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HomeMy WebLinkAboutMiscellaneous - 174 WEYLAND CIRCLE 4/30/2018IV- I ') 'I /Date ...... Z/ WN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... .......... A has permission to perform ..... ........ tl!)! ...... .................. wiring in the building of ..... at ........ .. ... ...................... . North Andover, Mass. -7- � Lic. No...�/2w ........................................................ ELECTRICAL INSPECTOR C q 5 � 101/14/98 10:46 2 0- 00 P'I;INIC�-reasur WHITE: Applicant CANARY: Building Dept. lx/� u�� �atnu uralth of �Bac4us= � �"Ce use °n"� o. Erpartintnt of Public *ufttg Occupancy A Fee CttodW BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORKAll work to be d ( P accordance with the Massacnusetts Electrical Code. 527 C4AR 2:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date //1 or Town of NORTH ANDQVFR To the Inspector at Wins: The udersigned applies for a permit to perform the electrical work described below. Location (Street 3 Number) 17"/ *,2 idxn d Owner or Tenant Ka6 u -r t( V Owner's Address 2#1-6 1= this permit. in conjunction with a building permit: Yes _ No C Purpose 5//7!a/E ��-c1��79 (Check Appropriate Box) of Building Utility Authorization No. Existing Service 9cU Amps40 /;�Llu Volts Overhead Undgrnd No. of Meters New Service Amps _� Volts Overneaci _ Unagrno C No. of Meters Number of Feeders and Ampaclty / Location and Nature of Proposed Electrical 'NorK W IR le 7 No. of Llgnting Outlets I No. of Hot "_-s I VvI (I No. of Total f ? uvA, No. of Lighting Fixtures i Swimming P -:o, Aocva -- ;n- f'- I grro _ grn° _ Generators KVA No. of Receotacla outlets No. of Oil co No. of Emergency Lightingrners Battery units No. of Swlicn Outlets I No. of Gas=urrers FIRE ALARMS No. of Zones No. Cf Ranges I No. of Air Czr..c. O1di No. of Detection and :cns Initiating Devices No. of Discosats I No.ol Heal '01a' Pur 'ons -.:5 KV4 No. of Sounding Devices No. of Oianwasnen SoaceiArea Heauc° K.v No. of Sed Contained Oetectson/Sounaing Devices No. of Dryers I Heating Cev,cesKVv Local '— Municicai ^Other Connection ' No. of No. of Water Heaters KW I Signs eaitas;s Low Voltage i Wiring No. Hydro Massage Tuos .: I No. of .'vfoicrs .oiai HP OTHER. INSURANCE COVERAGE. Pursuant to ins mouirements --r'.iassac-.,secs ;eneral Laws I have a current Liability Insurance Policy inctuoing C ,mc:si Ccerauons Coverage or have suomineo its substantial *auivaNnt. YE$ 7— NO _ t valid proof of same IC the Office. YES VO = If fou nave checked cttecxing the acoro ate Cox. YES. prase Inolcate the type at coverage filly INSURANCE _ 00N0 = OTHER = (Please Estllnatsa value of !ecln at worst S (Ettoiratton Oates . Wont to Start ! 417? Inspection Dale Aaci es;ec: Rougn Final Signed under ;he Pe allies of, Asrtury: /,�' FIRM NAME �W z::-Weet�L� 2 L G qq UC. NO. Licensee ,�, - f UpC. No. �1 ,may /// Addtase T'GC !/hl� �////'f /(�` /� f (/ �<.c o� ' Bull. TN. No. / All. .el. No. r OWNER'S INSURANCE WAIVER: I am aware Inat the t_:censee ^-ces not nave ins insurance coverage of its substantial equtvaiMt se to. duueo by Muaacnusetts General Laws. &no that my signature an 7nis cermn aopaCation waives this reoutrernent. AgMI tPlease cnecx onel- iieonone No. pacl, d PERMIT FEEFEEX, " T (S.gnawre of Owner or Agent "R - Office Use Only _ = _ 14t Unillolmalf1i Df fRuB=4uBdtD Permit No. iDepurtutcut of public fWag Occu anc & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 (leave blank) 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 x/ /? I q 6 Cit or Town of NORTH ANDOVER T Y To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. / / r Location (Street & Number) / �I W'e `/ `q,,,e r CyllG e Owner or Tenant Fo Owner's Address Is this permit in conjunction with et building permit: Yes No ❑ (Check Appropriate Box) Purpose of Building / /! �2 X( &. /e iNl Utility Authorization No. __ [n -/ 3 O Existing Service Amps —J Volts Overhead ❑ Undgrnd ❑ No. of Meters New Service �� Amps ZaJ 9QO Volts Overhead ❑ Undgrnd LJ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work V / HU Al -� No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- ❑ ❑ grnd. grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and No. of Ranges No. of Air Cond. Total tons Initiating Devices No. of Disposals No of Heat Total Total Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices LocalMunicipal ❑Other ❑ No. of Dryers Heating Devices KW Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements Vplet(�penations chusetts general Laws I have a current LiabilityInsurance Policy including ComCoverage or its substantial equivalent. YES O- NO ❑ have submitted valid oof of same to the Office. YES ❑ If you have checked YES, please indicate the type of coverage by checking the aper riate box. INSURANCE BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Valueof lectr'caI Work $ J�tWork to Start16 Signed under the Penalties of perjury: Inspection Date Requested: Rough �i7/.T/LaI;R/lt Licensee/ iSignatul Final LIC. NO. I % T 1719 - — w LIC. ��NO�..