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North Andover Board of Assessors Public Access
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roperty Record Card
Location: 18 PENNI LANE
Owner Name: VOUNESSEA, STEVEN
C/O SCOTT C. BRILEY
Owner Address: 18 PENNI LANE
City: NORTH ANDOVER State: MA Zip: 01845
Neighborhood: 7 - 7 Land Area: 1.24 acres
Use Code: 101-SNGL-FAM-RES Total Finished Area: 3213 sqft
ASSESSMENTS CURRENT YEAR PREVIOUS YEAR
Total Value: 590,700 590,700
Building Value: 363,200 363,200
Land Value: 227,500 227,500
Market Land Value: 227,500
Chapter Land Value:
http://csc-ma.us/PROPAPP/display.do?linkld=1896673&town=NandoverPubAcc 5/17/2012
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9050 J-1 Date
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform ... . . . . . . . .
plumbing in the buildings of . S r -.-417-T...13 f-. tz y ...........
at .... pt.n I,.,: ..t. . Pc
.......... North Andover, Mass.
Fee.L./Yl.e.o. . Lic. No...E,. Ip.Z -7 .. ..... *A—`t'-Xz---E-A �-/ ...
PLUMBING INSPECTOR
Check# 16,31S15- ,
FIXTHRFS
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town:
i
e ? , MA. Date:12 _ o:j Permit#
Building Location:_) $ PeN
Owners Name: Sc o �Q
Type of Occupancy: Commercial
❑ Educational ❑ Industrial ❑ Institutional ❑ Residential
New: ❑ Alteration: Renovation:
❑ Replacement: ❑ Plans Submitted: Yes ❑ No
FIXTHRFS
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.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNERIIS 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 ❑
S.i natur of Owner or Owner's Agent
I herebl 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
provision of the Massachusetts Stat
Pertinent p e Plumbing Code and Chapter 142.of the General Laws. — -- ---
Type of License:
Title ❑ Plumber Signat re o Licensed Fflum er - -
City/To k�JMaster License Number: $ ')
APPROV ED OFFICE USE ONLY ❑Journeyman
4k
DEDICATED
SYSTEMS
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3RD FLOO
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Check One Only.
Certificate # $ 5'
-
Installing
Company Name �iil
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cert
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-
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KCorporation
Address:
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S�ACity/Town:(,.INtA
State:ill�,
❑ Partnership
Business
Tel:l-S9'
7---71Z
Fax:
❑ Firm/Company
Name of
Licensed Plumber:
1 c h c
S L Sr^
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.
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNERIIS 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 ❑
S.i natur of Owner or Owner's Agent
I herebl 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
provision of the Massachusetts Stat
Pertinent p e Plumbing Code and Chapter 142.of the General Laws. — -- ---
Type of License:
Title ❑ Plumber Signat re o Licensed Fflum er - -
City/To k�JMaster License Number: $ ')
APPROV ED OFFICE USE ONLY ❑Journeyman
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Date....... 9 .........................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... '/'W C-
. .............................................................
has permission to perform ...................... i . ............................................
wiring in the building of ............ . . ..........................................
............ V1 North Andover, Mass
at ................ ............. ............ .... .. \..
Fee ..-.y ................. Lic.
Check #
Commonwealth of Massachusetts Official Use
/Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of. NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or herr intention to perform the electrical work described below.
Location (Street & Number) / F Pe, /1 / LR`] -e,
Owner or Tenant
Owner's Address /&Y Yin t, 44+r I--, -, Ivor---T-ti
Is this permit in conjunction with a building permit? Yes 10
Purpose of Building5�ciev�-�I i4
Telephone No.
No ❑ (Check Appropriate Box)
Utility Authorization No.
Existing Service , Amps / Volts Overhead ❑
New Service A)1,0 Amps / Volts Overhead ❑
Number of Feeders and Ampacity
Undgrd 2r
Undgrd ❑
No. of Meters %
No. of Meters
Location and Nature of Proposed Electrical Work: tiip-e- G 5 L .3n ��yh- 4:&hi-4 hua
au -5"grid � D ('�1 ���� l i!tVlf�.
