Lspr.OUT PIt,uA1e Tp DO 30 s au rove!No now 0.11 u4Plll�Oi11N� yPo11 RaufWt ITS AatMlss OR A6NWINT P faxed; 793-1953 AI!►NOl10W ATr Ll� Zi-S yNn 0 ACORD CORPORATION 19M 90vi SKI 113NKODO xTr 999tt9L90:T 3Yd. Zt=60 00/99/to FORM U - LOT RELEASE FORM ' INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *************``****************APPLICANT FILLS OUT THIS SECTION*********************** APPLICAN"[C' ' 1l�t a fj1_-6� PHONE ' C'1 J�(, LOCATION: Assessor's Map Number 0-)-/ PARCEL DQ SUBDIVISION LOT (S) _ STREET ( 1�,n l�rI ST. NUMBER_, *****************************************OFFICIAL USE REC MMENDATIONS OF TOWN AGENTS: 1W,54a/l 191X33' Above Cora ov CON ERVATI AD NIST DATE APPROVED 1&-t U DATE REJECTED COMMENTS "L) t1` 'T�� � 6"1 V) kod TOWN PLANNER DATE APPROVED i DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm NORTH oo over Z ' VIANo. 3 r- Ao dower, Mass. COCHIC MEWICK ADRATED P?�,`�� 1 S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT C41444 140{ � BUILDING INSPECTOR ... ........................... .A..l�. ............ ................................ ................ Y Foundation has permission to erect........1.�. . ... buildings on J.6......AV.� A.I .........�..... .................. Rough to be occupied as..........A...b.O we.......Groo-0......Pool.......voi �,r+r � I Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applica on on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Co struction of Buildings in the Town of North Andover. M a #0 �. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough ............. ...... .......................... Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. swnw t x 3 2 04 Date... � A M 40RTH TOWN OF NORTH ANDOVER pF4��to 4, PERMIT FOR GAS INSTALLATION �,SSACHUSEt m O This certifies that . . . .: !,c., r . . . . . . . • . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . .� /�!�f Z-<-. . . . . . . . . . . . . . . . . . . . . . . . at . . .lf . f. .� . .{ �`I ��� !.�.`. ., North Andover, Mass. Fee. . . y J. "Lic. No.. ; . . . Jam. *.' a. . . . . . GAS INSPECTOR y WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MAP a ti o PARCEL p a p ORM PLICATON FOR PERMIT TO DO GAS FfITING ITYPe or print) FORINARD�iate 19 NORTH ANDOVER, SSACHUSETTS Building Locations 6 Al/- T AliPerm it# Amount$ � Owner's Name �2S I�A�.r-�-tr y " New Renovation ❑ Replacement ❑ P Plans Submitted 1(/0 � c w � w cn w c - -zc SUB -BASENI EV — ` — z C w = C T c. BASEM ENT IST. FLOOR a` 2ND . FLOOR 3RD . FLOOR • JTH . FLOOR I 5TH . FL00 R '+ 6T II . FLOG R 7T 11 . F L O O R s T H F L O O R (Print or rype // Name �e i iG l f LF4 Check one: Certificate Installing Company Corp. Address 9-3 P i7i S J i rh C-rff1+')v pp-q-fS, Partner. Business Telephone g)9' g7S 27 2°/ Firm/Co. Name of Licensed Plumber or Gas Fitter F'NSURANrCE COVERAGE curent liability Insurance policy or it's substantial equivalent. Yes Check one: ave checked yes, please indicate the type coverage by checking the appropriat box Noo y 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 Laws,and that my signature on this permit application waives this requirement. Signature of Owner orOwner's Agent Check one: Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application wibe nthe compliance with all pertinent provisions of the Massachusetts State Gas Co e a Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title plumber City/Town 202391 Gas Fitter Liceii., umner Master APPROVED(OFFICE USE ONLY) �—Journeyman Date z!�.-. .`/�: 957 4058 f NOR*M q O TOWN OF NORTH ANDOVER l� PERMIT FOR PLUMBING SgACHUSEt This certifies that . . . . . . r has permission to perform . . . . . . . . . . . . . . . . . . . . . . . r plumbing in the buildings of . . . . . . . . . . . . . . . . . . at. .AG .��.?�!`1!.�g�???. ./t.�. . . . . . . ,I; North Andover, Mass. Fee. . ©. Lic. No.. ,2 .0. . . `.'. . . . . . . .�. t`.