�q lus. Tel. No. All. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re- quired 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) ?903 NORT1y 3� �, ..... • OL . 7•. ACNUSE� Date....... --I�q ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......�1 �� "( e......................................................... << ............. has permission to perform ........... .. � "-I- .. ................................... rr . wiring in the building of .......1.. v t�^;'� * ...............e. j? ................................ Cf at ...L.:.. fi.. .............../.L... V`..e �! �ct................ , North Andover, Mass. Fee......✓...%OA..)..... Lic. NoJ/?/- . .............................................................. ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File �)O — MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN� (Print or Type) NORTH ANDOVER Mass. Date 1huilding Location t k 3 -z— Permit ` Owners Name �-' � �•( New iYRenovation D Replacement Plans Submitted r (Frint or Type)Q r Check one: Certificate Installing Company Name o,, k- / G, Corp. Address . G - - d Partner. C l C 3 F-1 Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Other type of indemnity D Bond El Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above applieation are true and accurate to the best of my knowledge and that aU piumbing work and installations perforated under' Permit issued for this application will -be In compliance wi provisions of the Massachusetts State Cas Code And Chapter 142 of the General L►ws. __ Ira t PE LICENSE: Plumber fitter- Signature of Licensed Master Plumber o sfitter PE Journeyman Licen e Number • • • • • V • MEMO MEMEN MEN 0 0 mango MOSES MEMO NOR .1 MENEM No an on MENEM 0 MEMO No own 6TH FLoOR (Frint or Type)Q r Check one: Certificate Installing Company Name o,, k- / G, Corp. Address . G - - d Partner. C l C 3 F-1 Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [Other type of indemnity D Bond El Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner 17 Agent El I hereby certify that all of the details and information I have submitted (or entered) in above applieation are true and accurate to the best of my knowledge and that aU piumbing work and installations perforated under' Permit issued for this application will -be In compliance wi provisions of the Massachusetts State Cas Code And Chapter 142 of the General L►ws. __ Ira t PE LICENSE: Plumber fitter- Signature of Licensed Master Plumber o sfitter PE Journeyman Licen e Number r s� Date./- ,gid r ...... a NpRTM TOWN OF NORTH ANDOVER a 0 ° pp PERMIT FOR GAS INSTALLATION3 .. M This certifies that ..... ej!' s �? ... ..............�. has permission for gas installation .. .yi:ev.t '..... °'. in the buildings of ...................... at ..1 `! .. t!` !#��? �.. .. , North Andover, Mass. Fee. Lic. No.! U 3.v t ... ......................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Instal Addr m -o w-jr s t a unrrunm Rrrua.A l tun run rrnmi o 1 u Low s L-+llvewa (Print or Type) NORTH ANDOVER, Mass. Date L .l0 Budding� ` Permk * o� 8' 7 d Location .I�� 3 Z— w N° me a 3 3 vi New Cr, Renovation ❑ Replacement p Plana Submitted: Yea ❑ No. ❑ FIXTURE$ Check one: i iP- 8<. p Partnership A4,.) -6N4 -,L )-6N4-,L L VIA A o t 6 S) ❑ Firm/Co. Business Telephone 3 7 Y- l 7 Lf Z' / Name of Ucensed Plumber INSURANCE COVERAGE: UneCK one I have a current liability Insurance policy or Its substantial equivalent. Yea ®' No ❑ It you have checked y". please indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity ❑ Bond ❑ Certificate 1106 OWNER'S INSURANCE WAIVER: 1 am aware that the licenses 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: Sknatuts of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby cwgfy that al of the details and information I have submitted for entered) In above application are true and accurate to the best of my knovriedpe and that al pIumbing work and inst&Matlons performed under the permit Issued for lila picatlon be in Rana with all pertinent provisions of thi Massachusetts Stale Plumbkv Mode and Chapter 142 of OW Hy na a TNN Ucense Number J pty/Town Type of Plumbing Uanse: Master 0� /lPP WMD (OFFICE USE ONLY) Journeyman ❑ I Lit CM Check one: i iP- 8<. p Partnership A4,.) -6N4 -,L )-6N4-,L L VIA A o t 6 S) ❑ Firm/Co. Business Telephone 3 7 Y- l 7 Lf Z' / Name of Ucensed Plumber INSURANCE COVERAGE: UneCK one I have a current liability Insurance policy or Its substantial equivalent. Yea ®' No ❑ It you have checked y". please indicate the type coverage by checking the appropriate box A liability Insurance policy Other type of indemnity ❑ Bond ❑ Certificate 1106 OWNER'S INSURANCE WAIVER: 1 am aware that the licenses 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: Sknatuts of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby cwgfy that al of the details and information I have submitted for entered) In above application are true and accurate to the best of my knovriedpe and that al pIumbing work and inst&Matlons performed under the permit Issued for lila picatlon be in Rana with all pertinent provisions of thi Massachusetts Stale Plumbkv Mode and Chapter 142 of OW Hy na a TNN Ucense Number J pty/Town Type of Plumbing Uanse: Master 0� /lPP WMD (OFFICE USE ONLY) Journeyman ❑ 2890 Date. V../. J.