HomeMy WebLinkAboutMiscellaneous - 190 HILLSIDE ROAD 4/30/2018 (3) X190 RILL SI
J 21010980000.0
,1
Date. ...... I . . ..!.... .
NORTH
3� TOWN OF NORTH ANDOVER
O A
• PERMIT FOR GAS INSTALLATION
. 9
4 gs,SSAC NUSE�t
t
This certifies that . . . . . . . . . .
has permission for gas installation . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at �n". . /.Q�.-Q .- 'E: �.r:�' . ., North Andover, Mass.
Fee- Lic. No �!? . . / :J, !s!►. . . . . . . . . . . . .
G GAS IN6P�ECTOR
Check# r' �/�ca��
7UUU
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print) Date /Z 7
NORTH ANDOVER,MASSACHUSETTS
Building Locations 'go // �1 /,3 j cJ p 4A4 Permit#
Amount$
Owner's Name
NewE] enovation Replacement rlt;�v Plans Submitted El A-1 el)
rA
x w �
w w w x
x H z z F
w d x a 0 a G >
Gx U w v, z x o w
U F z F■ d F F W C� p � w F V a H W
z > w z a a a o °o w °o W H
> o a F o
SUB -BASEM ENT
B A S E M E N T
1ST. FLOOR
2ND . FLOOR
3RD . FLOOR
4TH . FLOOR
5TH . FLOOR
6TH . .FLOOR
7TH . FLOOR
8TH . FLOOR
(Print or type) ✓�, /�((�� f Check one: Certificate Installing Company
Name � �95'�Iv l•�� �./{� -J
El Corp.
Address a ��f 7 / 13 Partner.
/f
01970 �❑
Business a ep one / _ 17 Finn/Co.
Name of Licensed Plumber or Gas Fitter .
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes No
If you have checked yes,please indicate the type coverage by checking the appropriate box.
Liability insurance policy � Other type of indemnity 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.ItGeneral Laws,and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent 0
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusettse Code and C 142 of the General Laws.
3- (gj��
•-_��
By:
S' t e f Licensed Plumber Or Gas Fitter
Title P umber
City/Town Gas Fittericense"Num er
0 Master
APPROVED(OFFICE USE ONLY) Journeyman
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
60. 0 Washington Street
Boston, MA 02111
wwW-mas&gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 'Cws,,rc/
Address: a ��p� 7 7 s/
City/State/Zip: �,�le�'] �/� 0(9 7.07 Phone
Are you an employer?Check the appropriate box:
1.ElI am a employer with 4. ❑ I am a general contractor and I Type of project(required):
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2•Z I am a sole proprietor or partner- listed on the attached sheet 1 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance.
[No workers comp. insurance 5. 9. ❑Building addition
' p ❑ We are a corporation and its
required.] officers have exercised their 10.El Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no
12•❑
insurance requiredRoof repairs
.] t employees. [No workers
comp.insurance required.] 13.0 Other
*Pmy applicant_:hat checks box#1must also,fill out the section below showing
1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside ontiact
tractors 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 my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: 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 for insurance coverage verification.
I do hereby certify u de the pains and enalties ofperjury that the information provided above is true and correct
Si ature: �4,
Date.: l2-"f7—C?
Phone#: '7�
EEalDonly. Do not write in this area, to be completed by city or town official
n: Permit/License#
hority(circle one):Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
son: 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 bum leaves etc.)said person is NOT required to complete this affidavit.
Y
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 Investibatiions
600 Washington Street
Boston,MA 02111
Tel. #617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05
wwvv.mass.gov/dia
Date:�.. . :/z
".O RT TOWN OF NORTH ANDOVER
. o
3r oc
t
p PERMIT FOR PLUMBING
SA US
This certifies that .! . . . . . . . . . . . . . . .
has permission to perform . . . . . . . . . . . . . . .
plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . . . .
at . . . . . . . . North Andover, Mass.
Fee. Lic. Noc70.!`� . . . / .� ? r. . . . . . . . . . .
/ PLUMBING INSPECTOR
Check # �' �/ �,
8317
J: 1
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
y
� L �/
Building Location l %0 /�;" -S',C� P-0� DatePermit#
Owner �" �s�'''L ��! c3 .
Amount
New 0 Renovation Replacement Plans Submitted Yes [3 No
FIXTURES
IP
SuWdE
R4SEWM
1ST IYOQt '
re EWM
3MEWR
4IH EWCR
6IH IIOER
7IH EWOR f
SIH EWCR
(Print or type) Certificate
Check one:
Installing Company Name - fJ,$ is i /�` -jd,' ❑
� Corp.
