Loading...
HomeMy WebLinkAboutMiscellaneous - 162 HAY MEADOW ROAD 4/30/2018 (2) / 162 HAY MEADOW ROAD JJJ 2101104.B-0073-0000.0 I Dat .. ....Y26k.............. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING CHU This certifies that....................... ... .................. .................. has permission to perform..I, -.................. ..... ..... plumbing in the b *ldings of............................................................................................. /D$1 'k . ...... , North Andover, Mass. at Fee. ? .......... . ................................................................................ PLUMBING INSPECTOR Check 1 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l CITY n_ �� MA DATE � �".1 to PERMIT#- r 1 V 7 "k, L JOBSITE ADDRESS ( a. �-� l,�t U OWNER'S NAME�- f�P�-SS POWNER ADDRESS _ TEL= _j FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:[ PLANS SUBMITTED: YES© NO FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ _ __ I (; 1 DEDICATED WATER RECYCLE SYSTEM I ._-} I j _ ( I -- I . _ I I 1 VI DISHWASHER I ._-__..� _ —( —_- _� _ [ ___--I _..J I f ! _..__._l DRINKING FOUNTAIN _I ._-_-� __--9I. I _ _I ! J ! ....._.._( ! ___..._1 ,W_ . _....-_! FOOD DISPOSER _ i f --_I I ..___f. _._._..! __..! FLOOR/AREA DRAIN I 1 _- (. _- 1 I _...___ ____! __ __.P ___J ..____I INTERCEPTOR(INTERIOR) I J .. ! .__._._.! I KITCHEN SINK LAVATORY ..__j .—J ROOF DRAIN SHOWER STALL SERVICE/MOP SINK j TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ti INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES r;�K0 Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EA--" OTHER TYPE OF INDEMNITY Q BOND M OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ccurate to a best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia ith all P rtin n rovfsion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# FSx Q b I SIGNATURE MP Eq JP d CORPORATION Flu PARTNERSHIP P# ;LLC COMPANY NAME F��m `p;no, ADDRESS CITY to G V S _—_ -__ _ STATE ZIP L O Se TEL�— FAX —�CELL EMAIL ROUGH PLUMB ING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL/ SP TIO&NOTES Yes No THIS APPLICATION SERVES AS THE PERMITI ❑ ❑ FEE: $ PERMIT# j PLAN REVIEW NOTES { I 1 I V I I i I { i i i i I 1 � 1 i The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia LSM S��V ' Workers,Compensation insurance Affidavit:Bwilder�/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY• please Print Le •bl A licant information V1^ n Name(Business/Orgariizatition/In-divviidual):^ Address:_ �,C 6 Phone#: 024 ) City/State/Zip: AJC 7[[J1Nd-W . . ,Areyou an employer?Cecktheappropriatebox: required):em to ees full and/or part time).* ructionl.Q I am.employer with p y2. sole proprietor or partnership and have no employees working for me in g anycapacity.[Noworkers,comp.insurance required.] n i In I am a homeowner doing all work myself[No workers'comp.insurance required.]= 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or addrtioAs aw ensure thallcoitractois ertherpave-workers'compensation insurance or are sole • proprietors with no empl"ogees. I2.„�P—t1f zng repauS or addltio]IS 5.❑Tam a general con"eto and I have hired the sub-contractors listed on the attached sheet. 131.Q R06f repairs These sub-contractors have employees and have workers'comp.insurance.t 14.Q Other 6.Q We are a corporation and its,officers have exercised their right o£exemption per MGL c- 152,§1(4).11114 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: fi Homeowners who submit,this-MdOlt indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Tcontractors that check-ibis 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 workerscomp.policy number. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. � ('(� Insurance Company Name: �-f���� ` ��� / ( , �� o`-)(31a"1 Expiration Date: 6--15—( "� Policy#or Self-ins.Lic.