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HomeMy WebLinkAboutMiscellaneous - 171 FOREST STREET 4/30/2018 (2) 171 FOREST STREET J210/106.A-0176-0000.0 I I Date... ..... OF NORT/y TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION CHU this certifies that ............, ...k-o .........--4 ,. . P.... .................................... has permission for gas installation ......c5.��.-.�x.. ............................ in the buildings of......Zar....PS...........J.................................................................... at..............CI: .......�f C:5k..c-'............................. North Andover, Mass. Fee...�..y.......... Lic. No. 1510�.]....... ..................................................................... GAS INSPECTOR Check#=/G IvJ ! + MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK t CITY r1��/i 1.' � c.Y/J j MA DATE PERMIT# JOBSITE ADDRESS / qty, OWNER'S NAME GOWNER ADDRESS TEJFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PST ® RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES D N00 APPLIANCES 7 FLOORS- BSM 1 2 3 1 4 5 6 7 8 9 10 11 12 13 14 BOILER E::j=L-2j1. -- BOOSTER ( CONVERSION BURNER ---- COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACEI GENERATOR GRILLE INFRARED HEATER J -_ -�_ LABORATORY COCKS � � ) L _._ ._.... —i _--� _ �—._. �J. MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ ROOF TOP UNIT (-- TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER— r INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YESA NO �f IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY P OTHER TYPE INDEMNITY Ej BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER (] AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent prouisisan-of the Massachusetts State Plumbing Code.and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME _ LICENSE#-_ yf G 8 GN&URE MP PI MGF D JP 0JGF a LPGI� CORPORATION©#�PARTNERSHIP El#��LLC Ej#COMPANY NAME2. ADDRESS CITY l STATE ZIP TEL _ FAX CEL - -•- EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY 42 FIN INSPEC N NOTES Yes No r l3' THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES e i 1 r�I The Commonwealth of Massachusetts { Department ofIndustrial Accidents X Congress Street,Suite 100 ' _ y Boston,MA 02114-2017 ' www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contxactoxs/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ' .,Please Paint Le 'b '" l A licantInformation Name(Business/Orgat&ation/Indiviaual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropr➢ate box: Type of project(required): 1. 1 am a employer with _employees(full and/or part time). 7. E]NBVSI'dOristrilCtlOn 2.�1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9, []Demolition 30 1 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 ME]Electrical repaixs or additioAs ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 124[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•.0 R66f repairs Thesesub have einployees and have workers'comp.insurance.t 14.�Other s ��� 6.❑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 ch$cks 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(hose entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is pr ovidingwor kers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: S 2 Expiration Date: Policy#or Self-ins.Lie.#: City/State/Zip: lob Site Address: / ' Attach a copy of the workers'compensation policy declaration page(showing the poficy 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. ofperjury that the information provided above is t ue and correct. 