✓ �_:? ... . . . e P�L�IMBING INSPECTO� 06/23/99 14:08 40.04 PAID WHITE:Appl%128/99 14{OIARY: Build%Wept.PAID PINK:Treasurer k f FORWARD MASSAC SETTS UNIFOR ERMIT TO DO PLUMBING MAP ��- � (Type or print) NORTH ANDOVER,MASSACHUSETTS 'PARCEL GYy S _ Date 779 ate Building Location 1 G &TNAIII Owners N Permit C(o Amount �! Type of Occupancy 'Pune 1/1) New Renovation Replacement Plans Submitted Yes 11No FIXTURES z wCn Z Crw e�H w H z z h a z o W � w � � VC- x z x a a H d d w w x w CA cn Eo a SLRBM B�gIVI'1�II' � s ISL Eli" ZIQ FLOM 3Bn FLUB 4IH F"M 5IH FLOOR 6IH FLOCK 7IH FLOQ2 SIH FLOQt (Print or type) n Check one: Certificate Installing Company NameP� . Corp. Address Z 3 Z 42=,fteq� S7, - Partner. yk c-/7/t/0v 1 LSC Business Telephone al f- g?J-y Zg 0 Firm/Co. Name of Licensed Plumber: W,11� H 71:W Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy M____ Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S t bing Code and Chapter 142 of the General Laws. By i a ol wenseaum er Type of Plumbing License Title —2—o2-g9 City/Town LicenseNumber Master Journeyman APPROVED(OFFICE USE ONLY 1_I �r Location + S i S� 1 �1 N VLA �VIr� T No. -`� _l Date Ot NORTN TOWN OF NORTH ANDOVER 3? °... O` 'J ; Certificate of Occupancy $ ° ; #41 Building/Frame Permit Fee $ / Mu cam Foundation Permit Fee $ sACst Other Permit Fee $ Sewer Connection Fee $ •� 1° �Wa�her�onnection Fee $ TOTAL $ / —r 301991 Building Insl3i0oF- Div. Public Works PERMIT NO. I APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. I LOT NO. 2 RECORD OF OWNERSHIP DATE [BOOK 'PAGE — ZONE SUB DIV. LOT NO. LOCATI , /` Nc`� d V6 PURPOSE OF BUILDING �lwe A OWN NAM u I NO. OF STORIES , lJi E—C•^�-1 _Y_I�1YYi �[ OWNER'S A DRESS / A+,� � ��p L BASEMENT OR SLAB —_ ARCHITECT'S NAME 1 IJI V�G✓y SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN v - DISTANCE TO NEAREST BUILDING o DIMENSIONS OF SILLS DISTANCE FROM STREET 6)(6 " POSTS Q�1 �� DISTANCE FROM LOT LINES-SIDES /1"" REAR vim^` "' �a GIRDERS /C,p/� AREA OF LOT J FRONTAGE HEIGHT OF FOUNDATION M,`I J /THICKNESS '2 IS BUILDING NEW O SIZE OF FOOTING o � X 11 IS BUILDING ADDITION I MATERIAL OF CHIMNEY �� /?Lx IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENT[[S!!OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY 1p 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 :?nQad 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. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED AMP lfglk,,4� BOARD OF HEALTH SIGNATURE OF OWNER OlVAUTHORIZED AGENT OWNER TEL.# F E E o -�- CONTR.TEL.# CONTR.LIC.#Q 2re3 PLANNING BOARD PERMIT GRANTED 7 / 19 _ BOARD OF SELECTMEN BUILDING INSPECTOR .X BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION I 8 INTERIOR FINISH CONCRETE g _ a 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D __ /L{ 4 j/ PIERS PLASTER =—__ 'MA ,��'A' �x�'S�� , j��/1- ( `�V lO l DRY WALL Q f'�G 7�,(/ Y( rI_/ UNFIN. 3 BASEMENT AREA FULL I FIN. B'M'T' AREA 16 To i/ '/p V. FIN. ATTIC AREA NO 6 A,BMT FIRE PLACES 6k-6 - HEAD ROOM _ MODERN KITCHEN _ [� �/` v/�, / 4 WALLS I 9 FLOORS '^LAPBOARDS B 1 2 3 1,ROP SIDING CONCRETE WOOD SHINGLES EARTH __---111_ �� �� /f�c'� 70�� I� (��pjy� ASPHALT SIDING HARDV-/D �1�/ J� /tel v �J ASBESTOS SIDING _ COMnnCN CCJJ ) STUCCO SIDING MASONRY ASPH. TILE nQa (J (/ � f ' /T STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ ��C►RQ BRICK ON FRAME CONC. OR CINDER BLK. -- STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING / GABLE I HIP BATH (3 FIX.) _ J 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. &COIS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING I �- RADIANT H'T'G _ �! UNIT HEATERS y:C�_ GAS 7 NO. OF ROOMS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING ,;.WWIG. NORTII v 111 AL own ojL b Avlftldove � u 0 No. 325 6 OL _ �-- dRIVEWAY ENTRY PERMIT - Hc� n� er, Mass., �Y S0 195' 1 C ni HEw CK V AOR Qty\ SS BOARD OF HEALTH PERM I LD THIS CERTIFIES THAT... .r i.... r1"C I LI.. ................................................ BUILDING INSPECTOR has permission to erect■.. '. �. ••• buildings on ..... .... ••........ Rough Chimney to be occupied as...... +r. .....�5:.. ••••• �S•rf`. ••!.i4.!� ••••••••••••• •`•.. Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTORRough� Rough UNLESS CONSTR ION STA TS _ Service Final ........ . ... ...................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises .FIRE DEPT. Do Not Remove Burner No Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector .. . . _ ar f a HENT OF PIySUC SAFETY \ z' AVE A. COAAMONWEALTH <. OFi?L•STt)H,MkSS.,02215 1y` qtr ' MASSACHUSETTS r c{ * a IC-NO L ,.EXPIRATION DATE DATE r 3 e -CTiVE i �e .RWf31 ! 992 STRICTIONSj 1'.iS.A 119 1 a fF i ya s ti L [L, .� r.4 J' v > s 4,1 6 0230 SS . a r;. f 'nom PHOTO(BLASTING OPR ONLY)" FEE: Y7T-VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY y,` `-.:7 • HEIGHT STA A'EO-OR "SIGNAtURE.OFrTHE COMMISSbNER 5;4 ' DOB" :. ;.. #`y F: a SIG.NATURt •" NT THIS DOCUME .1A!JST 9E CARRIED ON THE PEFSN.I HEN bF. 'j't F,�.^Ly_ �'.t r• -� ,_ :j A.. THE HOLDER WE V' •ED IN,THIS. OCCUP A:f? \••••: T THUMB PRINT .•S _ �f•• •> X z �-{r7