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Miscellaneous - 200 HAY MEADOW ROAD 4/30/2018
i '10 1 ba Date .....f ..:�.` ..� . r� 1 �-- OWN OF NORTH ANDOVER �PERMIT FOR WIRING This certifies that ............�\> ......C`�U./........L�.C�. �..�.... has permission to perform�- .............................................................................. wiring in the building of ..............t'.}/9E`;............................. at .��-06.11l.4�%7.lbw0nt!%........ ..4LE . N rth Andover, Mass. Lic. No.(� W-2 Q.....................r CAL INSPECTOIE J'�y 4 Check # ,���� ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the ermit 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 applio tion has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the pot, firm, or corporation stated on the permit application. rich entit .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-invalidaf-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 puipose by establishing an automatic four-year extension to certain 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. 8 — Permit/Date Closed: Permit Extension Act — Permit/Date Closed: * * * Note: Reapply for new 0 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Utheial Use Only Permit No. / D / ,? Q Occupancy and Fee Checked _ :ev. 1/07] (]eave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WOR All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 547 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATlpl9 Date: City or Town of: NORTH ANDOVER To ' By this application the undersigned givenot s ice of his or her intention to erfozm the electrical work dies described below. Location (Street & Number) Z00 �1� er—� Owner or Tenant V GL .� C�-C) Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of Building No E](Check Appropriate Box) Utility Authorization No. Existing Service Amps _/ _Volts Overhead ❑ Undgrd ❑ No. New Service Amps _ / _Volts Overhead ❑ of Meters Undgrd ❑ No. Number of Feeders and.Ampacity of Meters Location and Nature of Proposed Electrical Work: Q of Recessed Luminaires et,No. Com IOn of the followin table may be waived by the Inspector of Wires. No. of Ceil.-Susp. (Paddle) Fans No. of Total No, of Luminaire OutletsTransformers No. of Hot Tubs KVA No. of Luminaires Swimming Pool Above ❑ In- Generators KVA o, o mergency Ig g ❑ No. of Receptacle Outletsd, IQ nd. No. of Oil Burners Batter Units No. of Switches t..J No, of Gas R c FBF ALA -MS No.'of Zones 11 Burners NO. of Detection and No. of Ranges No. of Air Cond. Total Initiatin Devices . No. of Waste Disposers p Num Tons_. No. of DishwashersDeteetion/Alertin .......... Devices Space/Area Heating KW Local ❑ M micipal EJ other No. of Dryers t 3' No. of Water Heating Appliances KW Connection SecuritySystems: Heaters KW No. of No. of lvo. of Devices or E uivalent No. Hydromassage Bathtubs Si s Ballasts . No. of Motors Data Wirin No. of Devics E eor, uivalent Total HP Telecommunications Wiring; OTHER: No. of Devices or F.n»i�at...+ Estimated Value of Electrical Work: Attach additional detail if desired, or as required by the Inspector of Wires. Work to Start(When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10, INSURANCE COVERAGE: Unless waived by the , no and upon completion. the licensee ownerpermit for the performance of electrical work may issue unless 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 EJ certify, under the pains and enalties o ❑ (Specify:) (perjury, that the information on this application is true and complete. FIRMNAME: (�; cc;�, . E�eC� C Licensee: _ C LIC. NO.: Z0 !