1 d hereby certify under tliepains andpenalties Date: Q 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 Phone#: Contact Person: I r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of We, express or implied,oral or written." An employer is'd'efnied as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver'dr 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 I52,§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 certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town.Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write•"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617.727-7749 Revised 02-23-15 www.mass.gov/dia i OMMONW d EAU OF MA...AOHUSETM • 7 -$QAF�E7F p� ° PLUMBERS AI+fiD GASEtTTE:.'R ISSl1ES THE P6LLOW11,10 Lt"`CENSE> 10ElVSE,D AS A MASTER , „.{�Mg s Iyf� �1A1�1ES A SWALGEN 20 FARRWO'OD DR OKSETT ' -+ NH 03106 2.162 0 0 l <1 G 2 GENERATOR APPLICATION DATE: LOCATION: f / ccGS� OWNERS NAME: GENERATOR kw /4Z NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: ELECTRICAL GASP RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVA ION APPROVAL !!50 '� North Andover MIMAP November 23, 2015 r, ka < A � YI 'O @ N x x 1 �eirad x a a N _ 4 .T. I' Y.- � x e: d S Y� 0 MVPC Be Interstates Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —SR MetersData Sources:The data for this map was produced by Merrimack Roads Gt MCRTq, Valley Planning Commission(MVPC)using data provided by the Town of �t..tp North Andover.Additional data provided by the Executive Office of 171 Easements ?�� ���Q Environmental Affairs/MassGIS.The information depicted on this map is 1 Parcels for planning purposes only.It may not be adequate for legal boundary to definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER Ill MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ♦ —Roll ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT # Q� i + ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 1y1 �»o THIS INFORMATION sSACXtIs 1"=128ft North Andover MIMAP November 23, 2015 106.A-0173 - 106.A-0008 137 FOREST ST 106:A-0174 ---'•:.: _...._.. 106.A-0190 --•106:A0182- 158 FOREST ST MW 106:#-0175=:=:_::::. ... .l, • ,:_:-_ p 10 JERAD PL 106.A-0213 106.A-0179 106.A-0041 ::_ ._`..,,p.. 159 FOREST ST d•ptace•poad ' ............ lets \145 FOREST ST 106.A-b 1 106.A-0178 106.A-0180 w 1 ' '• 165 FOREST ST R1 •`.- 171 FOREST ST 6 .......-_ .'-..:�_'• ..:._ 106.A-0176 -- -= - r�sltl.. 175 FOREST ST = ..... . .... .. .... ..._. 106.A-021 1,`•'•°'�-- :_: ! 106.A-0073 1 183 FOREST ST c>s 106.A-0186 1264 SALEM ST 1260 SALEM ST - "'Flu. :_._. ":.. _ 220 FOREST S :.__:• :`:::.r�kl(r.:._.? :. ,lu 106.A-0040 106.A-0187 `•-• .jai: :_::: .:.4 • ::::` sy... s.; 106.A-0074 106.A-0075 106.A-0188 - - ®MVPC Bo Wetlands Zoning E'Municipal Boundary C Exempt Lands Busine s 1 District C Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line C Busines 3 District Meters Data Sources:The data for this map was produced by Merrimack Interstates ®Busine s 4 District 1401111l Valley Planning Commission(MVPC)using data provided by the Town of — ■Genera Business DistrictOe - �o q� North Andover.Additional data provided by the Executive Office of —SR C Planne Commercial Dev ?����� ����00 Environmental Affairs/MassGIS.The information depicted on this map is Roads t.'.Corrido Development Dist 3' _ L for planning purposes only.It may not be adequate for legal boundary C Corrido Development Di sl O w definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER �,Easements C Corrido Development Dist .' 