-. Y. . A TOWN OF NORTH ANDOVER EE PERMIT FOR PLUMBING 8 This certifies that .. �.�!� �, y.....�................... M has permission to perform . ke L4'. - Mo. y F- ................ . �.T plumbing in the buildings of..�u-:.? ,,,,,,,,,,,,,,,,,,,a, at. P I . lti.,� y. �� f ...... ........ North Andover, Mass Fee >'. 7.0.. ' .. Lic. No../. U,7.eM .. .... . LUMBING INSP CTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File Date. . w HORTM fir,,.• .' TOWN OF NORTH A VER PERMIT FOR UMBING si r This, certifies that ... D. P. � .. �..... � .�. has permission to perform ... e. �:.T plumbing in the buildings of at....,iti., North Andover, Mass. Fee. Lic. No..c."l .Cj. I its,.7 ......... . PLUMBING INSPECTOR Check#`?G� 7353 .MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date R P2 o -z-, ZJ 0% Building Location 17 t/J Vy L M",�S (-(A Owners Name W(3" A IT'K r Permit #. % 3 5-3 Amount 3 Z • J Type of Occupancy 0 M New rl Renovation Replacement IZI Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate Installing CompanyName 7C1� f� l�/�%I L6 -� OTCs Corp. Address J3- Partner. 6' Cis Business Telephone ''j �, g 2 CO. �, �irra/ Name ofLicensed Plumber. Ke- x� -'o u .Po-�j�— Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy Other type of indemnity F-1 Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance lgnanue Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application ate true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa�hTetts Stat?P i<ode and Chaptert142 of the General Laws. ;own R .OVER (OFFICE USE ONLY Typp off PPlumbing License License uum er Master El Journeyman 11 Date. l%�./G i .......... TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION SACHUSE� �. This certifies that.....P.................. has permission for gas installation .... kJ— . ................. in the buildings of . , .�.-r �- ........................... at ..��! ...� . ` : `�.. ./. ! 1.. C; North--Andoyer, Mass. Lic. .. ......... OAS INSPECTOR Check # 7`7'o ? 5957 r 4ASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING or print) IvvxfH ANDOVER, MASSACHUSETTS Date i 0 Z t9— z oy -7 Building Locations V7 4 W a -Y C- k Q-- Permit # J~%) 3~ 7 Owner's Name NewF1Renovation 1:1Replacement rM Amount S 2-0 / .Oo tTk�\1 Plans Submitted ❑ (Print or type)I)U���r, ^ �� 4�..�--� Ch❑eckCnoeCertificate Installing Company Name `� Address L ❑ Partner. Business Telephone`—Z�o RFirm/Co. Name of Licensed Plumber or Gas Fitter \4 c �J INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other lupe 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 ❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the :Massachusetts State Gas Code and Chapter 142 of the General Laws. \ / —A \, c— itle own PROVED wFricr USE ONI.v) Signature of LicensedFiumber Or Gas Fitter Plumber Gy Q Gas Fitter License i umoer Master Journeyman Z r n N C C Z Z C Z Z :s1 n L w = Z =t C 'sl v i Z �t 'si rf, -� �A Z— Gyzl �. rJ 'C sl i C Lel s Z — •t C +1 C sl - - V V - - CC. - - - SUB-BASE.rt ENT BASE:M ENT 1ST. FLU U R 2ND. FLUOR 3RD. FLOUR 4T 11. FLUOR ST 11. FLUOR 6T 11. FLUUK 7T 11. F L 0 0 R 3T 11. FI,QUR (Print or type)I)U���r, ^ �� 4�..�--� Ch❑eckCnoeCertificate Installing Company Name `� Address L ❑ Partner. Business Telephone`—Z�o RFirm/Co. Name of Licensed Plumber or Gas Fitter \4 c �J INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy Other lupe 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 ❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the :Massachusetts State Gas Code and Chapter 142 of the General Laws. \ / —A \, c— itle own PROVED wFricr USE ONI.v) Signature of LicensedFiumber Or Gas Fitter Plumber Gy Q Gas Fitter License i umoer Master Journeyman .N Location 174 b)e ! -44 ` iee- 14 J� No. Date Z -14.9a r V9 ioz6 590 � IgG 02/27/96 4.52 1;977.50 9 �Id' g I at r PAID2 rv.u c Works A TOWN OF NORTH ANDOVER Certificate of Occupancy $ so Building/Frame Permit Fee $ Z4�_ Foundation Permit Fee $ Other Permit Fee $ 94 Sewer Connection Fee $ % %�o Water Connection Fee $ _ is 7715 TOTAL $ ZZ�� � IgG 02/27/96 4.52 1;977.50 9 �Id' g I at r PAID2 rv.u c Works Location No. Date -z—,R3 NORTH TOWN OF NORTH AN bVER �d Ot�t.ao ,a1�. Certificate of Occupancy f + # Building/Frame Permit Fee $ ��s�• �' CM Foundation Permit Fee $ 'Y ��!