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Miscellaneous - 18 JOHNSON STREET 4/30/2018 (3)
Date. Ta2.5 !! Z -.'� TOWN OF NORTH ANDOVER •`- �°c PERMIT FOR PLUMBING This certifies that . (,7.' L w;+ J! 7... � < <±�.......... has permission to perform .. ! ��t-�� k41-.. P?v 0I. `?v`.....a plumbing in the buildings of �Z' tZ LL '% / ....... 1U1'��'�M �-� ...... ,Uort,,Andover, Mass. at..R.� ........... �..pp.... Fee. Lic. NoIP3 ..D.. . 41,... �_�` PLUMBING INSPECTOR Check y _ 76-35' / -C\- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY `n%C k'I' 1;:%-� we% MA. DATE PERMIT # JOBSITE ADDRESS S to S r OWNER'S NAME C EHrTa C- _ k6-ai l POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT NEW. ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES El NO El FIXTURES Z FLOOR— BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 1d BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR, / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY 1 d ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET ( i URINAL WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch. 142. Yes [RrNo ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY c( OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: 1 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 BOX ONLY: OWNER AGENT ❑ ❑ Si nature of Owner or Owner's Agent 1 hereby certify that all of the details and information 1 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 provision of the Massachusetts State Plumbing Code and Chapt r 142 of the General Laws. PLUMBER NAME STi PACO C_ GALIOSKY SIGNATURE l' LIC # I034 MP [r JP ❑ CORPORATION X# .31916 PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME 661-I13SKY PLI)MDiMb't x_17111 (-� ADDRESS: P.D. GQX 0011 I17Y HAVE(ZItILL STATE rA•A• ZIw P 01131 EMAIL WW• n,rpiurAiDer �,� � Govh LEL 'OV -37`11-1743 CELL 508-50-590H FAX a7$- 821-'4 3i W ° H U W a z a Q z w ` �Ri I`9 r � z o (� c � o U z U LU y z Q � C > z ui d w a C7 z d 'r � h LU 1- Lt w Eµ O z z U W z z o., x O Date.... ry� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a This certifies that ........... .. ... ... y has permission for gas installation ...''' ` `.'...:. , S vv C -,— in the buildings of ... ..... . ` ......... ^. !-'. 7 ................ . at 1S`LA...... /A�dover, Mass. � .Lic. No. G ..........Fee3PECToR Check # � S K-3 8320 GOWNER TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: 1`tdlklk_� MA. DATE: Ct - t 0 -- a PERMIT 4 JOBSITE ADDRESS: ` � ��"� S t OWNER'S NAME: C,4,/ R�"y 7 ADDRESS: TEL: FAX: OCCUPANCY TYPE: COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL [' NEW: ❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES? FLOOR- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT w OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 9 OTHER TYPE INDEMNITY ❑ 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 [IAGENT ❑ 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 ill bei pliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER/GAS FITTER NAME:_ Si' E PN E N C G A L I NS KY LICENSE # 10 3 4 C SIGNATURE COMPANYNAME: CALW3K4 PL006IrJ1G + F4vA-f1rJ& ADDRESS: P.O- ROx 1701 CITY: 9AVErwILL, STATE: rn-A ZIP: 01231 FAX: q7$- 511-413 TEL: q7K-3714- 17143 CELL: 504- Ste- 5goy EMAIL: www- mrp1umbe(TCh01 G,,'% MASTER [✓I JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION /t 319t, PARTNERSHIP ❑ # LLC ❑ # O C G7 x a r� n 4> o z z 0 m = m � 'v y D � � O � C' cn h z � o W C7 o m x cr --q c ❑N o z r ❑a r � cn n � 0 z N z o � a N This certifies that ... /??. ??n. U ... �P.C' Ae ................ has permission to perform .:5 7 dux le! v . J� X !�!�-A ....... wiring in the building of . SQ %,�r . a �!?-�+� ........ . at ..... ,% ... Qh�,.Sc;�.,.. Js ........ North Andover, Mass. Fe e .! . Lie. No.IVU... ... EL CTRICAL INSPECTOR 'Check # �v 6.5 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Permit No. ! ! LU Occupancy and Fee Checked .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 IN INK OR TYPE ALL INFORMATION) Date: ! — ,`� �– fZ City or Town of: /\,A9Q r# AIVW V9k To the Inspector of Wires: A By this app 8t # application the undersigned gives notice of his or her intention to perform the electrical work described below. -�/u 4 :r 1; Location (Street & Number) IT0_ #/y � ✓� _ Owner or Tenant/Y% Owner's Address /o sG".�'i sr Is this permit in conjunction with a building permit? Yes Purpose of Building AV � Existing Service©a Amps ,/ Volts Overheac Telephone No. No 0 (Check Appropriate Box) Utility Authorization No. ❑ 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: EOL/7` Cmmnletinn ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires /� No. of Ceil: Sus . Paddle Fans P (Paddle) Transformers Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. grnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of zones No. of Switches D No. of Gas Burners ani o. o etectton an Initiating Devices _ No. of Ranges No. of Air Cond. Total Tons oc No. of Alerting Devices No. of Waste Disposers p eat u Totals um er ons - Mine o. o e o Detection/Alertin Devices No. of Dishwashers ' Space/Area Heating KW Local ❑ MunicipalOther Connection Connection No. of Dryers Heating Appliances KW ecu.rityystems: No. of Devices or E uivalent ter KW eaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent FNo.HydromassageBathtubs No. of Motors Total HP a eco of Deviceso r � ivalNo. of Devices or E uivalent 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 Q< BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application Is true and complete. FIRM NAME:LIC. NO.;A11983 Licensee: LOUIS CONTINO..Signature LIC. NO.9R7Sg (If appl{cable, enter "exempt" in the license number line) Bus. Tel. No.•a 7 8 — 3 6 3 — 5 4 0 Address: 1 nnNnvnN n1ZWEST bly-WBUFy913r,-, MA 01 ar, 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, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent . Signature Telephone No. PERMIT FEE: $ Date.... �..'..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that................................................................................ ma�y...................................... has permission to perform.�!5..:..!>.....�................................................... wiring in the building of ..... e X- �Z .�� ��'......... ..........7..