1 MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Induslri 111 Distrld ❑Parcels ♦ • THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY G Industri 12 District = w * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT Zoning Overtay C Industri I3 District ;o i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF {�Adult Entertainment O Industri I S District • ••r- E3Downtown Overlay District Reside ce 1 DisMcl 71.*+'+Artto��•�(°� THIS INFORMATION 13 Historic District Reside ce 2 District SSA 0 Water Protection xf Reside ce 3 District CNUS� IJ Hydrographic Features A de ce 4 District —Streams 1"=128 ft •de ce 5 District TT de ce 8 District ,��age esidential District w � 2/7 Date................ ......................... OF r►ORT{.�q,y 3�; •-. ao� TOWN OF NORTH ANDOVER O T PERMIT FOR WIRING s3ACHU56 This certifies that ........'E.......2 �1 �� G c.1 ............. ......................................................................................... has permission to perform ......... .e, ti Q P a` ........................................................................................ wiring in the building of........... �.C?N Q.. ...................................:..................................... at ...... A.... }`Q-i..sA...... .......................................North Andover,Mass. i Fee..... ........Lic.No .. !? .... . ......... ELECTRICAL INSPECTOR Check# Official Use Only Commonwealth of Massachusetts Y _ - Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) %-7/ F-nr-p—s--f- S-- Owner or Tenant U XS 0 h Telephone N<-6cD12 Owner's Address r-t✓" (� P�' SS V A Is this permit in conjunction with a b ilding permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Buildin p g )\� � Utility Authorization No. - Existing Service Amps Zq d / 120 Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity C.. Location and Nature of�roposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. 5 No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No,of Hot Tubs Generators I KVA i + No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergencyughting rnd. Lrrnd. Battery Units [No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No. of Zones.of, 11'ehes No.of Gas Burners No.—of-Detection and WI Initiatin Devices 43�" No.of Ranges No.of Air Cond. Total Tons 4Detection, rting Devices No. of Waste Disposers Heat Pump Number Tons KW f-Contained Totals: .••.. Alertin Devices No.of Dishwashers Space/Area Heating KW Municipal El other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No. of WaterHeaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent -T--�>OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE,V BOND ❑ OTHER ❑ (Specify:) I"certify,under the pains and penalties of erfury,that the information on this application is true and complete. FIRM NAME: D jp 1 G LIC.NO.: Zoq S Licensee: A, b4; y) Signature LIC.NO.: ?-aLJs J (If applicable,enter "exempt"in the license number line) Bus.Tel.No.- Address: Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ i 4 ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed f 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 y y electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Y Pass 0 Failed 0 Re-Inspection Required($.)❑ I Inspectors Comments: I Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: v FINAL INSP CTION: Pass 0 V Failed '❑ Re-Inspection Required($.) ❑ Inspectors Comments: 4 a4 we Inspectors Signature: we&&xlr&--- Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 4 i• The Commonwealth of Massachusetts Department of IndustrialAccidents :•-• a I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): b X tf 2 Elex +r i C Address: 77 >-VI\Ah c4 S , City/State/Zip: Cil 6 N 0_�06 0 Phone#:��� 543 --q4-79 Are you an employer?Check the appropriate box: Type of project(required): 1.W I am.a employer with__�__employces(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs '�,,_' These sub-contractors have employees and have workers'comp.insurance.