�,/k - ©t;er-Permit Fee $ L%Sewer Connection, Fee $ Water Connection Fee $ TOTAL $Fs .r 9 (2-Uliding Inspector 43/21/96 14:44 1,379.95 RAID 9572 Div. Public Works a i oIIL 1 0 F Y m U (n , rc to V 1 3 LY 1 N I z 0_ I N N M I N J N I IL z N tik � W tr Z f � N 0 p 3 O W z rb m Z X a O N J m J F O~C 0 Z O U IA LL o W to p N ILw 0 H Z 0 J LL IL I p N 0 L 0 0 Z 1 W N m 0 W N (a 1 m F LL LL I Q 0 0 N m W t: LOUJ W Q u I L L N I Z Qz v Cl ., d IL o J fj r i z 0 o � a M A ` Uyl W f < 0 Z O w i << z ul 0 < a Z N � m tj F r Q ? W< z No U W z 0 W z 0 = u i r. 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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***************** APPLICANT: _:Z�X 14 1 o A Phone LOCATION: Assessor's Map Number Parcel Subdivision Ea V, 1"1 0,0 G/ Lot(s) - Street AAA ,1 ho'll L-fYC( e St. Number ************************Official Use Only************************ RECO ATI OF WN S: A Date Approved 11 Conservation Administrator Date Rejected Comments Town Plaut Comments Food Inspector -Health Septic Inspector -Health Comments Date Approved �-- Date Rejected Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections 7 Le 2 - !e4 -46 - driveway permit / /� / � � Fire Department l ,/o�r� // !terl!%/j�/�'oej�,/(�jl^,.f,'��7,Pi� �-1- �:a;.�!�'-4ZZ Pr- �/✓Tir ,�� XI . c 1 .,.4610-n.. u n �C/� //Y& {P� (� P eceived by Building Inspector Date ,e = z90. ov' � r /VEREBY CE.cT/FY TO TyE T/TLE /,t/SURO.0 4.v0 7V THE BAN,r TNgT /S G4CATE0 O.t/ r1C 40r fS-%4VA,,a AoVO r6G4rrroa+CS co,1Faenw !Y/T/1 T.siE rou. ✓' OF Ivo. 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'92— ... . o� TOWN OF NORTH ANDOVER � A • PERMIT FOR GAS INSTALLATION 1 ,SgACMUSE� +This certifies that ... e ? ,%��.� ... .' . /74 .. . has permission for gas installation .... ... ..-1) ............ in the buildings of .. .............................. at ��l ...... ...... ... , North Andover, Mass. Li . No... .: .77.. ........ . / GAS I P� �OR Check # 4038 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS Ffl' (Type or print) Date C. NORTH ANDOVER, MASSACHUSETTS t -A CI Building Locations ` t a A Permit # % a� `1✓�y � � ,�-"`�`"� �7 — Amount $ ��i --Owner's Name New ❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Name Address K) P1U4fNr-k Name of Licensed Plumber or Gas Fitter 01 021! �2 Wt Sg7y one: Certificate Installing Company Corp. ❑ Partner. ❑ Firm/CO. INSURANCE COVERAGE Check one: I have a currant liability Insurance policy or it's substantial equivalent. Yes E2r No ❑ If you have checked M please indicate the type coverage by checking the appropriate box. Liability insurance policy 0-" 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 ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus3&js Stag Gas Code and 94pter 142 of the General Laws. (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter [• Plumber //"0,< 77 ❑ Gas Fitter icenseum er ❑ Master ❑ Journeyman Location��) W e y Uj ` � V - No. Date w-01- D a TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ b0 Is Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # a b CJ 6 1 Building Inspector TOWN OF NORTIR ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: 7 oZ-ao©� SIGNATURE: CO-_ Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required— Provided Required Provided 1.7 Water Supply M.G L.C.Q0. 54) , , 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public k4o, Private , 50 Zone Outside Flood Zone 0 Municipal Vo- On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record -)q y� // U� \ I� me ( rint) Address for Service � y3 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 icensed Construction Supervisor: Not Applicable ❑ 6 Gr .,)� • Licensed Constructionrvisor: �YJ� License Number Expiration Date Sig azure Telephone 3.2 Registered Home Improvement tractor Not Applicable ❑ Compan ame r-\7\ a 'Coo V Registration Number A s �di-� c1 1 \ ` Expiration ate Si azure Telephone The Commonwealth of Massachusetts Department of Industrial Accidents Off -ice or' -Investigations Boston, Mass. 02111 Wonkers' Compensation Insurance Affidavit Print M Citv 0% 0 M% Phone am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity WAMMON �m an employer providingworkers' compensation for my employees working on this job. C m_raariv name: ] !'�r�P„�►��- \ \. k QgMR rry name: Address _ Fai4rretu 80cure coverage as required under Section 26A or MGL 1,52--- tear) toftMVosftn of crirMu l peneides,d a fine up to $1,500.00 and/or one years' imprisonment as'well as civil penalties in the.form of a STOP WORK oftM and a fine of ($100 00) a day against rne. t understand that a copy of this statement may be forwarded to the Ofrrce of Investigations of the MA for coverage verification. t do herby certify under t 7ro the kAw maf w provk1ed above is hue ani- cored Signature Date .i) Print name s . Phone Official use only do not write in this- area to be completed by city or town official' DGheak if immediate response is requked Building Dept Contact person: Phone W WORKMAN'S COMPENSATION D Building Dept ' p Licensing Board p Selectman's Office? 