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HomeMy WebLinkAboutMiscellaneous - 17 MABLIN AVENUE 4/30/2018 (4) / 17 MABLIN AVENUE J 210/011.0-0037-0000.0 l i :I ti � � Loc / 2 IPA11 ation � !N �y� No. In a Date 1 q i f MORTM TOWN OF NORTH ANDOVER " c9 Certificate of Occupancy $ 16. 41 • ; Building/Frame Permit Fee $ Foundation Permit Fee $ 's CHUSE Other Permit Fee $ `- Sewer Connection Fee $ Water Connection Fee $ TOTAL $ E3 - ,A(ASM` --- Building Inspector � 3 04(& 11:25 11:25 136.00 PAID Div. Public Works 1'I�IaMIT IVO-�® � A1'i'I.ICAI'ION FOIL PCItMIT TO IIUII_11***** /ORT11 ANDOVER, MA 37 a_ N0('/1NIs(a�-`�I�\•I,,tNI/01N 7dsnl R-4 s11111lly.1.(►rN//. 3 0.�1 E OO�K !'AC,E "L' —`� 202,20 �i/►( .a'traaN_ 17 _Mablin Ave. -- �-1ef- 103? • �nwwEll's aA1.lE .. INNIIYIb1;17E1N1411nlx; Deta- c garage Josgpll Pi rrotta y ►Iaa (�r sl(�Ilks _ 1 �—— .nv1�N°sAnl>eltss Sl2F 17 AlablYn Ave. No. Andover ASI-1-I NrCMSLAIa 25' X 25' `AN/eM7E('r'SNAAIF N/A 251 X 251 ---._ fDIN/t)Eta•S K,&0E WEfw fie"TMNIENS NJA ! Payette Constructio C Company oo parry SPA" 3 1 Na{AN(1 7l)Nl d,14k,1 IRA@ I NNG 67.7v --- ----=---__�__ lalsrANct tNn1.ISTle�r fA --r w1ENstcmai(x'stt t.s 4X6 P.T. ---�_ 57, _ IIIAOLNsII?ZJs67F iM�'a5 IUSIAWE FrtMlgot uDrEs-slnEs 5_ 7# 69 9 . 6X6 AUDI-A C*LOT Rear 18 "LIENMWSOFCAIRIXKS NOA 10,000 FR(*SYAM 100 , aSl $= X13 r 3s' - e�eC,trr/>)-FrAYiiLlTt()r1 15 UI Yl.ahi[;NkN1I .!.!!lCI:NE$$ 1®i/ Is wn1.l�aNr AIT/I(DN =slat ot.t lx�u►x; :e_ .�. . Yes 20.1 x 10" iS1D1►11.[>oN(;wLTENATI(IN MAIERIwI.( EIYteNEY NSA IS IDWr N711_®Uet.U11J[i C(INF(JRM TO NE(�I 11NEMkN1"S OF I)►11;0?4-U .IDtVffll Et LAM Soli d CUM —^�`T�-----""�------ -- Yes t1 Aa(NI full;Ct$JrDECiEn TO r(yWIV WAl'ER N(1'\R( e APPEw1_S AC77(aN,IF A►DY N/A - _ Variance granted Is Mill OfWMIECsEli1 ar0MCEWEA December 8, 1998 N/A IIrtI1I.f11NC ("ECI Ela TO NA rlgtA!r;AS I INE ._ IV,1-f 1r•TIANS 3. t'NAYl/tT!•IPIFnN116Af'IOP1 N/A - �J p I.ANI)COST7� PAGE1 fit 1_r `1 xrrSEc-Tk*j5 1-3 �\�e �3©� ZS Esr.iDtrx;-Ccffir , , L/ 1?ST_ lit 17G.c/A 1 M. Sq.FT. 28 £t I(INIL A!E'1l:RS AN1S f HE nrr(Nrl'Stl la> Qtalt r)INr Erl. rselx;- caul rZNNI1c»bI N/A s%o�I 1c 1�t R►n r►Ica N/A �!'1AC1tlt)(;ANA/.ES"STC/y,1F(111MY[1SfA'IEFIRE REGIN.Ar11>M PLANS AIUST13EFit-EGIAND AM'A4YtDjjy1N/1tj)IN(i/t1SWCr(�t rG 111111.IIINc INSPECTOR ~� /)w ra:t et I.1 a _ raw/aEltsTtaM 686-2930 xrrA_tl=1x_0 1 454-5223 t �_11(:N-\11NlI:Ije:.x+'�. .°�,���o�v.a..7'y►e,� '_"' — -._.— j ( '. n1:r1Dt.t1(71I 021304 i t W31 I- 1,361 A 1.� 1 O l f341 P°INANalolt.\FOBrIt �� t l,s�iLirS;L; FORM U - LOT RELEASE FORM e2y� 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. *****************************APPLICA,NT FILLS(WT THIS SECTION************�***** A3,�,t. .�. z16-Lf- szz2 3- 1706Eg PAlcirr APPLICANTS pSoph Q)Z)L0:tn91 PHONE a 1340 LOCATION: Assessor's Map Number ©r 3 7 PARCEL SUBDIVISION LOT (S) ZO Z� 3 STREET_ 7 / (6? L /N Avg - ST. NUMBER_/-)— t **** * ****** *********** ** *OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED 9 BATE REJECTED r COMMENTS ��-� �- TOWN PLANNER DATE APPROVED 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 4NSPECTOR DATE Revised 9197 jm , " . t 40RTN " p e, tip • o �, rYCE 6E ;HAW p TOWH CLE:,K NORTH ANDOVER 9SS�CHUS� ��'• I� .^. I 1', Irl TOWN OF NORTH ANDOVER MASSACHUSETTS BOARD OF APPEALS Any appeal shall be filed within(20)days after the NOTICE OF DECISION date of filing of this Notice Property: 17 Mablin Avenue in the Office of the Town Clerk. NAME: Joseph Pirrotta.