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Miscellaneous - 198 LANCASTER ROAD 4/30/2018
198 LANCASTER ROAD 210/104.D-0-171-0000.0 _- -_ Date....0).1.... .. ........................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION $84CNU5� This certifies that. . c.' ...... .... 1 has permission for gas installation ........... inthe buildings of............. ^?. ...................................................................................... at..... .. . � C' a P: ............................ North Andover,Mass. Fee..?........ .... Lic. No.,......... i!- ..... ........................................................ GAS INSPECTOR Check# 8974 s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i G CITYMA DATE/f ! j PERMIT# JOBSITE ADDRESS OWNER'S NAME -- --- GOWNER ADDRESS TE I�— FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL® RESIDENTIAL PRINT CLEARLY NEW:Ef RENOVATION:[j REPLACEMENT:® PLANS SUBMITTED: YES❑ NO❑ APPLIANCES 7 FLOORS BSM 1 2 3 4 5 1 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE — GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS c� MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 71 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E] OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ® 3 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are t a urat to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co li with all ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Nicholas Savvas I LICENSE# 0 VV ATUFZE MP EI MGF❑ JP❑ JGF❑ LPGI 0 CORPORATION®# PARTNERSHIP®#®LLC®#® COMPANY NAME:Nicholas Sawas PI .&Ht . ADDRESS 115 Silvestri Circle#24 CITY IDerry STATE NH ZIP 03038 TEL 19788043303 FAX CELL EMAILSawas I @ mail.com 6ej e. j2�,+ a �� � The Commonwealth of Massachusetts - Department of IndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 g� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Nicholas Sawas Plg.&Htg. Address:15 Silvestri Circle#24 City/State/Zip:Derry, NH 03038 Phone #:978-804-3303 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 2 4. ❑ I am a general contractor and I employees full and/or part-time).** have hired the sub-contractors 6. ❑New construction ( P ) 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9 ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑■ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Automatic Data Processing Insurance Agency Inc. Policy#or Self-ins. Lic. #:76WEGEV9494 Expiration Date:1/1/14 Job Site Address:-OK K �iZ7�(� ���A City/State/Zip•- - -IW14- 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 or insurance coverage verification. I do hereby c rtify er the pas andpenalties ofperjury that the information provided Bove is true and correct. Si ature: Date: Phone#: 978-804-3 03 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: GENERATOR APPLICATION DATE: 1f��3113 LOCATION: I7 ff OWNERS NAME: GENERATOR kw I`J- NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: �Ii �IC�s sav ocz-s 14 �l PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR:R\��� Itzuse- , *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL - �,��'la. � L✓� 160 II. North Andover MIMAP November 13, 2013 e ':-'�'•'k J *ter. b Blue 1 , , d : y y oN L S � 1 r 3 ,4 rl rn x s � 1 2 1. ,r j� .J a C 1 r� , j I ' 1 i Interstates Interstate —Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack L r Easements NOR1q Valley Planning Commission(MVPC)using data provided by the Town of Of North Andover.Additional data provided by the Executive Office of (]MVPC Boundary =. eta .��6 OO Environmental Affairs/MassGIS.The information depicted on this map is L]Parcels •; L for planning purposes only.It may not be adequate for legal boundary F -'-• '" 9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING ♦ i THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ♦ i ,^, * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF .rao�� �oj THIS INFORMATION 9SS�cli 1"=138 ft •�° ,i COMMONWEALTH OF MASSACHUSETTS TryT� D AS A MASTER PLUMBER ���. • LICENSE t f iSSUES.THE ABOVE LICENSE TO: NICHOLAS 'P ,SAVVAS r !! 4 T5' SILVESTRI CIR f #24t DERRY ,-, 1\ NH' 03038- 1329 15234 .05/01/14 145211 s ft� 1 I� II . 1 i { j 10198 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . .1.�'` has permission to perform . . . plumbing in the buildings of. . 1. ! c?,!!� . . . . . . . . . . . . . . . . . . . . . at . . . .. . . . . . . , North Andover, Mass. Fee &5P. Lie. No. 162-12q. • H Pr . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check#�?i- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Qr („�, MA DATE j D PERMIT# JOBSITE ADDRESS / led I OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL[� PRINT 3 CLEARLY NEW:® RENOVATION:Ed REPLACEMENT:® PLANS SUBMITTED: YESE] NO® FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 �j— BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _ DEDICATED GRAY WATER SYSTEM_= DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN _ INTERCEPTOR(INTERIOR) _ KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET _ URINAL ASHING MACHINE CONNECTION WATER HEATER ALL TYPES �NATER PIPING JHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 3 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHEC E LY: OWNER ® AGENT ® � T SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application re t and a urate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be* c i II Pert' provision of the n!1 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1� PLUMBER'S NAME I Nicholas Sawas LICENSE# 15234-M SIGNATURE MPED JP® CORPORATION®#®PARTNERSHIP®#®LLC®#® 1 COMPANY NAME Nicholas Sawas Plg&Htg ADDRESS 115 Silvestri Circle Unit 24 CITY DERRY STATE NH ZIP 03038 TEL 9788043303 FAX CELLI EMAIL lsavvasplg@gmail.com `Z ”` v � 2 � z _r3 f� s ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date..*.. ....................... OF�RTH,h o�• ' °°� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 0105 ...��5 e 4.This certifies that .. .................... . ............................................ ........................... has permission for gas installation .. - ^' ......r.I o.................... inthe buildingsof.,.....J"..4AW.).................................................................................... at...........� ... ...... C.C �-- e R......................, North Andover, Mass. Fee�06b..... Lic. No. 16.2 .. ''. ................................................. 1 GAS INSPECMR Check# €910 A f CN\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK u,p I it CITY Or 1 MA DATE p /,3 PERMIT# JOBSITE ADDRESS OWNER'S NAME I✓VI___l.v�_�,D_______-_-_________ GOWNER ADDRESS TEL[— FAX TYPE OR OCCUPANCY TYPE CO PRINT MM CIAL® EDUCATIONAL® RESIDENTIAL CLEARLY I4EW:© RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YESE] NO❑ APPLIAN ES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE -- -- —a —� — —— — - — - - -- ---- -- , FRYOLATOR FURNACE - ------ ------ GENERATOR _ — -- --- ----- --- - -- - GRILLE - INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN -- — - — - -- - - POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ® BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ® AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true d to to t best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compl' nc all e_' rovisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME I Nicholas Sawas LICENSE# W SI TUBE MP Q MGF❑ JP© JGF© LPGI® CORPORATION❑# PARTNERSHIP❑#0 LLC 0#� COMPANY NAME: Nicholas Sawas Plumbing and Heating ADDRESS I P.O.Box 623 CITY I Methuen STATE=ZIP 01844TEL 9788043303 FAX CELL 19788043303 EMAIL sa asplg@gmail.com a ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES 1,� /dy/13.�j� Yes No ` THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Ax The Commonwealth of Massachusetts Department of Industrial Accidents UVOffice of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Namc,(Business/Organization/Individual): Nicholas Sawas Pig. & Mg. Address:15 Silvestri Circle Unit 24 City/State/Zip:Derry, NH 03038 Phone #:9788043303 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. 1 ❑ required.] 5. ❑ We are a corporation and its 10. 3. repairs or additions 3.E] officers have exercised their I am a homeowner doing all work 1 LQ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1.2.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Automatic Data Processing Insurance Agency, Inc. Policy#or Self-ins. Lic. #:76WEGEV9494 Expiration Date:1/1/14 Job Site Address: I TK � z2Ae l cC' - City/State/Zip:A/� oyit� &6,Locz I 1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).O",S Failure to secure coverag s r quired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 a /or e-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a A y a st the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations o e D forinsurance coverage verification. Ido herZe ' r the pat' alties of perjury that the information provided ab ve i true and correct. Signatur Date: Phone#: 97$$043303 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 77 -COMMONWEALTH OF MASSACHUSETTS LICENSED AS A MASTER PLUMBER �I ISSUES THE ABOVE LICENSE TO: r i + NICHOLAS ,Pi.,SAVVAS 15 SILVESTRI CIR s< �- #24 DERRY. •.� NH' 03038- 1329 15234 0 5/01/14 145211 i . I Date... .................. TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 88A.4v 0 C This certifies that47 .....................I i )o..0..r7 '�Q4Y has permission to perform .....�4,1-t r-e- w"j ................................................A........M..................... wiring in the building of.........P±. ....M..............................M.......................................... ........... at 19 '� Q4 s�, ....................................................................m....................................e/�Jorthh Andover,Mas W . ��7 Wee Lic.No ......................M....... ............. .. ......... -.............. ............ ELE&?jcAL INSPECTOR Check It D 11893 Commonwealth of Massachusetts Official Use Only ( - ' Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: /o/.3 1--:� City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) tg L el,7 e 4 /C✓• Owner or Tenant Telephone No. Owner's Address a Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) V Purpose of Building 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 Location and Nature of Proposed Electrical Work: r Completion of the following table may be waived by the Inspector of Wires. t� No.of Recessed Luminaires / No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outletsv No.of Hot Tubs 0 GeneratorsNJ KVA II Above In- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. E] Batter Units No.of Receptacle Outlets f No,of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges D No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers 1 Heat Pump Number Tons KW No.of Self-Contained ....................._................................. Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other I Connection No.of Dryers v Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs (� No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent n OTHER: ¢'/ Attach additional detail if desired,or as required by the Inspector of Wtres. * �{1 Estimated Value of Electrical Work: /000 (When required by municipal policy.) Work to Start: /0/3 a8 l.3 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 coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE P BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penallties ofperjury,that the information on this application is true and complete. FIRM NAME- M C A 1 iSTc SD S ' . LIC.NO.: / MQ Licensee: Dd ,I:d HrA Ls fe ✓ Signature --i�?< LIC.NO.: 6/6 '71 F (If applicable,enter "exempt"in the license number line) � Bus.Tel.No.• j 70 &V!Y1E�r' Address: Alt.Tel.No.: `Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent [P:P�MIT FEE. $ ~— Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the r L permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed ' on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an c� - electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass Failed IN Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: v Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 5� Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comm .t Inspectors Signature: Date: FINAL INSPECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Co ments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 4 V The Commonwealth ofMassachusetts Department of InlustrialAccidents Office of Investigations 600 Washington Street Boston,MA.02111 www.mass gov/d'ia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name(Business/Organization/individual): / l C A 47$�-C l 5 0,''7 5 Qe tie-✓:cd �C✓iJ�`c-� Address: City/State/Zip: /VaSL_,,_ lV�0023060 Phone#: MY-UA.-44,42' Are you an employer?Check the appropriate box: - Type of project(required): 1.4 1 am a employer with 0 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. �• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacityworkers'comp.insurance. 9, El Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp, c. 152,§1(4),and we have no 12.❑Roof repairs insurance .re uiredemployees.[No workers' q comp.insurance required.] 13.❑Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they ire doing all work and then hire outside contractors must submit a new 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 employees Below is the policy and job site information. Insurance Company Name:. A�, t,, Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 DTA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. - Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: L � Information and I nstruct ons Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along withtheir certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confnmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under".lob 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 i applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: `rho CQMx OMMalth ofMassachusetts Depaftent offdusWal Accidents oBice ofTnvestigations 600 Washitgton Siroet Boston?MA,02111 TO # 617-727-4900 ort 406 or 1-877-MASSAFF, Revised 5-26-05 Fax#617-727-7749 VV7MW_mace an-u-M-1p J " COMMONWEALTHOF MASSACHUSETTS BOARD Of E L E CTR I C I AN::S::;..;: ISSUES .T;HE FOLLOWING LICENSE ASA R G J:0URNEYMAN ELECTR I ICIC AN: Zo DAU.I>T)''A MCA I STER i 30 RITTER STREET WASHUV7NW 03060 3736 I 51679E 07/31/:16 77409 i�iiaiF�all.ni,=1-1:1 .%I a.IJ1Y_\II�1 �1\I iSa A ! y OMMONWEALTH OF MASSACHUSETTS, LSC • BOARt)Of CTItI C I AN SE AS THE FOLLOWING LICEN A. I 1:SSUES MASTER ELECTRICIAN IQ I REGISTER-D /, z MCALL I STER - 1� R,.ST 30 RITTE NH 03060 3736 410 N.ASNUA 1>/i6 Date ��-,�!.�4... . ... ,ORTH TOWN OF NORTH ANDOVER p A r • - PERMIT FOR GAS INSTALLATION y y,SSACMUSEtA This certifies that , .,!�G.l.� . . . ,p �` . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . in the buildings of .,��i tl t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . ., North Andover, Mass. Fee. . .G Lic. No..! �7`?. . . . . . . . . . . . . GAS INSPECTO Check# 3 O L 5565 a� _ W• MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING , � ' — � (Print or Type) , Mass. Date 67-10 oo6.PermitN �- Building Location Owner's Name llL Aw ko /O_ kA'VC467&,� PU _Type of Occupancy New ❑ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ i o1S- �AS� S 50 1 f t cn cc vi i cn U Z cc 3 w W c o ° Co Cr: U) O, z _ m U) cc W W cr CC 0 d 00C Z Q WW Lu U) W CC W Q w Q � > cn i (9 H Z J ~ Z W W 0 > O � 0 .J W. i Z Q W ¢ ac ►- >_ (n Co z O Z W 0 _ I o io � zLZD aQ) ° CC > o ° moo SUB-BSMT. *� v BASEMENT 1ST FLOOR i 2ND FLOOR I _ i 3RD FLOOR r/ 4TH FLOOR 5TH FLOOR 6TH FLOOR I 7TH FLOOR i 8TH FLOOR I Installing Company Name APOLLO PLG & HTG INC Check one: Certificate Address. 1SHATTUCK ST PO BOX 466 �] Corporation 1097 C i LAWRENCE', MA 01842-0966 0 Partnership Business Telephone 978-688-1755 0 Firm/Co. i Name of Licensed Plumber or Gas Fitier_170ruRjo I)eSAV/SS"U k INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes OI No ❑ . i If you have checked yes, please indicate the type of coverage by checking the appropriate box. I A liability insurance policy W Other type of indemnity O Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not.have the insurance coverage required by I 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 ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best-of my knowledge and that.all plumbing work and installations performed under 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. I By T pe of License i 0 Plumber Cc6nse aFWe-e Title ❑ Master hiriii`ureof Cleansed Plumber or i ❑ Master 8699 City/Town Journeyman License Number APPROVED OFFICE USE ONLY) • 'i BELOW FOR OFFICE USE ONLY .FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME &TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 • PLUMBING INSPECTOR Date........ NOR7M �' °t<�``° '•�" TOWN OF NORTH ANDOVER . o AL ^ - PERMIT FOR WIRING �,SSACMUSE� t This certifies that ... e zeG� has permission to perform .............Pao/................................................. wiring in the building of......... ..................................................... at............ .��. .. ! /.!'�.� ..... ..........,North Andover,Mass. r Fee..L/:$.*.g '.�..... Lic.No..91.4zz................. ELECTR ICALINSPECTOR ' Check # 65 '= 5 a. Department of Fire Services Permit No. 655 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work be performed in accordance with the Massachusetts Electrical Code MF.C: ,527 CMR 12.00 to(PLEASE, PRINT•W INK ORT PE ALL I. FORMATION) Date: U_113�6C.O — City or Town of: A/ (� V) l/ V To the Inspector of Wires: By th' application the undersibme b es noticeo is or her into tion to perform the electrical work described below. Lo tion(Street& Number) � e,411 S-(Cl- Owner or Tenant �vl t Telephone No.��g (p�7 (Q75_ Owner's Address _ SO$ (pc-! I Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Erisdug Service__ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service _ _ Amps _ / Volts- Overhead❑ Undgrd ❑ No:of Meters Number.of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work: INGROUND POOL: BONDING, PVC.,GFI., FILTER,PUMP and LIGHT Completion o the ollowin table may be waived by the Inspector of Wires. No. oTotal No. of Recessed Fixtures No, of-Ccil.-Susp.(Paddle) Fans . Transformers KVA No. of Lighting Outlets No.'of Hot Tubs Generators KVA - o. No. of Lighting Fixtures Swimming Pool ❑ no ,mergencytgng rnd.Above rnd. ❑ Battery Units No. of Receptacle Outlets No. of Oil Burners FGRE ALARMS I.No. of Zones No. of Switches No. of Gas Burners o..o etection an Initiatin Devices No. of Ranges No. of Air Cond. at Tons g No. of Alerting Devices No. of Waste Disposers eat Pump Number . ons o. o e = ontaine Totals: :' """""""":'"'"""""'"""" Detection/Alerfifig Devices No. of Dishwashers Space/Area Heating KW Local [] Municipal ❑ Other Connection No. of Dryers Heating Appliances KW SecuritySystems: No. of Devices or Eq uivalent oR�o mater KW o. o o. o Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: :Zouch adelitiunot detail•if desired, ar as required'b)%the Itupectur of Wires. INSURANCE COVERAGE: Unless waived by the owner,no peniiit for the performance of electrical work may issue unless. 1 tae licensee provides•proof'of liability insurance including"completed operation"coverage 6r its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof ofsai-de,'td the pen-nit issuing nfficC —7 CHECK ONE: INSURANCEXlkBOND ❑ OTHER [I (Specify:) •Q6$Q. a U o • t:stimated Value of Electrical Work:'- (When required by municipal policy.) (Expiratidll U•at'e) Work to Start: Inspections to be requestedin,accordance with MEC Rule I0,,and upon completion. ! cet7ify, under the pains and penalties of perjury, that the;-information on this application is t)ite and complete. I FIRM NAME: Village Electric. Inc LIC. NO.: 9163 Licensee: Anthony P DelPa a Signature WC. NO.; 21 861 !•/f applicable, enter "erempi"in the license number line,j"x " s;, Bus. Tel. No.: 978-256-4845 Address: 4 Kidder Rd. Chelmsford, MA O18 :4s ;,h3' Alt. Tel. No • 978-256-5804 OWNER'S INSURANCE WAIVER: I am aware that the L�cehsee d es rit�t heave the liability insurance coverdge normally required by taw.,;E},,.T.y sjgnatt te•beIowj--I hereby waive ahis.regtriremeriw f-afn the(check one)El owner [:] owner's a eat. Owner/Agent •� ;: Signature, PERMIT FEE: $ �S . , Telephone No. l " '� V I I It I IV I I"VW,4" v. ..•,.vv...v.....- --�. Department of Fire Services Permit No. b5 � 1 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev. 11/99) leave:blank P ( `?PLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance;with the Massachusetts Electrical Code MF,C ,527 CMR 12.00 (PLEASE PRIN7'W INK OR PE ail;l. I. F'OR�IATION) Date: ( i�j�[)�j City or Town of: +k Anl1mv er To the Inspector of Wlre.s: By this application the undersigned gives notice of Ks or herinte tion to perform the electrical work described below. Location(Street& Number)i V 6X1, 41 t of STC k Owner or Tenant jvl t _ Telephone No. q78 6*7 (Q7S•j Owner's AddressIs this permit in cohjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service__ Amps /. Volts Overhead ❑ Undgrd ❑ No: of Meters ew S.erviee _ Amps. / _Volts• Overhead E] Undgrd ❑ No:of Meters N Number-of Feeders and Ampacity. Location and Nature of Proposed Electrical Work: INGROUND POOL: BONDING, PVC,GFI, FILTER, PUMP and LIGHT Completion of the ollowin fable may be walved by fhe Ira ector of Wires. No. of Recessed Fixtures No. ofCcil.-Susp.(Paddle) Fans . Transformers KVA No.'or Lighting Outlets No.Ior Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ n- ❑ o• o 'fiergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE A.I�ARMS No. of Zones �1 Ivo.,__,/witches No. of Gas Burners o..o etection an Initiating Devices No. of Ranges No. of Air Cond. ons No. of Alerting Devices Heatumpmer ons � o. of e -wontauteNn. of Waste Disposers ' '''"''"'" '" " '_" "Totals: Detection/Alet.fi 'g Devices No, of Dishwashers Space/Area Heating KWLocal ❑ Municipal ElOther Connection . No. of Dryers Henting•Appliances KW ecurtty ystems: No. t No: of Devices'or Equivalent Heaters KW ° ° No. o Datta Wiring: Signs' ' Ballasts No. of Devices or -Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecom munications Wiring: No. of Devices or E uivalen( kruch ad litiunal detail•iiftlesirecd, or ea required b)y the Inspector r f Wires. INSURANCE COVERAGE: Unless waived by the owner,no pentiit for the performance of electrical work may issue unless. .tie licensee provides proof of liability insurance including`completed operation"coverage or its substantial equivalent. The Indersigned certifies that such coverage is in force, and has exhibited proof of satne,'tu the pen-nit issuing n1"fef. HECK ONE: INSURANCE >� BOND ❑ OTHER ❑ (Specify:) c - istimated Value oI-taectr)cal Work:' (When required by municipal policy.) ' York to Start: Inspections to be requested in accordance with-MEC Rule I0,,and upon completion. eerldfy, under the palns and penalties of perjury, that the,;. orM4lbn on this application is iAe ant!complete. I t 'IRM NAME: Village Electric. Inc 8 LIC. NO.: 9163 ,icensce: Anthony P I)elPapa Signature WC. NO.; 21-861 �japplic•able, enter "erempt"in the license number line.j..'` ,;, Bus. Tel. No.: 978-256-4845 �ddr 4 Kidder.Rd. Chelmsford, MA Q18•�:4: : �;' ' ' ,�:4, �' ::,•,; Alt. Tel. No:: 978-256-5804 `)Wl<�S INSURANCE WAIVER: f pm aware that t to C,tiensea:d0&.T not hrav�the Lability insurance coverdge iloraially squired by law.•,;E y,.an.y igtaatuie below; I here dy•waive this.requ,ircoenti,•1.'am the(check one)❑ owner ❑ owner's agent. )wnerlAgent. Telephone No'. fPERMIT FEE: $ jgnature,. S�- 1, r� Ov C D 1 ocation No. '5W Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ i ; Building/Frame Permit Fee $ ♦ i Foundation Permit Fee $ s�cHust Other Permit Fee $ c) r� Sewer Connection Fee $ Water Connection Fee $ ~� TOTAL $o� �v 'o Building Inspector GG r. _ 48'01/94 13:45 25,40 PAID 7330 Div. Public Works 16Cation /?` ' No. Date pORTIy ' TOWN OF NORTH ANDOVER p Certificate of Occupancy $ ` Building/Frame Permit Fee $ U ♦ i • Foundation Permit Fee $� S�cHus Other Permit Fee $ Sewer Connection Fee Water Connection Fee $ �✓ TOTAL $ Building Inspector 22064.00 RAID -c, 6816 Div. Public Works a I �;/z��S/6 q - ,••• . ,�. Com"a — v� ' Location) No. .3 /P Date NCItTN TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 6 Q•O J • , + Building/Frame Permit Fee ,$ Foundation Permit Fee $ /D d• U C� s�cMuae Other Permit Fee $ —'-' t Sewer Connection Fee $ --- Water Connection Fee $ —= TOTAL $ -CJ Building Inspector 35 .J 6794 Div.Public Works 4v-sp,ation de 81 6 IL 14/1 No. Z" Date 11,22-13 { i ' ! ,ORT" ! TOWN OF NORTH ANDOVER o ? O o � .. „ Certificate of Occupancy $ x ' Building/Frame Permit Fee $ Foundation Permit Fee $ J�CMUS ( Other Permit Fee $ to �� Sewer Connection Fee $ Water Connection Fee $ TOTAL- $ d,' ° U ildin� Inspector i s Divaublitworks IAltIT NO. c� APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. YX yJ r 'PAGE 1 MAP h40. LOT NO. e' 2 RECORD OF OWNERSHIP JDATE BOOK PAGE ZONE I SUB DIV. LOT NO. II " LOCATION PURPOSE OF BUILDING OWNER'S NAM / NO. OF STORIES stzkov OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS 1ST Of A i/ v 2ND �{i6 3RD Of d?1 1/�7 !J ./ i BUILDER'S NAME �/J.6 SPAN DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET /D d "' POSTS DISTANCE FROM LOT LINES-SIDES �� REAR GIRDERS d AREA OF LOT / � FRONTAGE HEIGHT OF FOUNDATION ri THICKNESS IS BUILDING NEW / SIZE OF FOOTING ll X v ' IS BUILDING ADDITION � � MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE rl/�_ 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 �� J�$� �/ ' ' EST. BLDG. COS Eq'9,9�J��Q�P f�+e'`j - - D� EST. BLDG. COST PER SQ. FT. PAGE 1 FILL OUT SECTIONS 1 - 3 �� EST. BLDG. COST PER ROOM P=ftS� �i PAGE 2 FILL OUT SECTIONS 1 - 12 WE SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING' 4 APPROVED BY X ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �S BOARD OF HEALTH S NATURE OF OWNER OR ALITHORIZED AGENT FEE 91,S-e) PERMIT GRANTED l d d OWNER TEL.# 7 PLANNING BOARD CONTR.TEL.# � ez /c is CONTR.LIC.# ' BOARD OF SELECTMEN 4 DECloo BY3 ILDININSPECTOR r BUILDING RECORD I OCCUPANCY 12 SINGLE .FAMILY (/ (SiORIES 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. -'CONS�R*TION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE a 1 2 13 CONCRETE BL K. ---III PINE _ BRICK OR STONELAS— D —_—— PIERS PLASTER _ DRY VJAIL _ _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/ +/1 % FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDVJ'D ASBESTOS SIDING _ COMMCN _ VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MAS N,RY � 'A d FLOOR •may�' BRICK ON FRAME STRS. CONC. OR CINDER BLK. STONE ON MASONRY WIRING Z €3GYlei' -iMIS 30 f STONE ON FRAME —..*boo"• SUPERIORI POOR to ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3 FIX.) _ GAMBRJEL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR d GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING \ WOOD JOIST 41,PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. _ HOT W'T'R OR VAPOR _ WOOD RAFTERS _ IR CONDITIONING \ w� RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAIL r' B'M'T 2nd ELECTRIC tCt ,NO HE TING �^ t r CERTIFIED FOUNDA TION PLAN LOCATED IN 0-zy--r7 1-4 SCALE/"_ DATE r2 1-1(a3 Scott L. Gi/es R.L.S. 50 Deer Meadow Road North Andover,Mass. u to n i E'x c sT. l N � �--dr- 43 �c�''C'— �-•� 'fl L oT 20 N 4-S�oS4 IE:.F.- N 0 ff , 2 1993 % s-r E.rz. o D / CERT/FY THAT OFFSETS SHOWN ARE FOR THE USEor THE OFFSETS OF THE SU/L DING/NSPEC TOR ONLY SHOWN COMPLY AND SUCH USE/S FOR THE WITH THE ZONING DETERMINATION OFZON/NG . 3M" BYLAWS OF CONFORMITY OR NON-CONFORM1 TY r ad WHEN CONSTRUCTED. LL WHEN BUILT d r FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: �� a� /���6 `/Pi Phone �c��'4 LOCATION: Assessor's Map Number 6 Parcel Subdivision Lots) f Street St. Number ************************Official Use Only************************ �REEC MMENDATIONS OF TOWN AGENTS:li� ►` ' Cgz Date Approved Conservatio Administrator Date Rejected Comments / Date Approved Town Planne3ij Date Rejected Comments Date Approved Food Inspector-Health Date Rejected �. Date Approved �� Z Septic Inspector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit �y2 Fire Department .'f ` iv l/�iJl ZZ jJ 01 Received by Building Inspector Date 03 19m r ,meq;..,*>tty �;.,,.,..., � .. � .. ,. s,. '_"T�.•i L�� t ,� � ' r i t ��N Vi z NORTH Town of dover 0 fn o A 0 dover, Mass., Dices / 19 h COCHICHEWICK 1 CD 11 �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... i....tylk......... . ..L. ............................................. "" Foundation has permission to erect.lM.0#19.4ftWbuildings on Rough to be occupied as%`J'Aht A.S..OAWA .. INS W,.$ �.... Chimney provided that the person accepting this permit shdll in ever respect conform to the terms of thea lication on file in p p p g p y p pp 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 PERMIT FOR FOUNDATION ONLY VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-5. B.C. Rough : . PERMIT EXPIRES IN 6 Mo .. _ v Final D ` -� FEE PAID jly ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S I TS PERMIT FOR#RAMEIPUHING. ° g Ru - - .. ..... .. . .. . .. .................................. Service EE PAID` BUILDING 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FI NAL DRIVEWAY ENTRY PERMIT ' �' %� r•r ,�i i I;A1 :Lss::.av '.•JI NORTH ANI�UtirL'!t BUILDING �'•.:; = �� t.l:l�:�;li F111•:c 11•:f11f4.1!" t:ONNI:1 t VA'17ON 111VIN111N 111° U i 1 :11 ill;..-17,-; I IlAIJI I'i.ANNIN(; 1'1,.ANNIN(i. & (;t)(11mUNI'I'A' Ul's111s1,01'AI1:N'1' , . I::\ltlad 11.1'. Nlaat )N, ! )Iltlil:l OIt ` • C11IAINEY APPLICAr1014 ANO IT1311I' ATE PERN1.1'. # )CATION G' ..T . YL, ka ,YCf., S 'rr--oP R A T 14 • LINER'S NAME: )} L L 1I LDER'S NAME: ' '� , /�'I/9- t [,1, T GC`s') S ?', '.e) ye ISON'S NAME: /Y1 5 O rYA Iq 19 /rc.H i N SON'S ADDRESS:�?y I�i. {� i� Ll �� �- N� Al . A-r✓z-� a 0 E �, ISON'S TELEPHONE: JERIAL OF CHIMNEY: ,Q r c. ,C ITERIOR CHIMNEY: _ L'XI LRI OR CIIIMNLY: Ili{BER AND SIZE OF FLUES: / /.Z X j X l 1 _r� IICK14ESS OF HEARTH: :,tt cfvnney oa (.vzep ace co11(oam to 411e nc(imi-lrenleli t.6 u(, .the curie fuld have Atice.3 full( :gutat,Zow bee11 neeebed: .TE: 61 ' `> .GNATURE OF MASON: :Rh{IT GRANTED: f'LL ,2� , c� 'BERT NICETTA JLDING INSPECTOR SPECTEO: -- AARKS: - SOLID FLOCK IZE(�U1KI U THIS PERMIT MAST- GL VISPLAYLV 014 IHE 1'UMI—S, fR CERTIFICATE OF USE & OCCUPANCY Town of North Andover r Building Permit Number .-5 e'2 Date/ — THIS CERTIFIES THAT THE BUILDING LOCATED ON MAY BE OCCUPIED AS IN ACCORDANCE WITH THE PROVISIONS OF TH MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. HORTM CERTIFICATE ISSUED TO p ADDRESS74 ^�ws Building Inspector r'- tAORTH Town of �! �r 4 over 0 . . mac- � N � 70 dover, Mass., _40, 13 19 COC HICHE WICK '1 A0";ATE0 P'P 'a BOARD OF HEALTH R Food/Kitchen Septic System,4 , PERMIT T D , . BUILDING INSPECTOR " :"THIS CERTIFIES THAT.......... .. .....ITS......... ... ... . .............. ................�.... - ...................................................................... ,., ou anon A has permission to erect 1M'A1N..04"buildings on ..#4.!y� Rough r !--to be occupied as /..►l*6-3.464*0iM t ...40 � ` Chimney AI „. # provided that the person accepting this permit shall in every respect conform to the terms of the application on file inFinal this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of ��� GJ y Buildinos:,in the Town of North Andover. PERMIT FOR FOUNDATION ONLY PLUMBING INSPECTOR �� VIOLATION of the Zoning or Building Regulations Voids this Permit. REGULATED BY PARA. 114.8-S. B.C. .� -��i s PERMIT EXPIRES IN 6 MON _ — .� FEE PAID��61, o 0 L/ S `f ELECTRIC SPEC OR UNLESS CONSTRUCTION ST TS � `' -�' d Rough C)l PERMIT FOR fRAMEIBUILDING Service • HE PAID66% U BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR (Rough%!)i Display in a Conspicuous Place on the Premises — Do Not Remove , OA . No Lathing or Dry Wall To Be Done FIRE EPARTMENT Until InSpecte and Approved by the Building Insp ct r ��� /_�� Burner Street No. PLANNING FINAL CONSERVATION FIN �� ' � � �\ Smoke Det. 7 SEWER/WATE G-3 A NAL DRIVEWAY ENTRY PERMIT I `