HomeMy WebLinkAboutMiscellaneous - 180 HIGH STREET 4/30/2018N
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the j
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such e4ty shall be responsible for the
notification of completion of the work as required -in M.G.L. c. 143, § 3L. . 4 '
Permits shall -be limited as to the time of.ongoing construction activity, and may be.deemed-by the Jaspector_ofWires abandoned.and.invalidsfhe—__ .. _
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
puipose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending"through August 15, 2012.
8 — Permit/Date Closed: ! ***Note: Reapply for new
0 Permit Extension Act — Permit/Date Closed:
Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING -
This certifies that ............4x. �..y ...
has permission to perform ......... 5 .. -7 .............................
wiring in the building of .......... Kk�q C-.-
. t ...........................................
......................... .
air.......... 5 ........... ...... . ................... . Nop ndover, Mass.
Fee ... Lic.No
No:....... ..........
...... ..
-iLi4i LINSPECTOR
Check #
10500
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. t tp, —6I)
Occupancy and Fee Checked
(Rev. 11/991 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) Datel 1/22/11
City or Town of North Andover To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)180 High Street
Owner or Tenant Chris Kearney Telephone No. 978.258.9632
Owner's Address same
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building existing dwelling Utility Authorization No
Existing Service 100 Amps 120/240 Volts Overhead ❑ Undgrd ❑ No. of Meters _
New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters 1
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (basement)wire replacement gas steam boiler
Completion o theJollowing table may be waived by the Inspector o Wires.
No. of Recessed Fixtures-
No. of Ceil: Susp. (Paddle) Fans
o. of Tota
Transformers KVA
No. of Lighting Outlets-
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures-
Swimming Pool Above ❑ In- 1:1o.
rnd. rnd.
o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches-
No. of Gas Burners -(1)
o. o Detection and
Initiating Devices
No. of Ranges-
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
eat Pump
Totals:
I Number
Tons
o. o Self -Contained
Detection/Alerting Devices
No. of Dishwashers-
Space/Area Heating KW
Local ❑ unec pa ❑ Other
Connection
No. of Dryers-
Heating Appliances KW
SecurityNo fystemss or Equivalent
No. of Water KW
o. of No. of
Data Wiring:
Heaters
signs Ballasts
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications o. of es WirinE uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) 3/12
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 11/2 1 /11 Inspections to be requested in accordance with. ,and upon completion.
I certify, under the pains and penabies of perjury, Heat the inform ' n on t s p cation true and complete.
FIRM NAME: Andrew F. Sheehan Electrical Service LIC O.: A11498
Licensee: Andrew F. Sheehan Signatur IC. NO.: Al 1498
(Ifapplicable, enter "exempt" in the license number line) Bus. Tel. No.: 978.375.4016
Address: 249 Pine Hill Road*Chelmsford Ma.01824-1965 Alt. Tel. No.: 978.622.5852
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 ent.
Signaturegeut Telephone No. PERMIT FEE: '
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9205 Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
SACHUS
This certifies that Xljf�-.
... ..... ......
has permission to perform.. .......
e4
plumbing in the buildings of . . NI -11, . f.......... ...........
at . Ig -0 I ....... e ........................... North Andover, Mass.
Fee. Lic. No.. 1�r 4 ......
PLUMBING INSPECTOR
Check # 4917-51
MASSACHUSETTS UNIFOR
M APPLICATION FOR PERMIT TO DO PLUMBING
s iLy/ Town:J Wusjh 0
MA. Date.1 permit#
FIL
SUB BSMr.
BASEMENT
5sT FLOOR
2NDFLOOR
3RD
FLOOR
R
4T" FL o0 R
5T" FLOOR
6T"
FLOOR
R
7TH F oL OR
eF OOL R
Building Location:_ r P S
Owners Name:{
V
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential &**'
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: r -,�
I� Plans Submitted: Yes ❑ No
FIXTURES
instaliirjJEOornp�.ny i"arn_ Ci;cc:Ono G h'
ti „
Address: 1�</ (�l pW► rr1� �� [Corporation 31
City/Town: �� State: •
Business Tel: 7 ❑ Partnership
�S�' � Fax:
Name of Licensed Plumber:
INSURANCE C(wFRnr_r.
