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Miscellaneous - 195 CANDLESTICK ROAD 4/30/2018 (2)
/ 195 CANDLESTICK ROAD 210/106.A-0206-0000.0 I I i I i I� I �lDate.. . .. . . ... .. . . E 40RTm o? TOWN OF NORTH ANDOVER D • - X PERMIT FOR GAS INSTALLATION �,SSACMUSEt t [ This certifies that C' .k.1 . . . .V. .'r' ^. . . . . . . . . a has permission for gas installat�jn .'Q ?� . °'A p . . . . . . . in the buildings of . '0t,,. 1. l�•`�-r?.��. . . . . . . . . . . . . . . . . . . . at . . . .��`. cass Fee .-P /.3.5/-5 Lic. No. . . . G ri � � . GAS INSPECTOR s, Check# 2G 8142 r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ( � I. MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAME _ GOWNER ADDRESS 1s - TEL �J FAX PRPINT OCCUPANCY TYPE COMMERCIAL[�_( EDUCATIONAL ® RESIDENTIAL CLEARLY NEW:® RENOVATION:Fl- REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO n APPLIANCES 1 --FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER -- COOK STOVE I l - -J I__j . .. ._( _I 1 � _ DIRECT VENT HEATER ) _7731 DRYER FIREPLACE _ !II FRYOLATOR ( I I�� �_ I I FURNACE � GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS __. �— _I i_._-(- - 1 .�l - f I3rr ._(L,-J ( -1 -_i►S7 MAKEUP AIR UNIT OVEN POOL HEATER TJ (u �J —J I ( ( I( rJ �T. [7D ROOM/SPACE HEATER ROOF TOP UNIT - TEST _TI UNIT HEATER UNVENTED ROOM HEATER h_ , L--11 WATER HEATER THTl1 OER �-11� - -(� �._ _- �-_ - •� - - -- - --...�---- - -�� ��l�--.�-I L_.�.�= it� I i� _1� (�..r�_ I I I z�r_ _I i_�1 i��J_ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent hich meets the requirements of MGL.Ch.142 YES _K01[�!� I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY I BOND i_� OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNERS ]_J AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P inert rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUM BER-GASFITTE R NAMEQ ^� LICENSE# J3S�1 SIGNATURE MP MGF0_( JP D JGF _; LPGI CORPORATION ___ 2 f8-O__�PARTNERSHIP - #�_.��LLC�-I#= COMPANY NAME:--S .. - _._.._— ADDRESS 1 __ #�~�- e-_--------- - - - ------------ ----aJ CITYr - i STATE ZIP Q�I �TEL FAX CELL EMAIL The Commonwealth of Massachusetts Department of Industrial Accidents Office ofinvestigations ..600 Washington Street Boston, MM 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Les>lbly• ' Name(Business/Organization/Individual): Address: City/State/Zip: !S�" Phone#: FAV-reyouemployer?Check the appropriate box: employer with 4. ❑ I am a general contractor and I Type of pr ' ct(required):' ees(full and/orpart-time).' have hired the sub-contractors6 ew construction2. I am a sole proprietor or partner- listed on the attached sheet t ?• ❑Remodeling ship and have no employees ZWe sub_contractors have working for me in any capacity. s' comp,insurance. g' Demolition 9. ❑Building addition j [No workers'comp.insurance 5. 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 myself. � g ep additions y [No workers comp. C. 152,§1(4),and we have no insurance required.]t 12-ElRoofrepairs qu ] employees. [No workers' comp.insurance required.] 13-El Other j "Any a_licant that checks box#1 must also fill out the section be? o�="`o;'';" " r Lionpo ,z7formafion T Homeowners who submit this affidavit indicating they are doing all work and:" then 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 and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my information. employees Below is the policy and job site Insurance Compiny Name: Policy#or Self4m.Lie.#: 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. Ido hereby certify under the pains and p aloes ofperjug that the information provided above is true and correct Sitmature: �, Date; Phone#• 7,fL S 176 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/I.icense# Issuing Authority(circle one): I.Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: " Phone#: j 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 employe;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 orrepair work on such dwelling--house-. --. - --.— - or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be employer." PP 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 coxnpliance 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=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. B6.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 ret'�red to the city or Shmu that the 1 lA a t;fn.for the pe-- i`- r"License;is atnn P � g tP' t �e re. Tit to tilrb 41,46 FUp FiCi.-�i .1,S�L o l:s�yi,�.� bt,—a rexpestud,����_ � '��T[.Trie_a�(1f 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 parnit/license applications m 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 homeowner 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'liike 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 Commonwealtlz of Massachusetts Department of Industrial Accidents Office ofInvestiptitons 600 Washing-ton Street Boston,MA 0211.1 Tel. #617-727-4900 ext 406 or 1-877-M.ASSARE Revised 5-26-05 Fax 4 617-727-7749 wT rnass._govfdia t Date.. .... ...... ...... I NORTH 3?°06- ;' � TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACNUS� This certifies that ................................:............................................................ has permission to perform. Tr .......................................`................................... wiring in the building of.... '''......t......�.................................................. at....... Vin........... -�............................. ,North Andover,Mass. • Fee ��.. ........ . Lic.No% �.Ff 1 �::�:: ........................... ELECTRICAL INSPECTOR ..� Check # ��� �' 4577 Official Use Only Permit No. e�evrtnrext a6 a�etey av D � S Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 5227 CMR 12:00 (Please Print in ink or type all information) Date L, CL To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number I�� CQpl�ri�e� /G�� �� Owner or Tenant �4/I� � �'3:f 4/ Owner's Address / Is this permit in conjunction with a building permit Yes EY No ❑ (Check Appropriate Box) Purpose of Building -'eon l�-�r�!C -p— Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Volts Overhead n❑ O /Undgmd ❑/�/� No.of/MM6ters Number of Feeders and Ampacity Ue-, /i//f C'i�/'© �ti cY /�O (C Cth�1� ��1� ��?