�; 1C) (If applicable, enter empt�secur�-rk� ne.) Slgaature LIC. NO.: [� Address: 1 L� Bus. Tel. No.: *Per M.G.L c. I47, s. 57-6es D Alt: Tel. No.:OWNER'S INSURANCE W Department of Public Safety "S" License: Lic. No. AIVER: 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 owners a Owner/Agent ❑'gent Signature Telephone No. [PjRIIIIT�FEZ $ \J ELECTRICAL PERwT No. ELECTRICAL INSPECTOR - DOUG SMALL TION RI;POR7C: a I. ROUGH INSPECTION: Passed — [ Fled — [ ] Re -inspection required[ ($50.00) - [ ] Inspectors' comments: (Inspectors' Signature - no ' itials) Date I WYNTAT ThT[„n'n-- -. �• ....i..iswu.vpr.Gt..A1Vl°I; Passed — [ ] Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: (Inspectors' Signature - no initials) Date r 3. UNDER GROUND INSPECTION. Passed — [ ] Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: ',.uuZ1kCcwrs- signature - no initials) Date 4. INSPECTION—SERVICE: - DATE CALLED NATIONAL GRID: NAME: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: .� (Inspectors' Signature - no initials) Date 5. INSPECTION - OTHER: Passed — [ ] Failed — [ ] Re -inspection required ($50.00) Inspectors' comments: ----------------------- (Inspectors' Signature - no initials) Date DOOR TAGS ARE TO RE FILLED) OUT AND LEFT ON SITE IF TBE AREA TO BE DNSPECTED IS NOT ACCESSIBLE AND ARE-INSpECTION OF $50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts .r Department of Industrial Accidents Office of 1"nvestigations UV 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information Please Print I,e ibll Laine (Business/Organization/lndividual) :"� cu -c- Address: City/State/Zip:__ SCUSU S A O Lei Ok Phone #: (3 7 Are you an employer? Check the appropriate .r`� box: 1. I am a employer with —1 4. ❑ I am 'a general contractor and I employees (full and/orpart-time).* 2. ❑ I have hired the sub -contractors am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These subcontractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL myself. [No workers' comp, C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] h Any apph�t 'fiat checks box I must also {1t out the section be,. sheen f ^ the= work— Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. F-1Building addition 10 Electrical repairs or additions 11 -El Plumbing repairs or additions 12.0 Roof repairs 13-Elother — Mmeoxvners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: CC�M Policy # or Self -ins. Lic. #: —UJ e. Q 00 1 L j Expiration Date: Job Site Address: �� I -[ c.YC G/0 City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify underthepains and penalties of perjury that the information provided abo a is true and correct Signature: Date.: Phone #: c� _ 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): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #: LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 —352-2858 cell: 978-502-5921 June 27, 2011 Mr. Kevin Murphy 169 Boxford Street North Andover, Ma 01845 RE: Partridge Residence, 200 Hay Meadow Rd., North Andover, Ma. 01845 Dear Mr. Murphy As you requested I visited the site to review the installation of the Engineered Materials consisting of LVL Beams in the framing of the above project. These are shown on drawings prepared by Steven Foster dated 10/28/10 and certified by me 11/11/2010. As we discussed the Simpson connection hardware as shown on the drawings need to be installed. The Ledger at the house should be connected to the rim board with Fasten Master Ledger Lok as shown on the drawings. Also you substituted 3-2*8 headers for the LVL members shown on the plan at the walls supporting the roof. This transfers the roof to the deck beams below, these beams should be increased as shown on the attached drawing with supports at the house as shown. Based on the above site visit and based on what I could visibly see provided the above additional work is completed I can certify that to the best of my knowledge the LVLs members and Engineered Joist utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the Massachusetts State Building Code for 1 &2 Family Residences. All other framing requirements of the drawings and code, including but not limited to materials, nailing schedules, blocking, connections and other details are the responsibility of the licensed construction supervisor responsible for the project. Should you have any questions please do not hesitate to call. Yours truly, OF,y,�, / LAWRENCE H O o G Lawrence H. Ogden P.E. Structural 27765 'A 27765 0 61271 '11 OV'TA kL. A, I f V. tkf" V7 C� 2-12 I -be_ Lawrence H. Ogden P.E. 198 East Main St Georgetown, MA 01833 � �a' t" A v (o (PT) V--LiA-r TO Chits r-P-lal'6. to -Or L— � 0 p `2 — 5 � k3 � v T1tS Nk L Ad L- 2 -Zx- I Z- fR D c\j c�,) T ca� Z77 I �j d 0 LL LL p� UJA Cld � M X Nm U (Ll W M a oo 0 moCD v 3%Ju 0 U J 3 O ww 3� LL a o 0 0 p� UJA Cld � M X Nm U (Ll W M a oo _ r moCD ri 0 U 3 O V) cD 2. 