$ �1 (�" �'a r 6.F1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other 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. t 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-contraciors 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.Lie.#: ` Expiration Date:/� Job Site Address: Jy Uc�' City/State/Zip: An ve-r- fv'1M 0 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 certify under the ains en Vties ofperjury that the information provided above is true and correct Signature: // 14�7 Date: o 20 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#: i y 4 i 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." I Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-'contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents fok confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia * « %bOMMON�E L H OF MAS§4HUSETT .. \ , , , . . ■ a ■ . ! � ,Q R i Of /bTRICIAN. r % i S E> HE FOELOWIN" a . , . AS R U,NE\MAS IL{ RIb 6 /S E A DAL O y ^ ) 7 DEMAN \M/H A 03060\ / , g,%g; " o Date. �.. .. .. . . ... .. rt OF`NORM 11, o� h` TOWN OF NORTH ANDOVER - PERMIT FOR GAS INSTALLATION . 09 SS^CHUSEt This certifies that . . .A. . . .. . . . .....e. - . . . . . . . . . . . . . . . . . . . . has permission for gas installation . ¢. . . . . . . . in the buildings of . .��'?'y`:�? -�-� . . . . . . . . . . . . . . . . . . . . t at . �7/. . . r:z . . �f. . . . . . . , North Andover, Mass. Fee: . . .�'.�" Lic. No: `.Y. �`/�! .. . . . . . . . . . . --GASINSPECTOR ' Check#r/i --- 50 1G MASSACHUSETTS UNIFORMAPPU TONFOR PERMIT TO DO GAS FrITING (Type or print) Date f�a7-dS NORTH ANDOVER,MASSACHUSETTS Building Locations 7/ tzLZT Permit# a / Amount$ O ner'sName ������ New❑ Renovation ❑ Rep cem t Plans Submitted 1-3 w v� Cn Cn U M a C6 w E. 10 z o a Z O Z W w H a p, a W Cn w v, z W a v' w . o a H c� H z WWH z H F w oo z U o a 0U a W A ate. F O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . FLOOR 5TH . F L O O R 6TH . FLOOR 7TH . FLOOR STH . FLOOR (Print or type Check one: Certificate Installing Company Name 4"/ (` ❑ Corp. Addressd� '�� ❑ Partner. Business Telephone Firm/Co. (Ogg -1` Name of Licensed Plumber or Gas Fitter 1 Fol GI INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes D No❑ If you have checked yes,please. dicate the type coverage by checking the appropriate box. t Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 13Agent El i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installati p o ed r Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S o a ter 142 of e General Laws. By: Sign re of Li nse mbe Gas H ter Title ❑ Plu ter City/Town ❑ Gas Fitter License Number ❑ Master APPROVED(OFFICE USE ONLY) muzi rneyman Date.....(7�. ... ........ ........,<. MORTIS o TOWN OF NORTH ANDOVER P PERMIT FOR WIRING 04 SES This certifies that ...... !` ! ... .. !� { IZ f { ...................... .............i .......`j�..i...... has permission to perform ......L�l , I :r n wiring in the building of...... ....eJ.�..... .Cf`. (��.:.Y. .................................... r . N rth Andover, Pt...../.71....j .'.:............ ...................................... ..Fee.. ... Lic.No... �1.�5.............��;�;ziN'SPECTDR ... C PAID ID WHITE:Applicant CANARY: Buildi p� PIN1l97ia su er 04/13/ �.