Comnletion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil: p• (Paddle) Sus le)
of
TransFans Total
Trsformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above [IIn- El
rnd. rnd.
o Emergency Lighting
Batter Units
Battery
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Detection and
No. of Switches
No. of Gas Burners
Initiatin Devices
No. of Ranges
No. of Air Cond. Tonal
No. of Alerting Devices
Heat Pump
Number]Tons
KW
No. of Self -Contained
No. of Waste Dis osers
p
Totals:
.......................
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
�'Y
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
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 operation" coverage or its substantial equivalent. The
undersigned certifies that such covera a is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penal ' s of perjury, tha the information on this!a!!�ica' n is true and complete.
FIRM NAME: f -A if 41 t<GAm C- LIC. NO.:
Licensee: Signature LIC. NO.:
(If applicable, ent "exempt" in a lic nse number line. Bus. Tel. No.
Address: Alt. Tel. NO.: 2� -
*Per M.G.L c. 147, s. 57-61, security work req ires Department of Public Safety "S" License: Lie. 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 a grit.
Owner/Agent
Signature Telephone No. PERMIT FEE:
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers
.Applicant Information Please Print Legibiy
Name (Business/Organization/Individual): � �//� n �( t'�' 7 /?-c L-
Addxess:Z�, G �W-a �� S
P Pp✓cot ; Phone) /1/li C��%S ( e #:
City/State/Zi
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).'
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. T
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
3. ❑ I 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.]
employees. NO workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
I. 0.0lectrical repairs or additions
11.0 Plumbing repairs or additions
12.❑ Roofrepairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
7 Homemyners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and 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
Policy # or Self -ins. Lie. #: L Expiration Date:
Job Site Address: City/State/Zip:
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 ofthis statement maybe forwarded to the Office of
Investigations of the DTA for insurance coverage verification.
I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct.
Signature: Date:
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
PermitUcense #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town CIerk 4. EIectrical Inspector 5. Plumbing Inspector
6. Other
Contact
Phone
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GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW
POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections
INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final.
FOOTINGS: Continuous Full 2x4 Keyway
Continuous strip footings for interior columns
FOUNDATION: Rebar as required
Anchor bolts or straps
Damproofing
Foundation drain - pipe/stone/fabric filter/cover and outlet connection.
FRAME: Fireblock - over girts/plates between floor joist
Penetrations for plumbing, heat, elec, etc.
Walls at stair stringers.
Windbrace corners and center bearing partitions.
Size ridge to provide full bearing at rafter cuts.
Hip and Valley rafters - watch bearing at walls.
Ridge & Hip - Provide proper connections.
Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate.
Stair stringers - watch cuts and heal support.
Joist hangers - fully nailed w/ hanger nails.
Sill plates 2-2X6 (1 PT) w/sill seal.
Girts - solid brick or steel plate bearing at foundations
'/ " air space at sides in foundation pockets.
Lateral bracing at ends.
Certified calculations. required for Beams/LVL's Trusses.
Solid bearing support for Headers/Beams etc.
Check headroom clearances - stairways, under beams
Attic Access. (min. 22x30 w/3' headroom above).
Crawl space access. (min. 18x24).
Bath exhaust fans to have metal duct to exterior (not in soffit).
Firecode S/R wood frame of "0" clearance fireplaces & stoves
Window Schedule or Every Habitable Room Must Have:
Natural light equal to 8% of floor area.
of required glazing shall be openable.
Bedrooms required min. 20x24 egress window or door.
Vent attic spaces - "proper vent", soffit and required ridge vents.
Firecode under stairs if used for storage
FIREPLACES: Separate permit required.
Inspections at Footing - Smoke Chamber - Finish
Smooth parging, clean joints, 8" solid @ combust. Surf
DECKS: Separate permit required:
Lag to house, provide flashing.
Rails min. 36 ` high, Baluster max space 5" on center.
Over 8' above grade, use 6x6 posts w/lateral bracing.
Lag all posts and rails.
Pier footings down 48", Conc. pad at stair base.
FINISH: Handrails returned to wall/newall post.
Guardrails required alongside open cellar stairs.
Exterior grading complete.
Certificate or occupancy required prior to occupying structure.
Temporary Stairs required for inspection.
Re -inspection fee - $25.00 (Be Ready).
Certificate of occupancy required prior to occupying structure.
BUTTERWORTH & O ' TOOLE, INC.