- at ....PTA... •�/K/ Com'{ 5 .....1? ............. .North Andover)Mass. '� -� Fee.......R ................... Lic. No.................. ............. .. ...... ELECTRICAL INSPECTOR :_A Check # S- 0/ i commonwealth of Massachusetts 9AM Department of Fire Services 1 BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked tev. 1/071 (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 TYPE ALL INFORMATION) Date: —" 1 To the Inspector o Wires: City or Town of: n/42"f(� AND 01«2 P By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) P 1-t11 S0 Al S j" Owner or Tenant C4EIV F fe k E14Z_ VS 7— Telephone No. Owner's Address A cq p % A1171;>7-1-4 14-/lf,1,�)o VC Is this permit in conjunction with a^building permit? Yes A No ❑ (Check Appropriate Box) Purpose of Building /� ��i/ VtN%� 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: R J�_ W 7- J -f' G %� a l L C R AA -17) 6iy %"l CIL =nftho f ttOOtiZ.may .i? by Inspector of Wires. lt{ No. of Recessed Luminaires - - No. of Ceil: Susp. (Paddle) Fans --- o. o ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above n- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency Lighting Battery Units No. of Receptacle Outlets C,� No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches fS' No. of Gas Burners G�� D an o. o Initiating Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices Disposers No. of Waste Dis P eat u Totals um er ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal❑ Other Connection No. of Dryers Y Heating Appliances Key Security ystems: No. of Devices or Equivalent No. of Water KW, Heaters o. of No. of Si ns Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunications firing: No. of Devices or Equivalent 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 ope_r__g�tion'.' coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited prooTbf same to the permit issuing office. CHECK ONE: INSURANCE a BOND F1 OTHER E](Specify.) I certify, under the pains and penalties of perjury, that the Information on this application is true and complete. FIRM NAME: LIC. NO.;A119 8 3 Licensee: LOUTS CONTTNO Signature e LIC. NO. 2g788 (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.•a 7 8 — 3 6 3 — S 4 0 Address: 1 nnNnvnN—LIR WEST—NEW$URYMA—O I Q S 5 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: l 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 C 5� C 7 Hu This certifies that............. has permission to perform.. plumbing in the buildings of at ....... it ..... Fee .... t6S ....... Lic. No. Check # 77/0 Date ..... ...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING W .. ****"* . ............................................ ................ *, o -44—k, ........... ....................... . I ............................... ".-I . . ................ North Andover, Mass. ..O -b ................................................................... PLUMBING INSPECTOR SL-\ POWNER TYPE OR C PEARLY RINT MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK IV CITY U h Y7� �U L MA. DATE b PERMIT # JOBSITE ADDRESS 1 IN OWNER'S NAME C L gTCA {2 (Z/') (-" ADDRESS TEL FAX OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL'® NEW: ElRENOVATION:V REPLACEMENT: ❑ PLANS SUBMITTED: YES El NO ❑ FIXTURES Z FLOOR— BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS E DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER ) FOOD DISPOSER j_ FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK 1 LAVATORY 1: 1 ROOF DRAIN SHOWER STALL ) . SERVICE / MOP SINK TOILET ) URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING U i rlcm INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch_ 142. Yes ZNo ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE SOX BELOW LIABILITY INSURANCE POLICY g- 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. of Owner or Owner's CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑ I 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the general Laws. PLUMBER NAME S T LPtfE1J L GAL-10SKY SIGNATUREAs� LIC # W3ti 15 MP [' JP ❑ CORPORATION [# 19 b PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME 6ALIOSKY PL0M60Jb *- kywnl,j(;� ADDRESS: P.O• GQX 1'701 CITY HAyCizKIL.L TEL 4'7V- 3?q- 1 7 y 3 STATE rn-rA. ZIP 01131 EMAIL www. rnrp1yrAber9jEp1 , C.owt CELL •508'-"50c►- a90q FAXg?$- 5ai - L4 O c G7 x r C G� Z b tai n �3 O Z z 0 a r m m - Fri I I I D � N N C7 rn D Z w C-7 � o � o -i C 0cn o z ❑o � � r z r� n y O z z 0 OMMONWEALTH OF ROM W OMMONWEALTH OF IIHATION DA (,, z� �� ................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . q ............... . has permission for gas,instal ation C t-- -p— -p- ................................ in the buildings of ....................... 9. .. . .... ................................. VD .... _771 11-1 - at ........ IX .. ki... KSur%-% �e. '--T North Andover, Mass. ................................ ........................ . f Fee............. Lic. No . ............. ........ .................................................................... GASINSPECTOR Check# 72/0 00 30P 'u, hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTERNAME: STEPHEN C. GALTNSKY LICENSE# 103y$S -1 " S ATURE COMPANYNAME: GALIr 3Kq PI_rj►ANOC + I4C*t-I0& ADDRESS: P.O. r-:.Dx 1701 CITY: PAVE -2N I LL STATE: m - ZIP: 0111931 FAX: 479- 52l - q l3i TEL: 978 - 3?14- r o CELL: 5af - 5th- 59oq EMAIL: W W " VV. mrpl V mbfff Aon. t am MASTER V JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION [X# 319t. PARTNERSHIP ❑ # LLC 0 # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - GOWNER ' TYPE OR PRINT CLEARLY CITY:�©� Y� ��"�U MA. DATE: 6 ' �" y PERMIT # I JOBSITE ADDRESS: q0k HSS 1&4 V OWNER'S NAME: ADDRESS: TEL: FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL;© NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCES! FLOOR— Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER .BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES[M[] If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY � OTHER TYPE INDEMNITY ❑ 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 mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTERNAME: STEPHEN C. GALTNSKY LICENSE# 103y$S -1 " S ATURE COMPANYNAME: GALIr 3Kq PI_rj►ANOC + I4C*t-I0& ADDRESS: P.O. r-:.Dx 1701 CITY: PAVE -2N I LL STATE: m - ZIP: 0111931 FAX: 479- 52l - q l3i TEL: 978 - 3?14- r o CELL: 5af - 5th- 59oq EMAIL: W W " VV. mrpl V mbfff Aon. t am MASTER V JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION [X# 319t. PARTNERSHIP ❑ # LLC 0 # -n m m ❑z 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....OvP*1.1u........................................ has permission to performA411, . . ....//{/�'`......................................... wiring inn the building of ..fes 41 ...�?t:tl�•,............................................... at /... ' !......5Z .......................... . North Andover, Mass. .. ........... .-... ;<. LFee 2.'..Z..... Lic. NO./aV..............`NSPECTOR ` Check # 1627 4841 The Commonwealth of Massachusetts Office Use only Department of Public Safety Permit # Board of Fire Prevention Regulations 527 CMR 1200 Occupancy & Fee Checked 3i90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date November 10, 2003 City or Town of No. Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 18A Johnson Street Owner or Tenant Dan Griffen Owner's Address Same Is this permit in conjunction with a building permit: Yes F7X No = (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead=Llndgrd No. of Transformers =No. of Meters New Service Amps Volts Overhead =Undgrd =No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Kitchen Remodel No. of Lighting Outlets No. of Hot Tubs No. of Transformers No. of Lighting Fixtures 6 Swimming Pool Generators • No. of Receptacle Outlets 8 No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switches 3 No. of Gas Burners FIRE ALARMS No. of Ranges 1 No. of Air Cond. Tons No. of Detection No. of Disposals 1 No. of Heat Pumps kw No. of Sounding No. of Dishwashers 1 Space / Area Heating kw No. of Self Contained No. of Dryers Heating Devices kw Local No. of Water Heaters INo. of Signs Municipal No. of Hydro Massage Tubs INo. of Motors ILow Voltage Wiring Other: (1) Sub Panel INSURANCE COVERAGE: Pursuant to requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES F x NO F I have submitted valid proof of the same to this office YEs No F— If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE � XX BOND OTHER (please specify) 2/2/2004 Estimated Value of Electrical Work (Expiration Date) Work to Start // _ io - 03 Inspection Date Requested: Rough Upon Request Signed under penalties of perjury: Final Upon Request FIRM NAME Dumais Electric LIC. NO. 12170A Licensee Mark A. Dumais Signature LIC. NO. 26665E Address 8 Newport Street Bus. Tel. No. 978-683-9438 Methuen, MA 01844 Alt. Tel No. 978-685-4553 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or it's substantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (please check one) Telephone No. Permit Fee© (� (Signature of Owner or Agent) Date... 1114 0 TOWN OF NORTH ANDOVER • MOO $�" PERMIT FOR GAS INSTALLATION X SACHUS I This certifies that .............................. has permission for gas installation.//I-Ae ............... — keef r/.:z- ....... in the buildings of 0-1 <! y atNorth Andover, Mass, Fee. . Lic. No. . .......................... GAS INSPECTOR Check # 4913 MASSACHUSEI'I'S UNIFORM APPUC 4DN FOR PERM TO DO GAS MING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS Building Locations �/' C�'`i Permit # _ Amount $ C, Owner's Name f 7-- New ❑ Renovation Replacement Plans Submitted � w 0 F x a7C7 O Z� U OOa AOCC4 1 UF 'Fj WH 0 w o' OG U wwmw SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND. F L O O R 3RD. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR or type) n t � i� -z-��_�� Check one: Certificate Installing Company Name 1 ` � Corp. Address d '2 `� �— Partner. usinesse ep one Q 7? G r-& cg Zv �tm i/Co. e Name of Licensed Plumber or Gas Fitter 34} 6 5 �C INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ©/ NoO If you have checked Yeses, please indicate the type coverage by checking theappropriate 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 13 Agent 1 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 I sued for this application will be in compliance with all pertinent provisions of the Massachus to GasoYde an Chapter2 of the eral Laws. IBy: itle ity/Town APPROVED (OFFICE USE ONLY) t Signature of Licensed"Plumber Or Gas Fitter umber O3 L Gas Fitter tcense Number Master Journeyman Date. l/-. � .`'. 2. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...n l.�-. .. C�� �`h �-1 .............. has permission to perform ...� w 4.. .� � � ' c ` ........................ plumbing in the buildings of .....r� ........... at ... jV .. ...... ,, North Andover, Mass. No. 77 ..Fee.�Lic. . .... ............... . PLUMBING INSPECTOR Check # Z111 I/ 1 57U07 MASSACHUSETTS UNIFORM APPLICATION FOR PERMCT TO DO PLUMBING P; inl or Typa? (?�rtc`� v j�' Malt Qate Pyr, � Type d ogcc 4i� SC_ Naw ❑ R Ston ;E3;;� R ePia ❑ Pons Sul.,rn,'-" c d : Yes ❑ No Cl FDCTU R ES I r s�xlln y n: ch-e,� ort: cert:`kx` � ;dress_ / � ran � '� 5 � ❑ 6,=: ss Tel tphofyc-1 7 L L- —1 / 5 a y �J `f FS F Co. N-L'M Cf Uo-- cd Piumbe INSURANCE COVERAGE: terve a ecruertt laNty tnsurzrce Pd:cy or t; s - eq�,ra'' w � mr-cis ttx re�G -t ,,--its of MGL Ctt 142. Yes 'a No ❑ r Y� have Chc cited y�r . P; ca sc tnd Hca `, c tY_ tfp,,-' by u' ecd-:i-�.o t, e' appropriate tr A 'y truurjrcc "icy ' Otte ty~,x d. lndcm.�y ❑ ao�, ❑ OWNER'S INSURANCE WAIVER: I aa- aw-ate • *` t )l- lc set do --.,s t -�c truuri,� covrra— Cru cr 14.2 o f tl-C Mass . G e,^ y u9 "' ` me by r.,ra. laws. aid t'� rr ra,ure � thl; pr.�-r;�t; ippfbeatfon vrt�r.a this ror,.t�renxttt C:h ck orr--: r-ZtLxc cx Omer ❑ A; ---n' ❑ i t7°r�Y 004 ttut a: of tie dens z-,-r�-and ;or ontwr ) in abo re Lpp4c2bon &=xate to t,3 tars; Ot my � 'A -A and instlL 50ns P -1 � tr e P—el=-)6d for t nu a oq+.rrtio ,.' N in Siete Pkrti xng {! u1d c rap to j 0! tht rXise c, Dcvz Seg Pgib,. c /rte Type a' Lic erx: V—%a--` n }•y- u , ❑ ti _ 1 1 rte•. Y. F i.. ^+. `�+_, z a _x Z O U Y < � to Y1 n Y X N J < n C { h W Z O J hu F- �+ p �C VF tl p Y < �. G - X V Z C O a 7 n 1 p C 2< r G < W O Z < C a <; c r. a O a u. Y C t! r> r o p; o" h v_ o v a Z Z ba ~ o z SUB—BSMT. SASEWENT IST FLOOR J 2X0 FLOOR 3RD FLOOR ATN FLOOR .STH FLOOR El 15TKFLOOR 77K FLOOR I -Fd d7KFLooR ±H±-LLu-t-H+ I r s�xlln y n: ch-e,� ort: cert:`kx` � ;dress_ / � ran � '� 5 � ❑ 6,=: ss Tel tphofyc-1 7 L L- —1 / 5 a y �J `f FS F Co. N-L'M Cf Uo-- cd Piumbe INSURANCE COVERAGE: terve a ecruertt laNty tnsurzrce Pd:cy or t; s - eq�,ra'' w � mr-cis ttx re�G -t ,,--its of MGL Ctt 142. Yes 'a No ❑ r Y� have Chc cited y�r . P; ca sc tnd Hca `, c tY_ tfp,,-' by u' ecd-:i-�.o t, e' appropriate tr A 'y truurjrcc "icy ' Otte ty~,x d. lndcm.�y ❑ ao�, ❑ OWNER'S INSURANCE WAIVER: I aa- aw-ate • *` t )l- lc set do --.,s t -�c truuri,� covrra— Cru cr 14.2 o f tl-C Mass . G e,^ y u9 "' ` me by r.,ra. laws. aid t'� rr ra,ure � thl; pr.�-r;�t; ippfbeatfon vrt�r.a this ror,.t�renxttt C:h ck orr--: r-ZtLxc cx Omer ❑ A; ---n' ❑ i t7°r�Y 004 ttut a: of tie dens z-,-r�-and ;or ontwr ) in abo re Lpp4c2bon &=xate to t,3 tars; Ot my � 'A -A and instlL 50ns P -1 � tr e P—el=-)6d for t nu a oq+.rrtio ,.' N in Siete Pkrti xng {! u1d c rap to j 0! tht rXise c, Dcvz Seg Pgib,. c /rte Type a' Lic erx: V—%a--` n }•y- u , ❑ ti _ 1 1 rte•. Y. F i.. ^+. `�+_, Date //-. . f� .J ......... ((Z TOWN OF NORTH ANDOVER F 40 PERMIT FOR GAS INSTALLATION This certifies that . J . .... C� .............. has permission for gas installation.<..�..�.:. - n j y r in the buildings of ./ . ........................ . at 1 :r ....... , North Andover, Mass. Fee.3.).' ? .. Lic. No../ . . '... .......f -!...S - ...... . GAS INSPECTOR Check # 'It" ) 449 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Tye) / l�f GCeii� /fes Q Mass Date `0- 3 --. Per--' r �! Bu'lding Location /�l 19 J� �.0 5�.�5� Owner's Name Type of Occupancy O c2 4 /SSC New C] Rcnaratian Reptat C]cemerrPian Subrr:ttd. Yes❑ No ❑ lnSt-sliN Company Nana )v Check orr_: Cert irate Address 9// �jpk 7 5' lor— ❑ Corperatic:-, Business Telephone �S %,y - S- / S- Zf 2 L/ r Firm/Co. Name of Licer,scd Plumber or. Gas Fr;ter 4q (C- Gtr p A4 o -VCG a y INSURANCE COVERAGE: I have a current I:atxlty insurance po;icy or Cs v,,hich meets the reti'J~e.