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HomeMy WebLinkAboutMiscellaneous - 17 SUGARCANE LANE 4/30/2018 17 SUGARCANE LANE r 210/106.A-0243-0000.0 h i lC` V..Rt Use O�tly—_�� mss\ The Commonwealth of Massachusetts P—,l No. :�2 Occupant & tee Checked t' Department of Public Safety 3/90 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:W 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 INFORHATION) Date-/-//a? � City or Town of N�4?TN /�N1�OlJEI� To the Inspector of Wires: The undersigned applies for a permit/�to/�perform the electrical work described below. Location (Street Number) 7 SV lT14&614NE /,N 0611-7 4aE NaA(t 2, OS'� Owner or Tenant [a E L EN -b C O/VS7_2(lGT1,11Y Owner's Address .�?;kl UE d2rD,�—' F n.t7 AMTS / AM �so�G��®7�7✓�' Is this permit in conjunction with a building permit: Yes ®, No ❑ (Check Appropriate Box) Purpose of Buildings/NG'L_E M ZV 1 L Y 17`6'44 Utility Authorization NO\50C C=Z7 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 A M to A-Z 2 0t/0 G 777 e s No. of Lighting Outlets No. of Hot Tubs No. of Transformers . TK VA of Lighting Fixtures Swimming Pool Above In- g g g grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners Battef EUnitsncy Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices Heat Total Total No. of Disposals No. ofpum s Tons KW No. of Sounding Devices Dishwashers S ace/Area Heating No. of Self Contained No. of Dis KW p Detection/Sounding Devices ❑ Municipal ❑ No. of Dryers Heating Devices KW Local Connection Other No. of Water Heaters KW No, of No. o Low Voltage Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[@ NO ❑ I have submitted valid proof of same to this office. YES❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ® BOND ❑ OTHER ❑ (Please Specify) 9/16/95 (Exp ration Date Estimated Value of Electrical Work S a F4P y NOtd/ Work to Start Inspection Date Requested: Rough Final !=UU 02. SNS/'fGT.d�Y Signed under the penalties of perjury: FIRM NAME CONTINO ELECTRIC. & CABLE INC. LIC. NO.A11983 Licensee LOUIS. CONT I NO Signatur LIC. NO.E 2° 88 Address 1 DONOVAN DR. WEST NEWBURY, 01985 Bus. Tel. No. 08 ) Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am,aware that the Licensee does not have the insurance coverage or its sub- stantial 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 S Signature of Owner or Agent >�.� .�► -::t,�.���-ate �+:,r.,,.-� -� �;� .�.,-. . . .t .. Date... .�. p+ 22-38 H NOR7M TOWN OF NORTH ANDOVER PERMIT FOR WIRING $ �,SSACMuSES This certifies that ......................... .. ...:..:.. .. ..............._.,.... has permission to perform':�... `: .!:.:...., /e. ............ .. . f E wiring in the building of:..: .. t l <-:.............. .....:f•! at.,/.J... ..>.���a. `✓ C...... /.................... .North Andover,Mass. Fee. k' r u1.. Lic. ............... .......... ........................... t 1, ELECTRICAL INSPECTOR WHITE: Applicant CANARY:.Building Dept. PINK:Treasurer GOLD: File No `L'�Gc Date o a a, Nip*.,tie' TOWN OF NORTH ANDOVER ` p Certificate of Occupancy $ :*ro # Building/Frame Permit Fee $ Ss,cMus�t Foundation Permit Fee $ Other Permit Fee $ _ ' Sewer Connection Fee. $ Water Connection Fee TOTAIwo L wilding Inspector 79-9.9 Diva Public Works Lt &ot Location t?