#: �o �0 City/State/Zip:\y n fob Site Address: ' OA- J Oq r '–�( orkers' coin ensattion policy declaration page(showing the policy number and expiration date). Attach a copy of the w p by a fifib up to$1500-00 Failure to secure coverage as required under MGL e ?in the form nal viol of a25A is a aSSTOP WORK ORDER ation and a fine of up to $250.00 a imprisonment,as well as civil penaltiesIA.for insurance of the D and/orone-year P be forwarded to the Office of In day against the violator.A copy of this statement may coverage verification. I do hereby certi er the pa' s penalties ofperjury that the information provided aboveistrue and correct Date: Si ature: Phone official use only. Do not write in this area,to be completed by city or town offzciai 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 Phone#• Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their eanployees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is'defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'or trustee of an individual,partnership,association or other legal entity,employing employees.•However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicailt•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 _ -ner-ossany supply_sub>contractor{s}name(s ddress{es)-and phony-number(s)-along-with-their-certifluate(s)-o ---- insurance. 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 IndustrialAccidenis. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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#61.7-727-7749 Revised 02-23-15 www.mass.gov/dia 4/ COMMONWEALTH OF MASSAGHUSE PLUMBERS AND GASF`ITT)T'S ISSUES THE FOLLOWING LICENSE L I CENtEI q' A JOURNEYMAN P i7M E . is : t+I OPE SALSMAN JR 3W, o ST JA1FE RD W ' UG us 6 E. t'II ................ OF r►ORTry TOWN OF NORTH ANDOVER oar PERMIT FOR WIRING `4S�CMUS� - 1 i-1-L1 a This certifies that ................... - 1 .................. .. ......................�..... has permission to perform .k.''..`.`tom:-.. .. .+`�. --.....��.r.`..... ..... wiring in the building of........... .{l . ,.w.................................................... at .... .,� ,,.. �.-. te,,P -�X C�; ,, POD. North Andover,Mass. s�.............. .D , �1 Fee..: `.�........Lic.No. ......�1....... ELECTRICAL INSPECTOR Check# r ,r Y Official Use Only r Commonwealth of Massachusetts ff Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATIOA9 Date: City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice°�his or her intention to perform the electrical work described below. Location(Street&Number) �IA- e W g`- Owner or Tenant GA ?44 SL Telephone No. {_ Owner's Address S A MU Is this permit in conjunction with a building permit? Ys No ❑ (Check Appropriate Box) Purpose of Building ))Lj e.'\ ✓l N Utility Authorization No. ej Existing Service�_M _ Amps 40 / d qO Volts Overhead[T Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters + Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table maybe waived by the Inspector of Wires. '\ of No.of Recessed Luminaires No.of Ceil: TranSusp.(Paddle)Fans s Total Trsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- o.o mergency Lighting rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of as Burners No.of Detection and 0'qq GB ` Initiating Devices \ No.of Ranges No.No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pum Number Tons KW No.of Self-Contained P ............................ P Totals: Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW Local ElConnection ElOther No.of Dryers Heating Appliances KW SecN o.t o Devices or E uivalent \\ No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: J. Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value o�RAGE: k: Eb (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE Cnless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covera is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify, under the aims andpenalties o er u ,that the information on this application is true and complete. fy� P f / n' FIRM NAME: . J�6G M6 6i 2 I^ Icc. LIC.NO.: A4 AM 35 Licensee: `VLIR.A f e Mi rig. Signature LIC.NO.: (If applicable,xnter "e empt"in the license number(ine.) Bus.Tel.No.- Address: y 3 Ir k A So en c r o"t'I c'_ A Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: Signature __ Telephone No. Al ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an ' electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. 