0%. 11:54 w.+.9 RECEIVED DEC 0 6 2005 TOWN U}'' TOWN OF NORTH ANDOVER U-`.' pomplNo p'? COKHEALTH DEPARTMENTE j y ADDREsS '17S DAT� OF p Q t) Y zo rvxt oy RZAYY 0 3 U'kMBa IN KQM.: . M"cKmLo KuNb"." WOMB $OLIP& I-- $0LrDOAMYgy-UK" CPO. Date ........ ................zq . 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................... ........ Zee-'aep4ep .............................. has permission to perform ....... e4lZ19: .... wiring in the building of.......... no ..................................... ......... ...... . North Andover, Mass. Fee ..'�.. 5� ......... Lic. No. ............... ELECTRICAL M,� pEcTOR Check # --i �, 1 910 4, �a�ulrler11t1x tai mpa xpr l"J511114 pal'rrtll 154w,lomew of Piro aftwovea E)caupAnt:y Alld f 6e 00rk/-NTI0N REGULAT10N' jsso 991 1�ava utznl �-- BOARD OF 11ir- �"f l pl"I#��11 �^C1 'I* 'MIIl1T,1T�flpa lAl ll� a fl�Iill"A� WORK All wrnl� taha Nerihnnaa in ecrta.l.0 Date;Z D (FJu1F"l# S PRINT iN JNA OR T)'f'' L lNFU h4 TICNI Tu file Jrlspectar u1 Wires: r� d� �xa1 pA^'1�Aa Ilk t1f1> fol I' hm Aleotricat Wo,'It dAAe`r119 d Val ow A pN'�Aor Oka ulidsrtai rl lftV na�cO o t��s o, 1iel : ncti c 1 4 , fay this 1t}tip ' (n '� I.oaattpAtA (��Mw NpAAIIAor) 'I'opoplAOAAc No. owner Ar Tonfilat �^ (a m>�k ApAproprpi 114 Ifllaat) QwA1�"{•oa A,e�d1'iaeta r sa {� ' Is tills Perin" In eAa#nl+atpoA AAi, n b1 NBIr1� f?ae'{Adt^ l't##lr AAAt#lar#xitltllt Nal p1AAA"pose Of 5111i#ding �1rNo. Of I1r 001 Oki 0't c1'I1w"Ad (� AI tAtlpgrst Bl(kSetAag sarvlem Aasp''s _-- ValiqL1sot# Ad No. o£MAtAirla ,MAMA" �� r#AR1`1ta Nllin iav off 1t1'IAQdora and Al nIPAalt) 1.0010101A sV no Nature of p ropowd No. of R1AaA,AAtf 1f+IAt�- Na. of 1.11holis 010108 No, of 11,116101119 plu No, oK RAA+AJF inelA 01010,t9 of 9witcholl Na. Alf RAUGOR N0. of WArAte pJapaolierq IVa. of papeprwntalltlrti �a. of Bryon p;l�ct1'#ca11 Will"1R: No. of C100.411st1, (PAtlddlo) pans f+lo. (it• Jim Ullp 9wi{A1na1r g Pnol er{,d. --9 No, of 00 001'1lllr11 NO. of (l a Burner >Vla. atf All, tcanttl Sp Are"Aven Il0601119 1(w ,.—..,.�' �•�ai�tlp,� 4,pp#taanr*ac p�1r►' I►.ih' ��....o tFpaptaste LII KVA FIRE ALARMS INO- Of Z081Ae of ARAA114111114044111 Data IVI QUIRIC111i 0 Other Canna ion No. Kytirni aARNage DAAM111#tt No, of A7otur+i Tntul He ^ TOTHER,mm - �_- _ _ v. _ �tu�ch nililirinual R�w�rr rl rry►rrQ�, nr ns rrrgrdrar! h,1' 1�a arrRiraai�►' ar JOWN. iNS URAiVlCU- COVERAGE, 1Jnlveil waivad by the: o%%I - el - 111) lzcrmtt for the performonce of mlactricAt work mAy iflatle {111,0911 tha iicommc prav{d+ 11 prOMWHability n,nuranc.e ill0kidwa wlllplt"tc4# cipvtvion" coverage or its sub8tantiall equivalent. Tilc widerillwd cel ifin, that 31.1ch cov l'up ill forcc. gild has ('01111lted I. -woof of 541MC to 1110 permit -$114uirl$ afftcA. C"ECK ONE: INSURANCE� BoNn � OTITR M -f �uacrt�:) %% I�% �1/S 6 Fatimated VlaiuA of E109TY)Aal WWI(' (t�lten rtgtltrcd 11y ntu:ltr�p�lll policy) Worlr to start.__ lttapec(irn,s to be ' I%J ested in acaardanca with MEC Rule 10. And upon complation. J IA►Adel, ft#a �1AI�ltSt�lliid)A�affin of (w;jdll1 (i4ll► file itatt)mrArlilil on 011.P kt1ti0l1 IS lrlAtt !►!►(i f1RANidAtsir, I'I1R.M NAME, �. ... � �� , ILIC. NO.: #riIGA+11t1QA: SlRnxtna'a LAC. NO.: f/rapaphrahAn, ni mrArn/rs hr rbv fr a.rs„ " ,., Y )Alt. Tall. Nfl. AaIlI1'AsB: Alt. 1l'Ap. No. . (AWN R A am as sere that Clic Ucensee ribs 1101 hard t e hAUrlliy insurance cove) 1p nar1Y►81iy regnii'wA bylaw 1�1y Illy 91 iiAture b�iow, 1 fleshy r.vsur t tl� 5 a�1�+iret�ient. i Ali' ti1c (VhMCt pile) a owner Q. Owner'I A alit t�W1AeRMIR�t"t1t PERMIT PRE $ si�tltaetAl•8,...�,..,�,�._.�..,,.�.,......