❑ Firm/Company
1 have a current nsuranCe 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 checkingtheappropriate box below.El
A liability insurance policy. Er� Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b
Massachusetts General Laws, and that mysignature on this permit application waives this requirement.
q y Chapter 142 of the
Check One Only
�'ignature of Owner or Owner's A ent Owner E] Agent ❑
Hereby certify that all or tfie detads and information I have submitted (or entered) re
Knowledge and that all p!umbing Work k and installations performed under the permit
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of tl
r_
ile
`y/Town
1 b ori •.-
Type of License:
(]Plumber
Gaster
❑Journeyman
atur$ of
Number:
o ..... .Nt„ucauon are true and accurate to the best of my
for this application will be in compliance with all
gyral Laws.
Plumber
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Address: 1�</ (�l pW► rr1� �� [Corporation 31
City/Town: �� State: •
Business Tel: 7 ❑ Partnership
�S�' � Fax:
Name of Licensed Plumber:
INSURANCE C(wFRnr_r.
❑ Firm/Company
1 have a current nsuranCe 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 checkingtheappropriate box below.El
A liability insurance policy. Er� Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required b
Massachusetts General Laws, and that mysignature on this permit application waives this requirement.
q y Chapter 142 of the
Check One Only
�'ignature of Owner or Owner's A ent Owner E] Agent ❑
Hereby certify that all or tfie detads and information I have submitted (or entered) re
Knowledge and that all p!umbing Work k and installations performed under the permit
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of tl
r_
ile
`y/Town
1 b ori •.-
Type of License:
(]Plumber
Gaster
❑Journeyman
atur$ of
Number:
o ..... .Nt„ucauon are true and accurate to the best of my
for this application will be in compliance with all
gyral Laws.
Plumber
The Commonwealth ofmassachusetts
Department oflnd'ustrid(Accidents
Office of Investigations'
600 Washington Street
z�
Boston, MA 02111
www.massgovldia
Workers' Compensation Insurance Affidavit: Builders/Contractors)Electricians/Plumbers
IUliC8i f Tnfnrmai-in„
Name (Business/Organization/Individual): � 1 �y� Ito.—
Address:
.City/State/Zip: 'WNGA AAA- Qf
W b Phone #-k—
: a/
Are
—Are you an employer? Check the appropriate box:
I. QUI
am a employer with
4. ❑ 1 am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or
have hired the sub -contractors
listed
partner-
on the attached sheget. t
ship and have no employees
These sub-contractorshave
working forme in any capacity,
[No workers' comp. insurance
workers' comp, insurance.
5. ❑ We are a corporation and its
required•]officers
3. ❑ I am a homeowner doing
have exercised their
all work
right of exemption per 1VIGL
myself. [No workers' comp.
C. 152, §1(4), and we have no
insurance required.] t
employees. [No workers'
comp, insurance re uired j
Type of project (required):
6. ❑ New construction
7. [?fIemodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
1111 Plumbing repairs or additions
12.❑ Roofrepairs
q I3.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.tside contractors must submit a new affidavit indicating such.
I
i Homeowners who submitthis affidavit indicating they are doing all work and then hire ou
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
informatlon.
Insurance Company
T
Policy # or Self -ins. Lie. #: W Al 030 f 1
Expiration Date:
Job Site Address: ) M if �f 1
City/State/Zip: v
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 maybe forwarded to the Office of
Investigations of the DIA• for insurance coverage verification.
I do hereby
pains and penalties ofperjury that the information provided above is true and correct.
Offrcial 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):
I. Board of Health 2. Building Department 3. City/Town CIerk
6. Other 4. Electrical Inspector 5. PIumbing Inspector
NEW
Contact Person:
' Phone #:
Date .. . ��/?. t3 �//.......
j oto ,°.ryO
TOWN OF NORTH ANDOVER
Vow PERMIT FOR GAS INSTALLATION
This certifies that ..AX-.. Te!l� . ,/J,w,.n4v6 X. �,
has permission for gas inst llation /u't? /�?P?f ffP��� r .4m — r
in the buildings of . . .... / !S �j�e��'rlj ...............
at .. ....... ,p. , North ndoverr,,Mass.
Fee.4O''� �l
Lic. No,:4. A-..c��!��z.- ..