-C-A Mfrs No H Date "M zq ks: 1 K] Q CL 4NCRtM 'TOWN OF NORTH ANDOVER p 1 G p Certificate of Occupancy $ Building/Frame Permit Fee $ .0 ,�SSACMUSEt� Foundation Permit Fee $ Other Permit Fee $ ~; .,Sewer Connection Fee $ W- / ter Connection Fee $ TOTAL $ S� Building.Inspector ` Div.Public Works .y �pyw,,v"-=rs..�,,,�,�-r».-y,,:n�+'•_...�,-w�}_,,c�, �y� .,..�...:.._:iar"r���rX.wf4�1�' �. Location Q Date No. 7 < 14°;T;,,�a TOWN OF NORTH ANDOVERA O cz F „ Certificate of Occupancy $ o Building/Frame Permit Fee $ -. 'f1 °tine►� } � «,,,SEt� Foundation Permit Fee $ Other Permit Fee $ ' Sewer Connection Fee $ 107 Water Connection Fee $ TOTAL $ F S P�*Au'j p.�: 5 �(KN0 'L® APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4'40-106 A LOT NO. � 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE — Z07aNE ' 2 I SUB DIV. LOT NO. „36 :2 L"OCATION17 sc,,�/JCA�E 4Alu a PURPOSE OF BUILDING ����/� ��y� '.` ,3 UQ GA ani! OWNER'S NAME .�i2-G, A c 7 �.�G NO. OF STORIES SIZE ,®� W -'® s�"��+�C OWNER'S ADDRESS s2-/ J7 y���I��t� BASEMENT OR SLAB Kd ARCHITECT'S NAME Ra,(,k 1C0SIZE OF FLOOR TIMBERS15TND3RD BUILDER'S NAME A&,ESPANDISTANCE TO NEAREST BUILDING �®/T� DIMENSIONS OF SILLS-� Ip/. --- w �I f� DISTANCE FROM STREETS POSTS X DISTANCE FROM LOT LINES-SIDES r,�® REAR „y1 I •' GIRDERS 1/ 2 AREA OF LOT /J , P V FRONTAGE C�.CJ HEIGHT OF FOUNDATION / THICKNESS IS BUILDING NEW 7 J J SIZE OF FOOTING r/ X Gr! IS BUILDING ADDITION MATERIAL OF CHIMNEY - 1 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND t-+® WILL BUILDING CONFORM TO REQUIREMENTS OF CODE t/'P crr IS BUILDING CONNECTED TO TOWN WATER `J Xe`/`- BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER 4® - p IS BUILDING CONNECTED TO NATURAL GAS LINE I.P 3 INSTRUCTIONS 3 PROPERTY INFORMATION SEE BOTH BIDES PERMLAND COST IT POR FOUNDATION ONLY / 3,o wo zst Iow REGULATED BY PARA. 114.8-S. B.C. EST' -BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. `i-9:9 PAGE 2 FILL OUT SECTIONS i - 12 r r, EST. BLDG. COST PER ROOM ®goo DATE 3 FEE PAID Ivvy� _PEPTIC PERMIT NO. _3a� ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING V 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR PATE FILED BUILDING INSPRCTOR SIGNATU E OF OWNER OR AUTHORIZED AGENT F E E lg,CllO PERMIT FOR ING OWNERTEL.# 673-7S71- 5a - tea ISERMIT GRANTED DATE: - _ FEE PAID• t�� CONTR.TEL. �9 CONTR.LIC.#. o �� • - - H.I.C.# BLDG.PERMIT FEE Q LESS FDA FEE. ......- �--= 9�, MAR 2 2 1995 , DUE FRAME PERMIT$ ti�� 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 d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDWD PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN, B'M'T AREA _ 7, 1/1 '/. FIN. ATTIC AREA _ NO 8 M T FIRE PLACES 7— HEAD HEAD ROOM MODERN KITCHEN 4 - WALLS I 9 FLOORS CLAPBOARDS B 1 _-2_f 3 DROP SIDING CONCRETE I_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D ASBESTOS SIDING COM/,AGN VERT. SIDING ASPH. TILE STUCCO ON MASONRY ~- STUCCO ON FRAME + _ BRICK ON MASONRY- ATTIC STRS. & FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. )i STEAM STEEL BMS. & COLS. HOT W T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS iOlL GAS B'M'T 2nd _ ELECTRICS— 1st 13rd I NO HEATING PERMIT NO. �©� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP KJO. LOT NO. _3 2 RECORD OF OWNERSHIP DATE BOOK :PAGE ZONE I SUB DIV. LOT NO.