P.O. BOX 8294
SALEM, MA 01971-8294
ADJUSTERS/APPRAISERS
FOR INSURANCE COMPANIES ONLY
TELEPHONE (978) 741-5731
April 14, 2011
FORM OF NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAW, CH. 139, SEC. 3B
TO: Building Commissioner or
Inspector of Buildings
ADDRESSES
City/Town Hall
'North Andover, MA 01845
RE: Insured: Marilyn and Steven Vounessea
Address: 18 Penni Lane..
North Andover, MA,01845
Policy No.: HP2100321
Loss of: April 11, 2011
File No.: 016-0874
Origin: Weight of ice and snow
FAX (978) 740-9109
Board or Health or
Board of Selectman
City/Town Hall
North Andover, MA 01845
APR �QX011
TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
Claim has been made involving loss, damage or destruction of the above captioned property, which may either
exceed $1,000.00 or cause Mass. Gen Law Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen
Law Chapter 139, Sec. 3B is appropriate, please direct it to the attention of the writer below and include a reference
to the captioned insured, location, policy number, date of loss and file/claim number.
If no reply is received from your office within ten days, we will assume you have no liens of any type against this
property and we will recommend to the insuring company that this claim is paid.
Thank You,
Jack McKeon
Adjuster
Location
No. � _ Date
e-1--03
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ 5
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 5�
Check #
t
w
16 5 9
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
.� fDT"� x
BUILDING PERMIT NUMBER: DATE ISSUED:
SIGNATURE:
Of
I SECTION 1- SITE INFORMATION I
Date
1.1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number
Parcel Number
iC
1.3 Zoning information:
1.4 Property Dimensions:
t
Zoning District Proposed Use
Lot Areas
Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard
Side Yard
Rear Yard
-Required I Provide
Required I Provided
Required
Provided
D
3 16 1 3-2-
1.7 WaterS lY M.G.L.C.40. 54)
1.5. Flood Zone Information:
Outside Flood Zone
1.8
Municipal
Sewerage Disposal System:
❑ On Site Disposal System
Public Private ❑
'Zone
I SECTION 2 - PROPERTY OWNERSIiIP/AUTHORIZED AGENT I -
2.1 Owner of Record
bxS—
Telephone
2.2 Owner of Record:
10
Address for Service:
Name Print Address for Service:
I
9ACTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Superviso
Addrs
SignatuV Telephone
3.2 Registered Home Improvement Contractor
Company Name )
6'53b0v�)
License Number
Expiration Date
Not Applicable ❑
I)�
Registration Number
Expiration Date
K111
SECTION 4 - WORKERS COMPENSATION (NLG.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 buildinE permit.
Signed affidavit Attached Yes ...... No ....... ❑
SECTION 5 Description of Pro7posed Work(check auapplicable)
New Construction ❑
Existing Building ❑
Repair(s) ❑
Alterations(s) 0
Addition
Accessory Bldg. ❑
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work: f I
L Z/ VF/ -I' \ L
19
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
Estimated Cost (Dollar) to be
Completed by permit applicant
1/
OFFICIAL
(a) Building Permit Fee
Multiplier
USE ONLY 4"�Nfn0=
2 Electrical
(b) Estimated Total Cost of
Construction
3 Plumbing
-'--'-"— --
Building Permit fee (8) X (b)
(� _
4 Mechanical HVAC
------
5 Fire Protection
6 Total 1+2+3+4+5)
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner/Authorized Agent of subject property
Hereby at orize I:. �. to act on
My be m all ma ers elative to work auth rize by this building permit application
3
Si nature of Owner Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
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
Prin a
Si e of Owner/A nt J Date
azo^ {
NO. OF STORIES SIZE
BASEMENT OR SLAB y Q
SIZE OF FLOOR T \4BERS IS12 ND 3KD
SPAN
DIWNSIONS OF SILLS 7-'Z x
DIMENSIONS OF POSTS tr,. �,►.L
DIWNSIONS OF GIRDERS
HEIGHT OF FOUNDATION \ THICKNESS
SIZE OF FOOTING X 1
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
act
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessaryapprovals/permits
frorn
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 e,�. � � S k ut �L� PHONE 1C ��'
LOCATION: Assessor's Map NumberAD—q,--. Q
PARCEL
SUBDIVISION LOT (S)
STREET_ �� �p� �.e a.,�l ST. NUMBER._
RECO 'MENDATIONSV/I�
CONSERVATION ADMINIS
COMMENTS
TOWN PLANNER
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR-HEALTI
COMMENTS
e
USE ONLY***************
AGENTS:
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE -REJECTED
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
11 RECEIVED BY BUILDING INSPECTO
Revised 9\97 im
DATE
1 Name
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
V
Location:
City �U. %�.�.� , %lc- a(f/gI- 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.