\ ThECOMUOAW L7HOFA14SS4(Cfftc 77S Office Use only -3 DEPARTM1D%f0FPUB1ICS4FM Permit No. BOARD OFMEPREVEMONREGU ATIOAS527CMR 200 Occupancy&Fees Checked APPUCATION FOR PERMIT TO PERFORM EC'TRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS AL CODE,527 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the I spector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 7— Owner or Tenant j1 Owner's Address Is AM S Is this permit in conjunction with a building permit: Yes® No M (Check Appropriate Box) Purpose of Building r /V G C i 1 /t'M/LY, �tyS.L L. ( Utility Authorization No. Existing Service Amps Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity I fixation and Nature of Proposed Electrical Work o.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices 7o.of Dryers Heating Devices KW Local a Municipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis 7No.Hydro Massage Tubs No.of Motors Total HP OTHER LmrxreCoaage Ptasuant0�ti�eregtritarafdt>sGareralLaws Iha%eaaxmtLiabtil ybwa=PoisymdLd%CaT t e CoArdWorgs eytnvalert YES F NO Ihaw%hnittedvandptoofafsarnebtheOffi=YES F-79 NO r7 Ifjouha%edvckedYESpimeuk&thetAxofWmaWbydakirrgthe Wopri*INSURANCE ® BOND a 011118-R M ftmSpefy') D& F&Ts iad VakxdUect<i ml wait$ WakIDSW hq=fi ,D*Rquesbad Rain, Final FIRMNAME f� 11S d L G` /C_ LioaseNa } Licasee j'/1�a6 i (In1Y5,- Sigttatine , , (( BmirmTel.Na VJ d L. &l 7" iP d;10 � U1 44 W ...._.... AiTeLNa U... �7;7� OWNEK`SlNSUl A EWANER,Ian lattht:Iix se lheirstraroet a etriss tet asrec��dbyMassadts�sC�ealL�vs and fat my sag�rattaeon this p�appli�on wain th's ragtmsrrrult (Please check one) Owner a Agent Telephone No. PERMIT FEE C Cd�� �t r 1 `•t :1 Date..`:...7. ...: ..'....... A NpRTM TOWN OF NORTH ANDOVER o or + PERMIT FOR GAS INSTALLATION ti A t • s "• ,SSACMUSES M This certifies that ., . . .� :.!. . . . . . . . . . . . has permission for gas installation `.:. c'.: . . . . ... ... : .r. . � .{�. in the buildings of P., . . . . . . . . . . . . . . . at . /. :. . . . .. . . . . . . l. . . . .! . . . . . . . . . . . .. North Andover, Mass. Fee. . . . . . . . . Lic. No.. . . . r. . :. . . . . . . . . . ..... . . . .`:. . . . .., . . GASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer ;LG 'F v MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASF117ING (Print or Type) N, M�ny E r- ,MA Dater;I L 195 Receipt# Permit# �-� y`S Building Location I"i I �oe-F s - S-E . ;io OwneesName I it k cL�m at'r� " ` Map: Lot: Zone: Type of Occupancy V' S s`c, n G t4 New ❑ Renovation ❑ Replacement❑ Plans Submitted: Yes❑ No ❑ Fee: w °1 ¢ p Y w ¢ y N N N V z f. Q W ¢ (n Q O ¢ N = 1- w ¢ O U xW ►- a 0a z F, 2 -I- a O w a x z o z cc m (n w w 0 a ¢ W Q V W = y Z R ¢ O p > W W W N W Z Q IL Q W S �y W V N 3 Z Q W J Q ¢ ~ > N m 2 O Z Q O H = Q W > Q W O Z G ¢ 6 < O O W — O W �- } ¢ X10 0 1 x I LL 3 a t7 v ¢ > o a F- O SUB-BSMT. I / BASEMENT V �— .S 1ST FLOOR Q 2ND FLOOR `� 3RD FLOOR 4TH FLOOR 5TH FLOOR (� 6TH FLOOR r� 7TH FLOOR a T H FLOOR Installing Company Name Checkone: Certificate rrVn Address '13 i. W a I-6 r ` r, -D a n v F r ri V-rl v*-'t Corporation V' Estimate Valueof Work: ❑ Partnership Business Telephone 1- Y oc7 - 3 1 1 -6 U a Y ❑ Firm/Co. Nameof Licensed Plumber orGas Fitter h INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes MrNo ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy 18r Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Checkone: Owner AgentO Signature of Owner or Owners Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed underthe permitissued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the n ra ws. By Type of License: Plumber Signature of Licesed Plumber or Gasatter Title Gasfitter �$ Master License Number City/Town Journeyman APPROVED (OFFICE USE ONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO OASFITTING NAME& TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED i DATE 19 4 OAS INSPECTOR �No i 9 .........