�P C Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In IZII/ No.of Lighting Fixtures Swimming Pool grnd ❑ gmd Generators KVA y No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Sp ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws / 1 have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO = have submitted valid proof of same to the Office YES= NO = If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE = BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Electrical Work$ Work to Start Inspection Date Resquested Rough Final q� Signed ena ies.of FIRM NAME r/CfPGddh/ ury' /}•tet�'� �G/1^/C✓�rio LIC.NO. /��p� Lkensee�( G �.�'` /70.E 1e C/— Signature �7 / LIC.NO./�O /1 Bus.Tel No. I�� 21—6��� Address�J�l ( ��Q� i7YY�S�yNY`,//7 D��/�'AFt Tel.No. �7 3 OWNER'S INSURANCE WAIVER: I am aware that the License does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) G� Telephone No. PERMITfEE $ �J (Signature of Owner or Agent) 1� �3{ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for rry employees working on this job. Company name: Address City Phone# Insurance.Co. - - Policy# Company name- V Address . City Phone# i Insurance Co. Policy# Faikre to secure coverage as required.under Section 25A or MGL 152 can lead to-the imposition of criminal penaltiess of.a fine up to s1,5oo.00 and/or one years'irnpnsonment_as wed-as c el penalties�n2heSnun�t aBTSJP3rY9PoC9RDFRand_afioe�f ll1O OB)�tla�r me ! understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification. 1 do hereby cerhiy under the pairs and penattr-,es ofperjury that the information provided above is burs and correct. Signature Date Print name Phone.# Official use only do not write in this area to be completed by city or town officiar ^ City or Town Permith-icensinq El r Building Dept []Check it immediate response is required . LJCenSil)Q Board E] Selectman's Office Contact person: Phone#: E] Health Department Ei Other 3570 Date:?. .. .n J... i „prrTM TOWN OF NORTH ANDOVER ? '�C, �p PERMIT FOR GAS INSTALLATION i • SACHUSE� This certifies that/'.,.')r: . . . . : : . . . :- has permission for gas installation . . . . . in the buildings of : :6 at ..... .. . .. . .y. .:., North Andover, Mass. Feer. . . . . . . Lic. No.. �=. . . . . . . . . . . rt^ �X / • GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or T ) Mass. Date 2 DPermit #��70 Building LocationL Owner's Name en Type of Occupancy New O Renovation ❑ Replacement Plans Submitted: Yes❑ No (3 N G ]yL W N N W V Z Q of y Q N Q O N = �5.. O J H W h O W ~ Z o ►- < ¢ _ ? O F, s < ¢ O W < m N h it W O - 6 C � i,- G W < �, N < Ul W W 10 W Z t S Q C W < W h C h S }. z ~ = J < C ~ F' W fA m Z U. < W i W O 2. < rL < t O O W 6 O O a: y G 6 SUB-BSMT. BASEMENT 1 ST FLOOR 2N0 FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR I i+ 7TH FLOOR STH FLOOR Installing Company Name Check one: Certificate Address _ 0) FR HEATERS IN TA ERS ING, 0-- Orporation 14 DARTMOUTH ST., SUITE D p Partnership Business Telephone 7711 -73O Fart/Co. Name of Ucensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current ljcity insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes Isr No ❑ If you have checked rtes, please/_Indicate the type coverage by checking the appropriate box A liability insurance policy 0 Other type of indemnity O 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: Signature of Owner or Owner's Agent OwnerO Agent 0 1 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 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 taws. 8Y T of Ucense: VBa72BdAeq Plumber Signature of used Plumber or as Fitter Title Gasfitter ter License Number 7 y City/Town Journeyman APPROVED(OFFtCE USE ONLY) BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 GAS INSPECTOR ": y Date T. N2 E. 3 ` 0 „QRT„ TOWN OF NORTH ANDOVER p� ,�•o ,•'9qo PERMIT FOR PLUMBING Y 1SS cmuscf n This certifies that . ... . . . .... . . . . . .�r ... . . . has permission to perform.. . . . . . . . . . plumbing in the buildings of�. )�+— . . . . . . . at. . . . . . .. North Andover, Mass. Fee's?. . . . . . .Lic. No?�- © r2 # ` 7 PLUMB119 ECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type Mass. Date Permit # � Building Location / 7 r a:e7GY/j4l Owner's Name Type of Occupancy New ❑ Renovation ❑ Replacement Ql-� Plans mitted: Yes ❑ No ❑ FIXTURES Z Z Z Y Q y In O Z W Y J cn Q U ��, co O O 0 Q M W W 14 J O Z m 1- W 2 Z O0 Z Z Z a = EH 9 W Q _ w V) _ 1 ~ a LU (j) X ¢ a a a Q 3 x H > U rZ o a N Cr g a w z 0 Q W Z � a rz o LL W = ►" F- 9 Q C 2 0 lzw J Q Y W LL Y W W W .3 W < �- X O M O Q �- Z O O O K w Q O U 2 d W = O Y J m W O C 1 � S H M LL 0 O D Q � � m p 0 <x W = CC C� C!] rn SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR r 5TH FLOOR 6TH FLOOR 7TH FLOOR tr STH FLOOR +F T—T— Check one: Certificate WATER HEATERS INSTALLERS INc 3-C oration c �— Installing Company Name ,, U �H ST., SUITE D Address AAAI D&N ��� O Partnership O Firm/Co. Business Telephone_�-> 73 Name of Licensed Plumber MNT . INSURANCE COVERAGE I have a current 5abf#ty policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No O If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy cher type of indemnity O Bond O OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner O Agent ❑ 1 hereby certify that all of the details and information 1 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 Plumbing Code and Chapter �,142 of the General Laws. • ,r�fes_/_,I' Signature of Ucensed Plumber Type of Ucense:Master� Journeyman C License Number BELOW FOR,OFFIC USE ONLY FINAL INSPECTIONS SKETCHES FEE PROGRESS INSPECTIONS NO. APPLICATION FOR PERMIT TO DO PLUMBING UNDERGROUND ROUGH COMPLETE ROUGH FINAL INSPECTION PERMIT GRANTED DATE 19 PLUMBING INSPECTOR I / 9 5� ft ti I Location � � � TIC No. Date N°"Th TOWN OF NORTH ANDOVER i � Ott �•o ,•,�O r 3? i • OL a } p Certificate of Occupancy $ * Building/Frame Permit Fee $ 04 �sJ�cMuS Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ or ( fey —75-0 Building Inspector I fA - 9 8 A:4 Div. Public Works PERlIrr NO. 7i / y APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE MAP h40." �`©� LOT NO. Y 2 RECORD OF OWNERSHIP IDATEBOOK PAGE ZONE I SUB DIV. LOT NO: ✓- :.