Address -- �� B1l X 7-7,V El Partner.
CJl�7G)
Business Telephone 1 Cir'/F -6 76-/ Firm/Co.
Name of Licensed Plumber: ,v �S/j�_ �____ �"� 4
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy 13, Other type of indemnity 1-1 Bond
Insurance waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner ❑ Agent r
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the
best of my knowledge and that all plumbing work and installations jgerfonned under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachus to lu bing an Chapter 142 of the General Laws.
By: - -
bignauire um er
Title Type;
ll �ng License
City/Town rcense rrm�"- Master El Journeyman
APPROVED(OFFICE USE ONLY
i
i
.,
.:, i.
_ �
- ,...
, .
J
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
,.600 Washington Street
Boston, MA 02111
ky www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Sjl:Iltt/
Address: 77k
City/State/Zip: -�14-/"'V / / O/V 74 Phone#: �,�� y/3 - C4 2 5V
Are you an employer?Check the appropriate box:
Type of project(required):-
LEI I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.C11 am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance.
�o workers' comp. insurance 5. 9. Building addition
p. ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.] t employees- [No workers'
comp.insurance required.] 13.❑Other
Any applicant that cheers box#1 must also fill out the section below showing:her wor='compensation T
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submoit 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 my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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
j Investigations of the DIA for insurance coverage verification.
I do hereby certify un er the pains and penalties of perjury that the information provided above is true and correct
Si ature:
Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
I
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�ersons 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(7i)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 I
Please 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 certificates)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 Jany 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
Tel. #617-72.7-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05
www.mass.gov/dia
Date. F... ... .
NORTH
TOWN OF NORTH ANDOVER
O T �
• - PERMIT FOR GASMSTALLATION
'1s,9SSAC HUSf,St
This certifies that . . . / . � . .:�. . . . . . . . . . . . . . . . . . . . .
has permission for gas installation . . kA. . ./." . . . . . . . . . . . . . . . . .
in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at ... . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass.
Fee. 3.o.—. . Lic. . . . . . . .4. .,.��. .. , ,-a,. . . . .
GAS INSPECTOR
Check# ( ) 4
6328
30
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
A/,- " , Mass. Date 2007 Permit#
Owner's Name Location CQ / �ilp
syr Owner's Tel# " �/ O 3 C1�4yyppe of Occupency /
New Renovation Replacement Plan Submitted: Yes No
cn
x cn
Y Z Q H
cn to L) 0: W Q
(W7 W N W 00 OU
z m U) W W � o o a o W <
cn U) 0 W x � z Lu Q~ o o > w
W W to 0 Z W Z Q 2 W WUj (9 2 W ~ W U J N Lu
tY
Z Q W 'J Q W H F- �- rn m Z O Z W O F- x
W > it W > z Q a Q o o W o N l—
x 0 O xu- o C7 L� > o a W 0
SUB-BSMT
BASEMENT
1st FLOOR
2nd FLOOR
3rd FLOOR
v
4th FLOOR
5th FLOOR
6th FLOOR
7th FLOOR
8th FLOOR
Installing Company Name Addario's Plumbing&Heating LLC. Check one: Certificate
Address 20 Cooper Street X Corporation 2720
Lynn, MA. 01905 Partnership
Business Telephone 339-440-8100 Firm/Co.
Name of Licensed Plumber or Gas Fitter Steven J.Addario Jr.
Insurance Coverage
I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch.142.
Yes EX No M
If you have checked Lies, please indicate the type coverage by checking the appropriate box.
A liability insurance policy MX Other type of indemnity Bond
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.
General Laws,and that my signature on this permit application waives this requirement.
Check One :
Owner F-1 Agent
Signature of Owner or Owner's Agent
I hearby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By Type of License: SAP
Title X Plumber
City/Town Gasfitter Signature of Licensed Plumber or Gas Fitter
Approved(OFFICE USE ONLY) X Master
Journeyman License Number 13106
wr A
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE
NO.
APPLICATION FOR PERMIT TO DO GASFITTING
NAME &TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE ,2007
GASINSPECTOR
Date. . . . .'q"4!<. . ... ..
„ORTIy
Of 14, .