�3 LOCATIONPURPOSE OF BUILDING �S'� n� �wL-ZCJ 3C6�L OWNER'S NAME �, NO. OF STORIES SIZE �'!' �I a sr- OWNER'S FOWNER'S ADDRESS Z�r n y'` e .��� I� y� BASEMENT OR SLAB ARCHITECT'S NAME �.�! a�UnO IGi SIZE OF FLOOR TIMBERS IST d •'�`iO,.2ND,- /Q 3RD `> BUILDER'S NAME C�C1 1 SPAN A !Y DISTANCE TO NEAREST BUILDING �0/ DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES 30 REAR �G,�. 7 GIRDERS /OJ�� ` AREA OF LOT ` FRONTAGE �� t HEIGHT OF FOUNDATION /� I THICKNESS /Q IS BUILDING NEW 'i/ SIZE OF FOOTING �� X /// IS BUILDING ADDITION MATERIAL OF CHIMNEY I G IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /e IS BUILDING CONNECTED TO TOWN WATER cid BOARD OF APPEALS ACTION. IF ANY J IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE e INSTRUCTIONS 3. PROPERTY INFORMATION LAND COST ZOOCJA l�® SEE BOTH SIDES EST. BLDG. COST A 9(I,i1 EST. BLDG. COST PER SQ. FT. 15-0-CCJJ �jl L�l.`�7^ PAGE 1 FILL OUT SECTIONS 1 - 3 _ PAGE 2 FILL OUT SECTIONS i - 12 EST. BLDG. COST PER ROOM /Soda SEPTIC PERMIT NO. 3as-, 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 BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT �L FEE OWNERTEL.# r^ PERMIT GRANTED CONTR.TEL.# ��17J1 5 S 19 CONTR.LIC.1/. y! 51/2 H.I.C.N BUILDING RECORD , 1e OCCUPANCY 12 SINGLE FAMILYSTORIES —LTHIS 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 I 2 FOUNDATION I 8 INTERIOR FINISH ` CONCRETE 3 i 2 13 CONCRETE BI K. PINE _ BRICK OR STONE HARDW-D PIERS PLASTER _ DRY WALL _ UNFIN. 3 BASEMENT I y AREA FULL FIN" B M'TAREA _ V, 1/1 '14 FIN. ATTIC AREA _ NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE ��_ _ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDx'J D _ ASBESTOS SIDING COMtAC;N VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME_..w..„, BRICK ON MASONRY" ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME - SUPERIOR I� POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.( 2 GAMBREL MANSARD TOILET RM. (2 FIX.( 1� FLAT SHED WATER CLOSET I ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING = I TAR & GRAVEL STALL SHOWER Ir ROLL ROOFING MODERN FIXTURES _ TILE FLOOR r' TILE DADO 6 FRAMING I 11 HEATING . + I WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. V STEAM STEEL BMS. & COLS. HOT W"T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC lsr (' 13rd NO HEATING 14 FORM U - IAT 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** pL, tAPPLICANT: 24F- Phone n �� '_7F7,1 LOCATION: Assessor's Map Number A14 Parcel Subdivision St)C4aY, r'h/y Lots) Streetc�J�rr�^�K1tiU� St. Number ************************Off//icial Use Only************************ RECOMMEND T ONS F T WN AGENTS: &iz Date Approved Conservation Administrator Date Rejected Comments �� J' Date Approved r Town Planner Date Rejected -- Comments co-r pck .m CLAW ©�OIC Date Approved Food Inspector-Health Date Rejected >_Al � Date Approved Cq AZ?19,5- Septic Inspector-Health Date Rejected Comments Public Works -_,9swa-r/water connections - driveway permit I r - Fire Department Received, by Building Inspector Date 2 1995 �. y � i 1 i � C:�'' J A 6 L oma" 2 iyo�' • 157oo4-1 �.0 7. 36/3 T 4- 3 5 6 0 S.150 F. 00 Arl. qtr ~ W E r L A N � LO-T- Y OT i 3`3A � 148--- — r G r Llti-jPATI D N OGUT � r l _ '!mater , NO CONS T ZONE Jw ,R, P\V�L IN6 int' UAB• N w � • 5g tg2 �" .I�cHT sod I_ E�G i•} "T FZ f" ti.t GI-� �..1•�. � — EGFR. � � 1' _ _=� — 186.OD TU f�E, �5O ER5EMENT .� F U _ _ — CO kD R- C , ,�� RML 148 e — r f , TOWN OF NORTH ANDOVER, MASSACHUSETTS " 2 2 11�q.5 DIVISION OF PUBLIC WORKS 384 OSGOOD STREET, 01845 _ GEORGE PERNA TELEPHONE 508 685-0950 DIRECTOR FAX 508 683-9381 DRIVEWAY ENTRY PERMIT DATE 7 /4�5 �-7 LOCATION 17 BUILDER PHONE: 6�3-7?7j OWNER PHONE: �I The North Andover Superintendent of Highway Utilities &Operations MUST be notified of the grade and set-back from street established in any driveway entry onto any street or way maintained by the Town. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. 17 FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. Remarks: Approval: NORTH TO" Of 4 over ' No. 1 o c= y <. •f, o �rt " dover, Mass., �,ee ZG 19RS' COC MIC ME WICK RATED Pf g PERMIT H BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT AOX.... -........................................................................................................................... •�•• Foundation ! 44494CA �.....�-0.......... Rough permission to erect. O.....FAxE buildings on .. t to be"occupled aS t. l;RV ...�7�4►f1�1ADU)e.A k4 ��,.... .�. .4dQ....�i!QR/ rCAL......... ............................ Chimney provided that the persoh accepting this permit shall in every res conform 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. PEhMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR REGULATED BY PARA. 114.8•S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough '� I �Q L Final PERMIT EXP 6 MOlR'� FEE PAID UNLESS CO TRU �' ELECTRICAL INSPECTOR I Rough • ..... Service V . ....... ......... ... 4BU1LD*1N4GPECTOR �RQ� , �0 f ;. Occupancy Permit Required to Occupy BuildingG SPECTOR t Display in a Conspicuous Place on the Premises — Do Not Remove �a�ti• Final - No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER ' FINAL DRIVEWAY ENTRY PERMIT Location AT Q No. .� � Date4 PIck .- a a Q „ORT TOWN OF NORTH ANDOVER p . Certificate of Occupancy $ �T Building/Frame Permit Fee $ cM+esEt Foundation Permit Fee $ �5 Other Permit F $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ �� Building Inspector rt. Q 8 170 Div. Public Works KAREN H.P. NELSON •+ Town of 120 M . Street, 01845 Director ' ' NORTH ANDOVER . (sos) 682-&83 BUILDING CONSERVATION "`"°°` DMSION OF HEALTH PLANNING & COMMUNITY DEVELOPMENT PLANNING CHIMNEY APPLICATION AND PERMIT DATE /f gS ' PERMIT # LOCATION OWNER'S NAME A;, BUILDER'S NAME W Bl/ MASON'S NAME MASON' S ADDRESS MASON' S TELEPHONE MATERIAL OF CHIMNEYr> z INTERIOR CHIMNEY �� - // EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES THICKNESS OF HEARTH /e Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: DATE 4,0� ewl SIGNATURE OF MASON -4CONTR. LIC. # / EST. CONSTRUCTION COS /CONTRACT PRICE /Zoe PERMIT GRANTED 4 U �� FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES CERTIFIED PLOT PLAN ` LOCATED IN NO. ANDOVER, MASS. SCALE;1'=60' 4/28/95 Scott L. Giles R.P.L.S. 50 Deer Meadow Road o (n North Andover, Mass. o G 7 rn 2 0 � m 0 1 � LOT 38A _ �2 Cn r.- LOT 36/37 o- 43560 S.F. �', 53.68 cr► 2g w rL06' LOT 35B CERTIFY THAT N OFFSETS SHOWN ARE FOR THE USE THE OFFSETS OF THE BUILDING INSPECTOR ONLY SHOWN COMPLY AND SUCH USE IS FOR THE . WITH THE ZONING DETERMINATION OF ZONING BY LAWS OF NO. ANDOVER CONFORMITY OR NON-CONFORMITY Ut1� WHEN BUILT WHEN CONSTRUCTED. Location No. C1 fa —C Datto e HORT►l TOWN OF NORTH ANDOVER �? ` ooa Certificate of Occupancy $ l ` ri Building/Frame Permit Fee $ �ss�cMusrR Foundation Permit Fee $ Other Permit Fe4C;W--,,$ " Sewer Connection Fee $ Water Connection Fee $ Lj TOTAL $ Building Inspector 85- 27, 06/19/95 14:54 54.00 PAID ` T12 435-2* Div. Public Works � b zy - - tiltiF``w'+uc.+Wish . Iu1RE H.P. NELsoN 'd .�. .ti� TOWI1 Of 120 Main Street. OI845 Dtrecror = .. (508) 682-6483 ` � NORTH ANDOVER BUILDING ,et:::y�.• L. CONSERVATION `""' DIVISION OF `G HEALTH PLANNING & COMMUNITY DEVELOPMENT PLANNIM L/ l � Fµ CHIMNEY APPLICATION AND PERMIT u, DATE PERMIT # LOCATION OWNER° S NAME 9 BUILDER' S LDER S NAM (.. --- 4. a MASON' S NAME *j o ` MASON ' S ADDRESS �' D'? n e- 5t MASON S TELEPHONE t�Q L l - q "� 890 J MATERIAL OF CHIMNEY ® 1B r G INTERIOR CHIMNEY EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES � ` C�� 7— THICKNESS THICKNESS OF HEARTH 5 C h Will chinney or fireplace conform to requirements of the code and have rules and regulations been received: DATE P` SIG;IATURE OF MASOPI �( CONTR. LIC. EST . CONSTRUCTION COST/CO1!T AC ' PRICE � e PER2IIT GRANTED [, RAPITEDFEL ROBERT NICETTA, BUILDI. G _. S_ =OR INSPECTED REMARKS c^"D 3 ICK REQUIRED THIS PER1-4IT ;LUST BE DISPLAYED ON THE PREMISES A KARES H.P. NELSON - . �: 124 Mala Street Or845 " Dirmfor 4. NORTH ANDOVER sos� s8a-sass BCILDING •�'+•mow DriWO1OF y CONSERVATION HEALTH PLANNING & COInIL-1, TY DEVELOPMENT �v PLANNING CHIMNEY APPLICATION AND PERMIT µ hil PERMIT G `�- DATE LOCATION ' OWNER' S NAME ® t 1 fo n? e Pz l BUILDER' S NAME �1 i s g t C� MASON ' S NAME �r MASON ' S ADDRESS_ M.=:SON I S TELEPHONE 4 30�- S PO 1 MATERIAL OF CHI_�INEY I L INTERIOR CHI u1E Y EXTERIOR CHIMNEY r NU -1 i:_.R Al10 SIVE 0t. CT T`:EC 12: � ( ':HTC�'NESS OF HEART: Iet� G Wii_ chimney or f__en _ca cc.,f..__., requirem.ents of the code and have relies and recu:aticns 'e_:: received: i Dr1.1i SIG;;ATURE OF MASON CONTR. LIC. 6 3[� rcT ...... `CnS� C TsPRIGTCONS � 36 00 PERi•ITT GRANTED (� F- RC'iBERT NICt"'_A, bi ;_D;::G _:�J':=.,.:'vR REMARKS C{ R_ OUIR E D THIS PERMIT :•IU S T BE DISPLAYED ON THE PRE•IISE S J 77 Fs4 2�za �.y:',.tc �, � "�^i4 'v' kar'^',,'[ r• . mss: �R...m ...,..-_ __ .R-'t:`yy a"' �sak z ,r•` ,ij '�J f4vk i"Mw Z E. - - x a..�!:.• xv? ` 3 .tom 4-i `'5.,���h��Y" .. '... ,_. '.. '„ Tx{ �Y�:•t�a����5� ���Ap':l t _ sem.�, �'G� � y...,,q.,���r� 1 �� ;v e �w`••,.�� ��-'�"""%t�s.�l+'r�� s'b-.......� _,..,.........'•«,fie�.� ^., 1 ..E`r a.. f at E�- �t#r` {�, �.�,' v'' ��,:rc`.� ,1,�. ��'�'i''J�-'L"n.`�,Ty; ,_ _ N$,�'✓•"�t.� a`«e '`n`'�;x��•"y`, Y •� a t< �'•+..cnsK Lir r �a rF '�' { �l>�`'.r�v �'`'4 _�r.,��, y�°•��..ann.'7�y-'`�,r'� e= �,F{�. i +�� r"•} ���„q'a` --- .- ,� - - .- ,� ✓die i�yyr/inanca�',�� c�uoe�� DEPARTMENT OF PUBLIC SAFETI CONSTRUCTION SUPERVISOR LICENSE Na�her Expires: Birthdat CS 0531Q� e.Ol/OS/1998a Ol/OS/1951 _ RestrleteTQ 00 a -.�. .. DANES C DIPANFILO BENNETT STREET I " - .. .`s r �1•_-.�a�4':ItZ -_ - _ r i I I ' 3 The Commonwealth of Massachusetts Department of Industrial Accidents � �_— OIIIexO1/�s�/gaUaoS - 600 Washington Street Boston,Mass. 02111 Workers'Compensation Insurance Affidavit name: -T C 1)%P- A n)c'=1 C c) location: S CA64aOilie: LA) city /Ux-T ti- d'N ooV,6�7tz- hone 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. eompanv name ' i .# 1 l L E1 address. 1� tUT ► `i city1� l� phone insurance co. '! C] 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: company:name .address. city phone# insurance co. policy# company name: address. >. city: phone# insurance co. policy# . na �et eeessa Failure a re to secure v i � coverage a as required under Section 25A of MGL L 1 2 n 1 i G 5 ca cad to them imposition of criminal penalties t fine u to 1 00.00 and/or g q po pe o a p $ ,$ one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature i Date Print name 1 M I PA lU - 1 C� Phone# l a V3 e4 1 L official use only do not write in,this area to,bye completed by city or town official city or town: hlL -.� permitticense# �O nBuilding Department pLicensing Board 0 check if immediate response is required []Selectmen's Office Health Department . contact person: phone#; MOther (revised 3/95 PJA) - Information and Instructions e Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 Iegal 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 section 25 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, 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. z�< .e.,IN �_`_rv«;w„ '�:l .z'` '.4� i• � / /� °`z Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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. vp _ mgww Now City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, _ please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents , office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 No ' 10131fqo o over r) E No. 4 North/ over,dover, Mass., r �;;, ��.� r: '�� 19 1 BOARD OF HEALTH Food/Kitchen . PERMIT T614UILD Septic System ` / BUILDING INSPECTOR �Cd THIS CERTIFIES THAT.�.`�.C�►. '. :. �. . Q....................................................................................... Foundatrot 1 w r has permission to erect.?,-a' ?t?.....C:s fit><; .. buildings on ... ... .....�� �:,�°:,.���:�• �...... � .•t.� . ............ rad `�, uJ`� 7 a• �Z to be occupied as. .......... �...:.,. !a..... �t. ',�►;� . ...................... I, 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. PERMIT FOR FOUNDATION ONLY PLUMBING INS[ECTO REGULATED BY PARA. 114.8-S. B.C. VIOLATION of the Zoning or Building Regulations Voids this Permit. :)U I'I'I t ��;'I I'..`;.i'1.l_ 1. .,`i �'�I (► TVi DATE �{ FEE PAID ELECTRICAL INT�SP R �J �f PERMIT FOR FRAME/BUILDING ..................................................,'....:........... . .... ::':..•:.:...:.....`....::........ Service ��� �` /f BUILDING INSPECTOR DATE. FEE PAID' 0)v � crTtrlcy ._'ertrlit Re( uir(.?d to Occuj)y Building GAS.INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove No Lathingor Dr Wall To Be Done v Y Until Inspected and Approved by the Building Inspector. FIRL DEPARTMENT Street No.` ��`( ' 36 PLANNING FINAL CONSERVATION " a Smoke Det. Q SEWER/WATER I FINAL DRIVEWAY ENTRY PERMIT � zz-?z; CERTIFICATE OF USE & OCCUPANCY � Town of North Andover Building Permit Number Date THIS CERTIFIES THAT F THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. NORTH CERTIFICATE ISSUED TO ' ADDRESS �► O+rye"A,•t� '^C"°'`� rl ing spector c I I , i i i I Y I