Address . �v-\_ `�tx ak _ g4r, ,
Ciiy- w)x. /\ �,.,� �.�.,. Phone# yS33
Tq
Company name: ,
Address
City " Phone*
Insurance Co. _ Policv #
Failure to segue coverage as requiredunder section 25A or MGL 152 can lead to the imposition of cnrtrnal penalties O(A fine
up to -a
500.00
and/or one years' imprisonrnent_as welLas_civA peoatiesjn-tbal m-f-a-STQPVMORK9RDER-md a fine -of iDA-ODis $1,
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for l
coverage verification-
/ do hff ebt c c'�'w7 Ufe' its and per lties ofperjur thattheinformabm prov/ded above sir true and correct.
Print namee� �` 1 (� .o .._ Pune.# E, %4- �5 3
Official use only do not write in this area to be completed by city or town official'
City or Town_ Permil/Licensing
[]Check if immediate response is requked
Contact person-.
G
I] Building. Dept
.p licensing Boarri
El Selectman's Office
E] Health Department
D 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:
�. v }
(Location of
Signature ofgPeffApplicant
)--( C �
Date
MOTE: Demolition permit from the Town of North Andover must be obtained: for
this project through. the Office of the Building Inspector
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Date .... .~. °�-.0-3.....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .... qk d..... '. ... SA f�� f S -Pr u t c 'c.,
.......... ..................
has permission to perform 5`r``t.' �e r- P�
.........................................................................
wiring in the building of . ® ve g..
................................ `.Y .............................................
/�- .................. . North Andover, Mass.
�p t (� --'eCo�� tit 14
Fee.... ............... Lic. No............. ......— ........ ............ .......................
ELECTRICAL INS ECTOR
Check # l
4764
THECOA MONWF.ALTHOFARMCHUSETTS �Office Use only
DEPAIZTMENTOFPUBIlCS9FE7Y �A Permit No.
BOARD OFFIREPRE[EMONREGUTATIONS527CAR I200 6
Occupancy & Fees Checked
APPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WO
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
/
Town of North Andover To the Inspector of Wires
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant ��A,/I,O i>,� (X, n Jo -n
Owner's Address �d J" Qj
Is this permit in conjunction with a building permit: Yes m No (Check Appropriate Box)
Purpose of Building 6).l ice, Utility Authorization No.
Existing Service Amps / Volts Overhead Underground = No. of Meters
New Service Amps olts Overhead Underground EZ3 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work d A6 7 X0 15 r, 5(iJe
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
round
ground
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of Water Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER•
<' InAuanoeCov$-age. PututanttothelegtmeattatLsofMass�n�ItsGa�aallaws
Ibawamnei tLiabkyh>Stna =PbhcyiwhxlingCorr>pl Cc)mnWorgsatamideVAalat YES NO
Ihavesthnithdvandpro0f0fsa=1DdrOffiM YES Ifyou havec rdwdYES, pla9e' thetypeofcowraWby
deddng(ly box
INSURANCE BOND OIER FLSPI
awSpecify)
ExpnarionDae
1,) Valueoffloc alWotk$
WorktoStatt OhispecfimD&Requestod Rough0.
FIRM NAME 12, p� - y �'� ✓L-/..5 -,12-. C1> LimwNo.
Liwam: ` �� Signature y LiccimNo L
Bul4l mTeLNo.
yAdd��-4aZ6/tqc AhTel.No.
OWNER'SINSURANCEWAIVER;IamawarethatdieLiamdoesnothavethei ardnmoovtWoritssubstinialegtrivablasrequiredbyMassaditisetsGGonedLaws
and thatmysignatureondiispenritapplicalionwaivesdiisreguitenot
(Please check one) Owner Agent
Telephone No. PERMIT FEE $
Signature o _ wner or Agent
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
. Name:
Location:
City Phone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City Phone #.