TOWN OF NORTH ANDOVER
o p
• - PERMIT FOR GAS INSTALLATION
.h
"S CH
This certifies that . . . . . . . . . . . • . . . • • • • • • • • • •
has permission for gas installation . .!A. .�. . . . . . . . . . . . . . . . . . . .
in the buildings of . . . . . �!? /. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
at . .� . . . .,eNf•!•�. • . •,. • • •„� . . • , North Andover, Mass.
Fee. ./.j Lic. No. .:3t.! .f. . . . . . .�
GAS INSPECTOR l
Check# /e/<
55��
ct to
M
,.� � _ r= _ 's Z to �'�', 1 � •
0 0 0M.
E " li1t'l1A NO
its
SL .pli
RA
k HEA t Q Op1L4ASOWN alp.m
O
uR Aae .
S U�ll ",gA Fits
wwi: R �AT. Re
$ o Gl►! Sttt EOATOR� D
p a t.xi t Y co Ks CL-
"a
Z
cd toK suWon
a (100P. TM
Ell
• P nt EAE '
t
3
. • . r s>T�OW hQR:ORFIC,�'It�1t"'��/dY.:' , r. •., . � ,
.FINA_ INSPECTION77
SKEfiCf1.Es '. E
---
'�R�'�R#fs31Ns:P ;ctlQ�+
ADPL,ICA?10N.F::01 1�'EKUITTO 00.0A!l.FITTIN4 ;
'• .. b',
NAME OINQ
�.bCAtInN rte AVIt nINQ'
PL0MIEh-0 A VAIIFL
I ..ko. _ A 7 tiiiw
20
' •rr 9Fi � ,a !� �=��M •�,do-'., 1
QAt IMMOTOt!
�
Date.
1_ HOR7q
•�,;._�+ TOWN OF NORTH ANDOVER
A PERMIT FOR PLUMBING
SA us
This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . .
has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of . . .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . .
at . . . ���a. . .�7�r.(.�r.r.,�.�. . . . . . . . . . . . . . North Andover, Mass.
Fee. J. % . ". . .Lic. No.. (5.1. `.- . . . . . . . . .4 L!-'�a ,- . . . . .
PLUMBING INSPECTOR
Check #
69z�?
101
CLOSETS KITCHEN SINKS
$
LAVATORIES . c
BATHTUB . ,
8HOWEA STALLS
S
'DISHWASHERS
DISPOSE %
Xr. R8 O � n1
LAUNaRY TRAYS
' 'V
WASH. MACH, CONN.
HOT WATER TANKS
TANKL
E88
SLOP SINKS O
O PO F10OR DRAINS
O' OAS TAAPB � �
" + , URINAL. °•
ORINKINO FOUNTAIN
REA OAAIN
WATER PIPING
O a ROOF DRAINS
S' $ BACKFLOW PREV,
r` 8' OTHER FIkT
UREB.
BOILER MATE
GREABRAP A
SCULLE•ItY .SINK
g'. SHOWER VALVE �' `~
.. , _BELOW FOR OFFICE USE ONLY
„
fINAIl1N.EPERt1.0 '3KRTCNESI FEE RAOdpEES INpECtiQN6
• ... •.r...... ...r........-ice....
NO.
APPLICATIOR POR*tRMIT TO 00 PLUMSINO'
UNDERGROUND ROUGH '
COMPLETE ROUGH
PINAL INSPECTION
PERMIT GRofto
DATE
.PLUM,I)I . INtPECTON. '
Location
No. % " = Date '
40*T" TOWN OF NORTH ANDOVER
„ Certificate of Occupancy $
+ ; + Building/Frame Permit Fee $
f O� .• •�'' a
'SswcMu
sE` Foundation Permit Fee $
t-',- .t
Other Permit Fee $
Sewer Connection Fee $
M lJ r �Me tFee $
TOTAL $
f '
'Building Inspector
L•r
Div. Public Works
a
Location 1 1y (i LLQ i�c L.c�.,��D
No. Date +7//7
f
PORT" TOWN OF NORTH ANDOVER
pftt�to
F p Certificate of Occupancy $
Building/F Permit Fee $
495
Foundation Per TrS ¢�e $
s�CHU
Other Permr( , �°qy�$
Seww. nnectiofneej
Water C4wion F/94;,. $
TOTAL r0 $
Building Inspector
-� Div. Public Works
Location
No. d 6S Date
s
cf AORT: TOWN OF NORTH ANDOVER
ooL DKV 00
p Certificate of Occupancy $
.+ uilding/Frame Permit Fee $
G E Foundation Permit Fee $
R� u
3 192 Other Permit Fee $
OR 1 sewer Connection Fee $
�d�et CQ\\Br Connection Fee $
NQ. TOTAL $
building Inspector
l 9 P
• � i.� t. i�%•C'J
/ Div. Public Works
Location
No. Date YAM
} , HORTp TOWN OF NORTH ANDOVER
o� ...a •.1tio
F p Ificate of Occupancy $
\`►``Building/Frame Permit Fee $