�..... Date...:......:..... NORTH °f++``°:•'"o TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ;,SS^CMUSE� + This certifies that `..'. f f has permission to perform ...................................................._ " ........................... U wiring in the building of.........: ......:.� . .................................................. at.........1.... // .....—..r'J.`..`�.'..:�.................................... .North Andover,Mass. Fee... ��............ Lic.No. ..'.../.... ........................ ..................................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer �5 THEC0111� 0NWE4L2^fl0li'11�ASS�4CffU.SE77'S' Office Use only DEPARTA&W0FPUXJCS4FETY Permit No. BOARD OFFIREPREVENTIONRF�GUI.ATI0AN5 7CNR 12•00D �I 'VA Occupancy&Fees Checked PPLICATTONFOo PERMIT TO PEWORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUsm ELECTRICAL CODE,$27 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) / 2 / Q ,)r ✓rj Owner or Tenant 1A� Ad A � rir� .rte` Ir r�rl Owner's Address 't�7. Is this permit in conjunction with a building permit: Yes m No I 4A (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Underground a No.of Meters New Service ZOL) Amps 4L, /. Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work JA1ck --1-L, IljIgJ Sr.a.0,,cs No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 0 ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal a Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER It>StrxloeGaeia�RrsuanttotheregtsrarratsofIviassadtsel�GmsalLaws Iha%eaamotLiabOtyh>stra=Po ymdu&gCmVlde GaadgeeritsalbdardialeWivalert YES NO Iha%ewbrr&dVAidpoolofsametothe0ffM YES M NO Ifjwha%edtec WYES,pimenic*4etAxofwawbydakirgthe INSURANCE BOND OTHER � (I�eSpetafy) Fxpuatron Dube Esti reeled Vaktec Ekbical Wodc$ WakiDSla t hspedmD*R49sted Rough Feral sigrtedunder�iel�ralaesof FIRMNAME1-1 C lL lit�>seNa lkarsae 149 utyf) tfi,/L� Signature / -71 Btsi rens TdNa Ate. riJJLL fp /A).r3,eL1 b1 .. Ak.Tel.No. --2Y�;�� OWNER'SRgKJRANMWAIVER;Iamawat fAtheTlhem,su=wv= eorilsmbsWWe4nvaia>tasragwWbyNb%xhzmGaeallaws wddratnrysignat cn t{spanniappheabm. ftrequsenat (Please check one) Owner Q Agent i Telephone No. PERMIT FEE$ Location No. Date / Y NORTN TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee $ �'�s"•"°'�<�' cMuFoundation Permit Fee $ -t- s� st it Other Permit Fee $ J� Sewer Connection Fee $ f Water Connection Fee $ I TOTAL $ = Building Inspector 1 :3 � JO Div. Public Works PER-MIT NO. ® APPLICATION FOR PERMIT TO BUILq/- NORTH ANDOVER, MASS. PAGE 1 MAP-$-4O/C,/ n II LOT NO. 1-7 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE ��/t SUB DIV. LOT NO. � -I LOCATION )`�7 j ¢� PURPOSE OF BUILDING OWNER'S NAME / / NO. OF STORIES SIZE OWNER'S ADDRESS cBASEMENT OR SLAB ARCHITECT'S NAME tQl /I�_„/7 SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN -- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET "" POSTS DISTANCE FROM LOT LINES-SIDES REAR "" '" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION y e.5 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TOR QUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY /,f, A/,/� �( / IS BUILDING CONNECTED TO TOWN SEWER ' IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS // 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES / x1 /•�,�. EST. BLDG. COST tf�OO of /J p� � / PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 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 _ 406-�- BUILDING INSPKCTOR 'SIGNATURE OF OWNVR OR AUTHORIZED AGENT / F E E l OWNERTEL.A PERMIT GRANTED �..