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HomeMy WebLinkAboutMiscellaneous - 190 MILL ROAD 4/30/2018 / 190 MILL ROAD J 210/107.A-0064-0000.0 ® The Commerce Insurance Companysm MAPFRE Citation Insurance Company'"" 11 Gore Road,Webster,Massachusetts 01570 INSURANCE 508.949.1500 1 www.ma pfrei nsu rance.com December 10, 2015 BUILDING COMMISSIONER or Board of Health or INSPECTOR OF BUILDINGS Board of Selectmen TOWN/CITY HALL Town/City Hall NORTH ANDOVER MA 01845 RE: Our Insured: KEVIN MACLEAN -MELANIE MACLEAN Property Address: KEVIN MACLEAN, 190 MILL ROAD Policy#: BDJGLY Date of Loss: 10/24/2015 File#: KWNV97-JNKHN2 Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. ANGELA LEMOINE Telephone: (508)949-1500 Ext: 15731 Sr Claim Representative,Property Toll Free: 1-800-221-1605,Ext:15731 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. December 10, 2015 CIC 254 (Rev.4/95) MAIL V20 Date...f?..`.. .. ..� .... �aOR711 TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSA CMUS� This certifies that ...... �.......... P.4..!it..! ............................... has permission to perform ..w:.: .......S'�i ...7,X..4. ......../..r.�e wirin/g in the building of... f! ...........,��a? L................................ at.., ,.�(�!...,�`1:. ........�ey ..................../....... ,North Andov r,Mass. Fee..:�S�........ Lic.No . ELECTRICAL INSPE R Check #10 711 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leaveblank) 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: June 2,2011 \( City or Town of North.Andover To the Inspector of Wires: \\ �o By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 190 Mill Road Owner or Tenant John Moglia Telephone No. 617-620-9004 Owner's Address 190 Mill Road Is this permit in conjunction with a building permit? Yes ❑ No 1Z (Check Appropriate Box) Purpose of Building Residential Dwelling Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 4 Location and Nature of Proposed Electrical Work: Wire septic pump,float switches and high water alarm panel. Completion of the followin table ma be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.o To Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- E] No.of Frnergency Lighting d. gmd. Battea Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o Det-;-nand Initiating Devices No.of Ranges No.of Air Cond. Tota No.of Alerting Devices No.of Waste Disposers Heat Pump umber Tons K o.of Self-Contained Totals: I..........................f ...... ....................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KWLocal❑ Mumcipa ❑ Connection Other No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW o.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 Total HP 1/40 Telecommumcations Wirmg: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:W l l cw i1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov permit rage is in force,and has exhibited proof of same to the peit issuing office. CHECK ONE: INSURANCE BOND E] OTHER ❑ (Specify:) I certify, under the pains and p nalties of perjury, that the information on this application is true and complete. FIRM NAME: David W Meehan LIC.NO.: 81296A Licensee: David W Meehan Signature A LIC.NO.: 8126A (If applicable, enter "exempt"in the license number line.) VBus.Tel.No.: 978-587-7518 Address: 4 Mulberry Drive Peabody,MA.01960 Alt.Tel.No.: 978-535-4022 *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re- quired 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� w . J / , � z / �� � �� • ` ,Ai The Commonwealth ofMassachusetts Department oflndustrial.Accidents !' Office of Investigations 600 Washington Street W .l1itF 2 C 1 r J a`e tt Boston,MA 02111 www mass gov/c a Worker s' Compensation l:nsurra.nee Aiixda'vit.-Builders/Contractors/Electricians/Flumbers Applicant Information . l- PleasePrinfLegibly Name(Business/Organization/Individual): �/��/ Q M v,,Q2 dm Address: r�u se City/State/Zip- ?ea JYi MA, Phone##: q73- -•15_02 913--56�-7s16 Are you ap employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2. 1 ain 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 forme in any capacity, .workers'comp.insurance. 9. Building addition [IVO workers' comp.insurance 5. EJWe are a corporation and its required.] officers have exercised their 10.Qf Electrical repairs or additions 3.❑ 1 ain a homeowner doing all work right ofexemption per MGL . 1 I.❑Plumbing repairs or additions myself.[No workers'comp, c. 1,52,§1(4),and we have no 12.❑Roofrepairs " insurance required.]T' employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box 41 must also,fill out the section below showingtheir workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors aiid their workers'comp,policy information. fain 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.