uSE� Foundation Permit Fee $
" �VC3fher Permit Fee $
�i
onnection Fee $
Water Connection Fee $ t 6 O
TOTAL $ c.1 Lo /` • /7 '�
Building Inspector
t Div. Public Works
illff 1N0. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PA GE 1
MAP i�a>. I " LOT NO. i - 2 RECORD OF OWNERSHIP IIATE BOOK 'PAGE
ZONE �„� I SUB DIV. LOT NO. boy` A- -41 /oviJ T. kly)iec. J'jZ. � l� MJ 7
• I LOCATION ♦Si/ \p �7 y ��d D PURPOSE OF BUILDING J'���/e
OWNEA'S NAME-/ /Z_OvGI-\ /�-"�C7�.Aly e C 7T'/A NO. OF STORIES � SIZE rYJz yCK y G/
OWNER'S ADDRESS Tin ,Q`;J�, e/` 0..� y�J i„ BASEMENT OR SLAB
ARCHITECT'S NAME ,JA//vod-A C t-� SIZE OF FLOOR TIMBERS 1ST �(/ `J2ND �'A' 3RD
BUILDER'S NAME T T.
6 falx ci-9-)-e-4 -�i� c SPAN / (�J/lvJ��
DISTANCE TO NEAREST BUILDING Q y� W, DIMENSIONS OF SILLS 6
DISTANCE FROM STREET ( F7- , J POSTS o I/
DISTANCE FROM LOT LINES-✓SIDES 91- REAR r '• GIRDERS Coo / 0
AREA OF LOTV t�'q.,/r FRONTAGE vQ7% ' HEIGHT OF FOUNDATION � THICKNESS � 0
IS BUILDING NEW J l`Q f' Of 7 SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY oLafl�Ck
IS BUILDING ALTERATION // O IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE 1/- f IS BUILDING CONNECTED TO TOWN WATER `'��.
BOARD OF APPEALS ACTION. IF ANY N D X77 IS BUILDING CONNECTED TO TOWN SEWER VY�fJ f
// IS BUILDING CONNECTED TO NATURAL GAS LINE „e J
INSTRUCTIONS
3 PROPERTY INFORMATION
LAND COST 0 a O d
SEE BOTH SIDES
EST. BLDG. COST // Q D
PAGE 1 FILL OUT SECTIONS 1 - 3 PERMIT FOR FRAMUBUILDING EST. BLDG. COST PER SQ. FT.
lJ ,
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING DATE: FEE PAID. 4 APPROVED BY
i
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLAN`. M-U T BE FILED G4P' IMPROVED BY BUILDING INSPECTOR
• DATE FIL
BOARD OF HEALTH
SIG %OW,- F OWNER OR AUTHORIZED AGENT
6 F6 .02A
OWNFIR TEL,9.=
, jF.E E `S'9�5, CONTR.TEL.
V CONTR.LIC.# DO y`t PLANNING BOARD
PERMIT GRA TED
�9 �z
`- _ "-M'iT FEC BOARD OF SELECTMEN
PERMIT FOR FOUNDATION ONLY LESS FDA FEE—,_
REGULATED BY PARA: 112.7 S.B.C. DUE FRAME PERMIT T
BUILDING INSPE OR
DATE: •� FEE PAIC�:�_
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY I STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILYOFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA-
APARTMENTS RAGES. HTC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE V- B 1 2 13
CONCRETE BL'K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER 1G _
_ DRY WALL _
UNFIN.
3 BASEMENT
AREA FULL FIN. B M AREA _
'/. 1/1 '/ FIN. ATTIC AREA
r —
NO BM T FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WARS I 9 FLOORS
CLAPBOARDS B 1 2 3
'DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH
ASPHALT SIDING HARD\'J'D _
ASBESTOS SIDING COMMON
VERT. SIDING ASPH.TILE
STUCCO ON MASONRY J_
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STIRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BILK. _
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR POOR _
11
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I 'I IP BATH (3BATH (3 FIXE—
GAMBREL MANSARD TOILET RM. 12 FIX.(
FLAT SHED WATER CLOSET _
ASPHALT INGLES LAVATORY
WOOD SHINGES KITCHEN SINK _
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
_ FORCED HOT AIR FURN.