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 conceming 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 M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: v Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ ; Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass F?] Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPE ION: Pass 2 L/ Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: 444 42 Inspectors Signature: Date: Z AG DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 11 � The Commonwealth of Massachusetts Department of IndustrialAceldents W,- 1 Congress Street,Suite 100 Boston AM 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. j Applicant Information Please Print L_a ibl Name(Business/Organization/Individual): e e Address: 3 r lA4) City/State/Zip: SGrn('ru Phone#: 61 6 a�' g 3 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with_J,employees(full and/or part-time).* 7. ❑New construction 2.❑I am 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.Q 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 are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.El Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance. # 14. Other 6.Q 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.•Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 cert' under h ains andpenalties of perjury that the information provided bove is true and correct. L Si ature: 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#: c L Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if 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 Depaftment 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 pennit/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 o r BOAR ' LE TR I Gl ANS r' ISSUES THE FOLLOWING LICENSE AS:A REG; JOURNEYMAN ELECTRIGIAN, Q z `.& �'l fig , w PAUL.;G PERE I RA ,. W p {� Z ui 10 KRKSHIRE 5T ,' f' fAN,9RIDGE AA .02141-1902 128 'j :g -0 /3.1/16 81038 6 i i 777 Date.../7. �_.!22..... NORTH 3?°;t�`` ;•�"a TOWN OF NORTH ANDOVER PERMIT FOR WIRING AMUS This certifies that .............. Cb � lT Scl/1l� has permission to perform I S �... ... .�1F .. wiring in the building of.. ..............at........1.4? .....,(North Andover,Mass.. Fee..,5 Lic.No-06R.2 R........... ... r ELECTRICAL INSPECTOR / Check # � �` 7133 Commonwealth of Massachusetts Official Use Only NEW Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 Ch!R 12.00 (PLEASE PRINTININK OR TYPE ALL INFORMATlOA9 Date: 3 -07 : City or Town of: I(/o r-j d., A n&j e,,,- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ((o a \io.y ecaJ o W A Owner or TenantCc l�}'� ¢A,► 1�Qa S2� Telephone No. Owner's Address 1-4 a,y Vke-k SL0,..,t 1Za f Is this permit in conjunction with a building permit? Yes [g No ❑ (Check Appropriate Boz) Purpose of Building -Vv Zn a w, Utility Authorization No. Existing Service t 00 Amps 110 / X Y 0 Volts Overhead ET" Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders.and Ampacity Location and Nature of Proposed Electrical Work: r, k,,.\A JS, Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA " No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1:1o.o Emergency Lighting rnd. rnd. Battea Units No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches I No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Total Tons g No.of Alerting Devices No.of Waste Disposers Heat Pump I Number. Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW , �rj Local Municipal 11 ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water o,of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: (o C:k r c in S�Jb Wit,►,�1 Estimated Value of Electrical Work c�0 0 Attach additional detail if desired,or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: t-L(-0'1 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 cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [�]BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,that the information on this application is true and complete../� FIRM NAME: E.S c —o'TE lei,L, �v%L� /7 LIC.NO.: d,008 A Licensee: I��u V� E-5� //f Signature �-�- LIC.NO.:E (Ifapplicable,enter"ex em t"in the number line.) BUS:Tel.No.