-len;s of N(Gt_ Ch. 142. Ycs,Q- No r ycu have checked Yes. please indiczte the type cc:crage by checking the appropriate b::., A IzSili;y insurance po;icy -K O',hcr type c' ir�jemn;',y ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware tr-,' tn: licenser does not have the Insu2-.:- cove2ge required by Crzptcr 142 of the Mass. Genera: Laws. arrd that r.-; s::raturc cn this permit appiicatia wa`:_s t ;is requirement. Check e-- Owner❑ ❑ Sc nature of C,,-ier or Oo ne;'s Agent I hereby certi`j that ali c' t P de its and in'orrrw' an I have S.: eo;e.,e_) in above a:)alication Le L-.:_ a -.t ac^urate to the btst o! my k.: -:-%{edge and that a:l plum`rr,g 1nr. Lill insta!;zlens perfc.-.._ u -Ne' G'4 Issued for this appliczr,- �-` ..? in w4 'u`r all C`:'JfY_nt proves+.3ns Oi the W2_,_ s_husets Statec—'s cod, vt v::.:.!e' 142 cr L'le neral Lz,,,, T c! lJx-.. ' 6L J25�� I ,urn.- Cyna., re of, Li:pnsr--d P1um_. Gas ,::e. gaster Li=ens C.um� /Q 2 MENEM SEEMENEEMEMESSME ME MOSSESOME lnSt-sliN Company Nana )v Check orr_: Cert irate Address 9// �jpk 7 5' lor— ❑ Corperatic:-, Business Telephone �S %,y - S- / S- Zf 2 L/ r Firm/Co. Name of Licer,scd Plumber or. Gas Fr;ter 4q (C- Gtr p A4 o -VCG a y INSURANCE COVERAGE: I have a current I:atxlty insurance po;icy or Cs v,,hich meets the reti'J~e.-len;s of N(Gt_ Ch. 142. Ycs,Q- No r ycu have checked Yes. please indiczte the type cc:crage by checking the appropriate b::., A IzSili;y insurance po;icy -K O',hcr type c' ir�jemn;',y ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware tr-,' tn: licenser does not have the Insu2-.:- cove2ge required by Crzptcr 142 of the Mass. Genera: Laws. arrd that r.-; s::raturc cn this permit appiicatia wa`:_s t ;is requirement. Check e-- Owner❑ ❑ Sc nature of C,,-ier or Oo ne;'s Agent I hereby certi`j that ali c' t P de its and in'orrrw' an I have S.: eo;e.,e_) in above a:)alication Le L-.:_ a -.t ac^urate to the btst o! my k.: -:-%{edge and that a:l plum`rr,g 1nr. Lill insta!;zlens perfc.-.._ u -Ne' G'4 Issued for this appliczr,- �-` ..? in w4 'u`r all C`:'JfY_nt proves+.3ns Oi the W2_,_ s_husets Statec—'s cod, vt v::.:.!e' 142 cr L'le neral Lz,,,, T c! lJx-.. ' 6L J25�� I ,urn.- Cyna., re of, Li:pnsr--d P1um_. Gas ,::e. gaster Li=ens C.um� /Q 2 � n� S N Location d v r No. _ Date I C) -cf a� TOWN OF NORTH ANDOVER TOTAL $ Com/ Check #_� i 170 ri 67 J ` Building Inspector 9 Certificate of Occupancy $ Its Eta ACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Com/ Check #_� i 170 ri 67 J ` Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s )! lC i£181 U9k!= b BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioneffl for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided R red Provided 1.7 Water Supply M.G.L.C.40. 54) Public ❑ private ❑ Zone 1.5. Flood Zone Infomration: Outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: ❑ On Site Disposal System ❑ SECTION 2 - PROPER'T'Y OWNERSHIP/AUTHORIZED AGENT Historic District: Yes _No 2.1 Owner of Record Name (Print) Address for Service Z. Z6 ,e ?,� 6 Signature Telephone 2.2 Owner of Record: Name Print Address for Service: t Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number .5— (! dGaz—L, 0v0 Vs - Address z Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address �..� .- Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work checkall a licahle New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ 1 Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description /of Proposed Work, J P./ -r, akn,1�;�� I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building C� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction c + 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total -(I +2+3+4+5 '' - W. -U ' Check Number SECHU1N 7a OWINEK AUl'HUKIZATIOIN TO HE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION Date I, ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvMERS 1 ST 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS i HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Location: 9 b City Ine- h Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: 00 %—�� e e Address v2be dr- Uvl �� li City. di'i'47 ✓, Phone#: Insurance Co. �v -rd Policy # C F4/G 240/! d U /! Company name: Address, Difv Phonb#: Faidme to secure coverage as required:under Section 25A or MGL 152 can lead to -the in position of2xirni►raft pence of a fine ups to $I and/or one years' imprismomt-as -aLLas_cixi pwaMeslo-tbelnno-d�aS79PYA)RK FMER id a.fm-aA.41Mm)LajdWagg�.affi understand that a copy of this statement may beforwarded to" office of Investigations of the DIA for overage verification, I do hereby certify under the pains 11 that the info matfw provided above is true a W cion ect Print name__ �J r' �-�-�t` Phone.# 1%' Official use only do not write in this area to be completed by city or town official' City or Town _ _ PetmittLicensirw Q Buildings Deja []Check if;mmediate response is required p Licensing Bo Q Selectnan's Contact person: Phone # E]Health Depa1 E] Other NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-954 . DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number M is that the debris resulting from.this work shall be disposed of in properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: r (Location of Facility) Signature of Permit Applicant /a -9-d.� Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 0 00 La n 0 0 z ol W x w A .0 o w° v a cin lz C40U z zz a a z w° y v 9 U `� w Q+z Cd w a w W a�' cn w OWZ z w°' w a w w w w� 0 cn Q o cn ui om c o as c w o � C ti O C ' dC R R O: • :tC O m Ea Q a NJ0 Ali :!! y �- ` O� m y y R 0 m ID E o 0 a• V � m O V cj a o �Z o :Rpm cp coao c H O y OCD CD C .O H CO3 y... R t O yt... LU O Z AD yam... c w •.� •GO CL= R C Z LIN C: o .y O y d O m .p _ .a y N .= CCLO- OR N R, 0 0 0D O CD L O O v Z co CL O y O CM i O-0 O Q .� y O O '7 m m CD 0 CD 3.0 O O O O d C occ L c v d O G) C G3 0 CL O C C CA 0 0 U) 0 CE w Ir U) I "License: CONSTRUCTION SUPERVISOR. - Number. CS 085173 `c Birthdate: 11/10/1964 t j Expires: 11/10/2006 Tr, no: 85173 ¢ _ Restricted: 00 WILLIAM T FOSTER 65 COACH DR_ DRACUT, MA 01826 Administrator r� 11 .,. f - ,`,,,� �� �l' l� ,; _- - . 1 TOWN OF NORTH ANDOVER, MASSACHUSETTS -.JAr.. JF 'o JS�CuU�E HISTORIC DISTRICT COMMISSION Application for Certificate of Appropriateness Application is hereby made for the issuance of a CERTIFICATE OF APPROPRIATENESS under Chapter 40C for proposed work as described below and on plans, drawings, or photographs accompanying this application. CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: Type of Building 2. Demolition or Removal of: 3. Signs or Billboards: 4. Structure: (Type or print legibly) ( ) New Building ( ) Addition ( ) Alteration ( ) Home ( ) Garage ( ) Commercial ( ✓ ) Other cco'eevvec( porch - at+mcG�e�f 'fv -near of- house. , ( ) New Sign ( ) Existing Sign ( ) Other ( ) Fence ( ) Wall ( ) Other Address of Proposed Work.;- J-d�1rtSOh 5� Date : 3 2 3 Owner: `&Wer Eed'fy �rt�s't �W�jCKe /��/reifi, /Pu ee� Telephone n: (617)'4gS-7'423 Home Address (if different from above) : P.0- 36X ��� , /ydrtk AnkV'er- Agent or Contractor: 11tin N, Wxf on Telephone 4: Address: ? O► goc -- K North kead��' , NA 01e6.1 Assessor's Map n: q& Lot tt : a6 � Y 41 1-4i- i 6&4 �' ��P , ��4t[.