TIMBER BMS. &COLS. _ STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
lsf 13rd I NO HEATING
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TOWN OF NORTH ANDOVER ,
LOT RELEASE FOIUI ,
SUBDIVISION � 'A �� T '
ASSESSORS MAP
SUBDIVISION LOT(S)
PERMANENT ADDRESS (ASSIGNED BY D.P.W.
STREET
APPLICANT — `�, �� So l k--r I:�C PRONE
DATE Or APPLICATION �►� � �' �.' C� 1 c�(1 •�
TOWN USE BELOW THIS LINE
PLANNI 'G BOARD
DATE APPROVED
TOWN PLANNER DATE REJECTED
C NSERVATION COMM SSION
Af
DATE APPROVED G7/
CONSERVATION ADMIN. DATE REJECTED
BOARD OF HEALTH /
G Y k1Q� ATE V 4
iE APPROVED I/
HEATA'JI SAVNITARIAN DATE REJECTED
DEPARTMENT OF PUBLIC WORKS
Q. 3 C?
DRIVEWAY PERriIT � , Gq—
I
SEWER/WATER CONNECTIONS
FIRE DEPT.
n LI
RECEIV BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Health Boards ,
the Conservation Commission prior to the issuance of any building permits
for the subject lot . This force shall not releive the applicant from the
compliance of any applicable Town requirement or Bylaw.
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/6 - 33 - 46W S 20 - 20 - 06W
NI I .SIDE (PUBLIC VARIABLE WIDTH 1 _ROf+1 D
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AL
'k 'rN O R T N
Town of �� 6Andover
�T L
M JV
)RiVEWAY ENTRY PERMITr - N
C K H HEWICK o` er, as 142
of F Pay
SSA I BOARD OF HEALTH
PERMIT T Ste
THIS CERTIFIES THA 0S.....4.r.....10".116C. ...V 0 .. fI! `0
I BUILDING INSPECTOR
has permission toFIN" dings on/f.d. ... . . ai.... ....... Rough
• Chimney
to be occupied a LIF.... .. ICK.........'� ..a/.t.i ....... Final
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in
PLUMBING INSPECTOR
this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough
Buildings in the Town of North Andover. PERMIT FOR FRAME/BUILDING
Final
VIOLATION of the Zoning or Building Regulations Voids t ' e it. �.� 4.�.._..��
PERMIT EXPIRES 6 M 0 fv�I�IT€ FEE PAID: ELECTRICAL INSPECTOR
�,I AA RTS
PERMIT FOR FOUNDATION ONLY"v L E S S CON RUC I'. S A R1 S Service
REGULATED Py PARA: 112.7 S.B.C. Final
f
/ ZFEE PAID: ��D�= ... .. ... .. . .. . ....... ...
DATE: UILDING INS CTOR
GAS INSPECTOR
Occupancy Perr1zit Required to Occupy Building Rough
- - Final
Display in a Conspicuous Place on the Prem PERMIT FEE -59..:ro
LESS FDA FE FIRE DEPT.
Do Not Remove PO .0.0Surrrer
DUE FRAM PE MIT$ 1L ET Ns.
No Lathing to Be Done Until Inspected and Approve �y Smoke Det.
Building Inspector
s NORTF-�',
ofP_ ;� Andover
own 0
� �,:�4 V^
110,. +� . ra ,a� 7
� -� =
iRi�/E�IAY ENTRY PER Mas . 1
Ery ApOPLI P2
fiver,
J2
PERMIT TCrB
AQ �
� BOARD OF HEALTH
1/z���z
IES THA ..... ....... + .� . ..........
THIS CERTIFIES UI N
has permission to WW 0•• dings on1P.•ov! •ve••• .......
.. � ....... Chimney
to beoccupied a� . •••••• ....... Final•"' FinalA/A44
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in J`y
PLUMBING INSPECTOR
this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Ro S �C. ��..L //-
_z_
PERMIT FOR FRAME/BUILDING
Buildings in the Town of North Andover. PEFinal 3,l)•
VIOLATION of the Zoningor Building Regulations Voids t ' e it. �.� �, 4�1'S 7 — 31- V.1-
MOND PERMIT EXPIRES 6 M 0T 'FEE PAID: ELECTRICAL INSPECTOR
Rough ��
RUC
- N S /ARTS Service
PERMIT FOR FOUNDATION ONLY�ILESS CON I Final
REGULATED BY PARA: 112.7 S.Bi y .•,••••
DATE: > IXFEE PAID: /DO •• UILDING INS CTOR GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
- Final
Display in a Conspicuous Place on the Premisol PERMIT FEE -593•°° ,..,.,,._ FIRE DEPT.