--""� �� '�,.-,, ONTR.TEL.# ��'Z 32V 19 r, CQNTR.LIC.# H.I.C.# 4 BUILDING RECORD 1, OCCUPANCY 12 SINGLE FAMILY StORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY �_ OFFICES APARTMENTS LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETEB t 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW'D PIERS PLASTER _ DRY UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/ 1/7 1/ FIN. ATTIC AREA _ NO B M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 11 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDVJ'D _ ASBESTOS SIDING COMMON _ VERT. SIDING ASP,.TIIE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR r ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.) GAMBRELMANSARD TOILET RM. 12 FIX.) FLAT A SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'Tnd _ ELECTRIC 1st 1 23rd NO HEATING R T dover Town of No. joy rdV' Ahdover, Mass., ,',I Of"ATED BOARD OF HEALTH Food/Kitchen B_ Septic System PERMIT TO UILD P4 pqc BUILDING INSPECTOR THIS CERTIFIES THAT.........1WfJfi#1#?...............4 ...... ........................................................... Foundation 4--------*****"...**...* has permission to erect... .... buildings on ........./..?/........ ...... Rough to be occupied as........ cAo+ Aw r .......r Roo ....... ........................ ...... .. ....................... 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 PEI�NIIIT EX.,[ MES IN 6 1\V10N1_'HS Final NS111ELECTRICAL INSPEC'W, U'�LESS ('O1 Service BUILDING INSPECTOR Final Occupancy P-e-,,,n't1Rcqu're(1 to _)y 0 1' ' ul In 1 Vi g 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 Street No. SEE REVERSE SIDE Smoke Det. FORM U - LOT -RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. ***********************`******APPLICA-NT FILLS OUT THIS SECTION"t*******''"�*""'`��""** APPLICANT_ �l h w 4 r EQ PHONE LOCATION: Assessor's Map Number l0 (� _ PARCEL(� SUBDIVISION �- LOT (S) STREET t], C� ST. NUMBER **** * ****** *********** **OFFICIAL USE ONLY** Fi N i 5 C-�, RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INS P - TOR-HEALTH DATE APPROVED DATE REJECTED T C PECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS /C PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 Jim REQUIREMENTS FOR FORM U SIGNOFFS BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Form U l. What is the proposed project? deck pool addition new house other- 2. Are plans attached? Yes No (For additions and new houses on septic systems, complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is municipal sewer available at this location? Yes No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes No 5. Is the location served by private well? Yes No 6. If this project is an addition and the house is served by a septic system, has there been a Title 5 inspection done recently on the septic system? Yes No 7. If, yes, is the inspection report on file at the BOH? Yes No A'VaIH. N :�I Nd1d NXVMOd ;j:, SAWOH ANIS -AU �iiciiin,.i V V `/• I-1-11A i0 lam :XVa , ,�� 5,�S Od IGl `:�u n ro l ' ' x 1 itis + I40hR9 vV v ` LLL 7N:` i .a..✓.4.Sy1.t.,r't..4..7 u ?..,,�.x.,.�w v -...tr,.[*x..Y.+. _ A ••• ... - .: JY§L.rwiLC' ilf.�. .a.U.,tn:n.�t,, .r."drr:w+..i�dai4w..:..+i,�`'i6 1�IM1.u 1...... �+ � R t u9'AI r 1111 ,9 y --EXIST UTILITY DUCT REIAlIVE DURTNCi COINST AS REM EXIST (4) PX10 1I 10 JOIST L M-GER BEAM TO REMAIN x PPHIRT FLOOR J'JIST "UEACH SIVE FIF CENTER 13EAM BEFORE -/7'--0'-4- TO SLA-8 REMI]VAL OF REAM REMOVE AFTER STEEL.. BEAM IS A- (4) 2x,10 BEAM-J I IN PLACE & SECURE EXI S T REINF_nRCE OR' REPLACEEXIST CIR-UMN _1'(_1 4 DE REMOVED SEE PLAN ____-2xI0 JOISTS-------_ F 112' cp LAC-1 9 3'-0'± O.C. OR CHANNIELS' EXISIMN6 CONDITRIN STAGCFR EACH SIDE T 0 BEAR FIN CTINC WALL SCALE, 3/4* 1' - 0' v!11)FN 1'11('f,FT AS REUR M-F.