�•. �'ci ��aa �t.. ��,.t'f'rtsGz'tt.9i�,t�-� Detailed Description of Proposed Work: Give all particulars of work to be- done (see 78 below), including materials to be used, if specifications do not accompany plans. In case of signs, give locations of existing signs and' proposed locations of new signs. (attach additional sheet if necessary.) !-t tacked are, ph df�nrapAs showIN�, f , re�CeJ, dw)A -Ae- VJewi -From 56hnsam Sfree"f, lso a-Ho'11ed are -�A-e- ''le. plains fir- Ae new pd rcA actt-�Owner (Agent, Contractor) DO NOT WRITE BELOW THIS LINE RECEIVED FOR HISTORIC DISTIRCT COMMISSION: TIME• DATE: BY APPLICATION n: THIS APPLICATION FOR CERTIFICATE OF APPROPRIATENESS: ( ) APPROVED ( ) DISAPPROVED Reason for Disapproval: ( ) NO CERTIFICATE OF APPROPRIATENESS REQUIRED A CERTIFICATE OR APPROPRIATENESS is in the application above and attached documents. Chairman: Vice Chairman: Secretary: for work described . s •moi-< ..a ! - !E�{lustt ttttttttt_ tttt� tt� a. i IN 1•'t� tKh«O � Y .1 f .` Tom•• k. 0 Millimeters to the Centimeter ---------- A --=t- 77� — - ------- - - -7-7- a ------ A.) w L 9L —A= -ZA Jl i ---------- A --=t- ME 7' 7 — — — ----------- ---------- f) -Millimeters to the Centimeter A --=t- 7' 7 f) -Millimeters to the Centimeter to rh,: cvntimeter A - - - - - - - - - - - - . . . . . . . {o Millimeters to the Centimeter . . ... . . . . . 71 L 7[=— 7-7' -4-= 24 7 rzi ♦ T 7 Z77 -7t. A - - - - - - - - - - - - . . . . . . . {o Millimeters to the Centimeter . . ... . . . . . 71 7[=— 7-7' -4-= 24 7 ♦ T 7 Z77 -7t. jk_ A - - - - - - - - - - - - . . . . . . . {o Millimeters to the Centimeter l TOWN CF NORTH ANDOVER. MASSACHUSETTS HISTORIC DISTRICT CojjjIISSIOPI Application for Cert-ifi.cate of Appr_opr_i3tene,s Application is hereby made for the issuance of a CERTIFICATE OF APPROPRIATENESS under Chapter 40C for proposed work as described beloc•1 and on plans, drawings, or photographs accompanying this application. CHECK CATEGORIES THAT APPLY: 1• Exterior Building Construction: ( ) tie.a Building ( ) AdelLtiOtl Type of Building ( ) Alteration ( ) Home ( ) Commercial ( ✓) Other <-CreeN Cc( orck of bac �eoQ �o 2 • Demolition or Removal of: rear o. House... 3. Signs or Billboards: ( ) lit -'-`.J S LgI1 ( ) ,'<ist.ing Sign ( ) Other 4. Structure: ( ) I'('IICn ( ) Wal I ( ) Other (Type or print legibly) Address of ProposedWork• /0 J-CAlgil 5't Date:391k3 Owner: Curr- Eemlly Trust (EVf1 he AVre7t Tru �� SfPe Telephone 1: Home Address (if different from above) Agent or Contractor: JvAP �1, �a'{Son -- - -- Telephone Address: f o� Acx - 1.4 North kp-adl' � lam% D(f16�f Assessor's Map 4 • �L Lot tt : .26 • Detailed Description of Proposed Work: Give all particulars of work to be- done (see 78 below), including materials to be used, if specifications do not accompany plans. In case of signs, give locations of existing signs and' proposed locations of new signs. (attach additional sheet if necessary.) AftachecQ are shown, 7,�e- vif)�aacfC �irr-k fe) b.� rcpiacej, Av%A -fAe- viewnso" Sfiree�f, N56 ca-"Clckeoi are. -/21.e- cymplefa p/ams fir- 4e. new par-cI-,, Owner (Agent, Contractor) DO NOT WRITE BELOW THIS LINE RECEIVED FOR HISTORIC DISTIRCL' COI•MISSION: TIriE 6 DATE BY:. ,V APPLICATION n: TRIS APPLICATION FOR CERTIFICATE OF APPROPRIATENESS: (N�) APPROVED ( ) DISAPPROVED Reason for Disapproval: _ NO CERTIFICATE OF APPROPRIATENESS REQUIRED A CERTIFICATE OR APPROPRIATENESS is in the application above at ached Chairman:1 '/���: Vice Chairman: for work described documents. Secretary:. l V Location JT No. �^ Date i t CA N TOWN OF NORTH ANDOVER A Certificate of Occupancy $ Building/Frame Permit Fee $ SACIIUSE Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ water Connection Fee $ TOTAL (�������� :�: �7 77! 9 $ 14 Building Inspector 39. ca pA D Div. Public Works PERMIT NO. El APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. I 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. LOCATION I (kA (To ko �o P T N CUf PURPOSE OF BUILDING 1 Q OWNER'S NAME c- 1 et:, Po-,aL I� l NO. OF STORIES SIZE OWNER'S ADDRESS I _tG NSA .I• J! V[[ BASEMENT OR SLAB ARCHITECT'S NAME _ SIZE OF FLOOR TIMBERS IST 2ND 3RD P BUILDER'S NAME JoN, c J.l IC c1 l N SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET 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 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER �• ��� A's HA U LT ST K I IS BUILDING CONNECTED TO NATURAL GAS LINE i N sZ' f `L I c f- IFsis�dLfcrt-,&S a R IS S'k A- c6 w/,4� ldjc,LT j< t --cel, e, 0 R,- P Lb cIf CA 13 1 Iv e-rC s SEE BOTH SIDES 11` S I N /' h F( -P. Rl, ��1 I JJ j" 1 / I SIL, 1 LODR PAGE I FILL OUT SECTIONS 1- 3 - IV v �l 15:00 PAGE 2 FILL OUT SECTIONS 1 - 12 I�I Y Z's oiO 'ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 6 I 1D 00 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED I. ti/ U V i 4 J &i _ - jN i,% 4,(x5t, SIGNA E OF -OWNER OR AUTHORIZED AGENT F E E PERMIT GRANTED A (14 19 ti 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. k 6 t -446—H17-> CONTR.TEL.N 5'0E -K69 " 3 S 10 CONTR. LIC. # 22—' z 4 01 H.I.C. a BUILDING RECORD 1 OCCUPANCY 12 r ' SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ _ CONSTRUCTION 2 FOUNDATION—I 8 INTERIOR FINISH CONCRETE PINE HARDW D B 1 2 13 _ CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY WALL UNFIN. _ 3 BASEMENT AREA FULL FIN. B M AREA _ V, '/r V, FIN. ATTIC AREA NO B M T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 �_ 3 _ _ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD"✓'D ASBESTOS SIDING COMMON VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBQEL HIP MANSARD BATH 13 FIX.) TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 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 NO. OF ROOMS GASOI L B'M'T 2n1ELECTRIC 3 d NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1st � � O EM4 e co UO3 O z W o A C� 'bD w° cn u C/)w° 0O w z z A b C s DO ao' v c U w `W z •-� Qr ppco ao' w U 0.4 U w ►.a W ao' v u C/) w Q a C7 C w H W w w ,. v o z U)cn (� v F� J O O O C3 ts0 z� fl. O CO) ca 0 CD y O -E m m L ow CL _ ♦... CD O L CD CD 0 0 m O Q CL cm Q CO2 C O Cc to Q_ J .Q O �O+ C Z CD CL V CA O C C - C R CO2 is J Q Z LL z 0 Q w Cn Z 0 U OE� cc w z w Q W J Z LL W Q W LU U) O C C C V O � o c �v CLC coO o CDL y A Ea .m ., c MCD E c Jc19 1: . m c �i N t0 cc:, �' N N 3 •�: C m 1 C � � = C N CO ti N Q 'E O .