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach h a co of the workers copy w r compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 A day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance'coverage verification. I do hereby certify under the pains and p nalties ofpesjury that the informado.n provided above is true and correct.' Signature: Date: 3 Phone#: FE- only. Do not write in_this area,to be eompleted by city or town offrciat i n: Permit/License# hority(circle one):Health 2.Building Department 3.City/'Town Clerk 4.Electrical Inspector 5.Plumbing inspector son: Phone#: t d Inf® mation and Instruefions 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 u de a express or lin lied •oral o r any contract of hire p r wriften. An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in aJoint enterprise,and including the legal representatives ofa 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 ba deerned to bean employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance' requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out,the workers'compensation.affidavit completely,by checking the bokes that apply to your situation and,if necessary,supply sub-contractors)naine(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 cavy 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 confirmationof 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 ifyou 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 ofthe 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 pennit/lieensenumber which will be used as a reference number. Irl 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 pen-nits or licenses. A new affidavit must bfilled out each year. Where a home owner or citizen is obtaining a license or pen-nit not related to any business or commercial venture e (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 Comnionwoalth of Massachusetts Dgpartmt�ut of Industdal Acoidents Office of Investigations 600 Washin&on Street Boston,MA 02111 Tel. 617-7274900 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.govldia OP ID: LR DATE It I AIDDIYYYY) oJ�ra° CERTIFICATE OF LIABILITY INSURANCE I 061D3111 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUIIHORIZED j REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, aubJect to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rl E)hts to the Certificate holder In lieu of such endorsement(s). CONTACT PRODUCER 781-593-9393 NAME: Soderberg Insurance Services 781-599-7338PH CAKQ, rtg; 200 Broadwav Lynnfleld,MA 01940 ADDRESS: Douglas G.Soderberg PRO k ME6HDA1 _cUSI91E�Io N INSURERS}AFFORDING COVERAGE NAIL 8 INSURED- David W.Meehan- INSURER A:Commerce Insurance. :14754 _ Patricia Ann Meehan INSURER e: - 4 Mulberry Drive INSURERG S. West Peabody,MA 01960 INSURER D: - - INSURER E _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLI 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 'IHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. w __ FF XP INSR - TYPE OF INSURANCE t POLICY NUMBER MM/DD YYY MM D YYY LIMITS LTR PN E $ '1,000,000 GENERAL LIABILITY F.ACI•I000URR. C A COMMERCIAL GENERAL LIABILITY VW3060 08127110 08127111 pREmj8ES lEq occurrence)„_ S 100,000 CLAIMS-MADE EllOCCURMF-D EXP(Any onn parson) !F - 5,000 _ PERSONAL&ADV INJURY S X Business Owners GENERAL AGGREGATE $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIDP AGG $ Pao- - a POLICY LOC ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ✓R (Ea accldonU ANY AUTO BODILY INJURY(Per person) S _ _ ALL OWNED AUTOS BODILY INJURY(Per eccldenl) S SCHEDULED AUTOS PROPERTY DAMAGE S (Per saddent) HIRED AUTOS - S NON-OWNED AUTOS 8 UMBRELLA LIAO OCCUR EACH OCCURRENCE >F EXCESS LIAO CLAIMS-MADE AGGREGATE - S - _ DEDUCTIBLE a RETENTION $ WORKERS COMPENSATION T,ORYJ,WC STATU- 0TH, - AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERlEXECUTIVE Y f N E.L.EACI I ACCIDENT 8 OFFICFRIMEMBER EXCLUDED? N I A (Mandatory In NH) El.DISEASE-EA EMPLOYE S _ Ifyyes,deecdbPERAnONS holow e under E.L.DISEASE-POI.ICY LIMIT R DCSCRIPTION OF DE8CRIPTION OF OPERATIONS I LOCATIONS I VEHICL@!B (Attach ACORD la1,Additlonnl Rnmerks Sehedula,if more space In roqulrod) fax to 978 688 9542 CERTIFICATE HOLDER CANCELLATION TOWNNAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANOE I.LED BEFORE Town Of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL Be CI_LIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St Bldg 20 2-36 , N.Andover,MA 01845 AUTHORIZED RBPRE$£NTATIVE you as G.Soderberg ©1988-2009 AC A CORPORATION. All righ"s reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD •- z COMMONWEALTH OF MASSACHUSETTS • ELECTRICIANS REGISTERED::WASTER'ELECTRICIAN ISSUES THE ABOVE LICENSE TO: C DAVID W 'MEEH`AN G MULBERRY DRTVE PEAGODY MA 01.960-464 s � b 7/91/13---06483 Location lob h'i�1Z No: . /S! Date WK-24-4 195;L ` t NORTH TOWN OF NORTH ANDOVER 3 ..._, o� A Certificate of Occupancy $ r . Building/Frame Permit Fee $ e� 4 �+s',^°•'•ct' Foundation Permit Fee $ s�cMU x; t Other Permit Fee J'gu $ Sewer Connection Fee $ Water Connection Fee $ i �P TOTAL $ A?12t- ,�j Building sn pector 374 25.oa gain t '1 9M i n&OK.), iv. Public Works PERMIT NO. ISI APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. V PAGE I MAP i-40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONE I SUB DIV. LOT NO. LOCATION 90 V./ PURPOSE OF BUILDING Q� , OWNER'S NAME I_ ) `if NO. OF STORIES 2 cTL �_' r6 § (/V _ �c SO OWNER'S ADDRE S BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME 1 A ✓y SPAN DISTANCE TO NEARES BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND w WILL BUILDING CONFORM TO REQUIREMENTS OF CODE / IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY Cs IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COSZ R i1r.h PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COSt PER Q. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLA�F. MUS BE FI/ tDD A;NDaPP OVED BY BUILDING 1 PECTO DATLE BUILDING IN8P[CTOR ISHO OF OWN R UTR AGENT �- OWNER TEL.# PERMIT GRANTED CONTR.TEL.# �, 9 7 CONTR.LIC.# o H.I.C.# //,,?0 / BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _ - LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS - RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE d t 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT AREA FULL FIN. E'M'TAREA _ y. '/' /. FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS i CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARD"J'D ASBESTOS SIDING _ COMMC:N VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAMESUPERI_ ADEOUOATE I� NONE - 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) _ GAMBQELAMANSARD TOILET RM. (2 FIX.) FL — AT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS 01L B'M'T 2nd _ ELECTRIC let 13rd 11 NO HEATING OFFICE s'OF: i20 Street .�- . --._ APPEALS >`r ..y; = NORTH ANDOVER = ` worth dove:. BUILDING t ;e - MassadhtL5eft5 O t 8-LS CONSERVATION Dri1StON OF HE.-kLTH -- s't1a.��t�c PLANNING & COMMUNITY DEVELOPMENT _ KARE'r`HLP-`EI_.SO`. DIRECTOR -- -- - .. -- In acz_-rdzincc with the r:vSiCC.S ^,i .'ri`^c:, S S C7n'.'li CR 61 BU1Iding Permit Number /S/ a s th t .,. ".ris resaltinQ frcrn the _work shall be disnosed or ;.- a orcne:, -s= --CHd ;ast �s^ _. :a_.. .� . ^s- �t•• :s ... ^d by �tGi. c iII. S :f0. i ne debris will be disposer' of in: ..:crier•. of .-ac: it,l i` , icn- e of PC, licnt Date NO TZ' Demolition permit fro= the Iow-u of :forth Andover must be obtained for this project through the Office of the Building Inspector_ n. a .d 0 R 6fth r - h: An over o il�A;, -- Forth"Andover, Mass., Pw195 ' �.:, > "c D 3 BOARD OF HEALTH ER Food/Kitchen cM 0 BUILD Septic System BUILDING INSPECTOR Tits CERTIFIES THAT...P?....c� 4ZL'...................... ..:: ?.R: .f . .... ..... .Y2N... S...(iJn!t!�.1..•. ., ,!vc-............... Foundation iizs permission to AW....... ........... bu idings on ..... ........ .. Rough . . 1 . 0 � Chimney as g ........................... that the person acceptinc its perm; ;iis,' Every respect conform to the terms of the application on file in Final th'i4 offlice, and to the provisions o` I:ie Cod(s .;s -Laws relating to the Inspection, Alteration and Construction of suilui�igs in the Town of North Ar� giver. PLUMBING INSPECTOR V=.CLATiON of the Zoning or Buildin j Rcr-,:i' ': --::;s :i ;s this Permit. Rough _,.{ 1 _-� Final - - ELECTRICAL INSPECTOR Rough .................... ... ....^................................................. ............................ Service BUILDING INSPECTOR Final ,.") 0; — _. -- _- - --_---- GAS INSPECTOR Display in a Conspicuou F € i" on the Premises — Do Not Remove ugh Fnal No Cry Mall To Be Done FIRE DEPARTMENT Until Inspected aRR - pff J,YUiv,ed by the Building Inspector. Burner Street No. Smoke Det. J �i8iC dW.N3(1H!3W aoldalswiwav Vol vzc J RBSTRICTIOAs, 00 ' DEPARTHENT OF PUBLIC SAFETY — 00 - None Licensed.:.- CONSTRUCTI(" pUPERVISOR 1A - y"0°r' onl; Nlaber` ExpiresBirthdate 1�1a�i1 ::, CS 040305 06/01/1991 06/01/19�� BYRREs z! 214 HAMPSTEAD ST — coMMLSSIONER "(BTHIlEN, Mf 01844 — t.. f-ER'lAIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE i MAP NO. LOT NO. 12 RECORD OF OWNERSHIP IDA'T-E BOOK PAGE ZONE I SUB DIV. LOT NO. I_ LOCATION �j 1� / j L�� PURPOSE OF BUILDING OWNER'S NAME !