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HomeMy WebLinkAboutMiscellaneous - 19 OLYMPIC LANE 4/30/2018 (2) 01 r lL LA-je- FILE 1 I 1 `1� I I I I I I I Date. Y; 2 -c }.. . . .... . ,fOttTM OF 14, 6 O TOWN OF NORTH A OVER - PERMIT FOR GAS STALLATIC . 9 w �,SSACHUSEt( This certifies that . . ./'` ,1:� /'6q. . . . . . . . . . . . has permission for gas installation . . . . H . . . . . . . . . . . . . . . . . . . in the buildings of . . .!<'. . . . . . . . . . . . . . . . . . . . . . . . . . at . ./. . . . . !. . . . . . . . . . . . . . . . . .. North Andover, Mass. ' f Fee. .3�. . . . . Lic. G S INSPECTOR Check# 7 )_2 1 5 6562 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTlN (Type or print) Date U NORTH ANDOVER, MASSACHUSETTS f Building Lggations Permit Amount$ 3 o Owner's Name I_Z_- 1�4 mUc ,f New Renovation Replacement Plans Submitted col U fi vi a a G 0 rn T N ze , ' c F H > a [-• w p O p z F. F v G7 F Z F z x W W y� 4 W 4' z W > W C F E" �+ y go Z Q Z S O x Fz = d C d d O O rzl O O SU B-BASEM ENT 3 G 'a U > G n0. F O BASEMENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR p 4TH . FLOOR ! , 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR or type) Name tf L� I T'/�IV /fi L f l�? Check o- rr. ne: Certific a InstallingCompany �� ' �i Address 7J tL L y V� S ��++ � d V L/ '7 IL .0 Partner. usiness a ep one 4 Q Firm/Co. Name of Licensed Plumber'or Gas Fitter T4 C [INSURANCE COVERAGE have a current liability Insurance policy or it's substantial equivalent. YeSck ooe: i you have checked es please indic a the type coverage by checking the appropriate box. - No� ability insurance policy � Other type of indemnity 0 Bond 1 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. Signature of Owner or Owner's Agent Check one: Owner 0 Agent 13 1 hereby certify that all of the details and information I have submitted( r ntered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations rf r ed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta ode d Cha ter 142 of the General Laws. By: Signat 'e icensed Plumber Gas Fitter Title Q Plumber C'��O`'n. ❑ Gas Fitter (cense mum er aster APPROVED(OFFICE USE ONLY) ❑ Journeyman i 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 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 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-ifhe—. . 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-tern 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: � �/� //L� *Note:Reapply for new permitV ❑Permit Extension Act—Permit/Date Closed: PDate.................................. MORTH ,N TOWN OF NORTH ANDOVER o PERMIT FOR WIRING $'ACMUSE� This certifies that ........ . .. .............. !!.7�; ................................ has permission to perform ........( .? ��. E 5....... .......................... wiring in the building of........... ................................ at......... ...D`: .` .6.....L .................... J orth Andover,Mass. _ Fee..2 f1...0.0 .. Lic.No.P...2 7i. 7................. � .. ELECTRICALINSPECTOR Check # � $ 3'► 2 Commonwealth of Massachusetts Official Use Only Department of Fire Services permit No. 22 l2— BOARD OF FIRE PREVENTION REGULATIONS [RevC Ip07]y and Fee Checked (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 (I'1.,I;A,S'F.PRINT II+IINK OR TYPE-ALL INFO TION) Date: City or Town of: T To the Inspe for(?fires.