� •o� �.
Do Not Remove LESS FDA FES /DUE FRAM PE Mlt$ ��• �� ,VL
�
No Lathingto Be Done Until Inspected and Approved �y Smoke Det.� _'
Building Inspector 14 t, , ^ ^
URTIFICATE OF USE & OCCUPANCY
Building Permit Number 065 Date J U L Y 31 , 1 9 9 2
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 190 HILLSIDE ROAD
MAY BE OCCUPIED AS SINGLE F A M I L y DWELLING IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
NORTH
O``., eo ,fi qti
o� CERTIFICATE ISSUED TO LOUIS J K M I E C , J R . /J J ASSOC . INC .
TURNPIKE STREET
ADDRESS NORTH ANDOVER. MA
i
Building Inspector
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GL�RTr �,ED �ouNDATraN �1-,�►N
ENVIRONEERS,r 11% Nowrt� A Nna��Q , MA
ALFRED A. SHASOO, P.E. �A4� � 1 " = yo' ,v►piz,� rT, 14Q2,
P.O. Box 516,160 Pleasant Street, North Andover, MA 01645 • (508)683-3883
C.9IZ 2T'PY -THAT THE (OFPSLT'S SAlOW N,1 C.0A,\PL.\C vv,T44.. _
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T-�IG oNING f3 Y- LAWS C,F �c2TH Npav�(Z� MA .
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P.0.Box 1957
Andover,MA 01810-0033
DESIGNERS
508-475-1486
Fax
508-474-9354
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P.O.Box 1957
' Andover,MA 01810-0033
RESIDENTIAL
MASTER BEDROOM DINING ROOM DESIGNERS
508-475-1486
SAT H KITCHEN Fax
508-474-9354
- OI OI i DRAWN
Alan Carroff
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DATE
February 28, 1992
7 - 0 - JOB NUMBER
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92011
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PLANS
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P.O.Box 1957
Andover,MA 01810-0033
RESIDENTIAL
DESIGNERS
508-475-1486
_ Fax
508-474-9354
_ DRAWN
ACan Carrod
`�• DATE
_ _ February 28, 1992
JOB NUMBER
92011
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GENERAL NOTES:
IMO8 VENT :<
1. ALL DIMENSIONS ARE TO BE FIELD VERIFIED BY THE `'>. «'.. .•:>•
.................... ..:...... ... ..
5�g� PL�(1..1G�'�
• CONTRACTOR AND ANY ADJUSTMENTS MADE Caff011 Designs
P.O.Box 1957
2. ALL WORK SHALL BE COMPLETED IN COMPLIANCE WITH ALL Andover,MA 01810-0033
12 APPLICABLE PLUMBING, ELECTRICAL AND BUILDING CODES.
5 @ 3. ALL WASTE MATERIALS AND DEBRIS SHALL BE REMOVED RESIDENTIAL
INSULA-T10rJ -
V- —30 AND DISPOSED OF PROPERLY. DESIGNERS
Z x 8 G I.Cad o,G. 4. ALL NEW STRUCTURAL MATERIALS SHALL BE VOID OF 508-475-1486
ANY DEFECTS THAT MAY DIMINISH THERE CAPACITY TO Fax
FUNCTION IN AN ADEQUATE MANNER. STRUCTURAL 508-474-9354
i - - ENGINEERING AND DETAILS SHALL BE PROVIDED BY DRAWN
OTHERS AS REQUIRED.
2 ...+e L a''o _,��N 1-e o Alan Carroll
�Ed�lrJ� W,csLL soFF•17 5. ALL FRAMING LUMBER SHALL BE S-P-F#2OR BETTER. DATE
t February 28, 1992
JOB NUMBER
92011
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P.O.Box 1957
Andover,MA 01810-0033
AV RESIDENTIAL
GARAGE ��URNACt: LAUNDRY ? _ FAM I LY ROOM _ DESIGNERS
508-475-1486
Fax
.)` O 508-474-9354
3p 1 DRAWN
G\ [Can Carroff
_ _ DATE
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0February 28, 1992
JOB NUMBER
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