GAS INSPECTOR
Check # LJ %s�
7922
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
City/Town: GY�h d0 ? -r' MA. Date:_ Permit#
J Building Location: ��d 5 Owners Name:i
Vi"S Mirr`ey
Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential []�
New: ❑ Alteration: ❑ Renovation: ❑ Replacement: C9' Plans Submitted: Yes ❑ No ❑
FIXTURES
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Installing Company Name: 1 n ' ,
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Address: /41 0)CW1,16A City/Town:_ tR } State: ,�1 .
Business Tel:bA SJ l -Y6S7 Fax:
Name of Licensed Plumber/Gas Fitter: .(ney tG>.
Check One Only Certificate #
Q" Corporation
❑ Partnership
ElFirm/Company
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 ❑
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
.Signature of Owner or Owner's Agent Owner 1:1 Agent ❑
By checking this box ❑; 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.
By Q i�Z3�i Type of License:
['Plumber
Title ❑C,as Fitter
our oicensed Plumber/Gas Fitter
B'Master
City/Town ❑Journeyman e Number:1�
APPROVED (OFFICE USE ONLY) ❑ LP Installer
The Commonwealth ofMassachusetts
Department oflndustrialAccidents
Of oflnvestigations'
600 Washington ,Street
Boston, MA 02111
www>mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Vicant Information
_.. 01P51
Name (Business/Organization/Individual): \\�l'
Address:
City/State/Zip _��O�l� , ,/�,4 . j �� Phone #17 �� qn - (, .L 3
Are you an employer? Check the appropriate
box:
I. I am a employer with 3
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or
have hired the sub -contractors
listed
partner-
on the attached sheget. I
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.]
3. ❑ I am a homeowner doing
.officers have exercised their
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 re aired ]
Type of project (required):
6. ❑ New construction
7. ff Remodeling
8. 0 Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
q 13.❑ Other
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information.
I am an employer that is providing workers' compensation insurance for
information. my employees Below is tlae policy and job site
Insurance Company Name:
Policy # or Self -ins. Lie. #: VC �• 10� 6 Q �( .
�\ — Expiration Date:_
Job Site Address:_
City/State/Zip:_flJ _k �t
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required Wider Section 25A ofMGL 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido IZeYeby cerci n er the pains and penalties ofperjury that the information provided above is true and correct.
A/ 1
only. Do not write in this area, to be completed by city or town official.
City or Town:
_Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
4. Electrical Inspector 5. Plumbing Inspector
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 of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
Of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
PIease fill out the workers; compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,; please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which Will be used as a referenc6 number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
Policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town ,may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The 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, telephone and fax number:
The Oo .onw e-aU- oA Massacl� setcs
Depaftent of Zndustrlal Accidents
Office of Investigations
600 WasbiVon Street
Boston; M.A. 02111,
Tel. # 61.7.727-4900 ext 4406 or 1-877-MASSM13
Revised 5-26-'05 Fax # 617-727-7749
www.mass.,avfdia
Date.....................
TOWN OF NORTH ANDOVER
.o
PERMIT FOR GAS INSTALLATION
!--
This certifies that .. r . . J .... s .......:.::...................
has permission for gas installation ..................
in the buildings of ... ./? !'. ' .' ! ..............................
at . %! .. ! '. } f ........ , North Andover, Mass.
Fee..!' 4 .. Lic. No.. t.4 :. .. ....... ..: ... .
.1.
GASeJNSPECTOFi
Check #
4013
MASSACHUSETTS UNIMRM APPUCATON FOR PERMIT TO DO GAS Fr-rn TG
(Type or print) Date v�Z 'le) -y
NORTH ANDOVER, MASSACHUSETTS
Building Locations 4�a /—J, ( j
--' Permit #
Amount $ h L
Owner's Name
New ❑ Renovation ❑ Replacement Plans Submitted ❑
Name or type) V �-j J >�r�.2 �^�-" ,/'" � i� CJicgk one: Certificate Installing Company
Corp.
Name of Licensed Plumber or Gas Fitter tbhJ -5-1w
❑ Partner.
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes ❑' No ❑
Ifyou have checked yes_please indicate the type coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity ❑ Bond ❑
r:
Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner ❑ Agent ❑
iX�V,vy ..guJLY uVaL a„ v, um ueuius mw a
mxuranon m nave suomruea (or eaterm) m at)ove application are true and accurate to the
best of my knowledge and that all plumbing work and installations under Permit Issu for plication will be in
compliance with all pertinent provisions of the Massachusetts S e and Cypter l4 ofth eral La s.
Title
City/Town
APPROVED (OFFICE USE ONLY)
of Licensed'Plumber Or Gas Fitter
❑Plumber
❑ Gas Fitter
rMaster
❑ Journeyman
3�
Icense NumDer
i
Date.... —. r1l. .
0
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that .......
has permission for gas installation_,,�I - �- ..................
in the buildings of �." ........................
at . AP�q .... .......... North Andover, Mass.
Fee/aw
.... Lic. No.. 4 :2.-:... ... ...........
Check #- lejp(a GAS-INsPgbj6R
3745
MASSACHUS!ITYS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type
,4L Mass. I �%a0 / Permit*
Bulding Location
/JVIA , Owners 1 at' #dr,1574�
i V /�j 4Le,-z, I Type of Occupancy --R FSt -r,)N T j . r
G
New ❑ Renovation ❑ Repacement 2 Plans submltted:--Yes ❑ No ❑
lrftWling Company Name r',A e T i ,. �rlm MA T ir140 Check one: Certificate
Address hA rJ L KI p
Corporation
t 01 i" TN UE nS Al A U t ❑ Partnership
Business Telephone 1 Y2 - Q 9 -7r���.
Name of Ucensed Plumber or Gas Fitter A E je T
INSURANCE COVERAGE:
I have a current lability insurance pocky or Its substantial equivalent which meets the roqulrements of MGL Ch. 142.
Yes Er No ❑
If you have checked yes. please Indicate the type coverage by dW*Ing the appropriate box
A liability insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit appticatIon waives this requirement.
1 Check one:
Signature of Owner or Owner's Agent Owner❑ Agent [I
I hereby certify that an of the details and inbrmatim I have submitted for entered) in above application are true and accurate to the bast of my
knowledge and that all plumbing work and 11WARSUM perkrned under the for thb apZor
be in compliance with d
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of laws
BY T of license: A
Rumber dw
cm
lrftWling Company Name r',A e T i ,. �rlm MA T ir140 Check one: Certificate
Address hA rJ L KI p
Corporation
t 01 i" TN UE nS Al A U t ❑ Partnership
Business Telephone 1 Y2 - Q 9 -7r���.
Name of Ucensed Plumber or Gas Fitter A E je T
INSURANCE COVERAGE:
I have a current lability insurance pocky or Its substantial equivalent which meets the roqulrements of MGL Ch. 142.
Yes Er No ❑
If you have checked yes. please Indicate the type coverage by dW*Ing the appropriate box
A liability insurance policy Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit appticatIon waives this requirement.
1 Check one:
Signature of Owner or Owner's Agent Owner❑ Agent [I
I hereby certify that an of the details and inbrmatim I have submitted for entered) in above application are true and accurate to the bast of my
knowledge and that all plumbing work and 11WARSUM perkrned under the for thb apZor
be in compliance with d
Pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of laws
BY T of license: A
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Location
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TOWN
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jl/98 09:57 320,00 PAID
Building Inspector
Div. Public Works
TOWN OF NORTH ANDOVER
p
Certificate of Occupancy
$
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Building/Frame Permit Fee
$ -
��b"••e
SSACMUSE
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$ `
Water Connection Fee
$ -
TOTAL
$ `
jl/98 09:57 320,00 PAID
Building Inspector
Div. Public Works
Location Ie -0 /fir r- -Sy
No. Date
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12907
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ z>' r
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL
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Building Inspector
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Town ofNorth Andover, MORTN
OFFICE OF ? 0 •.� o
COMMUNITY DEVELOPMENT AND SERVICES
• 146 Main Street • i
North Andover, Massachusetts 01845 '•.:;;,.:•'s5
W1I.LIAM J. SCOTT 'Ss+CHus°t
Director
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 I 11, S 150A.
The debris will be disposed of in:
vI CY
(Location 41F 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.
J
BOARD OF APPEALS 688-9541 BUU.DING 688-9545 CONSERVATION 688.9530 HEALTH 688-9540 PLANNING 688-9535
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i `- 2810
"OQ'M TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACNUS�
This certifies that .. t�. «.,!�. j .................
has permission to perform .. pc.A-f-. o �-n a� t
..................
plumbing in the buildings of .. G,, .(- ................. .
at .1. ................ . North Andover, Mass.
Fee. ..... Lic. No.. . ............................. .
PLUMBING INSPECTOR
02/09/96 12:43 35.00 PAID
WHITE: Applicant CANARY:. Building Dept. PINK: Treasurer GOLD: File
! M`
MASSACHUSE—iiTS UNIFORM APPLSCXTICH FCR PERMIT TO DO PLUMBING
lPtint or type1
NORTH ANDOVER. Masa. Oat• _ ,10-
Buftding Ptumit
Location
jo U /.� Ci W7
Cwner 11
Name l i C r
New ❑ Renovation RepAaeamem p Pians Submitted: Yaa ❑ No ❑
FiXTUAE3
14
Installing Cern
Address (9C
Business Te!erhone��
Name d Licensed Plumb
Check arse:
❑ Carp.,
Partnership
INSURANCE COVERAGE: ".. ecx one
I have a current IlabIRy Insuranca polcy cr Rs- substantial equMalenL Yes ❑ No ❑
It you have checked ve3, please I)/dlcite the tyrz cc-ierage by c!:ackirlg the appropriate box.
A ItablRy insurance policy Cther 17y—, -a cd indemnity ❑ Bcnd ❑
Carti(1c4te
OWNER'S INSURANCE WAIVER: 1 am aware tt^.at the licensee does ncol hate the Insurance coverage required by
Chapter 142 & the Mass. general Laws, and that my stgrattxs on this permtt appilcatton waives this requirement.
Check one:
Cwner ❑ Agent ❑
S4nstuts of Owmet or Omer s ►pent
I heteby cxUfy that iA of the detach and 1nfotrna0on I hays tL-berAtsd be entst
knowledge and that to p♦utnbing work and hstadatlona ur,dw the p
PwOment provisions of the Massachusetts Slate P!umbv+q Code araC Chanter t
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Tina
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MT110�O (CfF)CE USE ONLn
aaot3cation are
lot Ws ap pAmt
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INSURANCE COVERAGE: ".. ecx one
I have a current IlabIRy Insuranca polcy cr Rs- substantial equMalenL Yes ❑ No ❑
It you have checked ve3, please I)/dlcite the tyrz cc-ierage by c!:ackirlg the appropriate box.
A ItablRy insurance policy Cther 17y—, -a cd indemnity ❑ Bcnd ❑
Carti(1c4te
OWNER'S INSURANCE WAIVER: 1 am aware tt^.at the licensee does ncol hate the Insurance coverage required by
Chapter 142 & the Mass. general Laws, and that my stgrattxs on this permtt appilcatton waives this requirement.
Check one:
Cwner ❑ Agent ❑
S4nstuts of Owmet or Omer s ►pent
I heteby cxUfy that iA of the detach and 1nfotrna0on I hays tL-berAtsd be entst
knowledge and that to p♦utnbing work and hstadatlona ur,dw the p
PwOment provisions of the Massachusetts Slate P!umbv+q Code araC Chanter t
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MT110�O (CfF)CE USE ONLn
aaot3cation are
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Date....
0 TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
,SSACMUSEt
This certifies that ........... �,-?. ....... ........................
has permission to perform ........ kAsl.t�. ....... ...............
wiring in the building of ......& u. �.k ................................................
at .... ....... ..... C?. r .................................. . North Andover, Mass.
Fee... 60.'.Of ... Lic. No. d ...........................................................
ELECTRICAL INSPECTOR
C Ci L '�Q/09/% 12:42 65.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
4,
ry
Ottice Use Ottty�y
�1IIiIIIIffiIIlIIEZ ± III arhu� Permit No. f1
of �uhac �'' Cclpancy eave & Fee Clecked
r + blank
BOAR0 OF RE PR'lcaliiCN GU REG � C:�R 12:00 "�0 n 1
APPLICAT ION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in ac--rdance with trte Massachusetts Eect: cai Ccde. 527 CZAR 12:C0
(PLEASE PRINT IN INK OR TYPS ALL INFCRIMAT"ICN) Date o`_ �_ �G
=Yj or Town of NORTH dN OVrI To the Inspector of wires:
The udersigned applies for a permit :0 ;:er`cr•n /tne eiec=cal wcm described Below.
Lccation (Street 3 Numcer)
Cwr.er or Tenant ire L
C•.vner's Ad=cess Triv4
nS
Is t~Is permit in ccniunctie�nl with a cuiic;ng-�r--r.: Yes No _ (C`eCc nC�rCpnate Box)
�ur-cse cf cluiicir.c �e�) h `1 u'G� Utility Autrcrizaticn No. 00 y9
=Sistinc -cerrica Am Cs Vice -s Cverreac , Uncg ^,d No. of Meters
Ne,.-., _er:ica ''T) Amps �' '1 �-' `iccts Cverne__ Un _ r No. of Meters _ �—
Numcsr ct=eecers arc Arncac::y
== arz Nat_re _. - ,.=cseC=.eC:.._c. ..Crx
L1
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NC. _. _ _ .:n^y ...:e:s .•••. _. -... .___ Nc. _. rans:ermers C:A .
No. _ e — I 3aneratcrs KV:
No. or=mergerCy : ynnny
�1A'\ Nc r ac• -urs s -r� `ic. :t = .-yrs Saner,., Units
Nc. _. 3wrtc- :u:!ets J No_ =r _as =_. _._ I F.=.c ALARMS No. of "_nes
h/ _ c >1C c =.a: I ue. et =e -c::cn ane 1
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14 c. ^ =anyes r A'r -5 ini :aung �aviczs
No. _isccsa:s Nc - No. o. Sourcing :ev:ces 1
No. or Sett Ccnta:nec
No. -'r Cisnwasners 1 ' Soace?Area-__..r- C:t
::e:ec::onrSounc:ny Cev:css
No. or Cr,ers eaC- _ . a s I—
Munic:eal •-- Ctnar
-- _
No. or` C. I
__w vcaage
No. ar .Vater mea:ers CN S:cns 9-..as:s
.Yr.ng
No. =vcro massace ucs No_ =. ..o.o _ -,:-a; -- I
i
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INS:;qANC� Pt.•rsuant :O :ne recusernents er mass a= i ne!al
Insurance P=::cl �nc:z:rg Cs- e;dc Ccer3=cns average or
::s sucstanual ecwva;ent. YE_ NO -
I nave a current t-iaeaity
Croat of same to Me C:aica. YES L/ tiC = t ,cu nave cnecxec
`!ES. ^.:ease me:cate :ne rype of :averags _v
nave su=m:rea vauC
--ec:ung :ne acrrate Cox.
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INSt.:PANCZ�3CN0 - OT !VG.t
(ExC:ratton Case:
`Nora
Es*mratea Value of Er cat S
:vcnc :a Stat- � C tnsae�on =a:a=rcczs:zc Rcugn
S:gnec sneer :ne Pera;wes of ;erturl
P!.t NAME
Ltenses
UC. No.
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NC
i JT. l-i.0W t%n L ' (, 1.1 / Y
Alt. :al. `to.
AGCfes3 J `r I t as
CWNEa'S INSUPANCc V1rAIVERm : 1 aaware 3 -.ax 7e _re-=-=a"cese emet Have Me insurance c- or its suost. naleatuvaleA9 ente-
cuirso oy Mazzacrrusetm General Laws. arla rZit •-Y s:gni:�re on ��S mer': •:t ac^. ucatrc
n waives :nes reawrementCwner
MIS
;Please cnecx onel
C �d
�eC•-.pre No.
,PES MIT FE. S V
isignatwe of Cwner Cr a,erw
ale,�
Location I ,8ojt46�A S�
No.Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ _ 4
Foundation Permit Fee . $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL $
�j Building Inspector
11/16195 15:46 45.00 PAID
13 64 Div. Public Works
<J
PEAIiiT NO. 5SE .
A,
a.
1✓
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP 4-40.
LOT NO. 92— -93
I
12 RECORD OF OWNERSHIP :DATE
BOOK :PAGE
ZONE R
SUB DIV. LOT NO.
'CbCATION i �� �h I
6
RPOSE OF BUILDING j pf`T�.j C Z P -z --N T-
A6WNER'S NAME '"� / �, +�%j �/ %
NO. OF STORIES SIZE
OWNER'S ADDRESS '� Q h �'I
BASEMENT OR SLAB
ARCHITECT'S NAME_� �fL.1 (^'`+�.(�
SIZE OF FLOOR TIMBERS IST 2ND 3RD
19"UILDER'S NAME Vv'( LV14 „/_� � � ���
SPAN --
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES – SIDES REAR
" GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY
j81BUILDING ALTERATION Y-'--
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
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 1"4(LSEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3 =Q,v� —• C�.�� ,�-W
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
Q tL ( 1
OF OWNER OR AUTHORIZED AGENT
F E E �T'.► ��
PERMIT GRANTED
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST O
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
NUILDING INSPUCTOIi
OWNER TEL. k �8� 4t).Z3
CONTR. TEL.
CONTR. LIC. #
I.C. # i
RSA-0161liz�
BUILDING RECORD
1 OCCUPANCY 12 v
SINGLE FAMILY
STORIES
MULTI, FAMILY
OFFICES
APARTMENTS
_
CONSTRUCTION
2 FOUNDATION
—I
8 INTERIOR FINISH
CONCRETE
PINE
HARDW D
d
1
2 I3
CONCRETE BL K.
BRICK OR STONE
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B'M'T' AREA
_
FIN. ATTIC AREA
NO B M
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
_
4 WALLS
I 9 FLOORS
CLAPBOARDS
B
_
1
2 3
�_
_
_
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
_
HARDW'D
COMRICN
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
_
ATTIC STIRS. & FLOOR I_
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE—
5 ROOF
10 PLUMBING
GABLE
I_J
HIP
MANSARD
BATH (3 FIX.)
TOILET RM. (2 FIX.)
—
GAMBRE�I
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
_
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR 8 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
11
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.
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PERMIT NO.
APPLICATION
FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
MAP 440*.
LOT NO.'7/
9
2 RECORD OF OWNERSHIP iDATE
ZONE
I SUB DIV. LOT NO.�
c
LOCATION
—�`--
0 A t^T`
Y
:AR
PURPOSE OF BUILDING c/L
NO. OF STORIE2 Tw 3 SIZE
v Valy`5
BASEMENT OR SLAB �C
SIZE OF FLOOR TIMBERS IST IND
SPAN
DIMENSIONS OF SILLS
POSTS
GIRDERS
` TAGE HEIGHT OF FOUNDATION THICKNESS
u SIZE OF FOOTING X
PAGE 1
BOOK 'PAGE
3RD
i
MATERIAL OF CHIMNEY L---3 iC
• �\� IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO TOWN WATER �
IS BUILDING CONNECTED TO TOWN SEWER LY`S
IS BUILDING CONNECTED TO NATURAL GAS LINE
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATF-JFILED n ..r7 1 95
RE OF OWNER OR AUTHORIZED AGENT
FEE
PERMIT GRANTED
a q
f �tll1E
19
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
NUILDING INiPBCTOR
OWNER TEL. #
6 fla
CONTR. TEL # �
CONTR. LIC. M o f 6 7-4—Z:5 3
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY �OFF
RIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY ICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA -
APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
d 1 2 13
PINE
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
P
—
PIERS
PLASTER
—
—
—
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AREA FULL
'/. 1/2 1/
FIN. B'M'TAREA
FIN. ATTIC AREA
_
_
N_O B NIT
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
4 WALLS (
9 FLOORS
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B
1
2 3
_
_
_
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
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ASBESTOS SIDING
VERT. SIDING
_
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STUCCO ON FRAME
BRICK ON MAS N Y
BRICK ON FRAME
CONC. OR CINDER BLK.
_
ATTIC STRS. 8 FLOOR _
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR _
ADEQUATE NONE
10 PLUMBING
5 ROOF
GABLE
GAMBREL
I
I HIP
MANSARD
BATH (3 FIX.)
_
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FLAT
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_
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LAVATORY
WOOD SHINGES
KITCHEN SINK
_
SLATE
NO PLUMBING
_
TAR 8 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. 8 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
OI l
B'M'T 1 -3rd
1st 3rd
ELECTRIC11
NO HEATING
PERMIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE 1
MAP h40.LOT
NO. 1 9- 9
2 RECORD OF OWNERSHIP DATE
BOOK 'PAGE
ZONE _
I SUB DIV. LOT NO.
LOCATION t L[ ^� l
V�Q�
PURPOSE OF BUILDING v-, r C
OWNER'S NAME Zl leers N� j'��� (
�j-y
NO. OF STORIE '2
( v SIZE
two SIZE
OWNER'S ADDRESS ` rry jl r
` r� l�
BASEMENT OR SLAB & -1
ARCHITECT'S NAME nUL 1 f��jC C'
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME l�.% l (
— `
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
"' "' POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW %.i�
SIZE OF FOOTING %
IS BUILDING ADDITION
MATERIAL OF CHIMNEY L-3 1�
IS BUILDING ALTERATION `/'.'}-'r�
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /fes
7 C�
IS BUILDING CONNECTED TO TOWN WATER �
LYL�
BOARD OF APPEALS ACTION. IF ANY Ato
VV
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE. FILED 11 / — IC7 A 95
OF OWNER OR AUTHORIZED AGENT
FEE
PERMIT GRANTED
19
7
I 1
7 fool.
1 �
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 INOPKCTOR
OWNER TEL. #
6.� `a
CONTR. TEL. A �
CONTR. LIC. I! o % 4- 3
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
_
CONSTRUCTION
2 FOUNDATION—I
8 INTERIOR FINISH
CONCRETE
PINE
3
l
2 13
CONCRETE BL'K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
'/, 1/1 %
FIN. B'M'T' AREA
FIN. ATTIC AREA
_
_
N_O B M -T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
_
4 WALLS I
9 FLOORS
CLAPBOARDS
B
_
1
2 3
_
_
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
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COMMON
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ASBESTOS SIDING
VERT. SIDING
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MAS N Y
_
ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I� POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I
I HIP
BATH 13 FIX.)
_
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
FLAT
SHED
WATER CLOSET
_
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LAVATORY
WOOD SHINGES
KITCHEN SINK
_
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
_
_
TILE FLOOR
TILE DADO
6 FRAMING
i l HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T 12nd I _
ELECTRIC
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 3rd
PERMIT NO.
I
/t
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE 1
MAP K40.
ZONE j% _
LOT NO. r/ -
I SUB DIV. LOT NO.
2 RECORD OF OWNERSHIP iDATE
- L4 U�TrC`Jt
(BOOK iPAGE
-f{
LOCATION ( �D
11(��(� (\i
PURPOSE OF BUILDING VAC (- ( ( A)l
//� I
OWNER'S NAME �I Gt �,(t, I,�} �I t r'I` `
NO. OF STORIES( / U SIZE
OWNER'S ADDRESS l �7 (� ft( �1 (l (
BASEMENT OR SLAB
ARCHITECT'S NAME kC) uv
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME V\,/ 1 L { (-i� L
1
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING X
IS BUILDING ADDITION
MATERIAL OF CHIMNEY I
IS BUILDING ALTERATION .,/ '
IS BUILDING ON SOLID OR FILLED LAND 1 t
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE \lr
IS BUILDING CONNECTED TO TOWN WATER
/
BOARD OF APPEALS ACTION. IF ANY A, U
IS BUILDING CONNECTED TO TOWN SEWER YL
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE 1 FILL OUT SECTIONS 1 - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE, FILED (' +n 1 /
o 1077/
SIGNATURE OF OWNER OR AUTHORIZED AGENT
FEE
PERMIT GRANTED
19
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. #
CONTR. TEL. '92)O
(f -6-e
i
CONTR. LIC. (/
H.I.C. #
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY
S OkIES
MULTI. FAMILY
OFFICES
APARTMENTS
_
_
CONSTRUCTION
2 FOUNDATION
—I
8 INTERIOR FINISH
CONCRETE
PINE
d
1
2 I3
CONCRETE BL'K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
_
UNFIN.
3 BASEMENT
AREA FULL
FIN. B'M'TAREA
_
1/1 '/r '/,
FIN. ATTIC AREA
_
N_O 8 M
FIRE PLACES
_
HEAD ROOM
MODERN KITCHEN
4 WALLS
I 9 FLOORS
CLAPBOARDS
B
_
1
2
�_
—{I_
3
_
DROP SIDING
WOOD SHINGLES
CONCRETE
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ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
_
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BRICK ON MASONRY
ATTIC STRS. & FLOOR _
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CONC. OR CINDER BLK.
_
WIRING
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STONE ON FRAME
SUPERIOR I� POOR
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10 PLUMBING
5 ROOF
GABLE
GAMBREL1_1
I
I HIP
BATH 13 FIX.)
MANSARD
TOILET RM. (2 FIX.)
FLAT
SHED
WATER CLOSET
_
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
_
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES_I_
TILE FLOOR
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
_
AIR CONDITIONING
_
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
GAS
OIL
B'M'T
ELECTRIC
12nd I
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.
lat 3rd NO HEATING
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