- By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) J J plc, 1-.1tw s Owner or Ten ant r rio J �1eJ-CQ hoi)A Telephone No. Ov,ncr's Address is this permit in conjunction with a building permit? Yes ❑ No 0� (Check Appropriate Box) Purpose of Building.Zt&—Ac—e— Utility Authorization No. Existing Service Amps / Volts Overhead ❑ iJndgrd ❑ No. of Meters jolew Service Arnps / !Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Mature of Proposed Electrical Wk: f 'I' or �I Al e w S r"o /y-c e t� Completion o/the following table nuiy be waived by the Inspector n/Wires. . of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans No. of Total Transformers i VA No, of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Lwminaire,s Swimming Pool Above F] In- ❑ o. o Lighting igh ing rnd. rnd. B—attery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARNiS No. of�osaes No. of Switches No. of Gas Burners No. of Detection and initiating Devices No. of Ranges No.of Air Cond. Tons! No. of Alerting Devices No. of Waste Disposers Deat Pump Number 'Pons KW No. of Self-Contained Totals: I I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municiipal ❑ Other Connection No.of Dryers Beating Appliances KW Security Systems:* No.of Devices or iE uivalent No.taf Water No. of No. of Data Wiring: !!eaters KW Si ns Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of!Motors "Total HP Telecommunications Wiring 'O : No.of Devices or E uivalent OTHER: Attach additional detail y desired, or as required by the Inspector of Plires. t'.timated Value of Electrical Work (When required by municipal policy.) Ntork to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. iNSURANCE COVERAC E: 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. CHECKONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I F•cdr &, under Alt a%t, atatl iiiof pj�er��ury,that the inform([lioaa ora Itis application is trace(elan coraaplete. FIRM IvJf NAIVII?: o-rS Zr/fiAfUlnf- LIC. NO.: l icensec:( , )V( AJ t VU Signatu e LIC. N 9-7-7 applicabl�en�ler e:-sxw�:pt"in the license number In/�����,,��' Bus. Tel. No. . 7�f' '-9x33 /Address; �.v- 6So51� (15 � olt-ei- /ytfl of 1�4� Alt. Tel. No.:-7 1- Ter M-6.1,c. 147, s. 57-6 1, 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 nay signature below, I hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent :Signature Telephone No. PERMIT FEE $ Location No. ':32/0 Date MORTN TOWN OF NORTH ANDOVER O�t . o , 1.ti.0 + ; , Certificate of Occupancy $ swcMusE`� Building/Frame Permit Fee $ ® Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ Check # + J Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING c. :ps s{. zt 'i t F, •i r F�'S �,fs I, BUU,DING PERMIT NUMBER. lO DATE ISSUED. Ute— '—D M /UL 3 SIGNATURE: � Building Commissioner/Ir of BuildingsDate SECTION 1-SITE INFORMATION Z 1.1 Property Address: ' 1.2 Assessors Map and Parcel Number: C 9 oL y1qp1G )9VeNve— 6--4me) /01� _ 0/ ..LVO TX &A ver w it s-s Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: (� s�N le fiymiy1?e5-deA1 t 3 96P9 Zoning District Pro posed Use Ld Area Frotsta ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Watet Supply M.G.L.C.40. 54) 1.5. Flood Zone Infonaation: 1.6 Sewerage Disposal System: Public N, P ivate 0 zone Outside Flood Zone 8--' Municipal 0 On Site Disposal System N--1— SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record G OMiNiC. greNek T-err'9Nov /`l Olympic 49N-e- _ �) Name(Print) Address for Service: Signature Telephone O 2.2 Owner of Record: (� Name Print Address for Service: O Z Signature Telephone – m SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable 0 BRI?a1-Ey e /9Pw-ers Licensed Construction Supervisor: `— C 'R a U/y M g/v S Z 9N a0/N I V.,//,e /V 03 87 9 License Number Qon Address Signature Telephone Expiration Date 3.2 Registered Home improvement Contractor Not Applicable ❑ v /3rR6� ��t�-errs (foA3SirvcTio,v ?l00�77(� Company Name rn D r v V111-e N Registration Number �... Address r Expiration Date ^ Si store Tee hone Y) SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildiw permit. Signed affidavit Attached Yes....... No.......❑ SECTION S Description of Proposed Work(eheck ell. ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: r o'( G�;7-� Nem ec SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be QL ` Compfeted by permit applicant- 1. Building 7 5'o' (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingBuilding Permit fee(a)x M 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 0 2 y � � as Owner/Aute horized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief �2�3�L� E l ow�rf J-lZ Print N e C-, � I111 , L:1 �Ia/ b O Sip-nature of Owner/Agent Date NO.OF STORIES SIZE X U i)e BASEMENT OR SLAB SIZE OF FLOOR TIMBERSO T 1 2 3 1 SPAN DIMENSIONS OF SILLS 12 01 ovb DIMENSIONS OF POSTS 75—A(P P Jr DIMENSIONS OF GIRDERS — TMCKNESS T-1 IGHT OF FOUNDATION SIZE OF FOOTING e o )f `v SoNa 6e- X MATERIAL OF CHIMNE IS BUILDING ON SOLID OR FILLED LAND 56 Ji IS BUILDING CONNECTED TO NATURAL.GAS LINE /VO FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. .....................................mono.■................/............... APPLICANT S !Q/�/�6A9yc;-A- PHONE i ASSESSORS MAP NUMBER _LOT NUMBER / L�3 SUBDIVISION / �/� LOT NUMBER �/ STREET h X iol C LN STREET NUMBER C/ ............................................................................ OFFICIAL USE ONLY s.m....n..................................................................r. RECOMMENDATIONS OF TOWN AGENTS �-�P��c� (Ly_((6 �Ecam MEN MEN.l� w1 �1ta0 DATE APPROVED L. Z I CONSERVATION ADMINISTRATOR DATE REJECTED COMMENTS k)(5 (-a A&-J5 LA-1 (1 ob _ &Z+1)- Zw DATE APPROVED TOWN PLANNER DATE REJECTED CONUVIENTS DATE APPROVED FOOD INS CTOR-HEALTH DATE REJECTED DATE APPROVED /z- a a VC D49MCTOR-HEALTH DATE REJECTED rcONRVIENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTNIENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE MORTGAGE INSPECTION PLAN NORTHERN ASSOCIATES, INC. 9/41? N.MAIN STREET AAMVER NA 0149!0 rEL'-MR)474-4410 FAX MOW/7s-5067 MMMMM WWW= F.1 MARNt•1' A110vAlam. 49*M L0164 rZWC IS l7L171ssZC Aim apmPLAN REF. / ,7/eD CZ1'7;AWATZ AORTM AAnOMW AM 49CAEF !0 1 m 0. M 1 LOT 38 43,989 st.+/- M M �ai�l p pra I,or 39 p .�75 I (p t 1(j* eCy— 4eG �'lt�'IC An1?7UE / a sty.wood Iv 119 Lar 37 � 1 150.00" 'JL IMP IC AVENUE Brad Powers Construction a� �� Wwr:�ASE CO.rti+c. 22 Wymans Landing ///.,,,Danville, NH 0///38/1jt9+� Mee rota•pte.p .n.y.etl r„w.pnp•n•r villi•srrtgae. 'n.p•atien.•pl.p.r•a In meeors.nem y-�g r•e/liwlir t�r.rgge purpvet.anll eR lU Rn•f•chnl•.3 et•Mrr�• let oared"•loan ��YY Rot s•W '.t uaan u•Smra a<Pr•prdo' bi t,•-Liefto a Mtrat•d n the neffiurJtWttt eMN •} trove o,rwy, mrN eme taxer■a. pree•rin,a■n tttl t r a•.•t tptl•ra,•r con■CIV{tlah, hf tvtxert rtT• roe nRntlen al rt'tia■•iott TIWin.ere and Land nolo t.11atR•Irc•tlor.t"la otir.t•fir• fut.•ytrr 7xa:W 5pt, {pproti.mtgy 1.eerN h tM frerY rN CAlIM/ft 3 err h•r Berl■tn•t t•■y Plotufl■M•J oot nine ihni peorn tprtlf.{a71y la tool"(fManigtlm•1 ���' •h•.mactcraf faavn a'Afe"■Yith tM 11C.t Iarte�n.e lrMlnl .nlr five Its Aft to a ufei to fatapjjY,[a,ariy .1•Mu•/en•1 a•LMT rry4LraaM04 at tho tta•of••hittrailen v; aRe{• fe•a.eterp sown nrne■arf Ma■a ev are.x.■pt uMbr alar1t1er rr M.O.L. 011. •o-a a... o. tllant-tarnt•hta!tlaraatjw Lila wr b eee:.e• ' t•Iurtnar eut-.al N, t.ti.@fi. tommanta.n/r/eher ./ .�•YtOl3ft Lf/1i07M se not in a plmd M•■•rd. ee of. are oth"e•t%wa N rrrrea red pnutlpal... 'Ff �'tSi Q�.Ptopettr lxdu0a !. in • tj.0d me acrd Arr■. Int*r {fhta. rrrr _a.o.rt•e.., ir.. 12 ..w t. 52.tw!•Y•etLon to t...ltlelfnt to dot■tnipa n•a.reaieljitt ten in to tr.Is"■lova".r r•..prnt, lA Cioed Mf[fY6. aedeat•n.rwpe.el"I"y Irl byes!"._3 ll.@ fro■a•H /y. F100Z) Retard dKll7tMd fora 'aNat I■daral ►lead r^11•.e.pp.wrm.•ort"• ah.n et• ., ort,apn aM lr••■fie�1t ����7I jhLut{nCa late Jl•��PaRal 6 <aw.q.,rl to io rr.m•ra aorefep 7t■atatga uta■etep{.r. lyte•��,��(r/�7�� -- •.. a;t.tn L.'1V'nL unwuio'j io.Anw LE:O I 00-0Z-.Ady I Brad Powers Construction 22 Wymans Landing Danville, NW 038i9 phokf Ysm -c(oo3 Co 4a-lo4a8 P415,Cr WoR/c76�AO3)51o1—ala/d' �0\ 14.1 e , Mf pT OST- tA ` 16' Z x/o Pr � 0- rev/4r d4r ar Po s o�ife i ! 4O im ZX/o Toisr rt 2 12. 5,eq� —�1(/d I QV 1".SiDE ST��r' .3 rr,%N e!^S 0� CoNCre rtIV a below j• 5,opo Tv�x- 7"'�rr.,NoVapA 71 - - -- b? oc.ymPk- M)VE ACORD CERTIFICATE OF LIABILITY INSURANC R PT DATE(MM/DD/YY) WEBR2 03/07/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THE JOSEPH S. HILLS AGENCY INC HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 129 MAIN STREET, PO BOX 300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PLAISTOW NH 03865-0300 Phone: 603-382-9211 Fax: 603-382-3387 INSURERS AFFORDING COVERAGE INSURED INSURERA: National Grange Mutual INSURER B: Bradley Powers, Jr. INSURER C: 22 Wyman's Landing INSURER D: Danville NH 03819 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE MM/DD/YY DATE MM/DDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $300,000 A X COMMERCIAL GENERAL LIABILITY MPJ63691 01/20/00 01/20/01 FIRE DAMAGE(Any one fire) $500,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $300,000 GENERAL AGGREGATE $ 600,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 5 600,000 POLICY }, PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER TT EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYE $ E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CARPENTRY -RESIDENTIAL CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION HOWEDE 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Brad Powers Construction IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 22 Wymans Landing REPRESE TA IVES. Danville, NH 03819 ACORD 25-S(7/97) ACORD CORPORATION 1988 FORTH Town of over No. C�/O o = LA o dover, Mass., COc MICMEWIcK ADRATED P? C:) S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... . .�N. . .... ...Br*. .............. �h.�....oy. ............... O ' �/�� Foundation has permission to erect...../1i.... .............. buildings on ........I..1......01.. ..!o�"......,,.........L..A.�..�. Rough to be occupied as.....10.I Pt.A01 O I.C.K.......l�.!� I ....10 .... W.�1 �.�. Chimney provided that the person accepting this permit shall in eve respect conform to the terms of the application- on file in P P P � 9 P �l PFinal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ` D G '4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 4 �� Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START6 Rough C • ............... ........................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Location No. Date �4 ,.oRTM TOWN OF NORTH ANDOVER f • Op ♦ i � Certificate of Occupancy $ t��' Building/Frame Permit Fee $ s�CMUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ c� Check # r , 1 3 ! / Building Inspector v PERMIT NO. 0 � APPLICATION FOR PERMITTO BUILD**** "NORTH ANDOVER, NIA nl%I,No. 107 LOI.N(I. o1 S 2. HL('ORD OFOWNLrIS1111' DATE BOOK PACE 70NE SIIB©O 011'./LO'I NO. L 'A,// vJ (,(:.,TIONI 0�� v"R� /�" I'I,RrCXiE(N=BlIIIIRNc 21tx3�� �fh.1 ' IIw.+ h.cT/tl•�.n� S�,rrwtw✓�/�� IF ()\YNER'SNAME `14) L 14, �n �Qa NO.(M SFOR IES SIZE OWNER'S ADDRESS w ! J /1 /A BASIi1.lEN`F OR SLAB ARCI III ECI'S NAME o C "v SIZE OF I 1 00R I IMBERS IS 2 3 RD lit III DER'S NAME / n � f��_ SPAN DIS"IANCEIONEARES-I BUILDING . 45/cC.•,+ ✓"!/� DIMENSIONS GA:SILLS DIS LANCE FROM S"FREE F f DIMENSIONS(N 110S S DISTANCE FROk\l LOT LIMES-SIDES A17-l'.- l -l'- REAR DIMENSIONS OF GIRDERS i AREA OF I-OT FR(NJI'AGE IIEIGI IT Ol FOUNDATION THICKNESS IS BUILDING NEW SIZE Off O(JNNG X IS BUILDING ADDITION MAI ERIAL OF Cl11NINEY IS BUILDING ALTERATION IS BUILDING ON SOLID(1Rl 1l LED LAND WILL BUILDING CONFORM TO REQ IIREMENI S OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS AC'T'ION, IF ANY IS BUILDING CONNECT ED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INS l lwi-iONS 3. PROPER fY 1NI:OIIAI.A HON LAND COSI ESI'. BLDG.COST �Z PAGE I F111.OtIFSECTIONS 1-3 EST. BLDG.COS PER SQ. FT. EST. 131 DO.COS I PER RIXN 1 EI EC-TRIC METERS MAST BE ON OUTSIDE(N BUILDING SEI'1IC PERMI T NO. low AI-1 ACI IED GARAGES mus TCONFORM TOSFAIEFIRE RE(iULAIIONS 4.,--A.141HOV111) BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECRN( BI III.UING INSPECTOR DA FEFll1.1) Z�' Uy OWNERS'1EI)1• R (O ' / 0 C, o C(WI­RA 171 6gE­ 933? CINrIIT.1.IcN O I©:330 SICNATIIRI:IN:OWN1_R OR AUFIu Z : ilI� II.LC.N 11 (�Zo� Ill. , I'1 RLII I(MAN I11) 19 J, The Commonwealth of Massachusetts Department of Industrial Accidents — 011Jcs oJ/nML(Vatluns _ 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit name: J0h4% 4- LI nn location: 101) OU �,A-rt "H A#,00vf, ohnne d q9k- d k7_Wo f7 1 am a homeowner performing all work myself. L7 I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. K companv name: �14'✓u t L�1 ��tJ +`Y A`Il d k.e� add I �, S'� g�a w-.-i phone a- tcr �,, ,�li (� CucC 1s69YL199? LAA, 0011 yolifeg, Policy I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: addri:= cityr phone q insurance co, oolicv# _..:. .........:: .. ..:. cumpanV.name: address: city: ohone insurance cu. Failure to secure coverage as required under Scction 25A of iVIGL 152 can lead to the imposition of criminal penalties of a tine up M51.500.00 and/or one years' imprisonment as well as civil penalties in the form of:t STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Office of Invesugations of the DIA for coverage verif)cadon. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature (�a l-(-c.-�.-- n ltd �n Date 7' Ove- VV Print name a Le,�IJ 1 1 C� Cit Phone# � � �'�a 4C,301 7 Ccheck ly do not write in this area to be completed by city or town official permiUlicense q [7 Building Department C]Licensing Board mediate response is required CSelectmen's OfficeCHcaIth Departmentn: phone#: Other (reveal 3/95 PIA) � i • _ 0 HOME IMPROVEMENT CONTRACTOR . Registration 118204 Type - PRIVATE CORPORATION Expiration 02/12/01 • FAMILY POOLS 6 PATIOS INC GLENN WIGGIN BROADWAY LAWRENCE MA 01843 AMANISTRATOR � 1 ::�i�e �cm.+s�o9entirJL(oj:=�iroaa.-�rwdf� � - IBOARD OF SIALDING REGLRATNM Lic wm: CONSTRUCTION SUPERM" Nuebm:CS 010334 ShOmiMs:WORM E306";07119E"i Tr.no: 448 PAmbielsd Ea 44 512 S OROADWAY �iti�..*—e-4f4--' LAW ENCS, PAA OfU3 A vmimWslW r �i a Qoowa.na*ueall.6�.�aaeaaEuaelA HOME IMPROVEMENT CONTRACTOR Registration 118204 Type - PRIVATE CORPORATION Expiration 02/12/01 FAMILY POOLS 6 PATIOS INC WILLIAM C. GIANOPOULAS BROADWAY �`O'✓"OLAWRENCE MA 01843. ADMINISTRATOR 11 ti 1 E1 �—ABILL —� D OF C 8-8'Plain Panels(08-009-5) L ` 34'Plain Panels(08-016-5) 1-2'Main Panels(08418-5) LE�—F o N J K J 4.2'Radius Comers(08-141) 17-Tumbudde Braces(08-214) SIZE A B C D E F G H J K L 1-Steel Hardware rat(08-204) 16':32• 16' 32' E' 3'4" 3' 14', s'6' 4'6' 4'6• 1' 4'a' g, 4' 1-16x32 Straight Coping Set 6'Radius(10-001) K@IT14Eo-IIpIDIYRIG 16' 32' S'6' 3'4' 8' 14' S'6' 4'6' 4'6' 7' 2'2" 1-2'Radius Coping Comer Set(10-138) N119MMM M 1-Vinyl Uner(see options below) ADJUSTABLE TURNBUCKLE BRACE STEP OPTIONS ACRYLIC FIBERGLASS gP 6'Step-Remove 1-(08-009-5)8'panel and TURNBUCKLE 1-(08-016-5)4'panel. Insert 1-(01-006)6'step, 2•(08-011-5)3'panels and 1-(08-214) PANEL * turnbuckle brace. 8'Step-Remove 1-(08-009-5)8'panel andA01 " 1-(08-016-5)4'panel. Insert 1-(01-002)8'step, 2-(08-018-5)2'panels and 1-(08-214) turnbuckle brace. 2`VERMICULITE STEEL PANEL • • OR SANG 8' 4� STAKE Replace 4-8'plain panels(08-009-5)with: CONCRETE 1-8'skimmer panel(08-011-5) n�+ 2-8'inlet panels(08-010-5) 1-8'light panel(08-012-5) LAYOUT 13' 4' NSPI TYPE 11 VINYL LINER •. • 8' 6� 9' 2� 3' 8' 4' TOPAZ STERUNG STONETITE (03403-2) (03-P03-2) (03-NO3-2) NON DIVING LINERS Attenti°rs Dealer: Itis your responsibility to see that the safety package provided by FWP is delivered to pool owner and that the H-6(03-R40-2) 1-8(03-P40-2) S-14(03-1140-2) NO DIVING warning labels are properly installed. THIS DOCUMENT IS FOR ILLUSTRATIVE PURPOSES ONLY. ® FORT WAYNE POOLS®,INC,510 SUMPTER DRIVE, ADDITIONAL NOTESFWP makes only those representations which are slated in its wrieen STERLING FT WAYNE,IN 46804 USA 12191432-873! ° These dig dimensions comply with the National Spa and Pod `"an°nry MMyy other representations,statements,or contracts mode PCJL S 1 t0 9� Dint of corners. by the dealer/mn oc or to the customer regarding any materials r DRAWING NUM.FR P Institute suggested minimum standards For esidential pods. p by FWP am attributable to the dealer/contractor only.The • IF diving boards ar slides am b be used with these pools please dealer or contractor who sells or installs your pool s on independent OF r w—E .i G v_ES r a v.I I T. STR-006 eonwlt the manuFadurds instructions and the National Spa&Pod contractor and is not an agent or employee of FWP.The construction m bearing capacity of 2000 PS.F. 3.Excavation shall be T ksrger than pool all around. Institute's minimum standards prior to installing diving boards or methods illustrated hero aro wggastions and apply only to normal DAn nns - least 6'above surrounding Fill voids under base of panels and tamp well. slides on these pbds. For information concerning NSPI minimum gam„1d conditions.Thain may be additiorEol precautionsand/ar 4.Backfill with ran-expansive material. standards,Write: National Spa&Pool Institute,2111 Eisenhower methods d constmctian.The responsibility is the controcto/s. ,�9 _ Avenue,Alexandria,VA 22314-703/838-0083 ,,,.., r` CO.TRIONT 1003,PORT WAIN,,OOl3•,INC. EL EACH ACCIDENT ' �.� FORM U - LOT RELEASE FORM a INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT JOS - CK/s PHONE 79 - 6.17460( LOCATION: Assessor'S Map Number p PARCEL` �— SUBDIVISION n / LOT (S) Of STREET /0 0(J CA Q_-r ST. NUMBER "----**-""OFFICIAL USE ONLY aZ X38 Ip 6npaQ goof r� RECOMMENDATIONS OF TOWN AGENTS: _ yAR01. C,, 1, 5 CONSERVATION ADMIN15TRATOR DATE APPROVED _ DATE-REJECTED COMMENTS V v ""`� �R' L6 L),-" TOWN PLANNER DATE APPROVED �1► DATE REJECTED COMMENTS FOOD INSP CTO - LTH DATE APPROVED DATE REJECTED T I PECTOR-HEALTH DATE APPROVED Oct DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE i MORTGAGE PLOT PLAN EK SURVEY 17 ROYAL STREET, LAWRENCE, MA. 01841 Tel. 508-975-1413 MORTGAGOR 6-'ZZ DEED REF. y/69 PG. 90 ADDRESS OF PRINCIPLE BUILDING PLAN REF. /ZOz9 -4-or i& OLP G4er' kmv DATE OF INSPECTION N .4NLb eEe, M& �✓l,.4t-E I"=ye t p9.o' � o ey a y, 1 a 467' /(o W00o Vh� \ti e�.,v �- ��VA �' I FURTHER SATE THAT IN MY PRO1�'ESSiONAL NOTE Thls mortgage Inspection eros prepared o �' OPINION the principle structure/s and accessory speclflcolly for mortgage purposes and Is not to T' be railed upon as a survey% EK SUlt'#V dacdptV RUDEL outbuildings, GorjFWrA no responsblllty for damages No.36868 with the setback requirements of the local rellancd by anyone other than the sold mortgo ee o, zoning ardinances, and that no enahroechmwds and Its assigns In connection v th its proposedg �F '�f'IS1ER`�� ��� of major Improvements eithar way across mortgage financing to said mortgagor. Y �S�oNgl LAM��J property lines except as show. CERTIFICATION M . e1. Property Is not In a Flood Haxw d Aron. This c"I'lcatlon Is based on the location of amy markers E Z Properly V in a Flood MaYard Area. represent survey, therefoN�3' InfotmatIon is 6'1sufAdbrlt to.�titermfis Flood Hazard. of others, kind does not t a property Flood Haxord det+atmin'bd *QM tgr4aiot Federal Flood .4f3ets shown are not to be peed for the establishment of Insurance Rdte Mop Pand f Z,jW 9g-c0009G co/Z143 property lines. NORTH To'"M 0Andover No. � %r'g O©o� �=-- LA E ori dower, Mass., COCMICKEWICK ADRATED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System —7 BUILDING INSPECTOR THIS CERTIFIES THAT.................................... 11J... "... .N/1J .............................................................................. /� Foundation has permission to erect aa� ..�.a........ buildings on ...... .D....f/.....D./d--C T.... Y. Rough to be occupied as..... .......1.!V. .�v N� 00 IN N*O h &. ........................ Chimney provided that the person accepting this permit shall in every respect conform to the terms Jf the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration nd Construction of Buildings in the Town of North Andover. a PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. _ Rough - PERMIT EXPIRES IN 6 MONTHS Final ' UNLESS CONSTRUCTION ST ELECTRICAL INSPECTOR Rough �T .......... ..N.'0000#...... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. -FOP FKIL)-FQ 4„0SCE{. �D - z I s. X31 1>I cp D-Bo/v, —2 I S. 70 yp P.vC 14 LZ t- —= - ro N o' - -I 7soq� , 11.5 S. -A a vFR 1 � t�. '% cs may,zy, 1356,7 ' W- Ta+iq Tey3 x c4� II.17QCul�� TCW I I 3'Irl JC I n N I I �� BViL� �nc1{►�� -,-� _ I i I II � P(P I I 0 Cod, 3q.7 IFWD30 15' G tv OQJ AS BUILT PLAN OF SUBSURFACE DISPOSAL SYSTEM LOCATED IN AS PREPARED FOR LE M ETT\/ DATE : 1(0, l q4S` SCALE: l ' = qo , LoZi,�a OLE) GAS- T k-INY MERRIMACK ENGINEERING SERVICES, INC. PROFESSIONAL ENGINEERS ® LAND SURVEYORS A PLANNERS: 66 PARK STREET • ANDOVER, MiASSACHUSETTS 01810 TEL. (648) 475 7553, 375-5721