� 10Z csa o N v h O v '� Z n 1 r coo a H C O l CO - Co O msH V! W C ' :s -0 t �M C264 ujE � CD iE .0 n o, CCa m p a = R z �O„ y � $ aim J O O O C3 ts0 z� fl. O CO) ca 0 CD y O -E m m L ow CL _ ♦... CD O L CD CD 0 0 m O Q CL cm Q CO2 C O Cc to Q_ J .Q O �O+ C Z CD CL V CA O C C - C R CO2 is J Q Z LL z 0 Q w Cn Z 0 U OE� cc w z w Q W J Z LL W Q W LU U) TOWN OF NORTH ANDOVER, MASSACHUSETTS tic., 3 If 6 � uuiEt HISTORIC DISTRICT COMMISSION Application for Certificate of Appropriateness Application is hereby made for the issuance of a CERTIFICATE OF APPROPRIATENESS under Chapter 40C for proposed work as described below and on plans, drawings, or photographs accompanying this application. CHECK CATEGORIES THAT APPLY: 1: Exterior. Building Construction: ( ) New Building ( ) Addition Type of Building ( Alteration (� Home ( ) Garage ( ) Commercial ( ) Other 2. Demolition or Removal, of: 3. Signs or Billboards: ( ) New Sign ( ) Existing Sign ( ) Other 4. Structure: ( ) Fence ( ) Wall ( ) Other (Type or print legibly) Address of Proposed Work: S -o Q S'► Date: 1I S ti g Owner:_FJ 'C-Pl IR610 j -y (ZVST ,,, Telephone # . (age -19-11 Home Address (if different from above) : T0.410)cl// NO✓"1'kaver Agent or Contractor: JQ�p LATSON Telephone tt: Sy&-��y�3SIo Address: % oc -()y NO x)6010z kA Q)FO Assessor's Map #: Lot #: Detailed Description of Proposed Work: Give all particulars of work to be done (see it below), including, materials to be used, if specifications do not accompany plans. In case of signs, give locations of existing signs and N proposed locations of new signs. (attach additional sheet if necessary.) E f T ► S IJ cry Tti'� L.L _ F ► 0 G n o /0 a, 4. 0 ner (Agent, Contractor) DO NOT WRITE BELOW THIS LINE RECEIVED FOR HISTORIC DISTIRCT COMMISSION: TIME: DATE: BY: APPLICATION #: THIS APPLICATION FOR CERTIFICATE OF APPROPRIATENESS: ( ) APPROVED ( ) DISAPPROVED Reason for Disapproval: (� NO CERTIFICATE OF APPROPRIATENESS REQUIRED A CERTIFICATE OR APPROPRIATENESS is for work described in the application above a d ttached documents. Chairman: Secretary: Vice Chairman: SPECIALIZING IN THE PRESERVATION OF STRUCTURES John H. Watson BUILDING CONTRACT LABOR & MATERIALS Building contract made this fifteenth day of October, 1994 by and between Center Realty Trust 1 Johnson Street North Andover, MA Eugene Avrett and Gothic Carpenter Inc. Edgemere Road North Reading, MA John Watson (508) 664-3510 It is agreed that The Gothic Carpenter Inc. will reroof the asphault strip using ice shield and new asphault shingles and will also install new bottom cabinets, sink and vinyl floor in kitchen at 18/A Johnson Street, North Andover, MA and that all work will be done with good and substantial materials in accordance with all plans, specifications and codes and that it will be finished completely on or before November 15, 1994. Center Realty Trust agrees to pay The Gothic Carpenter Inc. the sum of Six Thousand dollars within thrity days of completion. This ag2eement is entered into as of the day and year first written above. Owner CENTER REALTY TRUST Eugene A tt Contractor THE GOTHIC CARPENTER INC. John H. a son Edgemere Road, P.O. Box 414, North Reading, MA 01864 Ae !OaAic Wa4lWn&� Jnc. SPECIALIZING IN THE PRESERVATION OF STRUCTURES John H. Watson BUILDING CONTRACT LABJR & I1ATERIALS Building contract rade this fifteenth day of October, 1994 by and between Center Realty Trust 1 Johnson Street North Andover, MA Eugene Avrett MI Gothic Carpenter Inc. Edgenere Road North Reading, 14A John .. atson 4 (508) 664-3510 It is agreed that The Gothic Carpenter Inc. gill reroof the asphault strip using ice shield and new asphault shingles and will also install nei: bottom cabinets, sink and vinyl floor in kitchen at 18/A Johnson Street, forth Andover, KA and that all work wi11 be done Frith good and substantial materials In accordance with all plans, specifications and codes and that it will be finished completely on or before November 15, 1994. Center Realty Trust agrees to pay The Gothic Carponter Inc. the sum of Six Thousand dollars within thrity days of completion. This agPeement is entered into as of the day and year first written above. r.; rnerC EtI'i'SR REALTY TRUS f Eugene Avrett Contractor I`1 G )11iIC CARPEIM, R INC. tot H. .:a on J Edgemere Road, P.O. Box 414, North Reading, MA 01864 ° m m•. m to m p x r N o Lid cDi b C M D ' z _ rr., :j Oz D O m H D N D 3 Z I C m 000 M Z uo W A W 2 T I N m ✓'9ZW4L d' a0r pO m .r. p m x -mi r oaroe� y fo n Zf3r1 r N i! Dp Z (iii m un iN m a nt _ m O a I u :N 9` ppm ' -'i ?�� I • Z , `• _ . m C) _m - rr c X00 Z m 0I n C) Z 3 yam' N N � ✓i1 N (nom a Z^/^Z� OZC� (� a :� m ll L/ m h n CO y mm ma=p m �D ZC)-iD O p Ocn mcoCZ r OFFICES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING ORT NH °f 1 Town of a NORTH ANDOVER .� CHUSES DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street North Andover, Massachusetts 01845' In accordance with the provisions 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 c 111, S 150A. The debris will be disposed of in: �Q(—+t..i�,D '�►spzSsAL (Location of Facility) j � rerw n>S o� 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. Location 1 P ToHNSc,-J No. !7- q-- Date r4_lj 17 /�V3 3? CHuSEt TOWN OF NORTH ANDOVER Certificate of Occupancy $ -'Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ -se�,wer Connection Fee $ VO Connection Fee $ LXJ TOTAL $ / u4- 6177 Building Inspector Div. Public Works Location—' No. Date _ 001.0T�TOWN OF NORTH ANDOVER '0000et SNA -e -°L A Certificate of Occupancy $ Building/Frame Permit Fee $ �;t•� Foundation Permit Fee $ A Other Permit Fee $ Sewer Connection Fee $ .' Water Connection Fee $ )00OTAL $ "r �f Building Inspector Div. Public Works PERMIT NO. v v APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP a-40. Cy( LOT NO. 9 2 RECORD OF OWNERSHIP (DATE BOOK :PAGE ZONER3 SUB DIV. LOT NO. OCATION /8 Jdl_�0� C�I RPOSE OF BUILDINGngW b� /� pO�y /_ OWNER'S NAME Ge;►*r. ii„_/J T S.-{ / /(„L'A: / J NO. OF STORIES ./ SIZE �/I �`/`'I// v '�1 9// 1. ID J OWNER'S ADDRESS I )I /SOX ! I' A)jfw l /1m /door+ / 1 l /v / I�`I �-'1 G[ BASEMENT OR SLAB nON� t ARCHITECT'S NAME flan e. SIZE OF FLOOR TIMBERS IST 2ND 3RD ,9161LDER'S NAME TD61 14.wQ f-ewn DISTANCE TO NEAREST BUILDING 50/1f holxe. at /D l SPAN DIMENSIONS OF SILLS (STANCE FROM STREET �0% - "' POSTS AYrSTANCE FROM LOT LINES - SIDES L1 U� REAR �T GIRDERS FRONTAGE /AREA OF LOT C ^2 Sr HEIGHT OF FOUNDATION THICKNESS 'IS BUILDING NEW new porck /O r'"flotCe. -old SIZE OF FOOTING X rS BUILDING ADDITION-f.j-A_I- �-f �Qus� J, ` MATERIAL OF CHIMNEY ,11 -BUILDING ALTERATION h� IS BUILDING ON SOLID OR FILLED LAND 'WILL BUILDING CONFORM TO REQUIREMENTS OF CODE Ye$ 7 IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 INSTRUCTIONS ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILEDANDAPPROVED BY BUILDING INSPECTOR DATE FILED 2� q3 4/ -ice 14-- SIGNATURE GF OWNER OR AUTHORIZED AGENT { ��{{ D F E E it 104- _— PERMIT GRANTED OWNER TEL # 19 93 drtt 2cn-c}$ 6177 — GINNER TEL. #-: 617 995-7923 CONTR. TEL. #-1508: (o& -3S1 O CONTR. LIC. #-& Z Flo a 3 PROPERTY INFORMATION LAND COST BEST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY WARD OF HEALTH PLANNING BOARD BOA -,RD Of SELECTMEN BUILDING INSPRCTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I STORIES MULTI. FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH d 1 ? 