• 78 T&9 3bfJ3 Address: d l%; e /),-. -Z-v4-7S'64,10 i9'1/ Alt.Tel.No.: 778 c/9 ?7 E?3 *Security System Contractor Lidense required for this orkf if applicable,enter the license number here: 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 orae)❑owner ❑owner's agent. OvFrner/Agent Signature Telephone No. PERMIT FEE. $ �� :, ,F �. � �i '.•'4�5; y'^l.�. '' iy4,,, r ,#Y,��iv�sr'15� 'J�'i, t„r'ki�,;e!'a ,'1� 'y � rs�t-00r •i�� S L�'�` ';•('fib i, •-r1� ice: �F ` . +ti'le`.. � i"s'.':, �)fti� �'L t.� a �'�p .. '��F� 1 `;• .A ♦ �yc�-'� ��•�S• Oji Hy ♦ b .S ..!'3� �a: �. .. :jf,� r', y, 10, No �i+D r• dra , it t a � �'{ ��*M � s � .+v rAll' ✓ k tt Y "� " l� � ,� �' ����" ,y e TYr� j r 0 40 IZ OVA —sl 40 ' p �. `!_ocation No. Date hpRTM TOWN OF NORTH ANDOVER .a16ti0 A Certificate of Occupancy $ --Building/Frame Permit Fee $ 'SSCMUSEt� �,*ndation Permit Fee $ O44efi,06rmit Fee $ Sewer Connection Fee $ -Z&'Nter Connection Fee $ a Building Inspector Div. Public Works APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. AGE 1 ` d KBO. LOT NO. of 41 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ZONE I SUB DIV. LOT NO. F-I 1 LOCATION /�/�YmeA 9�d uJ �6 PURPOSE OF BUILDING S��'�O /1o�/j�YL OWNER'S NAME Z-Ve-NAME /- Z NO. OF STORIES / SIZE/X'/&' OWNER'S ADDRESS/,!� � m e.4lJ� kJ Far BASEMENT OR SLAB 7 T ARCHITECT'S NAME (t L� SIZE OF FLOOR TIMBERS 1STVZv/D '-2ND 3RD BUILDER'S NAME .Q/l�n / •Q� �® SPAN /� DISTANCE TO NEAREST BUILDING S7- C.' 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 FOOTINGa�Ya / X IS BUILDING ADDITION y� MATERIAL OF CHIMNEY //�� IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND So L,. 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. 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 BOARD OF HEALTH SIGNATU E OF OWNER OR AUTHORIZED GENT �.� F E E / 0WNER TEL.# 4'ee.-,�•g PLANNING BOARD PERMIT GRANTEOF - �/ CONTR.TEL.#.��.,2 �3 0 19 CONTR.LIC.#.Q i"O BOARD OF SELECTMEN BUILDING INSP[CTOR BUILDING RECORD K 1 OCCUPANCY 12 SINGLE FAMILY S-ouIES ITHIS SECTION MUST SHOW EXACT DIM.- SIONS OF L ND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIO .OF BUILDINGS. ORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. TH EPLACES PLOT PLAN. CONSTRUCTION �� 2 FOUNDATION 8 INTERIOR FINISH CONCRETE ` CONCRETE PINE (�,/j' BRICK OR STONE HARDWD PIERS PLASTER — DRY VJAIL UNFIN. 3 BASEMENT AREA FULL 1 11I FIN. 8 M AREA Y. /7 '/, FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM _ MODERN KITCHEN 4 WAILS 9 FLOORS !y�rta CLAPBOARDS B 1 2 3 r7 DROP SIDING CONCRETE --�— � WOOD SHINGLES EARTH ----yy ASPHALT SIDING HARD�VJ'D p� ASBESTOS SIDING _ COMIACN VERT. SIDING ASPH. TILE r t? STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. 8 FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE NONE - - - i 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) ,' AMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ V ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL STALL SHOWER ,o /r��lT/1✓ ROLL ROOFING I MODERN FIXTURES A F TILE FLOOR O ,€ TILE DADO 1 11 0,C ' 6 FRAMING 11 HEATING NOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR NOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G - UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 44. 1st 13rd I NO HEATING FORM U - IAT RELEASE FORM N 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***************** � VV. IVIle"? APPLICANT: RLL e,.g .sf�- c�.'o/I Co Phone LOCATION: Assessor's Map Number Parcel Subdivision Lots) / Street VL/ R01-iD St. Number �-- ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: Onistrator eApprovedConse tion Date Rejected Comments 40L x, Date Approved Town Planner Date Rejected -0 Comments I Date Approved Foo Ins c -Health Date Rejected •`14 Date Approved -7ti Sepc spector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date v. ,.y I,l S F- C) 11-1 �e/vb -/Dec CoA/ Tit/,j-CT6 R� elv Cc n 5 fi-u �f��� N Co • �o S �N �v Z 9 (o RNDove-f, :5 A/v �h p 12, 6 VeS ,L C en s e o//-/D J� ��- 7V�13 .�S'.3,�T.J •J � - . .•..,s•.. .. .-b+a.y,,; r. ,•, .. .- -'-lP'._• :-..,.......r •-i%-�� ,• 4 7'-, -`t I d - fA 77 NO 0/xr Coy�d<t� t4 No5 40 `? 0.0% . ,i .7.0 N s ti off ,8 { VQ £/ FS _ 5 - h `tea / y�Qv� I '• �aC! p �v'47 y II OiXe dy�„'lam-'r`: -.-_....