Insurance. Co. Policv #
Company name:
Address
City Phone #
Insurance Co. Policv #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,5M.00
and/or one years' imprisonments weU_as_civil.penattiesinlhelmn-f-aBTOP.WORK ORDFRand_a.fine.d_($]Do.DD)-a day.against_mp_ I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
l do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date r
Print name Pbone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing.
I] Building Dept
Check tf immediate response is required Licensing Board
p Selectman's OfficE
Contact person: Phone A Health Departmen
Ei Other
} Dateo � : A.)
I
TOWN OF NORTH ANDOVER
p PERMIT FOR PLUMBING
This certifies that ...... J-/ 4 ....................... .
has permission to perform .. ���.. `Z
3 plumbing in the buildings of ./�.-. f?u•�sc��4 ............ .
at .. . e.. /' ...... .
L,P . '........ ,North Andover, Mass.
Fee.a.-' '0.Lic. No..'-' 3 / .............................
Check #16-7 PLUM BIN INSPECTOR
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Building
Owners Name 1a ` Vo
a
NewEr Renovation Replacement ® Plans
FIXTURES
e S5Y7Peate
rmit #__
■
(Print, or type)
Installing Company Name
Address
GG
Check one: Certificate
® Corp.
Partner.
&Ff�imVCo.
Name of Licensed Plumber:
Insurance Coverage: Indicate the tipeof insurance coverage by checking the appropriate box:
Liability insurance policyEy Other type of indemnity 0 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 ❑ 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 Massa chu {S to i C de and Chapter 142 of the General Laws.
By: Signature of Licenseaum er
Type of Plumbing License
Title .
City/Towni se um er Master ® Journeyman [�K
APPROVED (OFFICE USE ONLY
Date O.q�!I�.. �..3 .....
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
This certifies that ....!r.1���..j.....I.0 11��...............................................
has permission to perform r ...��..:...............................................
p
�yiring in the building of .... 7`P�! ...1 C1 ! ! ? .5..�? ..............................
at ...., ..�J-E'!'Ltd........ 4.S&�-.7........................ . North Andover, Mass.
5O
Fee 'G—D 9 Q C9 G12P ....r-
ELEC'rR{CAL INSPECTOR
Check # 73 2!2
4729
s
THE COMMONWFAL7HOFMASSACHUSETTS Office Use only
DEPARTIVfiM0FPUX1CS4FETY Permit No. 47,5:1,
BOARD OF FIRE PREVEV HONREGMKONS 527 CNIR I2: l O
Occupancy & Fees Checked
APPLICA77ONFOR 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
Town of North Andover To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below. 11,
Location (Street & Number) %�7 fh e
Owner or Tenant 3 f e ve I/O U `j 6 S
Owner's Address jape --
Is this permit in conjunction with a building permit: Yes ® No ® (Check Appropriate Box)
Purpose of Building `,J t ,l Cl2
21
Utility Authorization No.
Existing Service v Amps / Volts 'd Overhead Underground =1 No. of Meters
New Service Amps / Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work W i h i',IN 7077, Q 7o 7
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
�O
round
grolind
No. of Receptacle Outlets
'
No. of Oil Burners
No_ of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
Initiating Devices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
4
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
Connections
No. of N ater Heaters KW
No. of No. of
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER
lbawacaamLmbihtykwxmwPblicyrckxhngCorq*tcOperahmCc)vaag-critsabwntWeqxvalerit YES E3 NO F1
ItiaNi�abrnktcdvandproofofsmelotheOffim �� VotihawdiockDd YES, ptmirdcatetheWofooverageby
BOND
WotkIDSLUt hWecfioriDa1eReqxsbd' •
Licensee RA -0k �,( CaC V I Signature
LicffwNo.
Lice wNo RC061q
���s � U S U� v BusmessTeLNo. � 2L �' 37
Ar_die mcioG Alt Tel No. -791 b' I L(-7601
OWNER'S INSURANCE WAIVER I am aware that the Limm does nothave die i 19-11ar)01- coverage orits subuitiai equvakrit as regtured by Massachusetts Genetal Laws
and dlatmysignat imon dvs peimtapphcahon waives thisreyrmzanerlt
(Please check one) Owner ® Agent
Signature ot Uwner or Agent
Telephone No. PERMIT FEE $ S 0 r 0110
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Name Please Print
Name:
Location:
City Phone #
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity
oI am an employer providing workers' compensation for my employees working on this job.