�___ DATE: 12/9/98 Mablin ADDRESS: 17 Man Ave. S PETITION: 047-98 j North Andover, MA 01845 HEARING-12/8/98 The Board of Appeals held a regular meeting on Tuesday evening, December 8, 1998 upon the application of Joseph Pirrotta, 17 Mablin Ave., North Andover, MA, requesting a Variance from the requirements of Section 7, Paragraph 7.1 &7.3, of Table 2, within the R-4 Zoning district, for relief of front side and rear setbacks, to construct a 2 car garage, on a pre-existing non-conforming lot. i 9 The following members were present: William J. Sullivan, Walter F. Soule, John Pallone, Scott Karpinski. The hearing was advertised in the Lawrence Tribune on 11/24/98 &21/1/98 and all abutters were notified by regular mail. Upon a motion made by John Pallone and seconded by Scott Karpinski, the Board of Appeals voted to GRANT a Variance requested from the requirements of Section 7, Paragraph 7.1 &7.3 for relief of front setback from the house of 4.3 feet, relief of side setback from the proposed garage of 9.3 feet, relief of rear setback from the proposedara e of 12 feet on the 9 9 condition that there be no commercial use of the proposed garage and that the garage should be used for only light or minor automobile repair work and that there be allowed only electrical utilities, in accordance with the plan of land dated 9/17/98 as prepared by Stephen E. Stapinski, R.L.S., Registered Land Surveyor, Merrimack Engineering Services, 66 Park St., Andover, MA 01810. Voting in favor: William J. Sullivan, Walter F. Soule, John Pallone, Scott Karpinski. The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local, state and federal and building codes and regulations, prior to the issuance of a building permit as requested by the Building Commission. BOARD OF AP ALS William J. Sulli an, Chairman /decoct/11 Zoning Board 01 Appeals s The Commonwealth of Massachusetts - Department of Industrial Accidents — Office 1711nxestlg2dons = 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name, location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity (� I am an employer providing workers' compensation for my employees working on this job. Company name address.... l cit - C a _I'1 — phone#- 77O 4S4 15'Z Z ►- STK}?E ,u s. # IC 5 ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: comp2ny name: address= city: phone#. insurance co. policy# company-name: address; cite phone#- u�C.f Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one yean' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby cervi under the p nd penalties of perjury that the information provided above is true and correct A Signature7t4— Date '1a�7 7 Print name !22UN`TT,�ry Phone#�97 k, 4 Sy -SZ.2 official use only do not write in this area to be completed by city or town official city or town: permit/license# r7 Building Department C]Licensing Board I] check if immediate response is required Selectmen's Office C]Health Department contact person: phone 9: nOther (rwued)/95 P1A) t ✓tie Lnorwnzoor�uea�/� i�; �a:1��rclrcrel/s I DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE ti Number: Expires: Birthdate: CS 821304 91/20/2000 01/20/1948 Restricted To: 90 ROGER 6 PAYETTE 1110 METHUEN Sl i DRACUT, MA 01826 9 - - HOME IMPROVEMENT CONTRACTOR Registration 101841 I Type - PRIVATE CORPORATION Expiration .06/29/00 I PAYETTE CONSTRUCTION CO., INC er G. Payette i1 5 ADMINISTRATOR_ -1 11Methuen Street Dracut MA 01826 PLAN VIEW OF PROPOSED WORK Io P®uQt L V?g 0 D R 2d"t� t d° .°,�a90Gi 6o I�o4iQs� �HI E A!'14 P MV L� I S. �• � �..oGL�s G" �oce�d L'Quc,2E rive r.j 1c be M&A µ 6N Qowt/DiA1'E'� 67�CTT�i6e a I i , ' PP��A M�1 LIQfTcl� I j td►o�� Thu SGS�S�- f L4M lel D DA- 11!eat!4 F.N o r 4 r4 d- ri os• is tic D'' - �i Y avOOc$ foxVE jeme.41� poo wd ��(.S��� 2�1/E1gJA�l '"9'0 �.vNalamnl 1 dtf4SNi!St WAl L 1 �` I _ I r Proposed addition to hoose of: Mr. & Mrs. Joseph Pirrotta 17 Mablin Ave i No. Andover, MA 4 _ I i NDi"ES� { ® H LL W i N 1, -T[) f w! E1EL-regi L VeAT. Ne DtWEe j u r.lriw tS S ALLa wr*Ta i { _ Z5� D I > I l i i rAYEM COtWRUCTION CO- i *LkiI 1 !10 HETHUEW ST - -- ' " DRACUT, HA 01826 (979) 454-SI23 WO*Lte WWI (978) 453-0829 FAX �Np S-rt Rs -t-,D O� N ORT N l Town of over No. YD °�A-coc;3w9 rt lover, Mass., Aj Ji CRATED PP�G•C�C S 5` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System T BUILDING INSPECTOR THISCERTIFIES THAT..... .. .r.� .......��..�!..h . .....a............... ..... .................. ............................ Foundation I ..r?......J�I..A..........�.� �......�, .