�.....__..___.__ ft�tcpllottc �io.............�� i�0'� °� ��Z3`��Q`Z Date ...... I..z —../ .9 — ej G ....................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ (.,' 0.. j &ej has permission to perform ... wiring in the building of ..... ... . ...................................... at .............. e?. e ......... . North Andover, Mass. Fee ........... .......... Lic. No.. .74 ................ pzzzl� ..... ...... Check # i 27 — ELECTRICAL INSPECTOR e L 7 7107 No. of Recessed Luminaires c,ommonweairn or massacnusetts Vtticial use only Permit No. -7/ _7 •.....c ,,.,,, �c .ru.veu .r.e rrz� ec°vr v rrtres. °• ° ota Transformers KVA Department of Fire Services No. of Hot Tubs Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 No. of Luminaires leave blank o. o Emergency Lighting Battery Units APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK No. of Oil Burners All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 No. of Zones (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: If -- / S — ® C, No. of Gas Burners City or Town of: NORTH ANDOVER To the Inspector of Wires: No. of Ranges By this application the undersigned gives notice of his or her intention to perform the electrical work described below. No. of Alerting Devices Location (Street & Number)_2 C'>0 Onq fflkkc4i eatum Totals Owner or Tenant S' 19 !C Telephone No. ons Owner's Address ? 0 2:L, ,M POW o. oSelf-Contained Detection/Alerting Devices t Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Space/Area Heating KW Purpose of Building0C/V� �jn Utility Authorization No. No. of Dryers No. o ea KW Heaters Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters .p New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Motors Total HP Number of Feeders and Am acit p y OTHER: Location and Nature of Proposed Electrical Work: Completion -f the loll .,; o r Al t. No. of Recessed Luminaires --.._ _____._ ,. ...,.�,,..,....,. No. of Ceil.-Susp. (Paddle) Fans •.....c ,,.,,, �c .ru.veu .r.e rrz� ec°vr v rrtres. °• ° ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets — g No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eatum Totals Number .............._....._ ons o. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ un'c'pa ❑ Other Connection No. of Dryers No. o ea KW Heaters Heating Appliances KW o. o o. o Signs Ballasts Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: Attacn additional detail ij desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2�g�®°OU (When required by municipal policy.) Work to Start: A-1 -/ (o 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 cover ge 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: or "612 5kff TLF. ",%a LIC. NO.: 14 724 Licensee: �Qy NQS Signature _ LIC.�NO.:15—/'ZZ (/f applicable, enter "exert" jn the license number line. Bus. Tel. Address: ,3(e) "7 Al,_l 2d Alt. Tel. No.:t03-ScG *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally 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. $ 0-7 nn'� Date. Y11 -le,... TOWN OF NORTH ANDOVER eERIYIIT FOR PLUMBING This certifies that ... C4 ....................... has permission to perform ... Rf?. 4-'k .0. 1 f °................. . plumbing in the buildings of � ...................... at /U 49 ..//10 —<Ir . . ...... North Andover, Mass. Fee. Y Lic. No. . ..... PLUMBING IN PECTOR Check 3 2 '5 1 — 7037 tiey MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location New Renovation / Date `7 % )wners Name `` i �e�l r � L, mit # ��� A ount of Occupancy j� Replacement 1:1 Plans Submitted Yes a No ❑ FIXTiTRFC (Print or type) Installing Company Name Address Check one: Certificate Partner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate th f insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond El Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature I 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 Massachuset e Plum�Code d Chapter 142 of neral Laws. By: i o icense uumm�e_r Title ype of Plumbing License Ja �� City/Town tcense Numuer Master M ---Journeyman ED (OFFICE USE ONLY L j r Date .........7... Z. 7.,0 6 ;„``° '•_ "�,TOWN OF NORTH ANDOVER p 190 PERMIT FOR WIRING This certifies that ........... .:. PwA.5-15. ,qj.7 ......... —X 4n7— ......... has permission to perform .......... pi... !�I wiring in the building of ...........1.��.•r'• 11. ....................................... at ............. y�l ie #. Aa. North Andover Mass. d� Fee ..�.,T..: -... Lic. No.7/..............PLECTRIC-A-LI.N-SP;, c.,�; t7 .......... (} rOR Check # 60;1_4 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only / Permit No. `y Occupancy and Fee Checked [Rev. 9/051 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code MFC), 4 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: �.1 �rylpl-t/�_._ _ To the Inspector of fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) ;6 J:1! !q MC-A�9� Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work:�Ly.,. ,� S Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires 3 No. of Ceil.-Susp. (Paddle) Fans No. OT- Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. o mergency Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kms, Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Elec ical Work:yr�QCSO ` �G (When required by municipal policy.) Work to Start: IQ Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE M BOND ❑ OTHER ❑ (Specify:) / certify, under the airs and penalties of perjury, that the information on this application is true and complete. FIRM NAME:`�tib �� Gpl �\/ LIC. NO.: Licensee:,�Q Signatur LIC. NO.: (Ifapplicable, onAer"ez t" in th)(4�tAumerli?ge) Bus. Tel. No.: Address: _ Ifo �r'� Alt. Tel. No.: l k 4JL-3 Ii *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, 1 hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that........ �L,�G'z . ............................ has permission to perform ........... ... .. / wiring in the building of ......... IP .......................................... at . .......................... .. I North Andover, Mass. Fee ..,�' 460� .. Lic. No/:Ty`.7�/? ........ ......... Check # cPO537 At�1�9'CMICAL INSPECTOR 8 7 1 7 Comawnwea& of Maamackueef Official Use Only Permit No. Z7l eLJePartm�ent ol3ire �ervice� 7 Occupancy and Fee Checked r` 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 (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TY EALL INFORMATION) Date: City or Town of: ^Xi 1© sae n, 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) �2 (o 14 f+ -t M e-4*ygW Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building S& eS a 'o4~1 -e— Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity No. of Meters No. of Meters Location and Nature of Proposed Electrical Work: �/ b �� e� (SZ— -e -1, a Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires 3 No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires 2. Swimming Pool Above ❑ In ❑ rnd. rnd. o. o cy tg mg BatteryUnits Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons KW ... . ... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers j Space/Area Heating KWLocal „ °j kU ❑ Municipal [:]Other Connection No. of Dryers Heating Appliances KW SecN of Devi es or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: s to Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1!9,Q (When required by municipal policy.) Work to Start: 1/0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete, p FIRM NA 2)TA i ed t� �, ;i s1 ICA L s!�- LIC. NO.: 17/� Licensee: �'11P?A01fVtk ZL: Signature LIC. NO.: 3 `/ 4s DG (If applicable, enter "exert" 'n the license number line.)/ Bus. Tel. No.:rJ�fr 6,tz - 9j Address: 10 G! WJb� � ; Z� i'1 `J '�J s 4 6 I �`�K Alt. Tel. No.:Fir *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 Signature Telephone No. PERMIT FEE. $ Date.//-. . ?..�-.� . :rho TOWN OF NORTH ANDOVER 3: �c o PERMIT FOR PLUMBING This certifies that ...l�.. ...� �°� . (�............. has permission to perform .... ...................... plumbing in the buildings of ..Pe.. ...... j ................... �/� fir! ra `��. ` ` ...... ,North Andover, Mass. at. ��.�....�..... Fee. Lic. No... L ....... -... ....... I ......... VPLUMBING INSPECTOR Check # 1 �� 5014 0 21� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) de) y-�'�, Mass. Date �� PPermit # �!^� Y Building Location d Owner's NameP,,,, j / Q r Type of Occupancy Residential ihy V'` 1 New 1. --J Renovation (-J Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Narne Heritage Htg. &Pig. Co. Inc Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone Name of Licensed Plumbe 781 -3$= 7 7 — Gordon Switzer Check one: [X Corporation C7 Partnership F1 Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes N No 0 If you have checked ,yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy lX Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ or I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter1 of the General Laws. By SIgnatwe of lcenso�um 5,r Title _.__ ----- — Type of Liconse: Master t$ Journeyman ❑ City/Town $ 3 2 2 APPROVEGZO�—E F7l SE ONLY) License Number___ _ 2 Z N X 6 r > W O W n 1- W n X to J J N } o_ U Q 0 W K �-I ?-� t -r :n Z 0 Q a: ~ Z Z O Z 2 ` a ll� Ul �1 O J U — W In M F- W W S: N cC 1- U .( ¢ W VI X Z Q to � a u" ... S Q Q rt1 R1 rd �-I v ZCr O 7 2 .( N O 2 W N Q � w ^�✓i U > O N O Z O W rt cc a Q C Q -Y i-' i- ri Y J til Vf O D 4 J 3 Z f- N LL C7 7 `J Q L_ al SUB—BSMT. BASEMENT _ IST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Narne Heritage Htg. &Pig. Co. Inc Address 35 Pleasant Street Stoneham, Ma 02180 Business Telephone Name of Licensed Plumbe 781 -3$= 7 7 — Gordon Switzer Check one: [X Corporation C7 Partnership F1 Firm/Co. Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes N No 0 If you have checked ,yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy lX Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ or I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stale Plumbing Code and Chapter1 of the General Laws. By SIgnatwe of lcenso�um 5,r Title _.__ ----- — Type of Liconse: Master t$ Journeyman ❑ City/Town $ 3 2 2 APPROVEGZO�—E F7l SE ONLY) License Number___ _ T J z O w N D LU U U. U. O ¢ O LL O J w In Vol, W Y N z O h U W 4 cn z J a 2 n w W LL O z 0 w r z a ¢ 0 N ¢ W 4 W r a 0 Date. � . �'� 7 ? / NORTH .1� TOWN OF NORTH ANDOVER .p 9,00 go p PERMIT FOR PLUMBING This certifies that;..... ............ . has permission to perform ...... ..................... plumbing in the buildings of ..�/q�T�.!Q,%� .................... at ... Y. ...... North Andover, Mass. -b��Fee.. � :?.94 .............................. -�7C� PLUMBING INSPECTOR ' Check # ! 7 8d 8058. �' Date..................................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING' This certifies that .... ........... ................................ I ..................................... has permission to perform ...................................................................... wiringin the building of ........................ ............................................................... ...... .......... ,North Andover, Mass. at ................. . ............ I . ......... .... ...... .... . Fee-..'_ .................. tic. ................................................................ ELECTRICAL MpEcTOR Check # > FIXTURES MASSACHUSETTS UNIFORM APPLICATION.FOR PERMIT TO DO PLUMBING City/Town: A r A i :'�a'f "E� MA. Date: Permit# '%2 Z s Building LocationOwners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential - - New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ( Plans Submitted: Yes ❑ No FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes �o ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner [:] Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Tidelumber Signature of Licensed Plumber City/Town Master APPROVED ❑ OFFICE USE ONLY) Journeyman License Number:o`' Wiz, ,�_ Z Z Lu a U) z Y `1 N J O 2 H W V W W N Z N= N i.- w R' Z to F- W 2 Q i- O N fn m o Z QZ Q a U p a Z W �w Q W X_ Z W J Z V a u_ W v = a o y .v �z a LL °o 3 °x a Ix Ce X Y Z UJ LU W a N,_ ° m m o o ,LL a.ro �>> _o x Y� gW m o a R a a a� m �� 3 3 3 0 SUB BSMT. BASEMENT -TsT FLOOR 2 N u FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR v 7 FLOOR 8 FLOOR 7H I I I �� ChA�kO-Only Certificate # Installing Company Name: ll GLe'�tion Address: % /���i�-�-�-T�j�-,yCity/Town: State: ,r _ ❑ Partnership Business Tel: X15 �l��i� Fax: — ❑ Firm/Company Name COLicensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes �o ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner [:] Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Tidelumber Signature of Licensed Plumber City/Town Master APPROVED ❑ OFFICE USE ONLY) Journeyman License Number:o`' Wiz, ,�_ GO a r n ro x � H 0 z ro H C] m z 's7 h7 C17 ai z d ❑ U zm t Cro" r a z a H 'C ° ° b bo.) tx7 t tz O o 7 y o r r t ro O O cn cncn IV Io M n O z �'n /.. Date ...... /��....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to form // �%..... ff pe Per 1�� lC!�J.�% .....�........... ........ .. / ,/ wiring in the building of �,�.�..�:�Z:.t:::!�.,�./'�.-:� �..................................... at .. ...... !� �>. �.. ... , North Andover, Mass. Fee 6 ............ Lic. No.... 4flv.......... ELECTwcALINSPECTOR Check # A 5444 �n r4 tat r UW villy 0,0a r N, n• z BOARD OF FIRE PRI-EVENTiON FIF ()Cc"`PRnCY Ind Fr.c Chcc�cd —tv 11/9')) APPLICATION FOR PERMIT.1-() PERFORM ELE 1\11 %"Itk 10 lie Perlafrowo in acco(i,hoc., OW - j,. 1,11, Cj" 64SE PONY lft'01? f'Yp CTRIC AL WORK 12 00 City or Toll_ Dy IIIIS APPI, , sv 11 0 f: z �/_d -111011 (Ile ullcle(,� Ic. I , -1 6 J Ilk>l. To the /ji.f/icclo, C,7 7�,) ,! tic( Lociltivil (Street & . L_I-t W PiCrIcirm jhc vjCc(I jr3l \York. descr,,)e"j Owner Or Tenlill 07) U;f 6S Owner's Addreis _S& Is this Permit it11onjunctir.,r1Vill, I; I VfsZ_ of "I I a k—, iisfina U I d U 01 IN set 6-' Amps Q UJ Nu. Of � oils 0 1 Li Number Of Feeders tTl?(Jgj-tl 110d Any1cilY No. of :Meters." -4 41 No. Or C61-sv.sp of lb __4 I 1 1.1' Vo lDr Ugi_ 0(31 jJ10 Film D. orlalcrs No. of lit)( C r 3 f j) K VA 0, 0 er -RW )-f ir)(Recepi-acle oufle(sNn. of B ers Ultils "*4Q. orsivilefies FIRE ALARA JS of Zones '\Q. Df G I? Urner.j w l " C I electio Of 111110es r; m �jj es f Air _;I,, C N of Was Tom N�?. of e set's Akron DeOres On o r I)ij 11 Dev SPICUA ri'l fjf'I1;;I1g J<�llf ices Nr of Dryers 0 Qtlter INUI C er V - r) No. of"Ar.ricfS DI or 40. 14) illi -0111- N g Q 11 1 1 (0 bs 'NO. Of D e%1CLIS 0 U1 L 0 � a .. r " tell I r Total Itp I C -MI-111 OTHFA: I N _S U H. _*%, N CU1_ the lil,enscc prclvi,.J,�s kJlllcss lk'.Iivd by rhe ()�Nrj 04 required b, tile ploarof ly I is'�izrfor (tic, of —_Tf$,,rf.x lindc!"Signrd crrfir'jes lobili I ince Jildtid"Ill.' "corlopleted op. , Pec(Orm'Ince of Hercricat Nkrork- ni-iy isstAc unless ,hat SlIC11 covers jjtjoll, (:Ovc,agr n CFIJ'(;'K 0\1E m's; s III (()I(.c' :)'!d rxiliby'led pr;lor 0' '1�s SkJ()Sl1nliiI cquivocill. The I - Y� RA N C (� IC pCirlilt i�ssjjiljy ,5zd"4,?,iY S CIN D o) I 11. R office. Woik to reqM . rcij by Momcip.)l Poliq (E PI ra 1011� 1).)IC) Ik 0-1-0 (/ -- --- -, 4 IJIsPc( 11011s if) be rk:(1UT' Wd Ili ncr ij it / "" N' I" nnd jjj,()rj .7 . (11,1 01, 01, 0111plicali'l.to is elm/ -eolve-_ uc, m 11, A0 A d(jr 0 0 WN us. Tel. OSS 74�C 1-411, 1, 1* J by ln V MY s1qjj.jl(,c 'Y", f tol In),- Ille TO be, 1OV, I v 7 r, ill's cc„ er u 1-41 EJ o�\% tic r's a,,ie�w 00 ala m V � 0/ow 1,e Location c! No. P1 Dater��` MARTIy TOWN OF NORTH ANDOVER Check #r a� 1: i 17406 Building Inspector Certificate of Occupancy $ �,S',^4•E<� s�cMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $�..- Check #r a� 1: i 17406 Building Inspector TOWN OF NORTH ANDOVER - BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �� DATE ISSUED: SIGNATURE: Building COmmi' 9 oner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 13 Map Number Parcel umber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Regaired Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Is1 PIC District: Yes O ' 2.1 Owner of Record y - L Pa V- C5 Z ©Ci �-(a,1 MCOCAZU-3 Name (Print) �^ Address for Service': inl�L- Ck-Vjd- a��-Q-7 Signature Telephone 242 Owner of Record: flame Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: �, 5 License Number o Address r Eacpirati . t Date ' n e Telephone .z j h9,0-5, op 11����-->< 3.2 Registered Home Cgontractor Not Applicable ❑ ]Improvement t �_V Z40,G! � % j _ //0 47 s A Company Name N Registration Number Address gz� �6i-z�� 1/ �a 1,P6 ate ,6,aAExpiratiot Si nature Telephone Z O r v M r z G) SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: G`6 oxl �,���i ��lD f C/�:' Chir 1 �7�! l�l� V-�f SECT ON 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 10MCIAL USE , 1. Building a j yv (a) Building Perntit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction ®--- 3 PlurnbmE Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total. 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,Y S}e L ���- ic bc ; cl Ci as Owner/Authorized Agent of subject property Hereby authorize IVICk-r ic, j ���C, n S to act on My behalf, in all mattrelative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, [� /� i , "}moi %/ r `.0 S as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief �--- A J 162 S Print e , Signature of Owner A t Date T— NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE t'" North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) 0 rmit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston, Mass. 02191 Workers' Compensation Insurance Afdavit Name Please Print Name: `7 �' yci• t %P�v+/%jell s City Phone #M I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Company name: Address Cily: Phone #: -72- Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as _wellas_civil.penaltiesinfheform cfa_STOP WORK_ORDER..and_a fine of_($1D0..00)aslay against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify u?r the gains pd pe & perjury that the information provided above is true and correct. Print name /� •(/ S Phone# 7�i ��5�6�2 7 Official use only do not write in this area to be completed by city or town official' City or Town PermitiLicensino Building Dept ❑Check if immediate response is required Q Licensing Board r-1 Selectman's Office Contact person: Phone #: E] Health Department El Other I i e_ ► VL,UI v1. Marr -12 Jenkins Builder Ge-n-er-afCojtractor Roofing Syecialist Free Es-timates 25years EVerience Customer Name: Paul and Christina Partridge 280 Haymeadow Roast No. Hndouer, MA 01845 Job Location: Same Proposal, Shingle roof replacement Job -Cost: $6,40.0,110 Downpagment; $3.,208.®0 -Com_pletion: $3,20-0.60 Start, Date: June 2004 Completion Date: --2-3 days This proposal is valid for a period of 60 days- Workmanship aysWorkmanship guaranteed for a_period of 5 -years. Than y , Mark Jenkins Customer Acceptance_ ________Date:_ Q r lm5P,,, rry Marr. jenkins Bui(der Gen-ewfContractor Rpofing,5peciafist Free .Es-timates 25 years EV.erienTx Customer Name: Paul and Christina Partridge 208 Haymeadow Road No. Hndouer, MR 81845 Job Location: Same Proposal; Siding an -d trim reVac_ement Job Cost, _$ l M89AIl Downpagment: $1,388.00 Deliuery of mat'L $8,880.08 112 Completion: $4,800.00 Completion: $4,888.811 Start Date: June 2004 Completion Date; 2 weeks This proposal is valid for a period of 68 daft s_ Workmanship guaranteed for .a period of 5 _years. Thank y , Mark .Jenkins Customer Rcceptance_ _____----- 0ate:_��a� ��' _ 4 r4 M 9 COO x co x a o o ur.,� w w w w - w°' v co w x GO �'.0 0 C w CQ o z cn 0w cn z CLM aR co 0 G3 Z O h H .CD co C 0 O e� t� CIO O 0 Qs C42 C O ev c CO) rmw 0 cots CLH C CO CM C O C D� � m H .cm CD �CD D O Cl L d O O. C 4--9 C 2 cc Z cv O C. y C UA uj C4 LLI W o At �'.0 0 C . Ilse � 3 o �ccM �-0 co E� Q 4g m ' o a E .E m cw 0 0 m S all E � L cco H = N O N O c O m :E C1 -COD O =Na • o _ m c,3,3: -;g N G C.Ccm ti a C 'c CD 3 N b" �0 N 0.21 -- a� COD r .y w+ F.. m �E at = w cos .N Z o A 0 y'� O O.am aR co 0 G3 Z O h H .CD co C 0 O e� t� CIO O 0 Qs C42 C O ev c CO) rmw 0 cots CLH C CO CM C O C D� � m H .cm CD �CD D O Cl L d O O. C 4--9 C 2 cc Z cv O C. y C UA uj C4 LLI W