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HomeMy WebLinkAboutMiscellaneous - 20 CAMDEN STREET 4/30/2018 (2) /7 20 CAMDEN STREET O 2101085.0-0004-0000.0 J NpRph AM �' 71 NORTH ANDOVER BUILDING DEPARTMENT 1600 Osgood Street North Andover Tel: 978-688-9545 Fax: 978-688-9542 BUS'RVESS FORM FOR TOWN CLERK DATE: �' V NAME: ADDRESS: lJ Cma e,4n w ZONING DISTRICT: TYPE OF BUSMSS: BUILDING LAYOUT PROVIDED: YES NO AVAILABLE PARKING SPACES:. ` . � 1 ZONING BYLAW USAGE: YES NO BUIL16ING INSPECTOR SIGNATURE I BUSINESS FORM FORTOWN CLERK Deems, Maura om: Deems, Maura .gent: Monday, November 05, 2012 10:07 AM To: Fitzgibbons, Karen Subject: RE: DBA on Camden Street Dear Karen, Thanks for the information. The actual owner, Liban M.Said, of 20 Camden Street was in today and pulled a DBA for a Limo Service.We informed the owner that a DBA has already been issued for that address for the same type of business. He was informed that two DBA's for Limo Services cannot be allowed on the same property. He should be arriving at your office shortly. Maura From: Fitzgibbons, Karen Sent: Saturday, November 03, 2012 9:08 AM To: Deems, Maura Subject: RE: DBA on Camden Street 20 Camden Street From: Deems, Maura 'Rent: Friday, November 02, 2012 11:52 AM ( : Fitzgibbons, Karen Subject: DBA on Camden Street Dear Karen, We had a person come in today to fill out a DBA form.Jerry was not here to sign off on it so I think they will be back on Monday. My question is another person filled out a DBA for a limo service earlier this week on the same street.The street name is Camden Street and I would like to find out what number on Camden the DBA/Busines form for Town Clerk was actually issued to.We want to make sure that we are not issuing multiple DBA's for the same address. Thanks for your help, Maura Deems Building Department Assistant Town of North Andover 1600 Osgood Street Bldg. 20 Suite 2-36 North Andover, MA 01845 Phone 978.688.9545 Fax 978.688.9542 Email mdeems@townofnorthandover.com Web www.TownofNorthAndover.com i 1 F Date...J?....�Z."E'...1....... 3 L Of NORTN.1,y0 c: ,� TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ;�ss�cwus�� 14) 140M L: S;C&-e,Ty 42C Thiscertifies that ............................................................................................. has permission to perform ...:� . ........................ . wiring ng the building of.....�.....�.................................................................... at........ ............................................................. ..-:;. ,North Andover,Mass. ` Fee..?�::. Lic.No.299 ............. . .. �. .... S$ 061/�o Et ecrwCAL INSPEC FOR Check # 'yS 86 � '/ Commonwealth of Massachusetts Official Use Only HEM=P Department of Fire Services Permit No. l4? 3 a Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),537 CMR 12.00 (PLEASE PRINT OR TYPE ALL INFORMATION) Date: (� By City oTow ndersigned gives notice of is applicatioectorhis or her intention to perform the e f: �(��' �� To the Insp ector of Wires: n nlectrical work described below. Location (Street&Number) II � 1 S'('. Owner or Tenant t t rJ�. 3d l cA Telephone No. -.e-6W Owner's Address .t/� Is this permit in conjunction with a building permit? Yes ❑ No x BLDG PERMIT# Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters i New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install low voltage security system at above location Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ 1VO-50-T Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. In Detection and InDetection Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Dis posers Heat Pump Number Tons KW No. of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Other No.of Dryers Heating Appliances KW AtEuritNo.oyf Devi es or Equivalent 1 No.of Water No.of No. of . in : Heaters KW Signs Ballasts No.o eveces or quivalent Bathtubs No.of Motors Total HP Telecommunications Wiring: No.Hydromassage No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: g a (When required by municipal policy.) Work to Start: 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 ®. BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Brinks Home Security LIC. NO.: Licensee: John Holmes Signature u jiC _ LIC. NO.: 749C (If applicable, enter "exenspt"in the license number line.) Bus. Tel. No.: 978-657-0443 Address: 155 West Street, Suite 6 Wilmington,MA 01887 Alt.Tel. No.: *Per M.G.L. c.147,s. 57-61, security work requires Department of Public Safety"S"License LIC. NO.: SSCO 001163 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ® owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ��. Date. � 4,� /. f f NORTH 1 TOWN OF NORTH ANDOVER - PERMIT FOR PLUMBING 49 SA US This certifies that has permission to perform .