-.. : OWNER'S NAME(0n J dw y�,h w T !T►i Ci PURPOSE OF BUILDING 3 ry NO. OF STORIES SIZE� L _.. --`_ OWNER'S ADDRES O BASEMENT OR SLAB ARCHITECT'S NAME J SIZE OF FLOOR TIMBERS IST.�y N}pI/ 3RD BUILDER'S NAME �,�.C y� A ��/ SPAN 7 r "" R/' a�[ DISTANCE TO NEAREST BUILDING �W '�— 7 DIMENSIONS OF SIL�LLS DISTANCE FROM STREET rem POSTS 4 Y`57 DISTANCE FROM LOT LINES—SIVVDEES �„/� Q'7Q REAR 9s , GIRDERS Ax AREA OF LOT �9cr` Yom/ WFRONTAGE /��T-- HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW !O SIZE OF FOOTING /jam X IS BUILDING ADDITION MATERIAL OF CHIMNEY t IS BUILDING ALTERATION 'QQ IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TOR QUIREMENTS OF CODE �/',p� IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY !` IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST . - SEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. C! PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE 16ED �Ne% bA SU ILDI NO 1 NSPUCTO! O NER OR A T ORIZED AG FEE OWNERTEL# PERMIT GRANTED / CONTR.TEL#19 CONTR.LIC.# :. 4 r BUILDING RECORD I OCCUPANCY 12 SINGLE FAMILY sroRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM .• ::. .. .-...is-". MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION Q FOUNOATION 8 INTERIOR FINISH CONCRETE a- 1 2 3 CONCRETE BL'K. PINE _ BRICK OR STONE D PL STE =_ _ PIERS I PIASTER _ DRY WALL _ UNFIN, 3 BASEMENT AREA FULL FIN. B M'T' AREA _ 7. Vt 11 FIN. ATTIC AREA _ N_O B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS - (§.AP AR0$ B 1 2 3 DROP,SISI CONCRETE O $ LES EARTH _ A$PHAtT $101 HARDVI D ITE T• lDlt COMMON _ VETtT, SI01 ASPH—TILE _ ST I GO ON MMONRY' - STVCCO M4 FRAME t ' ATTIC STRS. 6 FLOOR I_ BRLC >.: N FRAME CO ._OR CE BLK. jjQMf,0N MASONRY! WIRING $T EKAE. - SUPERIOR I__jPOOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLEHIP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) — FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 6 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR _ TILE DADO r 6 FRAMING 11 HEATING WOOD JOIST t�L � FkIRTE. FO 1 ,T Aut FuRN. TIMBER BMS. &COLS- StfAM _ STEEL BMS. 6 COLS. T W'T' VAPOR' WOOD RAFTERS AIR C T Tfl 1 RADIA .O 'UNIT Y$ TE $. GAS 7 NO. OF ROOMS w. _ ..... ALL _ B'M'T 2nd Etf TRIC. ts1 13rd I '.NO 3-#BATT ORTH F Town of 0 Over 19 9-C o �LK dover, Mass., — C OC F41C ME WICK A0 RATED 4 SF BOARD OF HEALTH Food/Kitchen PERMIT T Septic System PJ /< BUILDING INSPECTOR THIS CERTIFIES THAT............................... 0!v..................... -!.........r..././/........................................................... Foundation has permission to erect.......... ......... k&kg on ......./.�.6......... 44 !�.h .S.7`1..�! ..... gat. Rough tobe occupied as................................................ .�r-C- "........................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARS ELECTRICAL INSPECTOR Rough ....................................... Service BUIL ING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. he �- Specialists" FOREMAN 0 "T FORM U - VERIFICATION FChavi /7� � INSTRUCTIONS: This form is used to verifyecessary approvals/permits from Boards and Departme have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: - 'ter✓ Ile Phone , v2i� i LOCATION: Assessor's Map Number Parcel 1456 Subdivision Lot(s) /r Street �� ( /}►��['�5 ��'° C� St. Number d ************************Official Use Only************************ RECO ATIO T AGENTS: Date Approved Conservation Adminlstrato Date Rejected Comments o s Date Approved Town Planner Date Rejected Comments Date Approved Food Inspector-Health Date Rejected Date Approved L_S�ftic Inspector-Health Date Rejected Comments Y)6Zfe A110677- -OE /j2T �.�u� �4.��A• /I/�Y ,tl��� ra -3E- 5Z/G�rc Y �/tli9CC�� Public Works - sewer/water connections - driveway permit i Fire Department Received by Building Inspector Date I ti i 1i TI I � X- rosy 10 'c,o. 'gyp W? 6•4 d c ''c� C • pLO7-* - (=o-R MoRTGA44 PUI�.hOSCS ^-�13�►.t'�E. 1. 5E O�IL.`l (56,SED UPa�I PU5UG j2Ec0RC) AUD Edf DZkCE Oex 'T;NECs�N[� ADDRfc55 544tUi>. r. 'GOLL(VA- K4.1 aSQ, "Z29. 40 , , Q 00 GO 1':,4.0 aYE :�o °� Z. 5C1� 'P .(. .� OWNERS) CERTIFICATE REGISTRY: E-k NAOZT44 I CERTIFY that the Lot shorn hereon DEED: BK. that the wELl_It-)C, shown � PLAN : fO� tS �. COtjF0264t CERT. OF TITLE; t TO _(-Ar-_ e suet Zoning `i'-L4W NOTE:.._ of -the of �• 0�/ t2. � ... . .. ._... .. .-..-- —_ The premises do not lie within ��� of by designated ,� Flood Hazard • � �i 11.0303T ; 4 Zone. ,<:., '.' = GILLETTcoorww ^, ROBERT G. GOODWIN , R.L.S. 82 -CENTRAL ST-BEETSQ ANDOVER) HASk4f •���-�tv~yr✓ � R`'�L`Y��t;1 E�'��p�'�,�� COMNO o Arm m y�p 60 Lk = a� U h S113S�a�a 13 SIVIO r By + SO ;. i ,L :. -. I a 99 rOD� � 3 -fR ENC A C,5"�X 4 /S'oa GA 7-/c 747�4 Nk Location �c�d LAN�Ie S� c Pj No. Date I j0WTPj TOWN OF NORTH ANDOVER Of .. o ,,1h O 041 s Certificate of Occupancy $ �sJA„°uSEtn Building/Frame Permit Fee $ "'/ Foundation Permit Fee $ Other Permit Fee $ p, TOTAL $ Check # C/L 41 /V, `� 54c, cr Building Inspector r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED. CcSIGNATURE: ( — Building Commissioner/Imeector of Buildings Date Z SECTION 1-SITE INFORMATION IO 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Vicer Map Number Parcel NumberV V`) 1.3 Zoning Information: 1.4 Property Dimensions: ZoningDia6c—t Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqLured Provided v 1.7 Water Supply M.GLyC.40.` ).,• 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 1 Zone Outside Flood Zone 0 Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record ham; zF - 20� c�aN�l,c << ,� ►/�.Q Name(Print) P,. ''� Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone g SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 4 Licensedf-onstruction Supervisor: O License Number mn d Address Expiration Date ic� Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v JE0 Company Name Mk U� Registration Number r Addr L�J�Y r L a ( 22. 