0 Health Department 0 other North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: acility) Signature qPermit Applicant UA,, I Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector all rrkos of ceramic&quarTy marble Insurers Free Estafraates 1.1f: .#.DB,A.$1, H.I.C. #122347 CUSTOMER MR+MRS WELLS AITKEN name � ' ADDRESS 1 0 ADDRESS 2 174 WEYLAND CIRCLE CITY, STATE NO. ANDOVER, MA 01864 & ZIP 0 PHONE 978-687-9593 ' Quality work comoiete remode/is stud to Tirii!ln Carper. tr),brr, g *o.loct rrcal' TREPANIER TILE & REMODELING 976-669-Z694 j� s Tu . n�c�+D D n � uam � i T r RESC I TI U A, 'ADD ON 2 STORY 10*20 ALCOVE: i iESTIMATED COST OF JOB 40,000.00: ■UOB TO BE DONE ON A COST PLUS BASIS: ■;LABOR AND MATERIAL PLUS 25%: 1 ■;PLANS PROVIDED BY THE HOME OWNER: 1 1 1 r 1 i a1 ■ i i• ■ i /1 1 1 1 t 1 /1 signature: PAYMENTI PAYMENT2 PAYMENT3 please make checks N^ay a�� �*s• Bob Trepanier Jr. Payment Schedule: DATE AMOUNT r r PRICE ■ HWUNT � ' s 0 : 1 ■ . 0 0 i• 0 ■0 i �0 ' �0 i 1 ■ 0 1 i 1 ■ 0 I � 1 ■ 0 1 0 1• ■ f : 1 .0 1• I 1• f .0 • / ■ 0 1• l R ■0 1 1 i SUBTOTAL 0 TAX TOTAL 0 GT/ze �omvn�aru�ea� q�,�avoac�«ae�a t E INPROVEHENT CONTRACTOR gistration: 122347 iration: 08/20/2002 ype: DBA TREPANIER TILE & REHODELIN XRT TREPANIER JR �IPITOL ST. ADMINISTRATOR HETHUEN HA 01844 ✓/eeonyman�uea�{% of 1G�ja.�ivaes BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 069815 Birthdate: 09/23/1965 Expires: 09/23/2002 Restricted To: 00 ROBERT W TREPANIER JR 14 EAST CAPITOL ST METHUEN, MA 01844 Tr. no: 5313 I Administrator FORM U - LOT RELEASE FORM AJ14toO 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 requireme ts. ******"""APPLICANT FILLS OUT THIS SECTION APPLICANT LOCATION: Assessor's Map Number (� SUBDIVISION 'I"Z�Y WA STREET PHONEJ,Zi— %_ 3 PARCEL LOT (S)� ST. NUMBER USE ONLY*********************************** REC MMENDATION F T WI CO SERVATION ADMINI RATOR AGENTS: DATE APPROVED DATE REJECTED TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNE DRIVEWAY PERMIT �IRE DEPARTMENT (Q RECEIVED BY BUILDING INSPECT R Revised 9197 jm OZ_ DATE 174 Weyland Circle Plot Plan ' •.a -1H r n 1 WE Y�-APS! t� I` � RC L �jwtuE�" Ar►9 L S a+ IcA s+ xb CS' . fto,4. Plop. UnC- LOCATION OF STSUMAE(sl &ASEt) 0t4i LINES OF OC7 CUFAMOh (i. UN:Y..4 h1gF11a tSl:� `iAA7E 1 OCAiIQtf + iiEQ�JtRE 1N : v: TRUMF+1T C/) m m C/) 0 m CD o .... .p CD 0 O CA n� O c CA C7 CD O CD CDa Cn. CD CA O s Co 0 CD ac?�o m 2 O —•M o Cr N So<m. 10 y 10 C2m m N O C', � z •- ?.0 y '� =r CL CL m C9 "� O CD N O N'0_ o i o m m m R Ca o �o o : o zdc —0 p4m O N O W • C9 rA R �' .c / ^ m CS N v c OR � s CD r ^D1• � c �) ,Q N `9lb * :Z m m d N .j N N Q o � � CA ON O O �" o o Z �= CDN �JJqv CD G �. Co r ; Co • 90 o r s r = p� m 0 0 c rn �' m 71 77- d R o c � 0-4 z = o w 0 Ci7 M E� = 0 aq 0 0 o � z 0 c Willamette Industries, Inc. Engineered Wood Products Doyle Lumber Co. Inc. E -Z Calc JOB NAME: Trepainier (v6.0.3 -R) LOCATION: Ridge Beam 07/01/2002 JOB NO: First Job DESIGNER: GRD SHEET: MARK ridge beam Roof Beam MEMBER SLOPE: 0/12 Input reflects horizontal center to center spans W1= 520 plf LL = 390 plf DL = 130 plf Duration = 115% Member Weight = 5.1 plf LOADS 10.5' 2757# SHEAR C MOMENT 7236'# -2757# Maximum Reactions Support 1 Support 2 Critical Live Load: (DOL) 2048 (115) 2048 (115) Dead Load: 709 709 % Allow. Maximum Allow. DOL - Control Shear: ( lbs) 49% 2237 4541 115% -All Loads Positive Moment: (ft -lbs) 62% 7236 11631 115% - All Loads Deflection LL Ratio TL Ratio Span: 0.218 1/577 0.294 1/429 EI =488 x 106 *** USF 1.75 x 11.875 INCH StrucLam(2.OE) *** Min end bearing w 2.1 inches. SNpport 49pring length requirements must be checked separately. Continuous lateral support required at top edge. Lateral support required at bearings for bottom edge. The products noted are intended for interior use, normal temperatures, untreated applications and must be installed in accordance with local building code requirements and Willamette Industries, Inc. recommendations. This calculation reflects the specific design information and product determination for engineered wood products manufactured by Willamette Industries, Inc. The loads, spans and spacings have been provided by others and all information noted should be carefully examined and verged for the accuracy and suitability of all design parameters and product selections. -A At Iry lit 5S �� �� a� Date........ ....... ........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING �Q ��S This certifies that....,`r9 Pi%(t-4� ...................................................................................... r C has permission to perform .......... ............................... wiring in the building of ....... 