-MEN'T CARI?Y EJEAM NEW CAP PEACH SIDE L FIN COL.-/ -C9 BEAFM TIGHT TO _j 0[S T S j--R_DAqVE COLUMN .............. BEAM I-LLVATION -- CHANNEL f..1PTJ0f',1 SCALE; J/8' flITI Si 01:yflf"!]) RENDVATHIN IN AU]nRDANCE WITH TIHE SIXTH 2xl(j's 16' ED11-1024 CY I-'11E HASSACHLJ�SDJS STATE BUILDING 2x11j's 16' ii 1/2'x8"x 112" CAP PL CDDE FUR THE F'11LL11V'T1'qG LIVE LOADS: C9 x 13.4 EACH SIDE [IF hEAM FIRST FIANIN C'jSJT(VE CONNECTION TO 410 PSF 1/2' DIA LAC, 4' LlING SUMNI) FL.FiCIR 30 ILSF 111A LALLY ICOLUMN _111M fjV7 9' I-ROM EACH END & SMIV LGAD 30 pl�t TJ N 13 E R SHIM HVER 3`0' t R(_ STAGH'D,' EACH SIJ)E. S]A M BASE PL, VO SL AD i E N G-T I i FIF CAP PL. (10 LAGS TfIT111L) VEPIFY DETAILL, & 1)fV1f-_.NSjFjNS PRIOR TO DRDERIk(i _ MLS (4111I , - FY E-1,16INEER fJF '11N'13-H1FJNS THAT "'p. TFV VDII.- PL_ MA IER DIFFER FkUM HIE PLAN PRIFIR TO CUNIINUINCi VfIRK, IJIA:1'1'r PL PIPE CM-UMNS SHALL BE AS',"Ji. A,)0! c:Fv = 3h 1(sl) SI EEL PE-AP-11 SHALL LIL hS.C.H, A:jc, ANDIFIR fil-.11-TS SHALL BE ALIERIN,ATIVE REINFEIRCEl) DE_f�fl_ APPRf-IFRIATE HARIWARE SCALD 3/4' = V- 01 DRAWN RD.M DESIGNED SCALE ::HEET NO. DATE 03/02/99 AS SHOWN OF I CHECKED P,fj,M _)[ U*C11-1 NA 1, 1-kl.EN()VA'11 0 N "AA) RJ) E-AIG.-INEERING CO, P.O. fR-OX 1244 F(Yh�' W'TLUA IN4 .. 1 ,--- --,E,� 11AVERI-IfLA I., M . 01831 ' -1 (50{i) _373--2396 LOCATF-D HN 1%4'0f%1Tff ANMOVEIZ, b!A,9,1'_)'A(A 1(.1"':7'f'j'tP4'Q' r. Z i EXIST U iILFFYr DUCT E ' EMOVF- DURTK2 CUNT S7 o, [fE: �1.], _._--.--_-- E_X I T (1) ..�- 1(i 16 US rt JDIS 1 i L 7 BEAM i I._l R;L_�AiN h 2- C. NEW �1 (1f� UIDER- - �- - r 10 r IJPI'[_I 'I 'r I !_'f 4 IEIi r A."Ji A F TACE[ (r') C -x, 13,, I Fvj rrl Si.p( D C'f-Cl i F R 13E+AF' fU rj1CF SIDE (.lF < 7'--I]'+ Io SI_.AI3 f EM[_IVAI,_ OF DEAM C;'- E xi ST .JDIST�- � REMOVE AI �lE R aTEES_ 13EAi-1 !' Air IN PLACE F, SEC'U'RE F:.'(IST <4) 2x1Q PEAM 4 _ --_ F'XI ;1" (__lL_Url N TEl RIA .—PF-INi EPRE^]1E EXISI(Jt; }3E f?EMLIV_D rf_LPf / FC ----- ---- --Y_ PLAIN ff I ! i x, 4 --DI_AM UP CHAidill_L-S /;! l f NG C1:=N1111- i-IUN � _--- ?o DEAR n,d WIDEN PPC!T'f AS REGJ i, CAI-E. 3/4' 1'-- 0' PAR FlAL PLAIT — DAA F-i`EENT CAI-CRY 13EAM � NE'„l CAP PL '�C':I SI:iJE UNCUL_, f I3E:Awi TICi:!F 1!J .i':!`: i' KOH --C4) 2x10 CD, 4�/Esx21 B[:_YUP.ii) � 2x10's Q_ 16” `! ,. f7 I!2'd+ / — 6 __� F OITIHN I_IF 1 i IE_ Hi"". r I/2 ;:[1"x 1/2` CAP PL_ FUR TiF F[ SHIM PI_' V �C9, x 13,4 EACH SITE OF I?L=AM F1f ST F-1-ULI' C1STT? ��. CUPJNECT1Uh1 F❑ ;i E-.F L I?EAh.1 �-.. 1/2" DiA, I_AG, 4' UINC.i ,IC7l.1.1 FLUUR 3 1/2' DTA LALLY C[7LUMN _ 9' FROM EACH END k R rl1w !_CISH EXIST Ull-UNN �; _1,ONDARD 13OSE PL. TINDER SHIM LIVER � 3'-0' _+_ L7.C., S FAGCIFP EACH SIDE MAY BE REUS(-1.1 AN1;I-11IR TO SLAD LENGTH ElF CAP PL, - (10 LOGS TCJTAL) VUe-TFr Dc1A1!_S k. tail IF CAP FI_ TS f 1 --Cpl_ CAP PL 1['y.,°„i/2' MATERIALS, NF1TIf � PEF LACED r./ R YP, TEF r F- FRUN )Pf- Pt / BASE PL P.CPF_ MIUNNS SlIN ! STEEL RF_Ar1 SIV)ll i,: 1 - ANCHOR 11H1. 1 S Sl Vkk t (ERIJ(-( I v F REINFORCE!) DETAILAPPRUPRiATF SCA(_F--t 3/4' = V- 0' DRAWN_ F',11.t;1 DESIi N'ED P,D,i l ------� ------ -----, CHECKED P,D,M I DATE 03/02/99 DIZ.ADF ORD ENGINEERING C0 STRUC°I'U L RE I; P.O. BOX 1244 IT,OR witil jAm REVISED ISED CIONDI i ION I-IAVET..11U, MA_ 01€.9-1 117- 1 1--�'' �:_�_�= P- s` - G, (500) 373-2'13'U6 hh r L 1 �rilfLQCA 1,H) IE! J-l�l.v.R O It ER,.. MM'