�1,yd f /7 / NO. OF STORIES / SIZE OWNER'S ADDRESS JG {'JiJj �/ BASEMENT OR SLAB ARCHITECT'S NAME / 1 K SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING30 / DIMENSIONS OF SILLS mak' DISTANCE FROM STREET `�0 f POSTS DISTANCE FROM LOT LINES-SIDES J J"�/ REAR /,iyR / GIRDERS AREA OF LOT / jFRONTAGE j� f HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW �-( SIZE OF FOOTING X IS BUILDING ADDITION !n MATER;AL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND n, lcel- WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER' BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE�q INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST / y/ v & PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND AL)PPttROBY BUILDING INSPECTOR DATE FILED 5J L/ BOARD OF HEALTH SIGNATU OF OWNER OR AUTHORIZED AGENT FIE E PLANNING BOARD - PERMIT GRANTED y19 BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTSRAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION $, . INTERIOR FINISH CONCRETE 3 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW'D _ PIERS PLASTER DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/ '/i '/. _ FIN. ATTIC AREA _ NO B'M'T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH A ASBESTOS SIDING COMMON SIDING HARDW'D _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BLK. _ STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR POOR ADEQUATE ADEQUATE NONE 1 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.( — GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES ,k LAVATORY _ WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER ! ROLL ROOFING MODERN FIXTURES TILE FLOOR - TILE DADO 6 FRAMING II 11 HEATING I WOOD JOIST _ PIPELESS FURNACE c:Zt, .,., FORCED HOT AIR FURN. TIMBER BAO.&COLS. STEAM it STEEL BMS. & COLS. HOT W'T'R OR VAPOR j WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS { 7 NO. OF ROOMS GAS 1 OIL B'M'T 2nd ELECTRIC 1st 13rd I NO HEATING I { N° 3 3 9 Date .� C./ ................ NORTH °ft"`°:• °� TOWN OF NORTH ANDOVER �r • p PERMIT FOR WIRING ,SSACMUS� Thiscertifies that ............. .�...................................................................... has permission to perform .............................................. �,. wiring in the building of... ............................................... at..�/(?.......�.: '.`.:5�...� f........................>- ' North Andover Mass. .......... . r � ' Fee..................... Lic.No.1.�::'..z�, ......,... ...:.... -..............:- ....................... f �` ELECTRICALINSPECTOR Check # Z ,l 2!,5, C/ WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts OMCW Use Only •' - - — Department of Fire Services Permit No. I a, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked�j— [Rev. 111991 mve blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Mamchusetis Electrical Code(h E4 527 CMR 1200 (PLFASE PRINT IN INK ORYPE ALL ORMA7I0M Date: —1"1 City or Town of: 1 AMok—r To the Inspector of Wires: By this application the undersigned ives notice of his orintention to perform the electrical work descnbed below. Location(Street& mber) O W60A Owner or Tenant r Q Telephone No. —6 (0 0L Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of vires. No.of Recessed Fiftures INo.of Cert-Susp.(Paddle)Fans No.of Total Transformers KVA No. of Lighting Outlets INo.of Hot Tubs Generators KVA * No.of Lighting Fixtures.. . (Swimming Pool Above ❑ in- ❑ o.of tmergcncy Lighting rnd. ornd. Battery Units No.of Receptacle Outlets INo. of OR Burners FIRE ALARMS INo. of Zones y No.of Switches INo.of Gas Burners No.of Detection and Initiatin-Devices No.of Ranges INo.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers (Heat Pump Number I TonsKW No.of Sclf ontarned Totals. Detection/Aierting Devices No.of Dishwashers Space/AreaHeating K-WLocal ❑ Municipal [I Other Connection No.of Dryers Heating Appliances K-W ecunty ystems: q No.of Devices or Eouivalent 1 No.of Water I{S�' o.o No.of Data Wiring Beaters Ballasts No.of Devices or Eouivaient No.Hvdromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eouivalent OTHER + r+ Attach additional detail if deme,4 or as mquUed by the Inspector of Ifires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless j the licensee provides proof of liability insurance inciudmg"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has odiibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [I BOND E] OTHER ❑ (Specify:) 1 (F—,q=uon Date) Estimated Value of Electrical Work _$ ('When required by municipal policy.) Work to Start q —U I Inspections to be rested in accordance with MEC Rule 10,and upon completion. 1 certify,under the pains and penalties of perjury,tharthe infornmtion on this application is true and complete.- FIRM NAME: ADT Security Services Dt; o.l 7 s NH 03049 LIC NO.: I533C Licensee: John S.Bassett Sigrtatu IG NO.: 1533C (Ijapplicable,enter"ezentpt"in dieGeetuenrrmberGne.J Bus.Tel.No.:J03 594-5900 Address: Alt TeL No.:_603 594-5928 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 :] lLLphone No. PERMIT FEE: S 35•