__,- i ,'X,', i �vowas )O Xis„ odl �o)x/E I r' �J�aQ Q/►'' leo o nvn /V1 7 li9 L r A • i /( De CK f}pu5� Feun Dftf7-(ji 3 Deck' �o i"X Jy dy GAJ e-Y q Z a C. D lz 13 y yX 3 5-t'r�P Mi Cro L,9MS Lm+e-b 5 I! (� F I C., fed �G y� « '�!'� �S� C2 NAM� L �•FFG - F�m� 5 � DSK 71 na DecK ax •a -r -0 -IE -ROVEI-IfENT CON] \,,)CI rS, REGI 1101'% Illr STRATION B(")ar-d of Dui.ldi.m- Lilld '2 Boston , 0 .1( HWIE I[-1PROVEHENT CONTRACTOR Rcgistratiol-. 10"')740 0 /'-;'-',4/ (i. ........ Type INDIVIDUAL HOME IMPROVEMENT CONTRACTOR Registration 109740 ALLEN CONI.DTRUCTION CO Type - INDIVIDUAL ROBERT W . ALL-EN Expiration 09/24/94 86 ANDOVER ST N ANDOVER 01045 ALLEN CONSTRUCTION CO ROBERT W. ALLEN 86 ANDOVER ST ADMINISTRATOR N .ANDOVER MA 01845 COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF 1010 COMMONWEALTH AVE. MASSACHUSETTS BOSTON,MA 02215 ;® Ll "ENSF EXPIRATION DATE LONST,t. SUPr-RVISOP CAUTION 03/31/1995 FOR PROTECTION AGAINST EFFECTIVE DATE LIC-NO. RESTRICTIONS THEFT, PUT RIGHT THUMB NONE 03/31 /19 )3 040927 PRINT IN APPROPRIATE 0 1 P BOX ON LICENSE. 0 PP()'3ERT W ALLEN OZ *6 ANDOVER, 1T 0 z BLASTING OPERATORS SS -0 402-30-5309 go_ N ANDOWcIR TIA 01845 c" z z MUST INCLUDE PHOTO. PHOTO(BLASTING OPP ONLY) Rb. 01) NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: 05/04/195? THIS DOCUMENT MUST BE SIGN NAME IN FULL ABOVE SIGNATURE LINE CARRIED ON THE PERSON OF SIGNATURFUF LICENSEE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION, COMMISSIONER SV 40%Pre-Consumer Content •10%Post-Consumer Content Page No. of Pages 5 'i r' Horne tIII l?rr Venilent f nntf, ,.4 r,• 86 Anlnver Street I iJQRTN AP!POVER, MASSACHIJ) F i T� 4.3 Horne .t'i i`Orl (508) 682-7431 82-7443 T i PROPOSAL SUBMITTED TO PHONE DATE i Joes h and 9ve Larrza 686-4278 July 2-7 , lqq'4 STREET JOB NAME 162 Haymeadow Road. Lanza CITY,STATE and ZIP CODE JOB LOCATION North Andover Mass "f ARCHITECT DATE OF PLANS JOB PHONE None 7-27-93 Plans drawn b builder 686-42711 Or propoOf hereby to furnish material and labor— complete in accordance with specifications below, for thesum of: j dollars ($20_r�_n n p )• Payment to be made as follows: payment is 9, 35900ne half of remaining balance( 5, 175) to be paid when job is half com.piete-REwalning be paid when jGb is eGfnplebeO All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from specifications be- Authorized low Involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,acci- dents or delays beyond our control.Owner to carry fire,tornado and other necessary Note:This proposal may be Insurance.Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: C o n s t r u c t i on o f a s u n r o om( 14 x 16-',- ' ) 1. d e c k( 14 x 19 1- 2 1-41x4 ' on grade platform. Foundation detailsi32"steel lally columns sitting ! ; on concrete footings 41below grade. Backfill holes with ditt . 3//111gravel and landscape fabric will be laid under room and deck before building begins . Framing details : sun.room, 2.x8 floor joists with 2x.10 perimeter jcists .l-ianger.s ' to be used.Walls : 2x6 , Roof : 2xl2 with a double 71811i 117/8"microlam beams ser:vi.1 !;! as a ridge beam.Spacing is 16"0.0. Sheathing : floor, 3/4 "oslo glued sub f_loor ad- i hesive arid nailed then 211bc plywood glued and nailed on top of the osh. 1,1a 11s : 7/16"osb, Roof: 5/8"cdx plywood .V.1AIIs and underside of floor frame will ►,e cc)vC ed with tyvek ai.rwrap. Pine trim boards will be installed on the ext er.ior .at2 5"alum.drip edge will he nai. l.ed alone eave and rake . Ice barrier. along G.'ave, the rest of roof covered with 15 pd felt .'-0year fiberglass shi.ngl_ls will than I be applied .A shingle over ridcle vent and soffit strip venting will he i.ri.stal 1, d Woodgrain hardboard sidi-r.o will Lover the eater. jor- wall .4-And�-r. sen rerma-shie c-16 casement windows 2-Andersen perma-shield fl.exiframe window- t.,2rr'atone in I color will be installed . 2-Prosco 8-34 fullview steel door units will be iusta i lled ,also deadbolt and passage i.nstalled . 2-Larsen alum.combo. doo.rs to be ins'-.i lled . 