1,q /i.1 .. ................................................. at ...I..... .; 7 ..1... �.. H..............:� ................... . No Andover; Fee..Ay .lJ".... Lic. No. / (•.............. �t !..1.... ......... ') EL ICALINSPECTOR Check # /�U 00 A SIF Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS a -LC L--- Official Use nl' ��j� Permit No. /L Occupancy and Fee Checked Lev. 11/99] (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 IN INK OR TYPf ALL INFORMATION) Date: o City or Town of: _ -9kA 41, Jul) t_f, 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) 1741 LJP-�/ JcL 1,, sir, , Owner or Tenant Owner's Address Telephone No.—Lc� j5 73 Is this permit in conjunction with a building permit? Yes 19' No ❑ (Check Appropriate Box) Purpose of Building t/✓ ''—M'A Utility Authorization 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: Completion of the following table may be waived by the Inspector o/"Wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans Attach additional detail i(desired, or cis required by the Inspector o/ Wires. 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 exhi ited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER Specify:) (Expiration Date) 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. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: r-7 _•t-1 c_ cr /- C'--"' P W;�I �::�;'s h LIC. NO.: 1 % C-1 Licensee: P),- I--1) /,- - 54 1"-Rl ire Signature _ LIC. NO.: (If applicable, enter 'exempt " in the lic se number line.) 417Bus. Tel. No.: Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ ,� S Signature Telephone No. No. TransTotal Trsformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ rnd. rnd. t o. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of .alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons KW INo. of Self -Contained I Detection/Alerting Devices I I No. of Dishwashers Space/Area Heating KW Municipal Local [IConnection Other No. of Dryers Heating Appliances KW SecuritNo.y Systems: r -r ofbevices or Equivalent No. of Water Kms, Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail i(desired, or cis required by the Inspector o/ Wires. 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 exhi ited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER Specify:) (Expiration Date) 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. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: r-7 _•t-1 c_ cr /- C'--"' P W;�I �::�;'s h LIC. NO.: 1 % C-1 Licensee: P),- I--1) /,- - 54 1"-Rl ire Signature _ LIC. NO.: (If applicable, enter 'exempt " in the lic se number line.) 417Bus. Tel. No.: Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ ,� S Signature Telephone No. NORTM O400 F ,SSACMUSi Date ..r. ..._ . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...� f"``Y has permission to perform... -.-J.. ' !: `. ............ • • • • • plumbing in the buildings of ..lal... ................ at . � /.. t c/ .. �` `'`�''P`" . • . , North Andover, Mass. 4 Fee �� ..... Lie�No.......... _ '' :?. 2..:........ . PLUMBINGINSPECTOR Check # s4b 4r- 5392 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date it �� — d /! d� Building Location � y it/t'��l�P{rl _ C'ti f() Owners Name t/✓Pl (S A` f p1 Permit # 152 Amount 115r - Type of Occupancy �PS New Renovation Replacement 1:1 Plans Submitted Yes No ❑ FIXTURES (Pri t or type) Installing Company Name 1 is Check one: Certificate ❑ Corp. Partner. Firm/Co. Name of Licensed Plumber: �i a " /j -T" , J Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ©/ Other type of indemnity ❑ Bond ❑. Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 0 Agent 0 I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By: ignawre of Lrcensea riumoer Type of Plumbing License Title )1y� City/Town icense9, umDer MasterJourneyman ID (OFFICE USE ONLY 11 Date .............-c^.7 —0 ............... it NORTH 0 - .6 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that'` ............ ......................................................................... has permission to perform . ......................................... wiring in the building of ........................................................ at./..7.1/ .......................... . North Andover, Mass. rev Fee .��!�ff . . .... . ... Lic. No./f//*"5 . . ................... ..................... ........................ ELECTRICAL INSPECTOR Check # �t THE COMMONWEALTHOFMASSACHUSEnS Office Use only DEPARTtYlE TOFPUBLICS4MY BOARD OFFIREPREVEMONREGULA77ONS527CMR12.M permit No. y l 1 Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �7 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) % 7 y L vii 1 " — ,] r , r Owner or Tenant Owner's Address Com, , A -P _ Is this permit in conjunction with a building permit: Purpose of Building V\ C, 1,4 Q-, Existing Service Amps / Volts New Service Amps Volts Number of Feeders and Ampacity Yes FLI No (Check Appropriate Box) Overhead Underground Overhead Underground' Location and Nature of Proposed Electrical Work y\ No. of Lighting Outlets No. of Hot Tubs I No. of Lighting Fixtures Swimming Pool Above No. of Receptacle Outlets 01 No. of Oil Burners round No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total No. of Disposals No. of Heat Total Tons Pum s Tons No. of Dishwashers Space Area Heating No. of Dryers Heating Devices No. of Wr/sr Heaters KW No. of No. of No. Hydro Massage Tubs Si ns No. of Motors Bailasis Total HP To the Inspector of Wires: Utility Authorization No. No. of Meters No. of Meters ..v. m rransrormers Below Generators und No. of Emergency Lighting Battery Units FIRE ALARMS Total No. of Detection and KW Initiating Devices KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices —— A L_J Connections Total KVA KVA No. of Zones Other OTHER• fimnanoeCovaage. PttoftWWiterr1CWofMassadn%�Gat,,.alLam [lmaamartLiabffitylrmanoeib?icymc)trlingCanpCoVMageoritssubstaYialetlttivalaY YES NO 'have subrrrittedvalidproofofsametotheOlPioe YES �>fyouha�edled®dYES, Piaen>dic&thetypeofwwlageby Igd>e box II��JJ NSURANCE BOLD � OIHER � SPAY) ���� `•..��� '7 Estirrtated VahteofFachcal Wodc $ vodCtoSatt OA, hlspeclronDaleRe�d Rough - oa r� �igred urrh•�ie l of peljtay. IItMNAME v\� L.p`vr i Lioa>seNo. 3 -7 -? 3 icersee the Signahue LioarmNo �/� Busit�essTel.No. (tet 7�) aka- 9n5 6 drirt:c_c '/ 0 1iy e, �� Ae� l l � L tJt°i� /" t o.. , �' GQ Gl WI�IFR S INSURANCE W Alt. Tel. No. 77 / - y 1 % RIVER;IamawatethattheL=wdoesnothavetheinstnar>oecovaageorits sul)StndaleqtlivalatasreqtmadbYMasssxltusefs C=etalLaws dthatmysignatuteonthispemmappfi aomwmves thistequueamrtt 'lease check one) Owner Agent Telephone No. PERMIT FEE Igna ure o caner or gen if ti -4v oRTH 0 13 Date...7/7/ - -, TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ....................... I .................... .......................................... has permission to perform .......... ...... Q:t..11-1.9 ... / ... ................................ wiring in the building of ... ........................................... at .....1..71•• WO /.'/"? . .............. \ ............... . North Andover-jMas,,-. ........ ... . . ............... Fee... ��.dJ Lic. No7 . ............. ....... . .. ..... .. .. ........... r .................... ELECTRICAL INSPECTOR Check # . - V111.1p�Oc vuL� ry 1 . Permit No. aogvo-rt od �u8lle Satiety Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGUI-ATIONS.527 CMR 12:00 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 —01) ^ G Z 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 `—)ul 'v3 r ` �� C , � Owner or Tenant Owner's Address Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 0 �'`� Utility Authorization No. E6sting Service Amps Vats Overhead ❑ Undgmd ❑ No. of Meters New Service Amps Vats Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity LoVation and Nature of Proposed Electrical Work - — - - Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool gmd ❑ grnd ❑ 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 No. of Detection and Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total o. of,Diposal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers SDacelArea Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other ';No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Si ns Bailases Wiring No. Hvdro 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 equivalent YES = NO = have submitted valid proof of same to the Office YES = NO = it 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 Resqpested Rough Final Signed under the Penalties of perjury: LIC NO FIRM NAME Licensee ��� �� �� �� �z��c Signature ( �C� C�1 C� c' jLIC. NO. _ Bus. Tel No. 6 U 0 1 D o o lj Address Alt Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Lihanses does n t have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my,signature on this permit application waives this regulrement. Owner Agent (Please Check one) // 7 Telephone No. PERMIT•f EE $ GS ` e (Signature of Owner or Agent) Locatlon GVH .vl � �,/J No. to 1 Date NORTq TOWN OF NORTH ANDOVER AL ~ 9 Certificate of Occupancy $ " --YS " i'cNust Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee $ I VD TOTAL $ 50 Check # 3✓ 5760 buil ing Inspector' TOWN OF NOR'T'H ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING R red . Provided BUF,DING PERMIT NUMBER: DATE ISSUED: `a ` D 3:S0 SIGNATURE: Building ComnlissionElEEkwor of Buildings Date SECTION i- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: V Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I Lot Area Frontage (ft) L.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R red . Provided S' 3:S0 1.7 Water Supply M.G.LC.