13 CONCRETE CONCRETE BL'K.PINE BRICK OR STONE HARDW D PIERS PLASTER DRY WALL _ UNFIN. 3 BASEMENT AREA FULL 1/1 '/f 1/1 FIN. B'M'T AREA FIN, ATTIC AREA _ _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B _ 1 2 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ CONCRETE EARTH HARDW D COMMCN ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME _ ATTIC STRS. d FLOOR _ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP GAMBREL MANSARD BATH Q FIX.) TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR b GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 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 ELECTRIC B'M'T 2nd _ 10 13rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. ON 7-4 r Cd H x w o O w v cn o U W z o� p w O rx c C U G w 0 u Wo a r-4n7o p C 0 z z U W W O v > v c G 0 O m G x GAG w C o z v cn Q 0 0 cn 04 ui 0 om z c o c � N O C ~" O CO.s C C2 C ID c :s o co co N �••' :.E a CF IS hCD :.o CO c" c. �. ... m m a CO ca H CA :03 = m N C � � M = C C H R O L -o av L� m �tt o .. +- c •'cm o CO2 0. a : o,z •a o m V mO i C•y ,•�Z O r.+ . C O C a CD h m C •C 013 Ca 0 y m c� m t U. r.+ y... _ m O •CO •O.Z O•C Z ="r mH O LU E LD 4D C.3 m=� g COO C• m �F. O t- $ CL..,.. m N u CD 0 CD O O v Z CD Q O CO) O O — CD C cm CO) p 'O CD On E m m CD O CD CL H = '... CD O � O i O Q ca L M O Q CL a �a CIO O O ca v J� C Z w CD CL V y ca c C _m C. 0 z O a W Z O U 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 local or state law, regulations or requirements. ****************Applicant fills out this section**************** APPLICANT: Eu CUA Avre- it, C�rnfer �Ze�lf y T�sf phone ((l7) -11S'-7 23 LOCATION: Subdivision Assessor's Map Number q6l Parcel Street J-ohn-om S1, Lot (s) EEO St. Number /a Use only************************ RECOMMENDATION OF TOWN AGENTS: i Date Approved Conservation Ad inistrator Date Rejected Comments / Date Approved L Town Planner Date Rejected Comments Date Approved Food Inspector -Health Date Rejected Date Approved Septic Inspector -Health Date Rejected Comments Public Works - sewer/water connections - drivewaype it Fire Department Received by Building Inspector v Date 'Q- I z Szr < L) . S2 co CL X 'o U) wz P�� LU CD cc N 0 q-4 cr LL �o u < z WCC Z, Vat CAW qc u 0 0 J U. 0z LUZ', • OE JGC LLI LU 0 0 z fA L)Z4AIW 5 LU ftw-,� kvac" E > w "0 ---Oz -n LUZ z OFFICES OF:. APPEALS 131,111.1 -ANG C ONSL'I1VA"1'1UN HEALTH PLANNING O � Town of �� ' NORTH ANDOVER l)IVI 1014 (UI: PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 1 zO Ntain Street North Atidover, Massa tilisctis () I ti4 i (61 i)(iH 5•477 i In accordance with Elle provisions 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 150A solid waste disposal facility as defined by MGL c 111, S ' The debris will be disposed of in: WASTE TRA05 r-FYZ ST hT100 (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. 3 c, 0j, 1� 2-- RZGISmZRZrl OTRUCTW" ENGINEERS DENCO ENaINEEA NGF,:INC. XW I= 373Is02 MUOMTALJWODMM a Isw k Street.=Ulf VZA&HW%300 NorhRead oU01" 864 OONMMClICUT 7487 (017) 944-8440. (508) 66"783 71M00a IWAND 3017 XWOM - ANMCM INIM OF CIVIL WGINUM PRorsasiomAL ENGINEERING BZRVICZ SINCE 1956 400 JOHMSOAJ Q)T, MIT OF-" 101 XI NO.- 0 1995 DENCO ENGINEERING# INC. OUE«T J to Q r FI(ZCH ZwOIF :�.< ``'`-, (-SF AT WA -Al F- L + g posr 1z ao r- 3, 9* 1400 XO lox 3 SX T, + smS2/411-S J. a rc coo 3 c, 0j, 1� 2-- qc> -- q POO q- 70 0 2I 3I I : 7. s,1-•> 5. )e s mod �S I � � ds�\ 6 �= 1 v v � Q o _ S o 3 L= s - S Q7 r L o�� r) Zs � Z v CL z� h N 'S N _d � � 6 v L U 1 v � v o 3 L= s - O L o�� v CL z� IK; - -- -- t - --- - r _ - 77— _YLi' ..., - _ _ .: xs 74 S -t—, 37f. — — — — — — S-- — — 1-7— — = - _ _ 74 S -t—, 37f. — — — — — 1. -L.- -1`- -._•- :' .. . w..1' - .-.__.. —.—._ - - i 71 —d.. — { is ;:.: !'_—.i_.i: _ _ � : _ •• — _ � _ `=_3-=---;.:�.: _�-��:--.�-_ .. .. ...... ----� ..�-,d ;c :......-......:!�_.:1 .��=�:.:�:_.�: moi:: ::.j_-• -_:���.!:�-:t:_.-f: _- M E , � �a+ ® M Grill 1111 Millimeters to the Centimeter — _ -77= .. l - - — - is - �- - - _ - �i r----- - •l'�. r :ice— - .t ............. -......_. - __—•--......_— _ r- 1111 Millimeters to the Centimeter Permit NO: Date Issued: LOCA PROPERTY OWN TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received ANT: Applicant must complete all items on this G111GT�PI/�U�� Print 100 Year Old Structure es no MAP NO: !fz&— PARCEL: ZONING DISTRICT: Historic District a no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Aodition two or more family ❑ Industrial R'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain 0 Wetlands ❑ Watershed District El Water/Sewer DESCRIPTIO y OF WORK TOB ER r,. e To,myo,G ,,e+��� �.c�G /� �ii ��`.� S/ .G �►s� i�� • r%i�� if/e cG ,d��i OWNER: Name: RMED: -grG Flpoats ee,,W0er- Please Type or Print Clearly) �9' 1�i�o 47S TwosPhoneme-- Address: o", © t3ox BW /La �4jomee. Orr",cid A� 11'q16ec0o0y ae we1i;w�l• CONTRACTOR Name: 'Pvr e C. O Phone: b 09 Address: (OF Supervisor's Construction License: G'S - 07-::UO2— Exp. Date: lo?/ Y//o Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COS�TIB,,A//SED ON $125.00 PER S.F. Total Project Cost: $ a?® Doo • FEE: $ �ry Check No.: k2n2 o Receipt No.:a! T NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Si nature of A ent/Ovv ' r �'� o ! inn of contract �r1 9_ _.9 . _. �_ 9, ____ _-.._ - __ Plans Submitted Pla Waived Certified Plot Plan 11St m [Iped Plans Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TWE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . f ,Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow Engineer: Si Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair Street Fire Department.signature/date COMMENTS ;, Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — (For department use) Doc.Building Permit Revised 2010 0 SICAQ C( O C 'j h, 0 mil N�� 1-0 YL4 Uj ® Notified for pickup - Date E E Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit L3 Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building Permit Application u Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app;,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Buil ing permit Revised 2012 Location j (,0 v7 X No. — / Date r !� Check #) TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL 1 Building Inspector 4 Location /F-,,4 ,,4 No. Date / Check # Pev rI, , r 4v�; J 7 TOWN OF NORTH ANDOVER Certificate of Occupancy $��.--- Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector �/ ��Oe. �. ✓MV 49 �SS�cHuSet CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 654-14 on 3/25/2014 Date: January 29, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 18A Johnson Street MAY BE OCCUPIED AS an apartment IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Center Realty Trust 177 Salem Street North Andover, MA 01845 Building Inspector Fee: $100.00 Receipt: 28457 "' Check: 8901 t n rA O x y O O ix O L CL 4) ) Q W N W� 'r " D ' WLLJJ \ 2 O as : QO.O m LnU. zz Z N J 1 � as •v W `n `\ a LLI C -a— O O LL.•y to d N O •= = t O W L--` m._ C N Ul m m as '> to j c 'y W WLo l=- n LL • l ? \ u O Q O s Ns. 7 a , N t j c6 7 I� X11 u i Cj (� O i ar C XO v O LCL (n .O u LL d' LL �' VI LL O Q' LL m N N C O O1.120 COO �f•+ Q. CD co= tQ o U Q L U) I � � � •O E O O _ co O cn v 3 °'`O n� :410 L m L Or d C c :•mac., C) 4) Q1 Z Q r y O O .g`E i �• 3 L CL 4) ) � w c Q d L N as : QO.O m � as •v LLI C -a— O O LL.•y to d N O •= = t O u V L O O y Q m as '> to N s •.Q O C l=- CL U) Cl) r— v LLI Ii. CL N i< 0 � U /•G�// CCO O I.f. W LLI -j CL Z Z w 'N E � O Z O V/ •E • a m W O i O Q a. CL O v J � �� O 4) C O CL V U^) CL 0 tra Samoa O G V, M W w 0- x LLJW 0- COZ O U U) J N 0 2 ES E O Z O 0 01— E .-E m m 0 CD W OW, �+ + 0- cc O Q. CL t Q o r v_ J 0 �CL O 4) W O CL V V9 c cl: o ASW Q 2 W ((A v` � Wyk H� ut � LU cn D- LL Z z Z ��Oc ? j -` LU NCL `� a a 05 o Co. L >.1 J < .y C6 �'y UJ LLJ LL O Q � O ,_ \ yam, =37 � U •� i 7 O 41 6 Z ai t 2 O LL N LL U LL LL -0 In LL Q' LL ca tra Samoa O G V, M W w 0- x LLJW 0- COZ O U U) J N 0 2 ES E O Z O 0 01— E .-E m m 0 CD W OW, �+ + 0- cc O Q. CL t Q o r v_ J 0 �CL O 4) W O CL V V9 c Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 209000.00 m $ - $ 240.00 Plumbing Fee $ 30.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 30.00 Total fees collected $ 400.00 18 A Johnson Street 654-14 on 3/25/2014 Structural Repair, Frame New Bath The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, AM 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / L Please Print Leizibly Name (Business/Organization/Individual): (2. fie[ �e ,4 i vc Address:_ 71•J �J' 1� C� ��, oC%e tluw b Ce4•tofvr-� City/State/Zip: Ve Phone #: S08 -3.aX - 0 3 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I _ _ Pmployees (full and/or part-time).* have hired the sub -contractors 2. n I am a sole proprietor or partner- listed on the attached sheet ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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 aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. , Insurance Company Name:. i(/detJ94 Af G S . r Policy # or Self -ins. Lic. #: (L,6 137617,94 Expiration Date: A116 1`' f y. a-4 r r Job Site Address: 046, f t18 � °`- S City/State/Zip: PDd��i1i Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert under the painl penaltie perjury that the information provided above is true and correct. -.�-• A(0%C.1 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 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 o£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<a`partmepts an .who xeSides therein or the occupant of the dwelling house of another who employs pers6n's to dormaintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant,tt;ereto'ghalltnot-lzca:use„ pf uch employtne�it bgde�jned to be anOinployer." MGL chapter 152; §2,5C(6) also Stites that "every state or local licensing,agency.shall.withbo'ld the8suance or renewal of a license or permit`to operate'a'business or to construct buildings hi the commonwealtiifor 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." s 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 numbers) 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 maybe 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 f6yolti to X11 out in the event the Office of Investigations laAd'ZRLI tyou-rek riling the applicant. L'.. Please be sure to fill in the permit/license number which will be used as a reference number., In -addition, an applicant , �; Yg. Y ; ''y' � ;. ,. q atmu ub iY•rriultiple erii t/license applications in an given ear need oft' siribri i"orie affidavit ihaicating 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,,tetephone dnd fax number: The Commollwealth.ofMassachusPtts� Department of Industrial Accidents OfMe of Investigations 600 Washington Street Boston, MA 02111 TeX. # 617-727-4900 ext 406 or 1-877,N1ASSAFB Revised 5-26-05 Fay, # 617-727-7744 wwwanass,gov/dia WORKERS COMPENSATION AND EMPLOYERS' LIABILTY INSURANCE POLICY ---- INFORMATION PAGE INSURER: NORFOLK & DEDHAM MUTUAL FIRE INSURANCE COMPANY 222 AMES STREET DEDHAM, MA 02026 ITEM 1. NAMED INSURED AND MAILING ADDRESS: CENTER REALTY TRUST P.O. BOX 876 N ANDOVER MA 01845 POLICY NO: WE139872A RENEWAL NCCI Company No: 21059 Account No: FEIN: 04-2348294 AGENT NAME AND ADDRESS: M.P. ROBERTS INS. AGENCY, INC. 1060 OSGOOD STREET NORTH ANDOVER, MA 01845 AGENT NO.: 20045 LEGAL ENTITY: REALTY TRUST OTHER WORKPLACES NOT SHOWN ABOVE: (See Workers Compensation Classification Schedule) ITEM 2. POLICY PERIOD: From: 02/10/2014 To: 02/10/2015 Effective 12:01 A.M. Standard Time at the Insured's mailing address. ITEM 3. COVERAGE: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident: $ 500,000 each accident Bodily Injury by Disease: $ 500,000 policy limit Bodily Injury by Disease: $ 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: See Schedule of Forms and Endorsements. ITEM 4. PREMIUM: The premium for this Policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required on the Workers Compensation Classification Schedule is subject to verification and change by audit. Total Estimated Minimum Premium: $ 266 Annual Premium: $ 809 Audit Period: ANNUAL Additional / Return Premium: Comments: Issued At: Date: 01/04/2014 Countersigned by WC 00 00 01 A Copyright 1987 National Council on Compensation Insurance INSURED COPY x LL Q ca tN U r-+ o LOL h Ln u Q (%j oc p Z Z J co +„ a LLL t K ? c u E U _ LL O cc Z Z C G= C t K _ LL Z V W W s d' Ln _ LL a Z Q _ LL Z W CL W W oc L � m O z + N ++ U) 41 0 v O t/1 �I id E \l -ZD r �I 0 0 FM VI co W A� Cl) A 7 Lu O W W J CL Z n 0; • N EI w N I -m1 O CL 0 - CD CD Q O Z t� Y,A/ E i � O O Z N O C 0 ' c O AN, W Q N O CL 0; • N EI w N I -m1 O CL 0 - CD CD Q O Z t� Y,A/ E9—* w 0 O x. J = p m u Y5. \O O LL E N Q V) o U Z LU Z m O C Lhe 7 CL Lto 0 K E !EC U — U- 0 W W CL Z Z J d b — t6 c U- o0 W Z U J W SOD V Z N — !6 .L LL O LU en Z t � 2 cp L LL uj o~c Q LV W LL N m z +"' v ai N N O 0 VI Al., __ 1.02� _ O O Q i CL O d Q c aL ✓ L Q C N N d 7 � � C tm L = 0 h P -a or - 0 i a� cc J L m d � O N � o d oz U) _ � y c o CD 3 a c � L Q Q d i yam. V ++ C o .y i-0 O== Q L L cc 0 N 2 -� H _ co O t m W C -0 +•+ O O mO N _ �v v v cn Q O� Ho `� .c 2 cQ L- M, = O F- M, '0 Q 0 U F IR `Iv .ti 21 E L _ �0 0 Qi Z N 0 Co0 I c A' O W Q .E m m CL 0 0 0 0 C' CL �a O _ J .v C,L O W 0 U U) c CL 0 JIMMassachusetts -Department of Public Safety Board of Building Regulations and Standards t Construction Supen icor License: CS -075302 BENJAMIN C OWOOD r 69 OLD VILLAGE LANE Q NO ANDOVER MA 018451 ,I ` Expiratior Commissioner 121041201d