Company name:
Address
City Phone #: '
Insurance. Co. Policv #
Company name:
Address
Cit c. Phone#: _
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine upWo $1,5oo.00
and/or one years' imprisonrnent_as_welt_as-civil_penaltiesin-theiormff-a STOP WORK..ORDF11-and_afore-of.($1-0-0-00)-asiay.againsi.me.
understand that a copy of this statement may be forwarded to the Office of Investigations of the DtA for coverage verification.
i
1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature Date
Print name Phone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensina .
i
E Building Dept
El Check if immediate response is required 0 Licensing Board
r Selectman's Office
Contact person: Phone A. E] Health Department
I] Other
Town of North Andover
Office of the health Department
Community Development and Services Division
27 Charles Street
North Andover, Massachusetts 07845
Sandra Starr
Public Health Director
Bill Dufresne
Merrimack Engineering
66 Park Street
Andover, MA 01810
Re: 8 Penni Lane, North Andover
r-- -- — —�
Dear Mr. Dufresne:
Telephone (978) 688-9540
Fax (978) 688-9542
August 12, 2003
Please be advised that the proposed plan dated 6/30/2003 and revised 8/11/2003
for the upgrade of the septic system at 18 Penni Lane has been approved.
Should you have any questions, please do not hesitate to call the Health office.
,Sincerely,
Sandra Starr,
Health Director
Cc: File
Homeowner
wilding Dept.
BOARD ()P APPEALS 6889541 BUILDING 688-9545 C{-\SERVXI IO 688-9530 HE ALI'H 688.-9540 PLANNrNIG 68S 9535
OM.ce Use Only
941 anmm,aomealt of Massat4imeng Permit No. ��/
vtt;tttLtritnd of Public $tl da Occupancy A Pee Checked
3190
..0
iOARD OF FIRE PREVENTION REGULATIONS 521 CMR 12:00 peeve blank)
A0PLIW,iO,N' FOUR PERMIT TO PERFORM ELECTRICAL WORK
All work tbe performed In accordance with the Massachusetts Electrical Code, 521 CMR 12:00
(PLEASE fRIN'f IN INK OR TYPE ALL INFORMATION) Date
0%,or lbwn. of—NORTH ANDOVER To the In pector of Wires:
"the triderelgned i pplfet3 fora permit to perform the electrical work described below. .
location (Street & Number)G���i'a/
Owner -or 'ieriertt $'d1F� i/d �' N CJV A-;74
It wrier'e Address
lis this permit In.cbrt)utiction with $ building permit: Yes ❑ No Ei (Check Appropriate Box)
i'uryosaof 8uildinj Pwei�'�� Utility Authorization No.
G'
Exi3ting Sory.1ce Amps _/ Volts Overhead ❑ Undgrnd ❑ No. of Meters
N", Service Amps / Volts Overhead ❑ Undgrnd ❑ No. of Meters
Nurhber of; Feeders and Ampacity
'Wei dtion and Nafure of Proposed Eledtrical Work lrt/ j R�r G I—A);2 L R /Z .
*6.4i Lighting f utlets
No. of Hot 'TUbs
No. of 71,ansformers '
KVA
No of ughttni ;Fixtures
Swimming Pool Above In•
❑ ❑
gmd. gmd.
Generators KVA
No of ReC6040116 Outlets
No.
No. of Emergency Lighting
;
of Oil Burners
Battery Units
No bt 6wR6h 0utlete .'
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
N6 df Rartg6s `:`''
No. of Air Cond. Total
tons
Initialing Devices
(Vo of bldobitiis.
. No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
LocalMunicipal ❑ Other
❑ Connection
No of bishwashita
Space/Area Heating KW
N0. of Drra
Heating Devices KW
N8 of witeY Hsaterb ' KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
Nb Hydf6 Manage 1t/bs
No. of Motors Total HP
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I hdvo At dutrent Liability insurance Policy Including Completed Operations Coverage or Its substantial equivalent. YES C NO G I
have submitted valid proof of same' to the, Office. YES = NO : If you have checked YES, please indicate the type of coverage by
Checking the appro-PrIfie box. /
INSURANCE I BOND C OTH aft, C (Please Specify)
F-stt tlinad Vilus of 0ift,trigal Work S (Expiration Date)
Work. to Start - Inspection Date Requested: Rough Final
nd* the en Ribs of perjury: .
r ;Fli M NAME LIC. NO.
fucinaae Sinnature ? LIC. NO.