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zow outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ' ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) 2.2 Owner of Record: Name Print I SECTION 3 - CONSTRUCTION SERVICES I 1-79 tJ EXUAWQ C eQuc- Address for Service : Address for Service: 3.I Licensed Construction Supervisor: Lc\. g tkn. tz L4 A Licensed Construction Supervisor: Z -C ae�Mb�Lo Address Signature Telephone 3.2 Registered Home Improvement Contractor Company Name ��nN\,& Address §mature Telephone Not Applicable 0 Cd &-771 I License Number 6�((p Zoo�l Expiration Date Not 1/863-7 Registration Number Expiration Date FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANT \ LC 4AEL.<� NCS LOCATION Assessor's Map Number_ SUBDIVISION STREET -5E eQAP'� C I L3_C.. _6 PHONE PARCEL LOT (S) 'YL ST. NUMBER1-79 ************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: SERVATION ADMI&iiATRATOR DATE APPROVED !! DATE REJECTED COMMENTS % COZs Gc1/e n /60 COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH CO DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIO DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector - The Commonwealth ofI A-e'sachu tt se s Department of Industrial Accidents Office of Investigation ' Boston, Mass. 029 9 7 Workers' Compensatlon Insurance Atitdavit j �1.G1-�►(�rl��i� am a homeowner performing all work myself fWI am a.sole proprietor and have no oniD working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. ` company name: Address yN,, C_il<ir: PhoneA moll ' i Address 4 �•+; .city. Phone #� FailUreP to-10cUta coverage as required under Section 25A or All k 1,32 can iii tat}* lmpostion of criminal penaJflm cra fine up. to $1.50Q.Oo and/or one years' in risonment aS wallas civil penalties in the.form of a SroP W0W of and a fine of ($ltxi 00) a day against me. 1 uriderstald that a copy of this statement may be forwarded to the OfrW of tnvestic, Jakm of the DIA for coverage vet on. l do herby certify under the pains and penaties of perjury that th, lnfamabm provided above is true andcorrect Signature Date—TY I nLZ Print name. Phone #_ 81 Z Official use only do not write in this area to be completed by city or town dflciar OCheck if immediate response is requiried Building Dept Contact person 'M WORKMAN'S COMPENSATION E) Building Dept ' p Licensing Board p SelecttrtenIs ice Q Health Department D Ofbl r 174 Weyland Circle Plot Plan 0 WEYWNID RC LE is A+ IeAs,+ to 0. �O+M Plop. L-4kC _ LpC1lTIQM # STfltDfTTtJRit81 sAgEt) ON USES Of 00O000MON t.. oNtr..� arc Aux?�w+7e LOCAnOW VALE REBS Ml 'Mg7p AW14T ` �j+�i IoLhg rkispeabf HENRY �,� q X8.688 • qs � i"Mm ; SCals: 31= N x N V4 P r N CA m u a c,,ac 40 e4 I"OIX AMMMMNWft k:o ✓he fa��c�na�uueal�/1- R� �Z113;SCIC�tI��G BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 062751 Birthdate: 06/16/1963 Expires: 06/16/2004 Tr. no: 576 Restricted: 00 MICHAEL P SHAW 98 ANDREW FARMS RD BOXFORD, MA 01921 Administrator f e %�amnxurau�nl!% n` � f/nksar.�«,sell r Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 118537 Expiration: 04/09/2003 Type: DBA MICHAEL P. SHAW CONST MICHAEL SHAW 32 ANDREWS FARM RD �w p �► N AV O�D I N TM 1.�Ri✓rtT,rF.L�M7�L� /� p �+ p A� /�► DATE MM/DD/YY) �N�7UR1�1tir 7/17/2002 PRODUCER (9 78 887 8304 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JAMES UGONE INSURANCE AGENCY 10 SOUTH MAIN ST., SUITE 208 TOPSFIELD , MA 01983 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE COMPANY A FARM FAMILY CASUALTY INSURANCE CO. INSURED COMPANY MICHAEL SHAW B DBA MICHAEL SHAW CONSTRUCTION COMPANY 98 ANDREWS FARM ROAD C BOXFORD, MA 01921 COMPANY D COVtRAGE3 n. _ ............ - - THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YY) POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A GENERAL LIABILITY 2005X0415 09/19/01 09/19/02 GENERAL AGGREGATE $ 1,000,000 PRODUCTS - COMP/OP AGG $ 500,000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE eX OCCUR PERSONAL & ADV INJURY $ 500,000 OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ 500,000 FIRE DAMAGE (Any onefire-$ 50,000 MED EXP (Any one person) $ 5,000 A AUTOMOBILE LIABILITY 2005C40342A 03/10/02 03/10/03 COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ _— 100'000 X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS NON-OWNED AUTOS $ 300,000 PROPERTY DAMAGE $ _ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ AGGREGATE $ UMBRELLA FORM $ OTHER THAN UMBRELLA FORM A WORKERS COMPENSATION AND 2005W6462 04/26/02 04/26/03 TA TWOCRYSLIJIU77 OER EL EACH ACCIDENT $ 500,000 EMPLOYERS' LIABILITY THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE OFFICERS ARE: PX EXCL EL DISEASE - POLICY LIMIT $ 500,000 EL DISEASE - EA EMPLOYEE $ 500,000 OTHER I I I DESCRIPTION OF OPERATIONS/LOCATION SNEHICLES/SPECIAL ITEMS CARPENTRY, PAINTING - EXTERIOR, STREET CLEANING CERTIFICATE HOLDEG CA V,�GELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF SWAMPSCOTT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. 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