'o DL ss <(4 !?7Pj Z I A...O PL, Z - Expir tion Date �1 Signature Telephone G) 1 y SECTION 4-WORKERS COMPENSATION(NLG.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 building permit. Signed affidavit Attached Yes.......0 No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ 7Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: m y� SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b permit applicant 1. Building � (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 7 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as er/Authorized Agensubje�prope�rty ' 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 1, as Owner/Authorized 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 Print Name Si ature of Own, er/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CH %4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE GENERAL CONTRACTING SERVICES 55A Portland Street Lawrence, MA 01843 1-978-423-7105 CONTRACT This Agreement is made between Betsy Chaitoff of 200 Candlestick Road, in the town of North Andover,MA. and General Contracting Services this day of March in the year 2002. (Description) See proposal as attached document Job Total: $ 14,577.00 b `b Deposit: $ /0 Y60— Payment: 6 —Payment: As needed Balance Based on allowances All jobs accepted by General Contracting Services are subject, however, to strikes, accidents, or details occasioned beyond the control of General Contracting Services. All sketches furnished by General Contracting Services shall remain the property of General Contracting Services and no use of same shall be made,nor any idea obtained therefrom be used,except upon compensation to be determined by General Contracting Services. By signing the acceptance the customer(or his/her representative) agrees to all terms and conditions as outlined,and binds him/herself to accept the contract in its entirety. The customer also promises to pay any and all attorneys fees and/or cost(s) associated with the collection of the amount stated herein this contract. All materials areg uaranteed to be as specified. All work to be completed in a workman like manner according to standard practices. Any alteration or deviation from specifications involving extra cost will be executed only upon written orders,and will become an extra charge over and above the original contract price. The terms of the contract are not to be varied, except in writing, signed by a duly authorized officer or agent of General Contracting Services. This contract covers all of the agreements between the two parties hereto, and is governed by the uniform Commercial Code and other applicable state laws. i Any request for a delay of said delivery of goods, merchandise, and site labor by the customer which exceeds a ten(10) day period shall cause customer to be liable to General Contracting Services for any damages caused by such delay, including but not limited to, storage charges on goods or merchandise, and General Contracting Services shall have the option to invoice customer and receive payment within ten(10) days. General Contracting Services guarantees its products for a period of one(1)year from the date of delivery against defects in workmanship or materials. General Contracting Services cannot be held responsible for damage to work after delivery to the delivery site. In any event, General Contracting Services' liability is limited to the repair or replacement at the option of General Contracting Services of such work that is defective in either workmanship or material. General Contracting Services By: Date: Edward E. Viel,Jr. Customer By: Date: U v Name: i 2 NOFCT►y Town - of � over - .4 0 �o�LA � dower, Mass. �A \� ' > > ORATED PPa�.�S . S H E BOARD OF HEALTH PERMIT T D . Food/Kitchen Septic System THIS CERTIFIES THAT......K-r-lih.........0.h..., tt .. .................................................................................... BLILDING INSPCTOR ... ... ...... .... .... Foundation has permission to erect....R.01%04*4 buildings on ..A%Q.... ...................... ..' ..• Rough to be occupied as..��.�� ..�.�.......rs.4� ....... N s ...V G A NN1 1 . 11 �1 Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. I D / 14 / 19 4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR t Rough ..........jM... . ..... ....I&......0 Service BUILDING INSPECTOR Final Occupancy. Permit Required t0 Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 i W 'ers'Compensation Insurance Affidavit OEM Please Print Name: Location: C2 cily Phone !"5 (-7 am a homeowner pefforming all work myself. �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. Company name: Address City: Phone#- suran . li Address city: . Phone# _ I s.ra . -.Co. o oli Fai[ur®td secure coverage as required under Section 25A or MGL 1.52 can teed to the ition of ainanar penalties•d a fine up to$1500.00 and/or one years'imprisonment well as civil penalties in the farm of a Slop wOt�lC OR and a fine of($100.00)a day against rne. understand that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification I do herby certify under the pains and penal'les of perjury that the information provided above is hue and correct Signature Ca ` --z Date Print name -7`Q Official use only do not write in this area to be completed by city or town oificiai' 0 Building Dep OCheck if immediate response is required Building Dept (] Licensing Board Contact person: Phone# p Selectman's Office' Q Health Department El Ofher RM WORKMAN'S CoMpENSATIOA! Date.�� ( �.I�. �.� ti "aRTM TOWN OF NORTH ANDOVER F PERMIT FOR PLUMBING 49 '�' •O•.r,o•A��S9 ,SSACMUS� This certifies that . . . . . . . ..... . . . . . . . . . . .�. . . . . . . . . . . . . . . . . . . . . . has permission to perform . - . . . . . :% . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . .. . . . . . . . . . . .+ at . . .-=`�.'''. .`. . �'�:�. . . '�... . . , North Andover, Mass. Fee.`AO. . . . . .Lic. Nom: • LUMBIZIt PECTOR Check # I 5230 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS g -�o \ Date�^ OA Buildin Location G t ��L Permi # Amount ' Owner New Renovation Replacement Plans Submitted Yes No FIXTURES Cr a x i SLRBM �15L1VIl�ir ]SI)FI" M KOCR 4IH EWOR M IIDM 6M HJOOR M HJ00R SIH FI M 1 +1 i (Print or type) Check one: Certificate Installing Company Name kkncjAy.%�u ��4 Corp. Address El Partner. Business Telephone - ��3 -W (n� Firm/Co. 4 Name of Licensed Plumber: �� � �r\ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ 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 El I hereby certify that all of the details and information IQhe tted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work an ' ns performed under Permit Issued for this application will be in compliance with all pertinent provisions of the M tate Plumbing Code and Chapter 142 of the General Laws. By: Sigiraturepi Licenseaum er Type of Plumbing License Title City/Townicee IN UMDer Master ❑ Journeyman APPROVED(OFFICE USE ONLY Location No. ^� Date l� n NOR,k TOWN OF NORTH ANDOVER 3: �� •BOOL I + Certificate of Occupancy $ f i 1 � • X01 .... !1 1'�b'•^°''tom Building/Frame/Frame Permit Fee $ sakwusa 9 Foundation Permit Fee $ Other Permit Fee $ �5 0' TOTAL $ w . -, " Check # —1117 1642' 6 �uilciing Inspecte I i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING x'his°Sec6ro ` brOff, Usle OnI BUILDING PERMIT NUMBER. DATE ISSUED: _ rn 8 d -z X l � SIGNATURE: •� Building Commissioner/1for or-lbuildings Date z SECTION I-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O I Map Number Parcel Number v 1.3 Zoning Information: 1.4 Property Dimensions: Zonin g District Proposed Use Lot Area(so Frontage R) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided l."IWater Sttppty:yl.G.L.C.40.§34) 1.5. Flood Zone Inforuntio1.8 Sewerage Disposal Systet Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of' Record Q�p + be) L�lz o6t t.es�,Zk #,A Name(Print) Address for Service a g�-622�-- O Signature Telephone W 2.2 Owner of Record: Mame Print Address for Service: O z M Sig,pature Telephone. M SECTION 3-CONSTRUCTION SERVICES 7� 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Address `d o ? - 19 - 03 J � ba Expiration Date Aign.t.re Telephone r' 3.2 Registered Home Improvement Contractor Not Applicable ❑ v +- a Company Name rn Registration Number Ad ess� ,r /3 Q 3 Let z�1.✓ p , Expiration ton Date Signature Telephone Y^ , f I 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. APPLICANT�G� Dingy 1 PHONE 6 ASSESSORS MAP NUMBER LOT NUMBER 02-0 SUBDIVISION LOT NUMBER STREETSTREET NUMBER S� OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS woman mangos G, DATE APPROVED I a CONSERVATION ADMINISTRA R DATE REJECTED i C0NOJENTS I DATE APPROVED DATE REJECTED COMMENTS DATE APPROVED F�OOQ INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS ��� �l�� l0� �.1� 11'� �'�l vkc -69 j S o b PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE a : die Comraorrw=fth of W==h=etts ro Department of btdustria[A=idey= _. off=of htvatati= 600 Wasiiington Sheet Boston WA 02111 Workers'Compensation Insurance Affidavit APPLICANT INFORMATION Please PRINT Legibly i.. Gt✓t L "� !J D,moi �trt/� Name: �f Location: U City: ©2T M Telephone#: 7 g 7 0 I am a homeowner performing all work myself. 0 I am sole proprietor and have no one working in my capacity '9I am an employer providing workers' compensation for my employees working on this job Company Name' pp Address:_ 7D City: -�,.,�w�-e e_✓I,P.G ` ' Telephone# q?& TI`�'� Insurance Company: s� `•'its Policy#: T� 1,5� � 0 I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following. 1. workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy th Company Name: i Address: City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can I.-ad to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information above is true and correct. PSignature: Date: 1 d _ Print Name: ��i� � ''fes I � Phone# Official Use ONLY-Do not write in this area ❑Building Department Permit/License#: ❑Licensing Board City or Town: o Selectmen's Office o Health Department 0 Check if immediate response is required o Other INFORMATION&INSTRUCTIONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law" 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, em to g gP Ym 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 s ersons to do maintenance construction or repair work on such dwelling house or on theounds or building a � g urte Want thereto shall not because of PP such employment be deemed to be an employer. MGL chapter 152 section 25 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, 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 in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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 applicationlication forthe permit or license is being requested,Mot 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has p7ovided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you,regardinj the applicant. .Please.be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in.advance for your coo eration and o Y p 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 Fax# (617) 727-7749 Telephone# (617) 727-4900 ext. 406,409, or 375 r6 AWED. CERTIFICATE OF I IABILITY INSURANCE U1J29 ZooZ (617)946-5000 FXX (6InE46-3108 ONLY AND CONFERS NO RJOWTS UPON THE CMAYWICAT E111ot, IMIIit#ier,:Hardy.& Roy MpLpE►t. THIS CORMICATE 00EI3 NOTAM00.9XTEND OR ? �nourance AWcy I Inc. ALTER THE OVERAGE AFFOIWED BY THE POLICIES BELOW. ;ir'putnam Street r INSIUREN AFF001W COVER,40E Ni»thr"i MA OZ152 y F30-1 a Paili n., TME (NOVAIRk Amrican Casualty Co. South Broadway INIURER a PLAN--AWArrM ASSIGNMENT "Lurre»ce, KA 01841 INIUnER C: � INJURER D: THE P�LICIEI OF IN8URER E: IN$UFtANQS LISTED BELOWA F,5U R THE ICY PERIOLI INOICAM.NOMMSTANOM ANY PZUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHdR DOCUMENT WtTii RESPECT TO WHICH YHIB CERTN'Iw4T6 MAY NE ISSUED OR MAY PERTAIN,THE tNBURANCe AFFORDED SY THE POLIG1E8 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCI.UVONSAND CONDITIONS OF SUCH POLICIES.AMOUGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA10 CLA ML TYPE 00INSURANC9 POLICYNUMIIR ) PAW UMIrs f x+� 6W1uaur 1630 11131/ZOQl 32/31/20QI 60GµOCCURRGNOL o 5000 M� cm ' € ' QCNMPCIAL GBNERAL UABIUri t SIR!D+WIAo1(Ani 0"In) J �� i CLA ms gal.a DG.UR I M40!!<P(My oro P~) : $ x P[REONAL S ADV NIJURY 1 $ 10 • r OCNIRAL AAOREOAT9 { 100 av ra ►RODUCTI.COMP/OPA00 t 0000 ENKAOORICATt LUT APPLU PIR: AN WN 3 3 - 'IOLIOY ;., JICT LOC iAu1oM011utJYlOillrT 7 1 4 11/31/x001 1x131/Z002 oOmoNect►Ncu¢uw t�noeld�IdJ * MV AM ( 11000109( '} '� ALLOVVN6OALIT05 ODYYWiURY S :rte IOHICUI.m AUTO ` ) ow X .�+ ;trek S �I : ` )( )IRIOARO>Z JODILYINJ)RY J ` NONP"10 AUTot t"°` -f 4i ~ PN J Ck�eMi 0 AUTOONLY.IAACOIDENT I GARAGE LWUaTY MY AUTO OTHtsR T" lA AOC s } ` T AUTO only. A90 i '.'§A.?...,. ,ASR ,eAo►+occuaRence I I enoyl LIAlMlTY 3Gomm C:]CWM$WAOS ADOREOATG i j 0l0UCTIILI S „�...�. III1"6NTroN J J wO�KvatcoMp-1-9 noNAND t6X65880Z 01/09 1041 Ol/09/2Q03 I(YL WAPLMW UAIULm I'L IA:MVCIOINT 600000 9 e1.OI31AJI-PAGMPLOY[ a 14pd0$ E.L 018SAIE•rOLIOYWIT 6 10-0 I i t - I � 4. AD0MaNAL IN8UNQD;INJUROR LMfTt1 —CAN-- LA i SHOULD ANY OF TW A10VE DUNOW POWs$so CANULLSO WORR TNI EEO t%MMTIDN OATi THNMOF,TWI 13SU INP COMPANY VNI.&IDGAVOR 10 MAIL ,. Ir OAYJ"mmun IYOT+CQ TO TMJ GIATN�IOAT/NOLOQII NAMIO TO SME LtFr OUT pAJ 16 MAIL JV01l 0=10dl HPOA No cmuGArm ORLIAON.ITY r+ ATIVN6 4 � u S�t•�{ pF D UPON TWA ,tT; tYTO +y A Il+formattio»,PurposasL.U»ly . . itM y a a Ara S3 42 zx' 7 { w!1' ✓4 `d Yr + :T +'t I �� a k� `�m u..taw b8, .4. w,.+A.t �43+a€ 1 i°9 rtI,K&p,� t 4r ar s.� ws # iw ee��� • i v v r v v v v a v r v ,�• r_ v xb a ad+v Id � • ..a" Bcseri of Building RtSulsflons,and 8tmdartts License or registration valid for individul use only OONTRACTOR before the expiration date. If found return lot <' Board of Building Regulations and Stmtdards ettV3i$ "1 one Ashburton Place Rm 1301 Boston,Na.02108 Soar ZZ— ..... ..�.. .. Administrator .Not valid wllhoul sIQ ( c � f o 1./d' r t4414n and s License or registration valid for individul use only .� before the expiration date. If found return to: IMIM R Board of Building Regulations and Standards tlo0l a « One Ashburton Place Rm 1301 o OZt3t1g; p Boston,biar OZi08 HOC kt d a tot Not valid witbopt signs. re 7 i registration valid for individul use only r Board of gdia uladotswild 8ta rets License or reg before theexpiration date. If found return lo. r 4,HCBIB 1fP V iVX' NIRA TOR 8 8 Board of Buildin Re mations and Standards t t One Ashburton Place Rat 1301 tl&u: 0210M Boston,Ma.02 108 fid„ Y I0 : polde OmpWaWn P ditlfr B'tl hf B INC ofA Nvt valid without gnature � \ ?� a�`Adatiatstitttot f F? 2 z � 4+ a «•j � �x,31 � 4 +,d��� � - vF Board of Building Regulations qq s One Ashburton Place, KM 1301 Boston, Ma 021 08-1 61 8 License: CONSTRUCTION SUPERVISOR LICENSE glg; 07/1971 r Number. CS 010330 Expires:07/192003 Resbicted To: 00 WILLIAM C POULOs - 70 S BROADWAY LAWRENCE, MA 01843 Tr.no- 11987 Keefe top for receipt and Change of address noUhm*iwL 5 12 rt BOA"im Mm"11180S fpc Re"Iscud To: W, dei , t .r x y t� 3 I � rkt al I , i r� a . h � c 8-8'Plain Panels(08-009-5) 3-4'Plain Panels(08416-5) ---F 2-2'Plain Panels(08-018 5) LE F G H J K J 4-2'Radar Corners(08-141) 17 Tunnbadde Brutes(08-214) SIZE A t3 C D E F G H J K l 1-Steel Hardware 10t(OB-204) �:ff Ili' s2• r rs- r te•, s•r 4•e' V6' 7' <•r 8• ,4• 1-16232 Straight Coping Set 6-Racers(10-001) t&• sr s•b- r4- r i4• s•s� rem �•�a r rr 1-2'Was Coping Emu Set(10.138) FM um 1-TO[bier(see options below) BRACE f.----moo--� g' 6'Sten-Remove 1-(08-009-5)8'pard and n,�oa.E s 1-(08-016-5)4'poneL insert 1-(01-006)6'step, * 2turCH17 brace. and 1-(08-214) PANEL—. 8'Step-Remove 1-(08.009-5)8'pond andKAM �+►�+�+ 1-(08-016.5)4'poneL insert 1-(01-002)8'step, 2-(08-018.5)2'panels and 1-(08-214) tundadde brace z-+ +eaf y so STAKE Replace 4-8'pain (08-009-5)Nick V ^' cno+ErE 1-8'slara er (08-011-5) wr t ' 2-8'inlet pooch rob-010-51 ovT+ 1-8'light panel(08-012-5) G H W rye. f:. }: t t k i. .. `� •.'.-+�,' �>xYi ''�x1r ,e_.,FF7`K.'#1r,. �.,�° L-�r t + r r ai a { 3z NSPI TYPE 11rd MI ALMAIIMR� '` e :y">s�. R N �r rV t r'• 'u` 7"^mss''' as,;z's'i ;ynt' ,.+'�S'. arm Mt TOPAZSTRUNG-1f ti _ r z r � (03-R03-Z) (03 M2) r len,C' ° tF, r:' .,a, *rS�.' LION DMNG LIKER5 -- }:Awin�firi poo is*�,.. .:rpenr y e...is du mwry todmge ad ser asr �+a " H-6 03.840.2 w: °.r+o o1v�G:an.np tae..e.o�ap.y a.a�a z .• • . ri�5 DO�Q rR�R aua�w RlRi06�S Onl1G e �.�w.�dr�aebs+a�m. Tia daa�rs� .JrtrNk�isiei �`••. Yri•,r■gp...d.�:uw�w�ewdsd•irndel�+dl paei; :. m+aoura�+.w......po.i y.�..w'" _ - • i drag 6oarrL er fGd�ser b ra.wrl.+ii�icer perch pLara.. t �saapi►.liiiar�_ ��� arm++e •� s ,,,,a x� � mri��sMoew/•iiraesr ad�Neiiad ape i ��� ,7, OEM Yin's wMM radord. b •1dw m�r>•Parr for iioesoias m�wn�r�/1�1 a.+w"M ►orw.ed/� er � _.. -7b"'�'�i .r.r:.av11 `�" M.IMM.�{.�1♦3r1a.V���Y'-7a��e�e' 'Y ir: ... 'G'�..t�lY�! .- -. ''t 'M111,111a >..� �- ��;r,;F�r', M' ' � - _ kr'E+•s«�tt wmc�d . rs .,,�' " ,;>.. ...T,�,, "�'..aa'•a"" , :t:s... _ s,„.r��aaay •c.'�i �. s ...xs. �,..�.�^'�a`� � .-:..-,,, - .., -;. .. �.:. ..,, .;.«-_. ..�,,�i'.�,+ f�edF :_$bt".' '2ar1�'�{}:r. a� s�ti�... ._..r ._ _.•._ �s a^.c".. '"s.�._..�` .x,.._�.._..�. L^3;vr', ..:a'��- ���' � FAMILY Pools & Patio, Inc. CSL #010330 HIC# 118204 Sales• Service•Supplies WC# 156942897 70 So. Broadway• Lawrence, Massachusetts 01843 LIAB#C0164095968 Tel: ( ) 688-8307 Fax: ( ) 688-1949 {+ NAME t Z DATE ?'� 0 Z- 20 i ADDRES CITY STATE 4SS ZIP TELEPHONE ." b YS Res. CROSS STREET Wk. EST.START DATE EST. COMPLETION DATE • PROPOSAL • h We propose to furnish and install one X04 x -to F-J e-0--.0 e.e .*_ CI'. swimming paoi f e sum of:$ The rice for normal installation.consists of: Nine hours total machine time including two trips for excavation, backfilling, and rough grading around pool. Use of one dump truck for six hours for removal of fill during excavation•Installation of pool with filter and wall skimmer. The pric does not include: tv^1 Any machine time over nine hours, additional machine time to be billed at( / per hour•Any trucking over six hours, additional trucks to be billed at(I o) per hour•Any dumping costs incurredd for disposal of ledge or large rocks Re-seeding of,grass around pool•Spreading of loam•Trucked In Water•Patio or fence around pool or any accessories, except as noted below•Additional fill, if necessary,for proper backfill or reshaping of hole•Disposal of large rocks Fuel Connections•Heater Venting•Fuel Storage Tanks• Permits•Damage done to sprinkler systems or any buried items(ex.dry well, electrical lines, cables, etc.)in the access and pool overdig areas. Stu ing and removal will be subject to an extra charge. W er or soil condition (ex,clay, peat, live sand, excessive rock,etc.) requiring Min. �Utax. stone pack of the hole will be subject to an extra charge of z4_1 _ c�J se of the above will be at the discretion of the job supervisor. Customer is to supply access for all trucks t is t e owner's responsibility to obtain the building permit or to assume the costs of necessary permits. • EXTRAS • • CONTRACT• Vacuum Cleaner LQ:te Steps 49 � Ladder(s) (2/0 _,�-�" Filter P$A pA Diving Board with ) ^'� Chemicals Liner Maintenance Kit Coping Lifeline Spa Main Drain Miscellaneous ) Solar Cover { ) Miscellaneous Fiberoptic Light ( ) Heater Agx4Towt R 11 OW ) l l !"f Q7 OTAL EXTRAS _SCt-acl-W Slide ( ) r BASIC POOL PRICE Caretaker 99 Pkg ( ) Environpool plus Pkg ;W 3 4� SUBTOTAL $ '( 3 w Environpool Pkg ( ) Polaris Vac Sweep ,rte 5%MA SALES TAX 3 Polaris retrofit only Inline Chlorinator TOTAL $ —7 { ❑ Patio, Electrical,or fence,see attached LESS DEPOSIT 5%minimum Z3 2 3 BALANCE OF CONTRACT $ PAYMENTS: 1/3 Excavation, 1/3 Backfill, 1/3 System Start-up The buyer hereby agrees to pay in full,the total amount of this transaction upon start up of installed pool.You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Credit card payments not accented on co r�t�mou�nt BUY --.�, 1 vim., R C'o SELLER CO-BU SECTION 4-WORKERS COMPENSATION(NLG.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 building rmit. Signed affidavit Attached Yes....: • No.......0 SECTION 5 Descri tion of Proposed Work check all a Hcable New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: (/u i AA AN 1 ✓lR SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be b CIAO IISE`ONL Y Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) / 4 Mechanical HVAC f V f r 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 I,..Ja,yV,4—� V(' C" ,as Owner/Authorized Agent of subject property Hereby authorize t^` C �S ` � to act on Mybe a r, in all matt rss rellaative to work authorized by this building permit application. AW d 7s Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property r Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Na Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINMERS I ST2ND 3 FLD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUH DING CONNECTED TO NATURAL GAS LINE °"T`'"MN°DYM AC-ORD. CERTIFICATE OF LIABILITY INSURANCE �gR FAMiL--4 O1 17 $ PRODUCEn THIS CERTIFICATE IS ISSUED A;$A MATTER OF INFORMATION ONLY AND CONFERS NO FLIGHTS UPON THE CERTIFICATE C.J.McCarthy Insurance Agency,Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR C/O Piazza Ir Wance Agency,Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIRS BELOW One Elm Square, Andover,MA 01810 ._ INSURED INSURERS AFFORDING CO}ERAaE NAIC# ..... INSURGR A; M Insurance FM:Lj p001B & patio Znc• INSURER B: American IntIp�ational Grou 16 11 & Ci.ndi GianopoTaloS INSURER C: S. Broaewa Lawrenc* MA 42843 INSURER D: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W141CH THIS CERTIFICATE MAY Bc ISSUED OR MAY PEWAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF.SUCH POLICIES.AMPGG'ATE LIMITS SHOWN MAY HAVE QEEN REDUCED BY PAID CLAIMS, MR LTR SRLE TYPE OF INSURANCE POLICY NUM86R LfGY EF ATE IMWDDIYY DATE M i LIMITS GENERAL LIABILITYi EAChI OCCURRENCE $1000000 _ A X COMMERCIAL GENERALLIABILITY 01098398230 12/31/02 12/31/03 PREMISES Accu s 100000 CLAIM$MADE �OCCUR MED EXP(Arty one pen) $10000 X PD Dee $2R X Blanket Addl Ins. 5ONAL&ADV INJURY $1000000 I L7OEPNERALAGGREdATE S 2000QQQ -77 GENLA6[#tEGATELlMITAPP4JEBPtR PRODUCTS-COMPIOPAGG s2000000 POLICY X JECT 17 LOC AUTOMOBILE LIABILnY A ANY AUTO Tait 12131/02 17/31!03 (E rc,aernslNeLe�e�R s 1000000 ALL OWNED AUTOS .... ..._...._......._ X SCHROULED AUTOS (Per 1ILY INJURY 3 X HIREOAUTOS _ X NOWOWNED AUTOS BODILY INJURY S (Per cuAdcM) [PROPERTY DAMAGE G (Plr�ccidenl) GARAGE LIABILITY ANY AUTO AUTOONLY-E'AACCIDENT 5 —••• GThR THAN •' ' ACC! S uTroo A ONR I — LY: AGG B EXCESSIUMBRELLA LIABILITY E . OCCURRENCE OCCUR E]CLAIMS MADE — AGGREGATE $ r DEDUCTIBLE •— a .•.•- S RETENTION s -• 0 WORKMC COMPENSATION AND B EMPLOYERVLIABILITYTO LI ITS BI I GR _._._..._... AMY PROPRIETORMARTNER/&XrCUTNE 12/31/02 12/31/03 E,l•'=ACHACCIDENT: .•"' $100000 OFFICERIMEMBER EXCLUDED? . x yesdes�beunuer 1,LDISEASE•EAE,(vIPLQYE 100000 AL O'niERE.L.1$EACE-POLICY LIMIT 1)500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VBkIC1l/E 0LUSION AADDED SY ENDORNIEMENT ISPECIAL PROYIEON9 C For Informational pnrpose,D only. I i CERTIFICATE HOLDER CANCELLATION SHOULD NOMORT* ANY OF THE ABOVE OpSCRIBEI POLICI 66 6E CANOE,I FA BEFORE THE EXPIRATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAY¢WRITTEN NOTICE TO THE CERTIMCATE HOLDER NArdEO TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OGLICATION OR L1AB[LITY IUND uao THE N • tNSURtR,Ors A6�IVT3 OR REPRESENTATNES AUTNORI2�REPRESENTATNG R [The-Piaz' za Ins. ACORD 25 20 1 ( 0 108) •r UJ ACO RATION 19M C.J.MCI,"ff:h WORM I Tl)OFA nVT T'V1 V QkTT V77FTI Cn73Irlsala VVJ r7•nT TVJ hA/1T/Tn 9,4e -Commowevewa Board of Building Regula ions and Standards One Ashburton Place - Room 1301 � a " Boston. Massachusetts 02108 Home Improvement:Contractor Registration Registration: 11.8204 ^i Type: Supplernent Card s .fii Y� Ii it tff, . Expiration: 2/13/2005 FAMILY POOLS & PATIOS INC `.a .. �' ' ; GLEN WIGGIN. 70 S. BROADWAY f:, r':,• LAWRENCE MA 01843 ' Update Address and return card.Mark reason for change. j Address E] Renewal ❑ Employment F� Lost Card -- --.----- - - -._ . __. ._.. _...- -------- - - - to ard --------- - -Board of Building Regulations and Standards License or registration valid for individul use only. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registratlari_.:118204 One Ashburton Place Rm 1301 j Eitplratfori 2/13L2005... Boston,Ma.02108 Supplement Card FAMILY POOLS$'PATIO' S�fNC a '. I -- GLEN WIGG N .70S.BROADWAY {J LAWRENCE:; MA 0.1843 . Administrator Not valid without 4#jne Board of Building Regulations s one Ashburton Place, !gym 1301 os B ton, Ma 02108-1618 . _ License: CONSTRUCTION SUPERVISOR UCENSE Birthdate: 07/1911960 Number. CS ' 010330 Expires: 07l192003 RezTo:a- 00 WIl.LIAM C POULOS 70 S BROADWAY. LAWRENCE, MA. 01843 Tr.no: 11987 n -77 x 5-z . - g cWDU ._".-.. .. , _..._.. ye V � aw rµ x - r � s ' • • ej 1 A c 8-8'Plain Panels(08-009-5) � 34'Plain Panels(08-016-5) LI i 2-2'Pkim Panels(08-0185) E----r---F G ---I M 4-2'Radius Carvers(08-141) 11Turabudde Braces(08-214) S I Z E A 1 d 1 G I D I E I F I G IN JI K I i 1-Steel Hordwaro Krt(08-204) 16' rr r r4- r 14'. s'V �•b- 4•i- r . rs- �• 4/ 1-16x32 Straight Coping Set 6'Radius(10-001) •,,,,• , . . . 1-7 Rack Caping Corner Set(10.138) FMSM0mo• li I'Y s a r4' r u s'e 4'a 4 r 2'2• 1-Yaryl.jkw(see options below) 81 r+ 6'Step-Remove 1408409-5)8'pmol and �►+�E 2„v` 1408-016-5)4'panel insert 1-(01-006)6'step, 2-(08-011-5)3'ponels and 1-(08-214) �� * turnbudde brace 41 8'Step-Remove 140E-009-5)8'panel and aenQ+MN 1-(06-016.5)4'poneL insert 1-(01-002)8'step, �'"� 1 . 2-(06-018-5)2'ponek and 1-(08-214) � turnbuckle trate y�� , j 2+.MER1.18MliiE y�- a • 4 T ' Repko 4.8'Pkrin panels(08.009-5) x, 4 paid r 1-8'sknmr (08-011.5) �yQTI2 3 WE W 2-8'adet ponds(0p8-010-5) &_s. 1-8'light panel(0&012- M . f if � i 74a ` ,,..rr.9 ,F ii --•z„'. 3.-' 7.',.k' q$"?'j, :.:?'hR4"W.� mu�d... ,r, •u„',. 3^'ti:,xN�Y .... z�. ,ate. _ Q•, - �? w:::' /. a+�yy uw 4,��r a s as3yr <1<r+ %�A zs NSPI TYPE 11 a ti G rAaf t r ' dr .. �vr �`.:, jq{^ -0,�'a r v. ^. �- � � #+ �' 6 t )}f ,� - .2�•l`-.�^.`��a yew �£ ,d•�3i w -zfd* 'r. aF.y 2s ,.i.av may' 1rt »rr� ° xdy;was; -uF •• �.'dr•` '�+�� ° x��ig' ia• ^�+ '�''r�,:. r� '- f .: `�.�.. '��,�, a° :.r+.+r�� -�-. '�"�, y�'�� yy�yc, TOPAZ�� .STERLING (03LR03-?) .(03-NO3-Z) r T T : { 'y':>z "siia6:. r s a� z. .,.it, ° �t �r fir. •s; ,��• a NON DIVING UNERS H-6 i _ �.NOa1VMNf'rersgim�s�a•�wr/f.d :-� ��' ��,�' �:• t .. � .� .. .. .. ,. .aur''.� mr .�'n• �."Jt�• �r.�n-e•• t�.�nr..«16�r-. �..�,> ;�r�. ; i;• . .r • • Sept WR7•AlNE Rl•IOSES OMlti��x`) ` •a!T�IITIE/OOrS®■� 0 SlYlrrB .. ,b��l'��.+��.d:chmsdwisw.� R ar4wot Rt�l4ilii7!' 76« dwwrar .+14f�1�ia�mie) satl ”: �' ��P��saeir.erae:•raeiramweo.�, � �� �� aa:a�` i - - •f dwg baste s.id�'s�b L•.a.d ah i�pm4�p{.�� �mn•mor�� t. -� _,,,� •mei i�wamaiee�ds ir•ress /W►r:•w•aLn�Y��r•�iwsd -", •�uwwM�wr�Y a+l. *seL�D �.Naiawl '� .. ... aYriirs."`�1. iddar•ar��I� ne/wd. !. r.: ,serdaid�••+c Plmimd 50o i Fed11:1 wisd�ti"". *ar�l� • .,. ... .., ,.: Mww.. 7 !/eAL�enLie.VA 2271I + rLii •n /a: i MIM _ l ,: .;,., .,,"�;.. , _.. ... w :. "i,r,. � � 1F ZY i' In �+, _ .�� •c-a,.jt - .k� �r i:..,,t.,.. .��f3'�fs3��"t `'": i•.,.:.� _ ._:.�...., ,:__��- .r. ..._ ter,�a' �?rYcat2�r,��w���°.���i�"� '�'"� (=o.R. t�/�oRTC.4.Gc C PV{�,t�OSCS "��3�►•1 V 5E 0�11.`C (EASED UPe�.I. PuBuC RECCRP*AUD EV(De1-LCE 0q,Y 'N1aG v0Wc1) AP C);Le S S • MO RTG.4GCaR. : . '�t.� F-1 , ��,•-+ ,til E � , I��c ���LL —_ SOUP-CE �" tLLP C, CGV �-L(V-& K4 95 2.. 229. 4o , • OT � 1 a � I 2 5M .. �� 5,b I SCA1.E:. . . , OWNERS) -P( CERTIFICATE REGISTRCERTIFY that the Loi: shown hereon DLED: BY, 325 I P. 34 At--1 D that the C�>W E L l_Ily�-V shown PLAN : co3t5 FO2f11A CERT. OF TITLE: �fAC esent Zoning RT NOTE: of' i;hn._..j.�`Li n.i u� The premises do � (�yAAA not lie within I!; ;;����{ of a designated I v Flood Hazard R0303T �s Zone. , r V. '' �; GILLETT ROBERT G. GOODM , R.L.S. ';_`,. ` ;, , cooGwlw �. \� '�, �j., d7S80 t 82 jCENTR,:�L ST-,11KET � �JIt ANDOVER, HA,'N. ... raver O rtb CIA , /iy r A'S - i COM&O�� m C o f E 190 . ,5 0 I Lo i 3 7`R ENCS�X 4 i /Soo GqA SEPT/� i CERTIFIED PLOT . PLAN LOCATED IN: t:�g�.9 DEED BK. � `/ PG.. ' 0WNER: l—Cl-teee4� PLAN N0. A231-5- SCALE: a3isSCALE: BK. PG. DA TE: INV. N0. i f� 3�IV I Z07- 77/ 3' I rtq 1)el u ,I f� O�' b�j �` SE�riC SYS M M 2 �Y o * , 7Z�wca ePS � I 77 !J ,PECK 0/0 z .STo2y i W F � UNOE� cs� �0 ;71°oa oa T, C /< To. 9z_L P.9,e7,Es I hereby certify that I have examined the premises and that the structures are located.on the ground as shown, and that they do ( ) conform to the zoning by—laws at the time of construction, except as noted. 1 also certify that this property is:(uor) located In the flood hazard area. NOTE.• This certffleation Is based on an Instrument survey, property 11nes shown from existing plans of record. This plan Is not to be modlfled for any other use without consent of Nor'thstar Land Survey Services. .I� /VOR THS TA R / 4 it jS. LAND SURVEYSERVICES "THE TANNERY"—SUITE 7 P.O. Box 131 —NEWBURYPORT, MA 01950 TEL :(978) 465-2940 Fax :(978) 465- 1017 NORTH Town of E over 4 No. o SOC L A ", dover, Mass., mic ORATED ! S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT. d N.......:+.......Dov....... .... t/ .............................................................. ..... .............. Foundat 0ion C..... ., has permission to erect.. ....�to../... ..... buildings on .........I ��� .......Ip g to be occupied as �p` V D.......?0.0 r......�ti ro 4 r a 4� Chimney O �V ..... ................................. ......... ........................................ . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws r lating to the Inspect' , Alteration and Construction of Buildings in the Town of North.Andover. /04 �� 6 �5�� monoPLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS, CONSTRUCTION TARTS ELECTRICAL INSPECTOR + Rough ...................... .... ..#i=�a-.:... ..... Service ILDING 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.