✓l X. .(�%: �;`!-� ! !. . . . . . . . . plumbing i he build'iggs of . CJ: G. . . . . . . . . . . . . . . . at .R11. �� 1�. . /. .�. . . . ., North Andover, Mass. Fee-�, . .Lic. No.. �. C PLUMBING INSPECTOR Check 633 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Mass. Date/M/ Permit7a A�A 3 %z # �� Building Location / Owner's Nam J Type of Occupancy ' S+ 17 E i J Ti �A I- New ❑ Renovation ❑ /Replacement EK' Plans Submitted: Yes O No ❑ FIXTURES z Z N Z Y N J N O Z . W YJ N Q Q N O O UJ N UJ W Z N Q ¢ Cc W U) _ ¢ N Z W Z Z Z a F- J N W y N F- V W S N Y aQ a C 3 X v Z s m w W r Q H H _Z c Q N O ¢ a O W O O W. d N o: Q W N J z p G U. W S = 3 O z Y_' a C 1- < Y Q W uL W O = a a N t- Z O O y _Z = W r- O (j 2 O = Q O < F' a < S 0: m O sus—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing.Company Name PS0t�,£eT A- ,-';j0(rMj4 TAe0 Check one: Certificate Address �� ? C. fi Ac i4mr4n) ',AJ ❑ Corporation lr E!N U C--I\); Al t 0 e,sl cA'/ ❑ Partnership Business Telephone k,4 Z-517 7 1 9--rirrn/Co. Name of Licensed Plumber 'z" Fie T i� SA,yiayl d9 �f Cl�� INSURANCE COVERAGE: I have a current I' ility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ ' If you have checked Ye, please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner E3 Agent [3Signature of Owner or Owner's Agent 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 installationsormed under the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum g e and apter of the eral Laws. Vlaty're of Licensed Plum er Ttl�� f Type of License: Master % Journeymah ❑ CAO/Town APPROVED(OFFICE USE ONLY) License Number 133 1 BELOW FOR OFFICE USE ONLY "s FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME$TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR !/ o Date. . . .. .. .. .. .. NpRTN x 3=0* „•° ,•�tipL TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION �9SS^CHUSE�S This certifies that . . . . . . . . . ., has permission for gs installation . . . . . . . . . . in the buildings of 1er A—, W. . . . . . . . . . . at f/�..0.1 : .li.A. .��/. . . . ., North Andover, Mass. EFee,-,-4'J.,. . . . Lic. No 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# L./ 4 1 4992 MASSACHUSETTS UNIFORMAPPUCA NFORPERMPI'TODD GAS FIrHNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations 6, D-Q/tel Permit# " X�, r-A, -I J A Ow er's Name Amount$ New❑ Renovation Replacement Plans Submitted a U Ea a a x H F C HO E-4 Cn z p F W C7 W C E+ OM O F+ aa Goc z o A H cdwh H z [-4 z w t5 WO rx O w r� c�7 a UO a A a H O SUB -BASEM ENT BASEMENT =' 1ST. FLOOR 2ND . F L O O R 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR Ej .*f#f (Print or type � ` Check one: Certificate Installing Company Name \ �nV� � Corp. Address �� l r`( �" � �� ��'� Partner. Business Te ep one Firm/Co. Name of Licensed Plumber or Gas FitterrZ`�A�W� INSURANCE COVERAGE Checkone: I have a current liability Insurance policy or it's substantial equivalent. Yes No o If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy 1 Other type of indemnity 13 Bond ti 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 El Agent E i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse State Ga 22endA/ hapter 142 of the General Laws. ignatur of Licensed Plumber Or Gas Fitter Title Plumber Tit � ��Z�� City/Town Gas Fitter License Number Master APPROVED(OFFICE USE ONLY) Journeyman Date..Y... TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING SM CHUS Thiscertifies that .... .................................................................................. has permission to perform ....................I....................................... 1. wiring in the building of .................I................y........................................... at-.,.-(" . ..... .............................................................North Andover,Mass. .. ......... Fee ._.�6.............. Lic.No.............. ...........................I............................... f. ELECTRICAL INSPECTOR Check 4454 Commonwealth of Massachusetts ofticialuse only----- i Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked c [Rev.,11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Bate: Z—6`j /Y City or Town of: 00% A r) o 11 1- To the Inspector of'Wires: By this application the undersigned gives notice of hisor her intention to perform the electrical work described below. Location(Street&Number) 2-1-) CAm rlell Et Lot Plat Owner or Tenant a r) Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) 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: ' Completion o the ollowin table may be waived by the Ins ector of Wires. No. oNo.of Recessed Fixtures No.of Ceii.-Susp.(Paddle)Fans Transot .- Trformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above n- No. of Emergency Lighting No.of Lighting Fixtures Swimming.Pool rnd. grnd. ❑ Batterv,Units No.of Receptacle Outlets No. of Oil Burners FIRE ALARMS No.of Zones of D No.of Switches No. of Gas Burners o. Initiating D and InDevices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers eat Pump Ngmber Tons K o.oSelf-Contained . . ........................................................ y Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local ❑ Municipal Connection P g ❑ Other . No.of Dryers Heating Appliances KSecurity Systems: i?' ey No.of Devices or Equivalent No.of Water KW No.o No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: Y g No.of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the,lnspector of Wires. INSURANCE COVERAGE: Un Ass 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 ['BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by munici%al policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. - 1 certify,ander t/te pains and penalties of perjury,that the information on this application is true and complete.III+ FIRM NAME: t�'e L ; LIC. NO.: Licensee: 7aMe S P-5a 2e Y Signature LIC. NO.: 'FU1gG (If applicable, enter "exe'{�pt"in the lic se nn Cber line.)• Bus.Tel.No.: UTERI D Address: flI c00 YQd I�F Alt.Tel. No.: V-621-0-75-5— 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 sit!nanure Telephone No. PERMIT FEE: SAS Ris ROBERT J. SWAJIAN & ASSOCIATES, INC. INSURANCE ADJUSTERS RECEIVED 161 SOUTH MAIN STREET G MIDDLETON,MA 01949 TELEPHONE(978)777-1400 MAR 2 0 2003 FAX(978)777-2255 Rjs988@cs.com BUILDING DEPT. FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman N. ANDOVER, MA 01845 RE: Our File No: 03-07869 Insured: Joseph Coffey Loss Location: 20 Camden St., N. Andover Date of Loss: 2-14-03 Policy Number: WY8310 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of-loss, and claim or file number. tA AD]IISTERS TITLE: On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Ro . Swajian, STE DATE N ASSOCIATION ,INDEPENDENT INSURANCE ADJUSTERS Z mwanp io�I�.s112 Date...N° ? J� 5 � P 6 T ! NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING . _ ;,SSACHUS� , f� ......................This certifies that y ,*......... i.... C has permission to perform ......... ../1... 4;... �a�. �-.................... wiring in the building of.................. ����<� . 7-7-........................ . . .......... at.......... ()........ / to f...F'.. ........ ....... ,North Andover,Mass. Fee....a ,! Lic.No. ..-, tC ........................................................ ' ELECTRICAL INSPECTOR C 4M/98 10:43 25.00 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Office Use Only Permit NcL D 4 rP-All S44 Occupancy 8 Fee Checked i 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 527 CMR 1 :OD (Please Print in ink or type all information) Date To the Inspector of Wires: Town of North Andover The undersigned applies for a permittto perform the electrical work described below. Location(Street&Number £� 0 CAM"n IN Q ^j c�T. Owner or Tenant TQ E Co r7=e-e Owner's Address aQ l A/' 4 C�eiV Z:S" * Is this permit in conjunction with a building permit Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Emsting Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of UghtAng Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Ughbnq Fixtures Swimming Pool gmd ❑ qmd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Sumers Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ran es No of Air Cond Tons Initiating Devices Heat Total Total No.df moo" No. Pumos Tons KW No.of Sounding Devices No.]of Self Contained No.of Dishwashers Soace/Area Heating KW DetectiorvSounding Devices C Municipal C Other No.0frbrver9 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 I have a current Uability 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 hive 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 �] ,-ems/ Signed underthe,Penaitlea of perj�ry.y �,�/ ��' 'C L1C.NO. &',, F z FIRM NAME S I')AWN [ /0��� _ I� Ucensee 5 PN 14,4.1 AJ \...�.+ �/ � Slgnature r LIC.NO. r I ^+" r Bus.Tel No. 6 -7 Q _ Address w t" Aft Tel.No. 46 OWNER'S INSURANCE WAIVER: I am aware that the Licenses 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) Telephone No. PERMIT FEF 5 (Signature of Owner or Agent) G r Date. .i . . . . . . . . . . . . . . .: . . AORTIy - TOWN OF NORTH ANDOVER OF tt�Eo r, O or 5E op PERMIT FOR GAS INSTALLATION �9SSACHUSEt This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . .. . . . . . . . . . ... . . . . .. North Andover, Mass. Fee—. . . . . . . Lic. No.. . . . . . . . . . �':. . . . . .r'!. . .� GAS INSPECTOR }� WHITE:Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File (Print or Type) UNIFORM�APPLICATION FOR PERMIT TO�DO~DASFITTINQ ; ^' �.• ' NORTH ANDOVER. , Mass. Date f Oki 1990 Uv y� Location Building Permit #_,, !/ Locallon -rte��e (y S Owner's Name _SIA 0, New ❑ Renovation p Replacement Plans Submitted: Yes p No [C��] N ol a 0 x R sl h sc N ar 0 NZ N v a N w N v a ►' y s N X p M < Y a 0 o se > < V Id N = V = d h '!C r o 4 M F tM O Ir. J rl 110 126 :0 01 a IL sUQ—daMT. • •ASIMENT 18T FLOOR 2NO.FLOOR t $NO FLOOR 4TH FLOOR 0TH FLOOR ! GTH FLOOR t TTH FLOOR r •TH FLOOR Check one: Certificate Insta"Ing Company Name C� Address Ld ` Q Corp. El Partnership r MrIrm/Co. Business Telephone � � G; S-901 Name of Ucensed Plumber or Das t=itter .l+°Im es Lgrco � INSURANCE COVERAGE: Check one have a current IIabNlty Insurance policy or its substantial equivalent. Yes Pit- No ❑ If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy'qO Other type of Indemnity ❑ Bond p OWNER'S INSURANCE WAIVER: I am aware that the licensee does nol 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 ❑ Agent❑ I hereby certify that an 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 per t Issued for this application will be In compliance with all pertinent provisions of the Massachusetts State Oas Code and Chapter 142 of gNumber T of License: THIS Plumber sum or as er Gastitter �ytT� Master 2Joumeymen APPRONEO(OFFICE USE ONLY) a. z Location ' "`�� ��� No. �g� Date ¢'/�g Of NORTIy., TOWN OF NORTH ANDOVER p Certificate of Occupancy $ 3° oto Building/Frame Permit Fee $ X58 Foundation Permit Fee $ s+cMust Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL r $ qua vim, r C 16 J M2 ` ' .03 ,x.00 PAID Building Inspector !i 7C6r i�SL�t Div. Public Works Yi•= c 'ERMI[T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP i,40 ' Ofd LOT NO. 00&4-- 2 RECORD OF OWNERSHIP (DATE BOOK 'PAGE ZONE I SUB DIV. LOT NO. LOCATION r K s '�--1 I�ZI Z- IZ�P� SI 3L+/� �/j� y- _IC� PURPOSE OF BUILDING J��1,J � C�•�.Q��,l ��Qbr OWNER'S NAME C )�,,,, - rrL\`1( ' ry)I NO. OF STORIES cSIZE 1 Fes 1 -��oc\a OWNER'S ADDRESS ' 1 BASEMENT OR SLAB ARCHITECT'S NAME `. SIZE OF FLOOR TIMBERS IST 2ND 3RD .BUILDER'S NAME C� ��" SPAN DISTANCE TO NEAREST BUILDING (('''• DIMENSIONS OF SILLS DISTANCE FROM STREET 10 F r POSTS DISTANCE FROM LOT LINES- SIDES `_f:T- REAR GIRDERS , ll(V� 1 AREA OF LOTFRONTAGE HEIGHT O �Z11�C� �F• .F FOUNDATION THICKNESS IS BUILDING NEW (� 1SIZE OF FOOTING X IS BUILDING ADDITION `1 MATERIAL OF CHIMNEY Ye,'A IS BUILDING ALTERATION 7 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE C IS BUILDING CONNECTED TO TOWN WATER ves BOARD OF APPEALS ACTION. IF ANY 1 J IS BUILDING CONNECTED TO TOWN SEWER I Q� IS BUILDING CONNECTED TO NATURAL GAS LIN c SOC INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COSTSSI pO0 2:t PAGE i FILL OUT SECTIONS i - 3 EST. BLDG. COST PER SQ. FT. 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 FILED BUILDING INGPKCTOR iIG TUkE OF OW R�ORIZED AGENT , FEE 3�8 OWNER TEL.A � ® 4� PERMIT GRANTED r �' I'� I'• I CONTR.TEL S 19�g 8 © CONTR.LIC.X H.I.c.a C �10RT Town ofdover No. q7 °o- _ 11KE : , dover, Mass., c-7b • 19`i 8 w '9 COC HICHE WICK`~Y'�• �_t1 Rg'rED v E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT �.S Y'. •f.....J .....Cor��� ............................... ........... ............................................................... Foundation has permission to erect...... ................ buildings on ............9-o........(:�! 11"�!—A.►.....��_^................... Rough to be occupied as................ 1�Zj....SEco+v t'Zi'ocrt. 8 Rld 1P..?o... �r sT' FXaCvL1.1)u?.� 4. NChimney ............................... ....provided that the person accepting this permit shall in every respect conform to the terms of the apation on file it 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 STARTS ELECTRICAL INSPECTOR Rough �� ... Service ........ ..... .. .... ....... `4 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 Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. 'l . F r10 RTown Tjy u}. of Andover No. I m * Z dower, Mass. t 'C73 . A+ 19 9S O i r.. IAKE ` A 1- -- WICK '�• �S OA r TPP`y gTED p. BOARD OF HEALTH Food/Kitchen P. ERMIT . T D Septic System THIS CERTIFIES THAT CO BUILDING INSPE R/ ounda . xr has permission to erect.......W .............. buildings on ....... � lVi2ty €� ................�........ .................... ° .... .......... .. .............. to be occupied as.......^! b.....sztmu ame l� o r� �5�j- tt 1, •�,�, .... ........0.............. .#.... � ..., L�.i!�.. Chimney provided that the person accepting this permit shall in every respect conform to the terms of tl application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of "Final Buildings in the Town of North Andover. PL G INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL SP BUILDING INSPECTOR /� Occupancy Permit Required to Occupy Building -GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove R° k Fin ; No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building InspectorFIRE DEPARTMENT 11 Bumer [ Q Street No. / 0 - Smoke Det. CERTIFICATE OF USE & OCCUPANCY Town of North Andov6r Building Permit Number �qla Date Zri4N• ' THIS CERTIFIES THAT THE BUILDING LOCATED ONv MAY BE OCCUPIED AS SiN — �'�+' We iN IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO ^• ADDRESS 20 C(P? I 'ACNU'`` Building Inspector -- _ -.__., FORM U - LOT RELEASE FORM INSTRUCTIONS:' This form is used to verify that all necessary approvals/permits f Boards and_^`-,oartments having jurisdiction have been obtaine from d. This does not relieve -� the applicant and/or landowner from compliance with any applicable or requirements. *"*"*""*************APPLICANT FILLS OUT THIS SECTION .APPLICANT .� PHONEZ7 3_0 /LOCATION: Assessor's Map Number e—m i S- vP'ARCEL ,-00-Z j- SUB VISION LOT(S) QST. NUMBER OFFICIAL USE ONLY RECOMMENDATIONS OF TOWN AGENTS: • r ly CONSERTION ADMINISTRA OR DATE APPROVED . � G DATE REJECTED f COMMENTS ` r TOWN PLANNER 1 DATE APPROVED ; DATE REJECTED COMMENTS f t FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED ' SEPTIC INSPECTOR-HEALTH � DATE APPROVED i DATE REJECTED I COMMENTS i i PUBLIC WORKS -SEWER/WATER CONNECTIONS DRIVEWAY PERMIT i /FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE 1 I Town of North Andover 1 BUILDING DEPARTMENT Homeowner Lit.ense Exemption FM Q.0 PA 1j)1ease print) ----i DATEPh E JOB LOCATION Number Street Address Section of town ;TOWNER" N \-Ali CQ Nama Ho e Phone -Work-?hon-e' PRE ENT MAILING ADDRESS City Town --slate Zip code ie current exemption for "homeowners" was extended to include owner ,.)ccupied dwellings of six units or less and to allow such homeowners to lwrrgage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code , Section 109 . 1 . 1 DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside , on which there is , or is intended to be, a one to six family dwell- �.n g , attached or detached structures accessory Lo such use and/or farm --ructures . A person who constructs more than one h - ear home in a two -y �riod shall not be considered a homeowner . Such "homeowner" shall submit ; o the Building Official, on a form acceptable to the Bulding Official , fiat he/she shall be responsible for all such work performed under the wilding permit . (Section 109. 1 . 1) ('he undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and regulations . The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ,requirements . HOMEOWNER' S SIGNATURE .'.1'PROVAL OF BUILDING OFF CIAL 9 g Note : Three family dwellings 35 ,000 cubic feet , or larger , will be coquired to comply with State Building Code Section 127 .0, Construction Control . 1 uE W ASG¢i� t l ii�..J A6 Ea. 1 'SL caOS.F. a to4oa ra. F. VII I d i y�F HVY•l� Q Q ,�J.� _ IY t�flh'.MJ�C.�,� i G o.SCY r�Y •_'wr. .rte err i• 4'7 'i-0rf` �dM Rip •22 _• , .. +aha; � � u�� �E� `--� 8-r- • �n two.C'.t. C c'1rZ'�.f=t�-� 7wGrs O�. — �, TSt l V�3S t=j..mo2 3'otb� NEW DOUBLE HUNG WINDOWS 24' X 22" GLASS SIZE I SULATING GLASS TYPICAL AT 2ND FLOOR) ■ REMOVE EXISTING ROOF STRUCTURE / FINISH 2ND FLOOR NEW MICROLAM BEAM I I I ENGINEERED WOOD FLOOR JOISTS TJI 16/35 II I I I I I NEW WOOD COLULMNS II Il . 11 � II II II I I I I FINISH 1ST FLOOR FINISH GRADE I EXISTING WINDOWSEXISTING DOOR & I TO REMAIN I NEW REINFORCED I STARS TO REMAIN I I MASONRY PIERS r L — 7 r- 1- J -1 NEW POURED CONCRETE FOOTINGS A q� FRONT ELEVATION i�3 / SCALE: 1/4" =1'-0' NEW POURED CONCRETE FOOTING & REINFORCED MASONRY PIERS ALIGN NEW MASONRY (V.I.F. LOCATIONS) PIERS WITH DOUBLE TYPICAL TJI MEMBERS AT EACH SIDE OF STAIRWAY OPENING I J EXISi_MASONRY PIERS EXISTING FRAMING MEMBERS f EXISTING MASONRY PIERS DO NOT UNDERMINE EXISTING FOUNDATION SYSTEMS DURING EXCAVATION FOR NEW PIERS STAIRWELL OPENING 4'-0" 12' MAXIMUM PIER SPACING CONSTRUCT NEW MASONRY PIERS AT SAME LOCATION AS -EXISTING PIERS PROPOSED BASEMENT FOUNDATION PLAN SCALE: 1/4" = 1'-0" r t Y DELETE/RELOCATE NOTE: EXISTING WINDOW ALL 1ST FLOOR WALLS,DOORS,WINDOWS,FIXTURES,ETC. ARE FOR NEW SUPPORT GOLUMN PRESENTLY EXISTING UNLESS NOTED OTHERWISE EXISTING WINDOWS EXTG WINDOW c Q00 3 CLOSET 0 0 ZREF 3 i' NEW WOOD SUPPORT EXTG c� �n COLUMNS DOOR EW WOOD SUPPORT z COLUMNS 11'-10"18'-1 " " NEW WOOD SUPPORT 5-6 LUMNS w EXTG WINDOW EXTG WINDOW SEAM ABOVE KITCHENcn NEW BASE/WALL CABINETS 0 1 & COUNTERTOP ovE Lo P LAY R O O M EATING SINK 8 —O 3 FAMILY 24'-5" . M NEW 10 R RELOCATE WATER METER CLOSET z ROOM �� M EXHAUST 20 MINUTE DOOR 28" TO w FAN 3'-0" WIDTH HALLWAY�W WIDf 7\LTH 36" EXTG DOOR 2'-6" ?��jWATER 11'-5 to-10" @-51` 11" 13'-5" METER NEW WOOD SUPPORT TUB UTILITY = HALL NEW STAIRS To 2ND FI_ooR COLUMNS H.W, BATH EXISTING DOOR TANK NEW 107 C FURNACE '- � ELEC E 1 PANEL WIN EXTG WIN LINE OF 2ND FLOOR REMOVE DpSTING WINDOWS r OVERHANG ABOVE NEW WOOD SUPPORT INSTALL ONE LAYER 5/8` TYPE X GWB THIS AREA. FILL-IN TO COLUMNS ON ALL WALL & CFJLING SURFACES MATCH EXISTING J INSIDE OF UTILILTY ROOM PROPOSED FIRST FLOOR PLAN DIRECT VENT GAS HIGH EFFICIENCY FURNACE SCALE: 1/4` = 1' - 0` PROVIDE DUCTED EXTERIOR COMBUSTION AIR DIRECT TO FURNACE OBSERVE/ CODE�LMINIMUM DISTANCE TO WINDOW OPENINGS,ETC. Y ti I!'I'• t^1�Yo bw 1'�C.C. f cT'A)1 N Y DOUBLE HUNG WINDOWS 24" X 22" GLASS SIZE TYPICAL AT 2ND FLOOR 14'-10� 11'-D` X-0' 12'-1 ` CL all a w o CL BEDROOM o BEDROOM r ALIGN WITH CENTER 2'-6" 2'-6" OF HOUSE MASTER Q . X " , x BEDROOM CL Q - N N CL CL 2' X N 6'-6" DOWN ATnC ACCESS HALL BEDROOM STAIRWAY s WET WALL 2'-8" 2'-4` XC X 6'-M" • 6'- a TYPICAL TUB We p CL o v 7' 8` -6" EXHAUST FAN NOTE: DUCT TO EXTERIOR ALL WORK SHOWN AT SECOND FLOOR. IS NEW D• w.eok-c PROPOSED SECOND FLOOR PLAN SCALE: 1/4" = 1'-0" DOUBLE HUNG 24" X 22" INSULATING GLASS TYPICAL AT 2ND FLOOR SECURE NEW WOOD COLUMNS TO NEW MICROLAM BEAM ❑ ❑ USING GALVANIZED FRAMING CONNECTORS T NEW STAIRWAY TO 2ND FLOOR 15 RISERS AT 8.25" +/- VIF 26'-1" PROVIDE MINIMUM HEADROOM -6" FINISH 2ND FLOOR � SECOND FLOOR OVERHANG 1ST FLOOR APPROX. 12" AT THIS AREA DOUBLE FRAMING MEMBERS AlOPNG MICROLAM LVL BEAM 2-1 3/4" X 14" MFGR TO PROVIDE ENG. CERT. FOLLOW MFGR RECOMENDATIONS I I I ( I I I IEll EXISTING WINDOW D t TO REMAIN E:l NEW COWOODD FINISH 1ST FLOOR I ( I I I I Li Li Li FINISH GRADE I I I I I I REMOVE EXISTING WINDOWS NEW REINFORCED �_ I I FOR NEW STAIRWAY NEW POURED PIERS MASONRY I CONCRETE r- �- FOOTINGS �L--� r L J--i r. L 1 1 __L__I r L LEFT SIDE ELEVATION SCALE: 1/4" =1'-0" Y h • ASPHALT SHINGLES NEW WINDOWS TO MATCH EXISTING REMOVE EXISTING WINDOW FOR NEW FE-711 7E:11 COLUMN FINISH 2ND FLOOR NEW MICROLAM BEAM I -�-.► I I { I . { � { I II ► I I ► 1 I ► I ► I { � ►� I I ► ElI I I EXISTING WINDOWS/ REMAIN TOI I I c ► I NEW WOOD I I I I I I \ COLUMNS { { I { I I { { { I I I FINISH IST FLOOR ITLi E F- ti FINISH GRADE EXISTING DOOR &I ! I I I I { I I I I I { ► { { NEW REINFORCED STAIRS TO REMAIN MASONRY PIERS I ► I I I I I I 1 1 r—L----1 , NEW POURED �J , CONCRETE 7 L- - - -I FOOTINGS RIGHT SIDE ELEVATION SCALE: 1/4" =1'-0" NEW DOUBLE HUNG WINDOWS GLASS SIZE 24" X 22" REMOVE EXISTING ROOF STRUCTURE / FINISH 2ND FLOOR t. w t 1.L NEW MICROLAM BEAM { { { NEW ENGINEERED WOOD FLOOR 16/35 TJI Lj { { EXISTING WINDOWS { ■ ❑ TO REMAIN { { { { FINISH 1 ST FLOOR � TT- FINISH GRADE NEW 1 { { { , MASONRY FPIERSD { rLJ � NEW POURED CONCRETE r L I , FOOTINGS REAR ELEVATION SCALE: 1/4" =1'-O" t MFGR TQ-p_ROVIDE=ENGINEER NIG CERTIFIC TIONATTIC (5) AS REQUIRED PROPOSED TRUSS TY P f CAL CROSS S EOT(0 N MOOD, MEMBER SIZING BY MFGR. (SECURE TRUSSES TO TOP PLATE USING GALVANIZED CONNECTORS SCALE: 1/4" = 1'-0" qJ RIDGE VENT 1/2- GWB ON 1 X 3 FURRING R-30 INSULATION 12 -16 TYPICAL EAVE DETAIL:- CONTINUOUS SOFFIT VENT METAL DRIP EDGE ICE/WATER MEMBRANE FASCIA & SOFFIT TO MATCH EXISTING TYPICAL EXTERIOR WALL: SIDING TO MATCH EXISTING 1/2- CDX PLYWOOD SHEATHING 3/4" T&G PLYWOOD DECK 2 X 4 WOOD STUDS AT 16" O.C. NAIL & GLUE TO FRAMING R-13 INSULATION POLY VAPOR BARRIER 1/2- G.W.B. REMOVE EXISTING ROOF STRUCTURE ` NEW ECONTINUOUS: MICRO-LAM LVL BEAM c2"1 3/4" X 14" BEAMS NEW WOOD COLUMNS TO SUPPORT BEAM FINISH 2ND FLOOR LOCATE COLUMNS AT NEW MASONRY PIERS -,MFGR ENGINEER TO PROVIDE ENGR CERT. ENEGINEERED WOOD(FLOOR TRUSS -TJ1: 16/35 AT 16" O:C MANUFACTURER 'ENGINEER TO PROVIDE CERTIFICATION(S) AS NECCY NEW R-19 INSULATION FOLLOW MFGR RECOMMENDATIONS WHEN INSTALLING PROVIDE VENTILATION PER CODE EXISTING WOOD FRAMED WALL STRUCTURE TO REMAIN EXISTING WOOD SILL/PERIMETER BEAM TO REMAIN EXISTING CEILING TO REMAIN V.I.F. CONDITION Of EXISTING FRAMING PROVIDE SUPPORT(S) TO NEW FRAMING AS NECESSARY REPAIR REPLACE AS NECESSARY EXISTING FLOOR FRAMING TO REMAIN PROVIDE ADDITIONAL BLOCKING AS NECC'Y REPLACE ANY DAMAGED FRAMING NEW REINFORCED MASONRY PIERS 16" X 16" USE CHIMNEY BLOCK) 'STEEL CONNECTOR4__ GROUT SOLID 2-#4 STEEL REINFORCING SECURE TO NEW COLUMN & EXISTING FRAM&G SEE FOUNDATION PLAN FOR LOCATIONS ANCHOR TO NEW MASONRY PIER FINISH GRADE CONFIRM PROPER SOIL BEARING CAPACITY NEW POURED CONCRETE FOOTING PROVIDE MINIMUM 4' FROST PROTECTION 36" x 36" X 12" 2- 4 STEEL REINFORCING BARS PROVVDE 6 MIL POLY EXISTING MASONRY PIERS TO REMAIN VAPOR BARRIER REPAIR/REPLACE AS NECESSARY TYPYICAL AT INTERIOR & EXTERIOR PIERS �. .� r, ; ' } 4 .a , � � 1 1 � � ! � � .. 't. � � �. :;� •. .. � Y, t � ,� ' i � 4 ,, .. �. ' � +• { ,. ` , - f 5 � - e � .. .. i • � t I � ' � � � � � ,i�. � � \ - �' \, - r I � EXISTING FLOOR FRAMING TO REMAIN PROVIDE ADDITIONAL BLOCKING AS NECC ' Y REPLACE ANY DAMAGED FRAMING 11,111,111,11",................................... .............. STEEL CONNECTOR SECURE TO NEW COLUMN & EXISTING FRAMING ANCHOR TO NEW MASONRY PIER FINISH GRADE i- I [-iTi=fl -iT ii-iTi=iTi-iTi�TeiTi ol i=ll=mil — i=In I 11 11-111-11 L�T�111= a—iii=111 NEW POURED CONCRETE FOOTING 36 x 36 X 12 " 2 - # 4 STEEL REINFORCING BARS L 1 a EXISTING WOOD SILL/PERIMETER BEAM TO REMAIN V. I . F. CONDITION OF EXISTING FRAMING REPAIR/REPLACE AS NECESSARY NEW REINFORCED MASONRY PIERS 16" X 16" (USE CHIMNEY BLOCK) GROUT SOLID 2 -#4 STEEL REINFORCING SEE FOUNDATION PLAN FOR LOCATIONS i1: jjjl jjj CONFIRM PROPER SOIL BEARING CAPACTIY PROVIDE MINIMUM 4FROST PROTECTION °a 11 ol ol PROIVDE 6 MIL POLY VAPOR BARRIER r ~ Date.�. :,;2 9. .? s 3771 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBINGcz CL 41 ;,SSACMU 1�2 This certifies that . .!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . plumbing int a buildin s of� ='� 'at +�. . . . . . . . . . . . . . . . . . . . . orth Andover, Mass. 4Fee.9p. . .Lic. No./.9��3j'. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK:Treasurer U9 (, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING T -2)A?ype or print)t)NORTH ANDOVER,MASS HUSETTS Date uilding Locations rr 0 a NYM t? � Permit # ..�� mount ev 0 Owner's Name New Renovation Replacement ❑ Plans Submitted FIXTURES 04 Q 7 W F W F Cn Cn a � W F d a z d a A a F '� SLsBM msEmm LL 2MFLOCR R. 3t HIM 4M Rfm MFLOOR sup rpt 7M FUM 9IR RDM (Print or type) Check one: Certificate Installing Company Name ❑ Corp. q yh S ❑ Partner. Address rg Business Telephone °j v Firm/Co. Name of Licensed Plumber: L ifIn ► I Q S� w e: Indicate the a of insuranc verage y checking the appropriate box: Insurance Covera type Liability insurance policy Other type of indemnity Bond ❑ ❑ Insurance Waiver: I,the undersigned,have been mdde aware that the licensee of this application does not have any one of the above t insu c + a re � 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 Permit Issued for this application will be in compliance with all pertinent provisions of the���ittgCode n apter 42 f the General Lawsn apter 42 f the General Laws. By; +gna re o Icense um Type of Plumbing Lice s Title02- 0,,- City/Town ice mer Master Joumeyman ❑ APPROVED(OFFICE USE ONLY r } 291 1Date.. . . -"q%' '' .. .. i HOR7M TOWN OF NORTH ANDOVER 3?oya4,�an ,a,�4'pL A PERMIT FOR GAS INSTALLATION f 9 # • oo ,SSAC14USEt This certifies that �Q. ./ `. . . . . . . ... . . • • • • • • • • • • • • • • • • • te- 7 has permission for gas installationco in the buildings�of . ! . . . . . . . . . . . . . . . . . at ..r�?. .,.. . . . . . . . . . . . . . . .-- . . . . . ., North Andover, Mks. Fee. !.`�. . . . . Lic. No�n� �7. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer s > MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING Type or print) Date 19 7 NORTH ANDOVER, MASSACHUSETTS Building Locations �(I l 12 m A 12 �i Permit#— 1?11 XF Owner's Name �.1 a Q w New❑ Renovation Replacement ❑ Plans Submitted ❑ � W z �i F z z E, C ir. w n V7 C7 w z C C C w w Z x w r U z E~ w c - U z -t w -e �- z c z C w : w z '� x a =� C C w C SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4T Ii . FLOOR 5"rH . FLOOR 6TH . FLOOR 7 T 11 . F L O O R S'rif . FLOGR (Print or type) ^ Check one: Certificate Installing Company Name S t� PG ❑ Corp. Address S ❑ Partner. • Business Telephone �Firm/Co. A Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No E3 If you have checked yes,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does nb{have the Insurance coverage required by Chapter 142 of the M S. enef I aw , hat my signature on this permit application waives this requirement. Check one: Si re of Owner orUne GAgent 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 Permit Issued for this application will be in compliance with all pertinent provisions of the Massachus Chap 2 oft neral Laws. By: Si e of Licensed PI ber Or Gas Fitter Title lumber City/Town ❑ as Fitter License Number Master s APPROVED(OFFICE USE ONLY) Journeyman Date.�.-./ 00—o?00 3 f ,apRTN q "o,� TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACMUS� ►r � Q � l This certifies that �� Lission ............................................................................................. has to perform ����� `°P� rr S .............. ................................................................ wiring in the building of..!��(.`.°.:" ......... ........................................................ at...,,e269 C. ll /aA ,North Andover,Mass. ...................................................... Fee.....:A......... Lic.Nol"`fi P. .'�... ��° lAl.`''.'u ........ ELECTRICAL INSPECTOR Check # 4348 THE COMMONR ALTHOFMASSACHUSETTS Office Use n y DEPARTNIF'NTOFPUBLIC,SAFETP 41r I ermit No. Permit ccupancy&Fees Checke APPLICA71ONFORPEIMTTOPERFORMELE=CALWOIZX ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) Owner or Tenant (�;l e-iJ 9'yw.4,�,; y Owner's Address Is this permit in conjunction with a building permit: Yes M No (� (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead r"-�TTUnderground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ound ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections, No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP tT IER• stnanceCovt.PtusmtiDtheregzmia&ofM GffxdLaws ra,&aataatLmbdityhmaat=Pb yindxkCCMV]et Cowmgccrtssst dogmvaleri YES F-1 NO avest>Ixr WdvaldpeofofsamelotbeOfce.YES Ifywhawched®dYFS,pimwin thetgrof coverageby eckingthe box _ . _..._ SURANCE BOND OIIIIQt (P]easeSpecy) EVitafim Dale / � Est n*d Vahte ofDact iral Wtxk$ xktoStart hq)eC1i nDatReWes1ed Rough Fuel ped=T)iePerr��esefp 'syr MNAME ! /' �10_11 �.ldl�� LicenseNo. 1,� �� alsee LxenseNo f� A/ BtlsrnessTel No. a3 362 iress� //%//11w AXvx G�3 ��SOI✓ / . /�z AfL Tel No. 2 INER'S INSURANCE WARU2 I am aware that the LK)Eim doesnothave the irtw&-Ce mwrage orits aibswM egtuvaler t as regtmed byMassachusezGenerall-awk (hat mysiglahue on dwpeirntapphcation waives this regaaetnalt. :ase check one) Owner ® Agent ® Telephone No. PERMIT FEE Signature of Uwner or Agent