Addreee.` ZL;5 OF, :.'J :G� /_ y r in Of Z-/' Alt. Alt. Tel. No.
{ OWNEPI`S INIWRANCE WAIVER: 1 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 S
(Signature of Owner or Agent)
.. x.r3585
8� Date. 4P �...
i4- 10 .8
,� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING'
:�-
�SSACNUS� '
This certifies that ........................................................... ..... ....:
.
has permission to perf rm ..........U()
....'+. .......
wiring in the building of ..........{"—�'�' ...... .. .....
at .........1..Er ............/........ /""'" ' , North Andover;. Mass..
Fee .... Lic. No ..............
........................................ ........................
. .
ELECTRICAL INSPECTOR
06/24/97 08:40 25.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
M': 409?
�'•F r10RTq - -
Ott...w
TOWN OF NORTH
oANDOVER
PERMIT FOR PLUMBING
SSACH
This certifies that j r':. ................
has permission to perform.
plumbing in -the buildings of
�f
at. -................. r :, ...... North.Andover, Mass:
Fee%?...... Lic.
'---.P-LUMBING INSPgCT R
08/04/99 11:35 15,00 PAID
WHITE: Applicant, CANARY: Building Dept. PINK Treasurer
MAP
PARCEL-kIASSACHU ETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type
NORTH ANDOVER, MASSACHUSETTS
j Date
Building Location�/,,L b44 Owners Name��_ I /�Ip[�r'1 %���� Permit # iia 97 40
��-^^
Amount
Type of Occupancy cl!n e- qnq/�/
New ❑ Renovation IT Replacement ® Plans Submitted Yes ❑ No (l
FIXTURES
(Print or type) f ( j Check one: Certificate
Installing Company Name Kc 1� b� 1 �,tlilt�✓.e «.1 ® Corp.
Address 2L &f Ssj ® Partner.
�L�Atnti fl�L9 11�A L
Business Telephone I :;Z x ( Q") q Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the a 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 ❑ 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 Massachusetts State P urrbin Code and Chapter 142 of the General Laws.
By: Signature of Licensea riumoer
Type of Plumbing License
Title <16lb
City/Town =se Numoer Master �//r Journeyman
APPROVED (OFFICE USE ONLY u
J
OWN
mom=
Now
ON
mom,moommoommo
MONO
Now
• s • ����������===mom
wommommo■
ON
loom
mo�m
wommo
(Print or type) f ( j Check one: Certificate
Installing Company Name Kc 1� b� 1 �,tlilt�✓.e «.1 ® Corp.
Address 2L &f Ssj ® Partner.
�L�Atnti fl�L9 11�A L
Business Telephone I :;Z x ( Q") q Finn/Co.
Name of Licensed Plumber:
Insurance Coverage: Indicate the a 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 ❑ 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 Massachusetts State P urrbin Code and Chapter 142 of the General Laws.
By: Signature of Licensea riumoer
Type of Plumbing License
Title <16lb
City/Town =se Numoer Master �//r Journeyman
APPROVED (OFFICE USE ONLY u
TVyNO.FNORTHANDOVER--
11,S.YSTEM PUMPING RECORD
t) AT V: >^ � o I' ` 3 2003
-o'sTEM OWNER & ADDRESS „ `SYSTEM LO_CAT-fO-N
(example: left front of houNt)
UATC OF PUMPING; � QUANTITY PUMPED
NO YES SEPTIC TANK: NO YES
NATURE OFSERVICE; ROUTINE__Z ZEMERCENCY
uIisrRVAT IONS:
GOOD CONDITION. NULL TO COVER
HEAYY CREASE BAFFLES IN PIACI:
ROOTS LEACHFICLD RUNBACK...
EXCESSIVE SOLIDS FLOODED
SOLIDS CARRYOVER�p�HRR (EX!'LAaN)
>>'a't't=M >'UMPCO 0Y:�t'r`l�c�'1''�-
c'U.N;I kl rNTS:
U N, I , FNT5 I'ltANSrCIZRLD T0: