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Miscellaneous - 188 HAY MEADOW ROAD 4/30/2018 (2)
N m X7.62 Date// TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ./eo!�,l-.G-('... !?? l ...... r. . has permission to perform . .>? .0!?^oc:. plumbing in the buildings of.. .................... at .....l0. � .... � a. ....�U:. , N rth Andove Mass. Fee . + 5. ?Re. C/..: .. . �... Lic. No.�. PLUMBING INSPECTOR../ Check 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK POWNER TYPE OR PRINT CLEARLY CITY o _�1 — _ MA DATE /_ I PERMIT # !/ JOBSITE ADDRESS -- OWNER'S NAME ADDRESS _ i TEL _ r FAX OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL NEW: Q RENOVATION:, REPLACEMENT: Q PLANS SUBMITTED: YES 0 NO FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BATHTUB E _ �. f .-_._-. _._ [ _._ _ I _ _ i ...-__-._( f e __._._# _-__.__J = = I CROSS CONNECTION DEVICE E .._ f f i _ � i .... _E _. ! . - __.i ._.: .._! ; 177 ! = = 1 DEDICATED SPECIAL WASTE SYSTEM I _.. .__, I I J ..___. I l -__.- _J .-. _f .! ------ DEDICATED GASl01L/SAND SYSTEM I I ... ... .._,I DEDICATED GREASE SYSTEM -- I I __....__. .._._-__..I .-._...._c (.---_.._.! _.-----f .__.._..._._! i DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ ..__I .. ! _. . -.` _._.I DRINKING FOUNTAIN I. --._..._I ---.,_. ' ' I FOOD DISPOSER FLOOR/AREA DRAIN i .-. ._-._F k -_._--_' ._.__._I INTERCEPTOR INTERIOR C �! __-..._(.-_.._..._f KITCHEN SINK LAVATORY �. (_._ __.� -__ ._I __.._._.fi ._ .__s _.._._._.I ! _. (..._ ...J .-._._ ' I _( I ROOF DRAIN SHOWER STALL ( ..._._._l _-_.- i ._---..._( ..._...___i . I ..._..._.-..-; _J1 __i -___71== .__-..J SERVICE lMOP SINK _ __..J i _......._-!( f i f .__. _P _..___1 _.. -_.; -._.-- -! _.,.._' . _J TOILET URINAL i _._ I _ _._._.I I I J._._.....J ___..__..E WASHING MACHINE CONNECTION ; f s ! E IL WATER HEATER ALL TYPES _..._ -_ ___.. ..._.. -- _----._.._. _.__.._l !._.. WATER PIPING --=-- OTHER INSURANCE COVERAGE: B�ha'v.'ti a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES XL NO .. i IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 4_ OTHER TYPE OF INDEMNITY Ej BOND Q 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 E] AGENT JL-`�-`1 SIGNATURE OF OWNER OR 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 c mpliancewith II Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME�7f�!/Z_,T .._. LICENSE # SIGNATOR CORPORATION[# ;PARTNERSHIP]# LLC COMPANY NAME �S —� f� _; ADDRESS CITY �� 1� "` � 1 STATE � 1 ZIP ,01, _+ TEL FAX yl CELL �3 EMAIL 0-j �3 — 0-jILwA ce. jv- -,4 ' Ie- w . C v IzV7-o Ira tin The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip:-4n"� y phone #64 1/L/d��� Are you an employer? Check the appropriate box: L ❑ 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. 1 am a sole proprietor or partner- listed on the attached sheet. t 'p 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 all work officers have exercised their 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 El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. F Homeowners who submit this affidavit indicating they are doing all work and then hireoutside contractors must submit a new affidavit indicating such. 1Contractors 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 my employees. Below is the policy and job site information. Insurance Company Name: ?olicy # or Self -ins. Lic. #: Expiration Date: ob Site Address: City/State/Zip: kttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 -f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certif under the pis and penalties of perjury that the information provided above is true and correct. 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): L Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: 4. Electrical Inspector 5. Plumbing Inspector Phone w' 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;.'oi the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ainjuOiS I uj LU 0 U) 75 Lu Cl)(j) in ELI w z 0 LL ow L-L:jj Z: 0 M > 0 Co. - zo, < LU cn Mcn m ,O 5 Q) L aim Lu 'L z C.J C) 7'. Ln. This certifies that . , . (.+�-?.1-�c�-r2 e._, has permission to perform . � , �C.:hs?. 3 . P Nr• c,c �'l. , . , , , .. . wiring in the building of ., l �P/PP. 'j ......................... at .. '! %"'56.-A.1 q\A-p p,(A ... , . , , , , .. , No Andover, Mass. ` Fee .. Lic.NoU\7).(,a.HK H.6 ....RICAL INSPECTOR Check #14 1�9 ELECT 11363 = t; Commonwealth of Massachusetts Official Use Only � � Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 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 her intention to perform the electrical work described below. Location (Street & Number) 1 f{ 4 - MPK W 90 k)001 AA (— M Owner or Tenant(-,I'Pt1 TelephoneNo. Owner's Address C me— Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 1-5� kt en 12e- — M 0A e- Utility Authorization No. - Existing Service d Amps )cam / oZC(OVolts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires 16 No. of Cell: Susp. (Paddle) Fans s Total of Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires LI/ Swimming Pool Above El 1:1o. rnd. rnd. o Emergency Lighting B atter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number Tons KW ..................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal E] Other Connection No. of Dryers Heating Appliances KW Security Devime : or E uivalent 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 No. of Devices or Ea u valent OTHER: Ki' t 1, e- p c'a ee 77 � C Ft+ uo 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 NEC 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, tinder thepains and penalties ofperjury, that the information on his application is true and complete. FIRM NAME:2M& CI eft LIC. NO.: 1036" Licensee: %wrigs m j� ,G, Signature LIC. NO.: (If applicable ente "exem t" in t li nse number line.) Bus. Tel. No.: !�O?v'36S' 99,Z% Address: 50 Ll 16/2 XY► .t) 4 0-,:�C7 % Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed ' 1 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 G electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass [N Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 7c9 (OLA --n, Inspectors Signature: Date: RO H SPECTION: Pas Failed Re- Inspection Required ($.) ❑ Inspectors omments: Inspectors Signature: VDate: FINAL INSPE TIO Pass F?1 V Failed M Re- Inspection Required ($.) ❑ Inspectors Com ents: Inspectors Sig ature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com n CIX The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �%if%j ��o�`�j,�C , �p(Z Address: I/C) 2 o(,()<�`/ I� City/State/Zip: CIC, I -P, /t)/-/ �3�i� Phone #: Are you an employer? Check the appropriate box: 1. [ h 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. 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.] 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.] 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 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 isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. , a Insurance Company Name: Policy # or Self -ins. Lic. #: 7 YAS,i rot n C 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 of this statement may be forwarded to the Office of Investigations of the DIA fV''nsurance coverage verification. I do hereby certify ung a pains and pe Ities of perjury that the information provided above is true and correct. 5i nature: i Date. Phone #:®3 j(p a °] 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): I. 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 of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and 'including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. " City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www,mass.gov/dia Date. /.........G.. ` ° ehppL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ...........................G � r haspermission to perform ..........................J........................................... wiring in the building of ............................................................................... r ....... orth Andov s. Fee ... Lic. No. S r LECTRICAL INSPECTOR Check # �� i 67, .C-\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 3_ BOARD OF FIRE PREVENTION REGULATIONS 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) Date: � —17 — 91 City or Town of: V,, /,) l(/ j V C1 C_ P 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) /)ff; Owner or Tenant � k/l�'�� WTelephone 12 4Ic e//,47 Owner's Address 514V z2 J C' is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpg of Buildin P g ) Utiliut ty orization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps ! Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: Completion of the lollnwino tnhly nine hn wnivnir h., tho 1--t— rtd/:..,,.. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- E] rnd. grnd. No. of Emergency ig mg Units No. of Receptacle Outlets No. of Oil Burners -Battery FIRE ALARMS �oofZones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons Alerting No. of Devices g No. of Waste Disposers Heat Pump Totals: I Number ... Tons KW ......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers No. o Water Heaters Kit Heating Appliances KW No. o No. o Signs Ballasts SecuritySystems: No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail 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 peril issuing office. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (When required by municipal policy.) (Expiration Date) Work to Start: ol ^ — * Inspections to be requested in accordance with MEC Rule 10, and upon completion. certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Express Electric Unlimited LIC. NO.: A 12757 Licensee: Yan Kener Signature Wn LIC. NO.: (If applicable, enter "exempt " in the license number line.) Bus. TO. No.: 877-263-2500 Address: PO Box 1169 Everett MA 02149-1169 Alt. TO. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 5-p , ocation Flo. Date IORT#q TOWN OF NORTH ANDOVER p Certificate of Occupancy $ '54'0 U Building/Frame Permit Fee $ / 9S U c� Foundation Permit Fee $ .00 6609 Other Permit Fee $ -- Sewer Connection Fee Water Connection Fee $ TOTALocT $ 2 V�y iV vV Building Inspector Div. 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FORK U - LOT RELEASE FOm[ r 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: \ /. n AM Phone �� 4-' LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) 0 Street c !,nkf A&Uj� St. Number _ �L Use only************************ REC014H=DATIONS OF TOWN AGENTS: L'��[ ` • `��c<'Q�4/ Date Approved Conservation Administrator Date Rejected Comments l/ Date Approved Town Planner Y Date Rejected Comments Date Approved Health Aaent Date Rejected Comments ZRN/C o,C Public Worcs - sewer; water connections - driveway pe=it Fire Department ' Received by Building Inspector Date MORTGAGE INSPECTION BAY STATE SURVEYING ASSOCIATES 234 CABOT ST., BEVERLY MA LOCATION NORTH ANDOVER. MASS. SCALE : 1 = 80 FT. DATE : APR. 26-.--1993 - - REFERENCE t DEED BK. + 2155 PG. 6 296 RECORDED IN THE ESSEX NORTH DIST. REGISTRY OF DEEDS To SALEM FIVE MORTGAGE CORP. _ The location of the building(s) as shown, either complied with the local zoning set backs at the time of construction or is exempt from violation enforcement action under Mass. G.L. Title VII Chapter 40A Section 7. Lo -c- ZZ NOTES: • This is a Mortgage Inspection survey and not an instrument survey, therefore this plot plan is for mortgage inspection purposes only. • This survey is based on survey marks of others. • Bushes, shrubs, fences and tree lines do not necessarily indicate property lines. • In my professional opinion the building(s) are not located in the special flood hazard zone, as defined by H.U.D. • Whenever an offset is 1'± or less, an instrument survey is recommended to determine prop. lines. • Offsets shown are approximate by tape survey. f; '&� t -A O W � c ct o ,sy�K OF 4f; xI GVW U 1 T I P- 9 No. 26094 S w, V ARTICLE 1 THE WORK OF THIS CONTRACT 1.1 The Contractor shall execute the entire Work described in the Contract Documents, except to the extent specifically indicated in the Contract Documents to be the responsibility of others, or as follows: 1. Removal of existing screened in porch from house into durmpster. 2. Excavation and installation of foundation and basement by others - coordinated by Mike Rodden, G.C. (fileted after Septic system relocation by others) 3. Building New Sunroom, New Screened in Porch , and New Deck - Removal cf bow window in kitchen, installation of 'ndw sliding door, removal of window over sink - installation of new window, removal of window in half bath - installation of new wall, removal and then relocation of bedroom upstairs window, removal of wall section in existing family room and installation of new door - all work in this section - labor only. ARTICLE 2 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 2.1 The date of commencement is the date from which the Contract Time of Paragraph 2.2 is measured, and shall be the date of this Agreement, as first written above, unless a different date is stated below or provision is made for the date to be fixed in a notice to pro- ceed issued by the Owner. (Insert the date of commencement, if it differs from the date of this Agreement or, if applicable, state that the date will be fixed in a notice to proceed.) The project shall commence after approval of septic systen relocation plans._ - The local building inspector shall review the plans enumerated in this agreement and shall issue a building permit. 2.2 The Contractor shall achieve Substantial Completion of the entire Work not later than Seven (7) weeks after start. (insert the calendar date or number of calendar days after the date of commencement. Also insert any requirements for earlier Substantial Completion of certain por- tions of the Work, if not stated elsewbere in the Contract Documents.) , subject to adjustments of this Contract Time as provided in the Contract Documents. (insert provisions, if any, for liquidated damages relating to failure to complete on time.) N.A. ARTICLE 3 CONTRACT SUM 3.1 The Owner shall pay the Contractor in current funds for the Contractor'serformance of the Contract the Contract Sum of Twenty -Four Thousand and n6 00 Dollars (3 24,000.00* ), subject to additions and deductions as provided in the Contract Documents. (* as defined in section 3.3) AIA DOCUMENT Al 07 -ABBREVIATED OWNER -CONTRACTOR AGREEMENT • NINTH EDITION - AIA � - ccs 1987 THE AMERICAN INSTITUTE OF ARCHITECTS, 1737 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 A107-1987 2 +i s"�.' '.. N r 3.2 The Contract Sum is based upon the following alternates, if any, which are described in the Contract Documents and are hereby accepted by the Owner: (State the numbers or other identification of accepted alternates. If decisions on other alternates are to be made by the Owner subsequent to the execution of this Agreement, attach a schedule of such other alternates showing the amount for each and the date until which that amount is valid.) Additional work proposed costs for work by General Contractor above base contract: 1. Removal of existing kitchen floor and foyer tops and underlayment. Installation of new plywood underlayment - $ 2,000.00 2. Front entry carpenty work, labor and material - $ 2,000.00 3. Additional Carpentry work as requested quoted based upon the following hourly rates: Carpenter Supervisor (M. Rodden) - $ 29.00 an hour Carpenter - $ 25.00 an hour s 3.3 Unit prices, if any, are as follows: Base Contract Enumeration: Excavation for foundation and basement: by others/coordination by G.C. Foundation, basement and concrete floors: by others/coordination by G.C. Cutting concrete wall from garage into new basement;. by others/coordination Material as shown on plans:- supplied by house owner including blueboard & plaster- Labor laster Labor for plans: by Mike.Rodden, General Contractor Electrical, Plumbing/Heating, Painting/Finishing, Carnet/Tile: by others/ coordination by G.C. ARTICLE 4 PROGRESS PAYMENTS 4.1 Based upon Applications for Payment submitted to the Architect by the Contractor and Certificates for Payment issued by the Architect, the Owner shall make progress payments on account of the Contract Sum to the Contractor as provided below and else- where in the Contract Documents. The period covered by each Application for Payment shall be one calendar month ending on the last day of the month, or as follows: Material purchased by General Contractor: within 10.days upon receipt of billing Payment for labor: within 10 days upon receipt of billing less 10% holdback Final Payment for labor: within 30 days upon receipt of billing 4.2 Payments due and unpaid under the Contract shall bear interest from the date payment is due at the rate stated below, or in the absence thereof, at the legal rate prevailing from time to time at the place where the Project is located. (Insert rate of interest agreed upon, if any.) N.A. (Usury laws and requirements under the Federal Truth in Lending Act. similar state and local consumer credit laws and other regulations at the Owner's and Contractor's principal places of business. the location of the Project and elsewhere may affect the validity of this provision. Legal advice should be obtained with respect to deletions or modifications. and also regarding requirements such as written disclosures or watvers.) AIA DOCUMENT A107 -ABBREVIATED OWNER -CONTRACTOR AGREEMENT • NINTH EDITION • AlA " • 9)1987 THE AMERICAN INSTITUTE OF ARCHITECTS, 17_5 NEW YORK AVENUE. N.W., WASHINGTON. D.C. 20006 A107-1987 3 4 z � w a G w° O V) O z z 7 w° C U G w 4 z 7 iu w GG z ~i W ADO � a>> V) m w w w w cn cn F 0 C/) W • CD E c c coc CD c CD Q c v N 0 CD C R o co LU CA CD _a oCcc a 2 3 aR = o w :>.CD ♦: �- -- p ClO N yd E a O i O L �Q acN ca C .O E � c sm C ~_-• J : J -p o p V c z c 1 N A d V y lL N R .� cm Oi N cc MR cr LU NA �=c CO.) Cc C G N E -0 O vy�W 0 = CU) V _ o � c vs c lei c IC, Q K N O. c = 5 m ID CD h o CN3 G ..: LM c o H m c c o N W ♦. N m co •Nc.= 4;:5 'C = .E c = :. •N Ci 'p C7m Z O LU 07 COO _ 06 ca .0 C) H �� O = ami F 0 C/) W J z CD E coc CD Q 0 co LU CA CD _a > a 2 0� .O m m Cw z w :>.CD O GD OU p O i O L �Q ca C .O O c J CJ J -p z c Z cj CD z V y lL R .� cc cr LU NA 6 F- G z z � cr: W J CU) Location %74kh No. 3 7 Date 9T 00 S TOWN OF NORTH ANDOXV*XR O: •• • OA „ Certificate of Occupancy $ r + • ; Building/Frame Permit Fee $ C% U SAC Eta Foundation Permit Fee $ s Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ 30• dV Building Inspector 40127 Div. 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WE CL C z o U CiaUr Q O= G C Q = LyC � O` o •� � O • U co O CO 0 Z O D y E L CD t� C O CD V CL CO) O O cv .51 Cl) C O V L 0 co CL CO) C i CD 0 Q L- CL QL O EL cmQ C 0-0 C O CD —j -a 0 CO Z co CL Cl) C o[=FtGES OF: _ . _. "'' _ TOWIl Of _ _ j - ':_izo Main's'aeet APPE'�LS _ _ _ -North Andover• # .y. NORTH ANDOVER massachusetts 01845 BUILDING CONSERVATION - DMISIOv OF HEALTH nr PLANNIN 8r COMMUNITY DEVELOPMENT � G C UNITY DE EL . IENT .� G 4 t J TURF—` I -LP_ NELSON, DIRECTOR - - In aczzralance with the orc-isic _s Ci S a condition of Building ?e-n:it Numbers "ZI dc' -'s resulting free: this work shall be disposed eC in a �rcpe:i� 'i. .-s: -,Clid W:IS._i':�,osa. `a .ii: s ::..ec: by tGi. c ill. S .L -C. �- V i ne debris will be disposed cf in: 1//7- stc:'at::re of Pc, -mit Aoolicnt - Date NOT=To- --a Demolition permit from the Ton of North Andover must be obtained for this project through the Office of the Building Inspector. Growth Management Bylaw Exemption Statement Town of North Andover Building Department This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. Name of Applicant on Building Permit (below) Address of Property for Permit (below) Map and Parcel : Purpose of Application (check below) Phone Number of Applicant: Single Family _ Two Family - &'71-/— !? 9 - I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a properly executed and recorded deed restriction running with the land. For purposes of this Section "senior" shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate information, or the checking off of an above item which does not comply, whether done to my knowledge or �A is grounds for refusal bype Building Department to issue a Building Permit. itu a of Owner or Authorized Agent who signed the Attached Building Permit Date form must be attached to the Building Permit upon application for such permit. --2x ����:4..r ... �1 :_`�. as+.'ch �..�.��".� ��.wst`y .gr�:.;;::f��`-,�y$�'.i �'y'C. �.//(../- _ .' Mw4'•', Q Date....... �!...`�.....�...... / V T1 4 NORTFI O�t.�•o .. 1tiO �: ; •__,, o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING At �,SSACMUS� This certifies that .......... . .... �...... .... C...... ..............:..` has permission to perform ...... ItLa.,�.....•, t.,,,,��f,,�u�j wiring in the building o ... .......... ........ at .......IS. S.......... orth Andover, ass. Fee.... .. — . Lic. o. �.a..Yrl/ LECTRICAL INSPECTOR %142/ WHITE: Applicant CANARY: BuAiriy%t. PMjCarea I�r Office Use Only G `C uhe �amrnart�u2i Qf�ruE Pe,�t,it Na. it S� �. 'Erpa tmrITt Lf �Iuffflz f *1fztt1 Occupant(lB Fee Checked yr 3!190 (leave blank) FIRE PREVENTION REGULATIONS c,27 VMR 12:fl0 BOARD OF f APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to to performed in accordance with the Massachusetts Elec.rical Code, 527 C.MR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date & QM or Town of ,-ry .,r,rA NDOV'FR To the Inspector of Wires: The udersigned applies for a permit t erform the electrical work described below. Location (Street &Number) G A-�f ffif Dw r -\vI--- Owner or Tenant �,\ Owner's Address t �8 Y:y 'r�l `eyk 0tj'-r �r1�f Is this permit in conjunction with a building permit: Yes No (Check Apprcoriate 8cx) 0 2 �J c Purccse of 9uiidiric ►\e �w 1 E>" Utility Authorization No. Existing Service 700 Amos �yy�lc•ts Overread Uncgrnd No. of Meters New SerJice Amos _J Vcits Overhead Uncgrnc r— No. of Meters Numoer of Feeders aria Amcacity Location anc Nature of Prccosec E!eCricai ':lcrx �iJ1� �1ODY No. at Lign:Ing Outlets No. of Llghung F= xtures No. of Recectacte Outlets No. of Switch Outlets No. at :Ranges No. of Discosais No. of Disnwasners No. of Driers No. of .Vater Heaters � No. 'Hycro Massage Tubs OTHER: Nc. C t Tres Abcver•— In - Swimming ?aoc grno. — Erna. _' i No. of Oil Eumers I No. or Gas=urners Total No. at Air C` nc. ;Ons t Heat Tocai Tocai No.er 1 Purr.as Tans K�'J i ScaceiArea Heating K%V Heaanc Devices KW iNO. of No. OT Sicns Sailasts No. of Molars -,aiai LP Totai i No. of ransformers K`Ja IGaneratars KVA No. of Emergency Lighting Saaery Units =IRE ALARMS No. of Zones No. at ^election aria initiating Devices No. at Sourcing Oev ces No. of Seit Containea Detect:oroSounoing Oevices — Municioat ^ Other Lccai Connec:ton _ Low `lcitage Wir:nc INSURANCE CCVERAGE: Pursuant ;o the reeuirements at '.tassacnusetts general Laws YES NO I have a current Liaciiity Insurance Policy inctuccngcC r et�eOOcera ta�cuv^averis achecxec 'ESge or ;is s aeasle,ncicatenehe Vice of coverage Cy nave suamittea valid proof of same to the Office. S X — checxing the aciprOcriate Cox. INSURANCE SO.ND = OTHER = (Pease Scec:'y) (Exotration Oaiei EValue�-1 siimateo Value of Electric ark _ Roti n renal C. Werx :a Start Insoec:con Oa;e �acues;ec: S• *^� ^� Signea unoer the cities of per LIC NO of `� =iRM NAME i G �?O� r1L vLy L(C. NO. It% L Signac re �pb Licenses �1 c� �0 C) i V (9 �,T,Tm SAlt. `el. No. 2iTIJJ Alt. Tel. ..^!O. ACCfe55 OWNER'S INSURANCE WAIVER: I arrWaAC2^nat tr.P a •sea o es not rave trig insurance w coverage or its suost. ow eauroaleet as aUireO Ov Massacnusetts General Laws. aria :rat my signature an ^.:5 7errnit aepiiaaflOn waives this reawrement. Owner 9 (P!ease cnecx ones Telecnone No. _.----- PEntvtlT rc. 5 (Signature at Owner ar Agentt