�. has permission to erect.............)......................... buildings on .... '... Rough to be occupied as .... ..1�... .. ..... .... . .'....... .. .ra..a. ...�....R. s�� wd. �� imney 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. 2 9S A fA QP h G V A- ( -44: o&4 r); PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. So S J I t I 8 sir Rough �c PERMIT .EXPIRES IN b MONTHS ` Final S T UNLESS CONS R C I� T TS ELECTRICAL INSPECTOR C Rough I 3 ..... ........ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough • Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ORT►y Town o �� "_ , 0 ,. ndover No. 0 � _ - o ndover, Mass., /gr 2 CAKE COCMICrEwICK 7� A0, A T E O P`p SSA C N U5� FOR EXCAVATION AND FOUNDATION THIS CERTIFIES THAT ....—J A ....h.........A..o.r,Q7Ywv................................................................ has permission to excavate and pour foundation at ...../....07.........eV„/.Q. hov.........Av-v............ G:;T.0-qC for the purpose of.... ,........................................... ��...... 4........�f s_���......a......�J.. DULY The person accepting this permit must return to the office of the Buildin ns ector a certified lot Ian show 9 P P P of building thereon before Foundation will be inspected. S,^ 0 % 1010 ( �S 4- ` � � R! s T S�����S p e ll- Z 13 �4 '� eC• -� 0 � �1 �-a$ VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS The holder of this Foundation Permit proceeds at own risk and without UNLESS CONSTRUCTION STARTS assurance that a permit for entire building structure will be granted. R eco► 13 0� $ BUILDING INSPECTOR vAORDTA TOF 0 own . of dover No. YD _ 4 C% OSA lover, Mass.,—AV COCHVIM ORATED 74 BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....*T IkIP-P,�N OP0114'rk ..... .................. ..... .... . ............. Foundation has permission to erect.............1 ­4 1 )...... ........................... buildings on ....i...Ir7......Apo....... ..%..4 Rough to be occupied as....!4..w 'm....I.R ..... ....**0.1.'....... a.wara.. ...r... ....4484"1 V&4&himney 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. Z B A APPOOVA- ( -*014r)qW CIS PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 641 S 1 J 0 + I a, it oar Rough lop- PERMIT EXPIRES IN 6 MONTHS Final �+ 8 ELECTRICAL INSPECTOR UNLESS CONSTRU N TS Rough "too_ ... . ............................. Service BUILDING INSPEC;i6ii 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 C?,U/.?f' Street No. SEE REVERSE SIDE ��/� Smoke Det. GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations %" air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min. 22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging, clean joints, 8"solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 6"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newali post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee-$25.00(Be Ready). Certificate of occupancy required prior to occupying structure. Date... NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA This certifies that ........ c.'C. rcj.................... has permission to perform ....... ...... .......... t wiring in the building of.....j.—OA(A............... . .................. il at.... ........ ... ... ... ............. North Andover, ss. oe' Fee......i .. ....... Lic.No.............. .......... ELEMICAL INSPECTOR Check 4 5228 THE COMMONWE4LTHOFM4SS4CHUSE7TS 06ffice Use o ly DEPA)U34ENT0FPUX1CS4FLTY Permit I f BOARDOFFIREPREVEMONREGULAHONS527CMRI2.W Occupancy&Fees C cce APPUCATTONFOR PERMIT T'PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH HE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) ! Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) IV 6 61f/J Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes In No r7 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service /100 Amps Zo /2yv Volts OverheadUnderground No.of Meters New Service Amps/p /2, Q Volts Overhead Underground No. of Meters Number of Feeders and Ampacity - Location and Nature of Proposed Electrical Work /✓ 7 A No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Swiitch Outlets 1 I No.of Gas Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW Nq,of Sounding Devices No of'Self Contained Deiebtion/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro MaF'sage Tubs No.of Motors Total HP OTHER' de fimanceComnge.Rmianttodlemgm ofMa%adugeusctnealLaws [have aamuALd3kkorancePbhcyiwkxhngODrinpletE OppationsCoverageoritssubstantialegrMlat YES NO [haw&bniWdvafidp=fofsametotheO,ffiM YES q/ Lr-1) ff}ouhavEdkckedYES,pkasemdicatetbetypeofwveageby I)addng the 1NS'URANCEE BOND M OIHIERZ• (Please-Spa*) EviralimDab Estin ValueofEbAdcalWodc$ dloiktoSw InspeLlionDateRequested Rough Final >igned underlie Penalties of perjury: 7RMNAME L rLO 0-74f l-7W IC Iicense-No. f(oQ a 3 A- imwe ��� F60 Signature Lio=No Business Tel.No. 9 •-6' AitTUNo. )Wi\IER'S INSURANCE WAVER;I am awate that dr Lime does nothave the mstuance covaWorits substantial eaaivalent as rearmed byMassachuseas C,eneral Laws xl thatmy signatureon thispermit application waives this reg aten-mt 'lease check one) OwnerED Agent Telephone No. PERMIT FEE$ igna ure oT Owner or 7genT W The Commonwealth of Massachusetts d Department of Industrial Accidents R< Office of Investigations a Boston; Mass. 02111 Workers'Compensation insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. 0 ' I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address A City: Phone#: ' Insurance.Co. Policy# t Company name: Address City: Phone#: Insurance Co. Policy# r Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment-as web-as_civil,penalties in the form Df_a..STOP WORK ORDER..and_a.fine..of-(.$100--0Q)_a-day-against..me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing Building Dept ❑Check if immediate response is required [] Licensing Board F-1 Selectman's Office Contact persona Phone A F-1 Health Department Other Location No. �°� Date ' c� —� NORTH TOWN OF NORTH ANDOVER O� 9 Certificate of Occupancy $ s�+CHU t� Building/Frame Permit Fee $ Foundation Permit Fee $ _ Other Permit Fee $ TOTAL $ A3 9 Check # � 17219 '�`Brilding Inspector R � TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT'REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER 142 DATE ISSUED. SIGNATURE: y — Building Cdmmissioner/I25 ector of Buildings Date SECTION I-SITE INFORMATION O 1.1 Property Address: , 1.2 Assessors Map and Parcel Number. Map Number Parcel Number p� 1.3 Zoning Information: 1.4 Propeaty Dimensions: �\ /aLl ' 7ming District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided red Provided 0` S'. , 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public Private ❑ Zone Outside Flood Zone R Municipal ❑ On Site Disposal System 9 SEFnON 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 21 Owner of Record H t Address for Service e gn re Telephone 0 j 2.2 Owner of Record: I Name Print Address for Service: ,&nature Telephone j SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ >.. ., A ,fir Licensed Constru tc on Supervisor. J 7 Jif„ l�-rhe �(7a,' I&A C �—^i k Z. 1 U&—nse Number or �._ E� oh n�U,4�� Expiration ate ignatur Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ V PA.U 6 TTE 60AjS-"r LJ Compa y Name /U' / �7. i' Registration Nurtiber r' 17 Mi 1 ?'one �� 7 2yk(��) ez r Adore �a y/Zd O y 2 7 7 y�� `S Z Expiration Date iQttature Tele hone a SECTION 4-WORKERS COMPENSATION(1VLG.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 emit. Signed affidavit Attached Yes....... No.......0 { SECTION 5 Description of Proposed Work check a0 applicable New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY , , Completed by tapplicant 1. Building (a) Building Permit Fee � 9,6 Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection Allf 6 Total 1+2+3+4+5 C � heck Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .as Cheer/Authorized Agent of subject property Hereby authorize `� to act on My behal all ma a rye ork authorized by this building permit application. rLt Si atureer 000 SECTIOk1b OWNER/AUTHORIZED AGENT DECLARATION Date --X ,as Owner/Authorized Agent of subject property a Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief 7ign e aforeK�mer/ gkent Date' NO.OF STORIES SIZE BASEMENT OR SLAB ,S SIZE OF FLOOR TIMBERS Isr 2 3 RD SPAN r DIMENSIONS OF SILLS Z/Z. Ar' DD TENSIONS OF POSTS 31y. DIMENSIONS OF GIRDERS N HEIGHT OF FOUNDATION THICKNESS Q SIZE OF FOOTING h "X ZO ti MATERIAL OF CHIMNEY /}- IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE . i A� `` ✓1��ainmronuiea�C o�✓GfaQaaclauaelta . BOARD OF BUILDINGG REGULATIONS • ;' License: CONSTRUCTION SUPERVISOR Number: CS 021304 s Birthdate: 01/20/1948 Ex ires: 01/20/2006 P Tr.no: 16212 Restricted: 00 ROGER G PAYETTE 17 MILTON ST DRACUT, MA 01826 w Acting CoOmissiffirfer ✓lze-Po�irvinovausece�/ o��� '' ac/u -- Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 101841 Expiration: 6/29/2004 -_- Type:"Private Corporation PAYETTE CONSTRUCT_ION,CO.,I roger Payette 17 MILTON ST. �may. Dracut,MA 01826 4, ,, , • ... F . 'Sts..}.,.,... i j - The Commonwealth of Massachusetts t Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. F--]I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers' compensation for my employees working on this job. ' Company name: Address /7 /0 J ' City: ( I\ 1 C fi�� . rT Phone#: �,� Y �� 6—a0?.3 Insurance Co. Policy# Company name: Address City: Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cert' under th pains:an=penaite ofbrythat the information provided above is true and correct Signatur Date 4 Print name Phone# 9 rCc3c)a 13 Official use only do not write in this area to be completed by city or town official' n Building Dept E]Check irimmediate response is required Building Dept p Licensing Board p Selectman's Office Contact person: Phone# Health Department Other FORM WORKMAN'S COMPENSATION Official Use Only Permit No. amt°d�" Saady Occu anc &Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 p y APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgmd 0 No.of Meters New Service Amps Vofts Overhead 0 Undgmd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimmi Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Diposal No. Pum Tons KW No.of Sounding Devices NoJ of Self Contained No.of Dishwashers S Area Heating KW Detection/Sounding Devices 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivatent'YES= NO have submitted valid proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE - BOND - OTHER - (Please Specify) (Expiration Date) Estimated Value of.Electrical Work$ Work to Start Inspection Date Resquested Rough Final Signed under the Penafties of perjury: FIRM NAME LIC.NO. Licensee Signature LIC.NO. Bus.Tel No. Address Aft Tel.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) ACORD. CERTIFICATE OF LIABILITY INSURANCE 04/08/200 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION M.P. Roberts Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1060 Osgood Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover MA 01845 978 683-8073 INSURERS AFFORDING COVERAGE INSURED PAYETTE CONSTRUCTION COMPANY INSURERA: WESTERN WORLD INSURANCE CO ROGER PAYETTE DBA INSURER B: 17 MILTON STREET INSURER C: DRACUT, MA 01826 INSURER D: ASSOCIATED EMPLOYERS INSURANCE CO 978-454-5223 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY $FIRE DAMAGE(Any one fire) 5�,0 0 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 A NPP873382 02/17/04 02/17/05 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000 POLICY PRO LOC i JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- I X OTH- TORY LIMITS ER EMPLOYERS'LIABILITY WCC 5004956012004 03/15/04 03/15/05 E.L.EACH ACCIDENT $ 500,000 D E.L.DISEASE-EA EMPLOYEE $ 500,000 E.L.DISEASE-POLICY LIMIT I $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: 17 MABLIN AVE FAX: 978-688-9542 CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF NORTH ANDOVER DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN ATTN: BUILDING DEPT. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 27 CHARLES STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR NO. ANDOVER, MA 01845 REPRESENTATIVES. ATTN: MICHAEL MCGUIRE AUTHORIZED REPRESENTATIVE p, ACORD 25S(7/97) o ACORD CORPORATION 1988 h� rth Andover. f NORTH oEa32x,9hal th County Registry of Deed g Board Of Appeals �'�,'�•o 301.- Ccnmlon� treet, , .; F nt.and Services Division Lawrence, Massachusetts 018408 les Street 03/24/04 assachusetts 01845 ��S us Telephone(978)688-9541 Fax(978)688-9542 fi i a.til 11 .`_; 'mac Y pe �'' ''° J 'his is to certtty, that twenty(20)days DOC. 11'-r1 f_•_ i-':: %tJA Ul' have elapsed fro m:date of dedsion,filed: Re an I. without filing of R i,� G5. `_ i:f' `r F et::: 1:,, e %L f'td iso.0i; Decision Joyce A.BradsMW }OC. 11742 i�z F'_ fi,tlf; :004 Town Clerk Oc; Mablin Avenue f e 11 �a R�'c::b 1`Sue DEED 1i�On Ori �a,Jr. HEARING(S): February 10,2004 RR D n L,,, -PETITION:' 200-002- DEED 100---f 0 TYPING DATE: 2/12/04 L i 111, i; tearing at its regular meeting on Tuesday;the I Oth of February 2004 R. D. 00 forth Andover upon the application of John G.Pirrotta &Joseph 'riance from Section 7,Paragraph 7.3&Table 2 for side and rear 1 r ta_t.l T�*%i, .f) al) 9.1 &9.2 of the Zoning Bylaw in order to construct a two car t:The said.premise affected is property with frontage on the North 1� The legal notice was published in the Eagle Tribune on January John'M Pallone,Ellen P McIntyre,Joseph D LaGrasse Joe E y 4 ° r i6irtiK '�(.1! lhnt�� o - Je Burkt_a v� ti r ' 4� �4pfit' ?�fj`,1ra63jt�y3 4 ; ,�r''+, rd�� r' 4wti Register of Deeds nth . `voted to GRANT a Varaance'froth,Sec' ,>4 € .k Pallone;, e.Board »� - and ;from the Northeast side,setback==;and +� 6 GRANT a Special Permrt from Section 9,Paragraphs 94 &9.2 in order to construct a proposed 2 car 1 stor de$ache ; garage onto a pre-existing 25'x25'cement slab on a pre-existing,non-conforming lot per Plan of Land in North Andover MA. drawn for John G and Jose h A Pirrott ' Joseph a,Jr.,r. and Daniel B. and Sarah B. Mees December 18=-' � ,�OQ3 by Stephen E. Stapinski, RL:.S.#29876,Merrimack Engineering Services, 66 Park Street,Andover;Mas sachuse' '-' L- and Plan of Proposed Work,Mr. &Mrs.Joseph Pirrotta; 17 Mablin Ave. [by]Payette Construction Co., 1110 Methuft Street,Dracut,Massachusetts 01826 [3 pages]on the following conditions: 1. The 2 car 1 story detached garage roof peak will be no higher from the ground than 19'. Voting in favor: Walter F. Soule;John M.Pallone,Joseph D. LaGrasse, and Joe E.Smith. Voting against: Ellen P. McIntyre. The Board finds that the applicants s have provided the Board with the remedy,the signed statement of Daniel B.and o Sarah B. Mees dated January 28,2004 for the land swap conveyance, for the 047-98 Variance decision granted 12/8/98- which depended on a mistaken rear lot line. The Board isnow satisfied that the provisions of Section 10,paragraph.ice of the Zoning Bylaw allowing the granting of this Variance will not adversely affect the neighborhood or derogate frees the intent and purpose of the Zoning Bylaw, and satisfy the provisions of Section 9,Paragraph 9.2 of the Zoning Bylaw; that such change,extension, or alteration shall not be substantially more detrimental than the existing structure to the neighborhood, as stated in the applicant's in7favoi form letters signed by seven abutters. = r . 1 'f'FEST: Page 1 of 2 a A True Copy c' - •j�G?.:..Q�;�1(,411'CG-iii`- jj r )' - TowI1 Clerk, f 0 /.. Board of Appeals 978-688-9541 Building 978-688-9545 .Conservation 978-688-9530 Health 978-688-9540 Planning 978-688-9535 v °PAYETfE CONSTRUCTION CO. j 1.1omes 4t Additions of Distinction 111®Methuen Strut �L ��1 ����o1sED wO� ID"Ctff, MASSACHUSETTS 01926 1 tA e v_ L4P-s. was,ev h -Of#-"-rz-k n. warEI&XICld- 3L' -Te51"►ArL.— k C-sG ray' F-A 'L Y-rAlk 4ecn-(e mop �e.s i s R N • Proposed addition to home of: CROSS SECTION/FRAMING PLAN OF PROPOSED WORK Mr. & Mrs. Joseph Pirrotta 17 Mablin Ave No. Andover, MA r E/ ALe '/,A "= 1,- big Car��;rvunu �;dbE vEntr FA0E-L6LAss S40, 4l,-s 0 1sr5ir61 0-D K ?Lvwoad wlOtYwopd e Pas Pk-E AAANu Fac.-ruP-Ez) q" a�L VL-i woods LD DUA `rP LA." LSee.SpY-L&a C LES W � Lrtd 3L�, r�r L)c )/- R-3$ C3An �NSuL. O bN r i Nu 'O LU S'Z—r u m t'cl _ smGmss , -7'� Ex�aSu � 3 zxtip w �.� lo'b n 2`-2.� �7T rNS U1.141'i 0 it/ Q ME #c�4n 2�21,L Or --SALkS /2xL PST, (,' I/ PAYETTE CONSTRUCTION CO. � 24 R E l-AsN iN G 1110 METHUEN ST "� 2ed a�� wA!.L•y DRACUT, MA 01826 � (978) 4S4-5223 1 ON Qo a ed Q rvL. (978) 453-0829 FAX 5-C*5 T't, 1�1. L2i vE wr41 ELe vrAw-r ON �� X IUPDuAe, n 'c' r • Proposed addition to home of.-' PLAN VIEW OF PROPOSED WORK Mr. & Mrs. Joseph Pirrotta 17 Mablin Ave I F 2x1� l� 2.0" a,el, No. Andover, MA i o" _;u o ho 90 u R-e a- / r/2" D PIV tue01 SL'A-L.E � ►/y� _ �� � n I Zb"X 1 D" .'.�000�Ia 1�®U2Q d. �1��rgi'1k�`ril �s N 0 fi E S a►u c.r4.n�`„c' l=moo N ly ALL S1d� N � 7v ba bac �raLYL� s 1t.1 r fi )+ 'rbt V E.k 00 Eb vt i V. 064p,.A-6 5 To bz I ( 6" Aui e d. ewu o.r -rr Ft tso � WI E 1 Ez--tT2-i z- V P A-i, No d-t1f'r e- ►ja l G f bR_Z Ma i I-- AN ic-nM O4LLrgZ �afict4v�L., ALLD wi5ric, I I ► f WDod. V/1 tlIi p-. . ]sib DN 3/2%-1D IM#JPP - lv1 PI y!!/04nt- PAYETTE CONSTRUCTION CO. 2y I Lv4LL40 o ga S 1110 METHUEN ST 8 � � fax „ - DRACUT, MA O 1826 V 15)e H.I”e42) 000 e 0 VE,e i4e,41) .foo P— (978) 454-5223 � �� LJ4 L V W A y (978) 453-0829 FAX 4N-Z S- p- Ag t-1, F_�t;S,'G 1� 'tiuc WAy rt'� �c'a nn � Rpt Z i NL w A! L NORTH Town of 6Andover �i �,o =o '� dover, Mass.,LAK If, COC1i1C ME WICK S U BOARD OF HEALTH PERMI -T T D Food/Kitchen Septic System /► T BUILDING INSPECTOR THIS CERTIFIES THAT �O ..!v...v ...11�S'op /�I►Cr . �. ................. ............................... Foundation .... ................. ..... .... a has permission to erect.. ., ...... buildings on J4 � Rough � . 1v � ...... i1 ....:C?r ..................................................................... ............... Chimney be occupied as.. 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 nspection, Alteration and Construction of Buildings in the Town of North Andover. ///a 0734 ► PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough tomer- 2 p A. DOG PERMIT EXPIRES IN 6 MONTHS Final ' 0166— 00 A ELECTRICAL INSPECTOR 2— j2 . Oct 'UNLESS CONSTRUCTION STARTS Rough ./ .. ......... ... ... ......... ...... ....................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFina, No Lathing or Dry Wall To Be Done FIRE Until Inspected and Approved by the Building Inspector. Burner DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. ' N° 3 L 1 2 Date... ..................... NORT/� 6 TOWN OF NORTH ANDOVER - p PERMIT FOR WIRING SSACMUSEt - t 1. This certifies that ' x.16 ............................................... ...................................... has permission to perform �.. ...........:............:.:.......:............................................ j wiring in the building of.. .::....-:..-.",-.�_—..... -� J �................................................... at..1........N....:............................................ti.............�,North Andover,Mass. Fee.)................ Lic.No.............. ...............................................................` -ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer (fommonwaa&of MaedaclWalla Official Use Only Permit No: f .[J¢Parinunl o`,.tira �arvi-ca! • Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 (cave blank) — APPLICATION FOR PERMIT TO PERFORM'ELECTRICAL WORK All work to be performed in accordance with the.Massachusetts Elcetricnl Code(MEC),527 CMR 12.00 (PLEASE PRINT ItV INK OR TYPE:ILL/N/--Ow,-1 77019 Date: City or Town of: NO, A t"_�ovE,, To the Inspector of fril•es: By this application the undersigned gives notice ofn�his��or ;her intention to perform the electrical work described below. Location (Street & Number) (Y i\ Owner or Tenant 0 Se'?H PLI P077- `1' Telephone No. j� ( .19 30 Owner's Address _ S/� rnn E Is this permit in conjunction with n building permit? Yes ❑ No-.Q (Check Appropriate Box) 1'un•I)osc of Building Utility AutlIiorizatiun No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No. of Meters.. Number of Feeders and Ampacity Location and Nature.of Proposed Electrical Work: tiG4 , Completion of the followin table may be ivaived by the loo cclor of Wires. No.of Recessed Fixtures No.ofCcil:Susp.(Paddle)Faus Transformers KVA No. of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above n- 0.0 Emergency Lijilting rod. grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.oetection and— Initiating and- InitiatingDevices Total No. of Ranges No.of Air Cond. Tons No.of Alerting Devices eat Pump i um er _ons o.oSelf-Contained ,,\o. oC�Yastellisposers Totals: .__. DetectioiL/Alerting Devices No.of Dishir•ashers Space/Area Heating K`Y Local Qryluiiicjpal Q Other . Connection No. of Dryers Healing Appliances CW ecuritySystems: No.of Devices or Equivalent No. or Water K1Y No.of No.of Data Winug: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydrannassage Bathtubs No.of illotors Total IIP a ecommunications irutg: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of{Vires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical workmay 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 [!r BOND ❑ O'('I•IER ❑ (Specify) S 60< -4 SIVA?Q 19-131 p / Estimated Value of Electrical Work:" /00--- (When required by municipal policy.) (ExpirationDate) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains and penalties of perjury,thal the information on this application is late and complete. F1101 NAME: �)_o H N C n_#1&C GCL(-Iq l✓ ©I L Coc LIC.NO.: Licensee: . Signature LIC.NO.: (If applicable. enter "ecaupl"in the license number line.) Bus.Tel.No.• '714L8.04/// . Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nol 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 Si;nature 'I'clephone No. Pl Ril11T FE•E: ROUGH FINAL I i THECO DEPARTTAMWOHOUFMS',FSA�SETTS P 'Use o ly BOARD OFFIREPREVEN770NREGUTA77ONS527CMR12. ccupancy&Fees ce Y _ 0 APPLICATIONFOR PERMIT TSO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE lkrrH HE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 9 11Date �— 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) 117f , Owner or Tenant /11Y10 Trlt- Owner's Address Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service �� Amps /2 Volts Overhead Underground No. of Meters New Service �2.04) � Amps /Z,�Volts Overhead Underground No.of Meters —� Number of Feeders and Ampacity Nature of Proposed Electrical Work / CL P Outlets No.of Hot Tubs No.of Transformers Total i KVA Fixtures Swimming Pool Above Below Generators KVA round ground le Outlets No.of Oil Burners No.of Emergency Lighting Battery Units utlets No.of Gas Burners No.of Air Cond. Total FIRE ALARMS No.of zones Tons s No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices hers Space Area Heating KW Np,of Sounding Devices No.'M,Self Contained De'4ction/Sounding Devices Heating Devices KW Local Municipal Other' Connections aters KW No.of No.of Signs Bailasis age Tubs No.of Motors Total HP Ptnsualgtoltleteqtm�rl�ltsOfMassaclat�.4tsGelaalLaws tyhrnuarroePblicyinchidrngComple� Covoritssubs�ntiateclrrivala>t YES NO blid pwof of sama to dr Offica YESFq v Ifynuhaved YES,pleareindicatethetypeofwta-ageby �utc��iv�G BOND MHM M (Pl mSpacafy) Expiration D& EstrnWd Vahre of Eletical Work$ dctoSlart ''� �`� h>SpactionDateRequ�cl Rough Final �edimder�iePenaltiesofperjury. . ANA IE 1, tV IfL flM1c c�• LicenseNo. `(pD 2 3 A— ,see Jzi- L� Signature LiC=No Business Tel No. — D At Tel,No. 7 —7W7-1411 *R'S INSURANCE WAIVEP,I am aware d at theLioensedoes nut have theinAuarxeCovetageorits subslandal egtovalemasregtutedbyMassaLiRLg tLs Gerieral I-am -at my signature on this perrnit application waves this Equirerr ent ' ase check one) Owner O Agent F Telephone No. PERMIT FEE$ rgna tae oi Mwner or Agent � �-005 Location No. Date :� • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 0 a,0U A40 Foundation Permit Fee • $ Other Permit Fee $ TOTAL $ Check#9 21 26317 Building Inspector