2-Ve_lux Vs606 skylights with poi��rer openers and power venetian blinds to be i-nstalled.7'He c- 16s come with scre<?ns ,gri.11es ,ext.jatnbs .TTTc walls and floo j will be insulated with 6" fiberglass ceiling, with 9" all areas will. Oe covern(T with a 4mil. . poly vapor Barrier.Tlle existing bathroom window wegl.l be removed j and blocked up. 2"blueboard will , be screwed to walls acid ceiling th=en a er will skimcoat both . Patiodoor- will be removed and the opening Finished oft` . Interior trim will consist of. 220colonia.1 casing for the doors anrt Zv i ;1(. c V 3 , and Baseboard to match the house base.Nails will be set and filled on thi.� int' rfi or trim.Botb exterior and interior will painted with 2 coats( prinier, f- irii :�tt} � Electrical : o+atlets to code, instal 1. fanlight 200 .00 allowed for f.an ,6 lights, fanlight in batllr(:lont,cal)let-rir^.p�iorte wire, 2 f000dliahts , electr:i.c heat- 4 outside outlets , switches for skylights and fan. Plumbing : i outside Eaucet ne; r.. garage door, l faucet in the sunr.00m.doc!c will be }:wilt witi) 2x10 floor framte j on 32"1allyS. 5/4x6"deck ing will be nailed with spiral rlail.s . 6 ' stairs-,will I--)(- built ebuilt.Railings will be colonial posts and ballusters.9ides of decl� a nd the. front and side of room will be cligoed in with lattice sheets . lx8 and 1x.6 trim will finish off the lattice.addoor will cut in the lattice for access .A 4�,4 platform will be built near the sides doors .The deck and platform C;.dor? •l-ill i)r peessure treated .Alumgutters and doun—Ispouts will be installe ! on the sun?:ooip Ceramic tile will be i.nst t.11ed on the room floor( 3 .00 a.11.(� anc ) Ei. + ',cr. a ODD! or marble threshold will be inst=alled by the patio door openirt(r .Old r?eck and all debris produced from the job will be removed .Contractor will draw plans, and obtain building permit . i I Arreptaurr of proposal—The above prices,specifications r - and conditions are satisfactory and are hereby accepted. You are authorized Signature �,�a •c;* � ` to do the work as specified. Payment will be made as outlined above. Date of Acceptance: .1 Signature I r • p f�'T If , or Town of • No.3 3 20 J'&LIOW-19ty Qrt�114ndover, Mass., / A0RATED BOARD OF HEALTH Food/Kitchen Septic System . , PERMIT T LD BUILDING INSPECTOR THIS CERTIFIES THAT..... .. v � .. `. ........ .................................................................. Foundation has permission to erect,SM..11/..RVO..0.4..... buildings on ....1.41C.A.MAYAZOA*� Rough to be occupied AI ...*40.41V�. ....I. V... -log ............. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough Service BUILDING PECTOR Final Occupancy I'errnit Required to Occupy Bultdirig GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. 0MAIED MIATED PNIAI nRivF\A/AY FNTRY PERMIT _ _._ r. CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 332 Date SEPTEMBER 17, 1993 THIS CERTIFIES THAT THE BUILDING LOCATED ON 162 HAYMEADOW ROAD MAY BE OCCUPIED AS SUNROOM & DECK IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. y,ORTk o ,..•• ,,�ti CERTIFICATE ISSUED TO Joe & Eva Lanza �r •` " '� 162 Haymeadow Road .0 9 ADDRESS North Andover, MA aeLd- pt . , �ss,C""'� Buildin Inspector D Town of �� s �� over ® �L .. . _• , to D h11'&L /? 19 C OC H, wQ dower, Mass., ADRATED FPa\�.�� �S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS NSPECTORTHIS CERTIFIES THAT . 1 ..v .I . . .Z.0................................................................... Foundation .has permission to erect S10. ..... buildings on ....149. X&/.X&A Y./..� /,�I . ..... .. .... ..... Rought SCI C • �• —� to be occupied as :`.�/.:�N&A.-M.-IJUP� j...�40.411C �....I..V...V i ...... ...... Chimney � provided that the person accepting this.permit shall in every respect conform to the terms of the application on file in Final dlc 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 Fina' UNLESS CONSTRUCTION STARTS ELECTRICAL PECTOR � Rough�G Service BUILDING PECTOR Final Occl,tpancy Permit Required to Occt.tpy Bttllding GAS INSPECTOR gh Display in a Conspicuous Place on the Premises — Do Not Remove F nal No Lathing or Dry Wall To Be Done Until Inspected and Approved .by the Building Inspector. FIRE DEPARTMENT Burner PLANNING FINALCONSERVATION FINAL Street No. Smoke Det. SFWFR/WATER ._ FINAL 63/,Z DRIVEWAY ENTRY PERMIT