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Miscellaneous - 21 FULLER MEADOW ROAD 4/30/2018 (2)
Cl R v 0 N 9D O O O O O e nt- c� 4 ; J 01 1; Date... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that-� ..... ...... . ........ .... .......................... b . cc . M - C ... h'as permission to perform ...... . .. T f ...................... pjumbing in the building 0 . ............................................................ I -ec t .................. .......... .................. North Andover, Mass. a' jo Fee...... Lic. No.d.1-1.1 ....... 0 ............................................................................ ILAP9 PLUMBING INSPECTOR Check * - s WHIST= M' TYPE OR CLEARLY ■ • • :% ■ ' • ••• PRINT __ ■■ MOM ME EN EN IN do MEN NMI INMUCII FM M FM EN man "I MFM 1FMF=—F= I Inn "I, 1—OM 1�1�---���1���"��II��—�---�-����il���i����— 00 FM • 1�lItI�. �i ' - Fm-- 0 FON[S O!FEN URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I hive a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES E] NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I t ereby 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 arm tt:at as plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the t_'assacl usetts State Plumbing Code and Chapter 142 of the General Laws. : -J'.!cER'S NAME JAMES BURKE _ LICENSE # 10469 SIGNATURE Jp❑ CORPORATION M#2727C PARTNERSHIP❑#E::=LLC❑#= C0� '.PANY NAME BURKE & SONS PLG & HTG INC ADDRESS PO BOX 102 CITY GROVELAND STATE MA ZIP 01834 -1 TEL 978-374-7837 FAX 978-373-6615 CELL 978 360 4453 EMAIL I jim@b urkeandsonsplumbing.com 5� _y Km t] 3 kr r 10, The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations ieF 600 Washington Street Boston, MA. 02111 www.mass gov/dia 'Porkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Address: P o V / d Z City/State/Zip:, Phone #: 9 -` --7737 Are ou an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4• El am a general contractor and I 6. [] New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner - have lured the sub -contractors listed on the attached sheet. 7• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance.9. ❑Building addition [No workers' comp. insurance 5. ElWe are a corporation and its 10.❑Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c.152, § 1(4), and we have no 12.Q Roof repairs insurance I ired. re q u employees. [No workers' 13.❑Other comp. insurance required.] ,Any applicant that checks box#I must also fill outthe section below showingtheir workers' compensation policy information. l -Homeowners who submit this affidavit indicating they nre doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that checkthis 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. yy�� Insurance Company Name:.I1 /r�2C'✓ ,, 5 Policy # or Self -ins. Lie. Expiration Date: .J Job Site Address: Z, City/State/Zip: %,/11&41) el 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 e. 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 DTA for insurance coverage verification. X do hereby cert#yutnl4l the pains and penaltief perjury tliat the information provided above is trice a`nrl correct. Simature: 1 Date: Official use only. Do not write in this area, to he 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. EIectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,- express or implied, oral ox 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 with their certificates) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other that the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, apolicy is required. Bo advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be 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 "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner 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 anal fax number: Tho Co onwcatth of Mfmachuseutts Dop.axtment of MuMat .Accldwta Off tee of Inlvestigat$ona 6.00 Waftgtaa Strut Boston, MA 421 It UL # 617-7.27-4900 at 406 ox 1-877-MASSAFE Revised 5-26-05 Fay ,# 617-727-7749 www=ua-,govfdia DIRATIUN UP co co O O N N CD <D U T T LO ooUWU � N ca a) N 0 c0 N -0 0' U .. .. U aCU-@= a Cl) a) c o N wU 0 N LL p Fad O O o O c � � o ca T •0 C O ~ o U mU0-0 p a m>>m3 of OE W �Z N O 4 - W J J 000 O_ N LL r rn N U Uj o U mMU t= -0 Q z U H Q Q m J w o a) 2 O O (1) �U rnL Q a o a LOoa'>- n I C: > 'UOO O a)ma)a)� cncocnwU O J o N t. 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O Q �Q a�Q 5• c as rn m y cQ o E LL mm ai 0 p LL C: W M Z LL LL cii W m 0- co ami 000 W. r6 U �DQDt- w> C�Ua o a Z h W 00 -t C-4 , C F- F- N 4) tin a co Fn ii X V E ULLL m m " U�LL Oorn 00mmca000 00" oapm m C.Nv _ _ tea- oow EEO <L) 0a� Fu 76:=x (nU)V f-Mu-mwmYw mmQ N 0 0N2m U 20MZ U -aa~ d = Q) 0Q 4i ac H U o� N @ a) Cc L w (6 w fly w � Li m LL LL o d w � (n Q) 0) co w North Andover Boarc ssors Public Access f NORT1{ 7 O •tT�.o h•� tiO +,r.o 9SSACHUSE� Click Seal To Return Search for Parcels Search for Sales Summary Residence Detached Structure Condo Commercial Page 1 of 1 North Andover Board of Assessors 'Zroperty Record Card Location: 21 FULLER MEADOW ROAD Owner Name: KISSEL, WILLIAM S. KISSEL, NATALIE A. Owner Address: 21 FULLER MEADOW ROAD City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood: 7 - 7 Land Area: 1.62 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 2714 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 612,700 569,500 Building Value: 372,700 339,100 Land Value: 240,000 230,400 Market Land Value: 240,000 Chapter Land Value: http://csc-ma.us/PROPAPP/display.do?linkld=2257400&town=NandoverPubAcc 11/4/2013 a Date ...11 1..(Pj)..? ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that has permission to pert y' (Z fjw SSA ................p......................`........................ wiring in the building of.............L!........................................................................ at ...2J........ . , - ........ .N.`�..C....&.t:.'....... P), North Andover, Mass. `l Fee .... ���.�'�.......... Lic. No) ......M�................................................................ �% ► �� ��� ELECTRICAL INSPECTOR ►. Check # �" 0 �L\ Commonwealth of Massachusetts J o Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS 14 it L Official Use Only Permit No. 1 Occupancy and Fee Checked tev.1/07] (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 WINK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector ofMires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Al 5616 rn thDol) (1-0 Owner or Tenant N i SCJ Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes Q,,"INo ❑ (Check Appropriate Box) Purpose of Building 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:" f�ti 15t 1`�cu( �a �-�h } Com letion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Cell: (Paddle) Fans of Total TransSusp. Trsformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- El rnd. rnd. o mergency ig ting Batter Units Battery No. of Receptacle Outlets 3 No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ran es g No. of Air Cond. Total Tons No. of Alerting Devices Heat Pump Number Tons KW No. of Self -Contained No. of Waste Dis osers P Totals: ....................... Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑Other Connection No. of Dryers Y Heating Appliances r Security Systems:* No. of Devices or Equivalent No. of Water KW No. 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 OTHER: Attach additional detail if desired, oras required by the Inspector of wires. Estimated Value of Electrical Work: S066 (When required by municipal policy.) Work to Start: J 1— (.-13 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:) Icertify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: `T770k-,,,, n5 Signature LIC. NO.: IC0OS"3 (If applicable, en r "exempt in the license nutnbe 1 e.) Bus. Tel. No.:t ,� I 7 5y Address: Lf r Cr;— »'kms d Alt. Tel. No.: 7 �13671`tiY *Per M.G.L c. 147, S. 57-61, security'— work requires—D epartment 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 ent.Owner/Agent PERMIT 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 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 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 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. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass F?] Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Co ents: G Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comm nts: Inspectors Sig ature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com U 1 C The Commonwealth of Massachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):, Address: `12� City/Stat15 Phone #: d(_7 73 (lq Are you an employer? Check the appropriate box: 1. [�am a employer with �L 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. E] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. lectrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box41 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they a'rd 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. q Insurance Company Name:ctE!L�� ft//Q)i Q �►JI�Jti / Policy # or Self -ins. Lic. #: C -✓C Q 06 1`7 Expiration Date: Job Site Address: 9)t -c, l� 1^�1-c JOv City/State/Zip: /1 %/a r,d 6 rr��, 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certo under thins qa�nalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # /0-6-1`3 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 4: Information and instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employeiis 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 -contractors) name(s), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the 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 "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for :future permits or licenses. A new affidavit must be filled out each year. Where a home owner 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston} MA 0211. t Tel, # 617-727-4900 oxt 406 or i-877r,MSS.A.BB Revised 5-26-05 Fax ## 617-727-7749 _WWW-Mass.govaa A E'L.E'CTR , C I ANS TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ......?...u. s�' �" (.V1 �° 1 RYJ .......................................................................................... has permission to perform................................e`M�p�S plumbing in the buil ings of ................'C' S5 e ............................................................. at .....2. ........ �.. .......�. �',!'r �n M'i��North Andover, Mass. .................. �U Fee .,.......-...... Lic. No. ` .1 b-. . .................................................................................. Check # PLUMBING INSPECTOR. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _� —__ MA DATE / /3 PERMIT# JOBSITE ADDRESS y , OWNER'S NAME 1✓' SSS j P OWNER ADDRESS j /''1 c ig�' TEL IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL p} EDUCATIONAL ® RESIDENTIAL �— PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES NO© FIXTURES'l FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB =J f CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _ (_-_- f •.___._t _ _.,f _ _._.J DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _ i .------J -_--_. I _.___..f .__._f __ f ._.__._I __.--_ I •_---j .,._._._I ..__.... f __.._.1 __...-� . _..._..! FOOD DISPOSER -__..._J ._...-_._I - --_J __._J ____.f _-...._-_1 I FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) T! f } _._ --__.I ! _....__i �.._---I i ._..__I ------ -_._) KITCHEN SINK LAVATORY RQ1F DRAIN V SHOWER STALL .___1 _j} f SERVICE/MOP SINK ,_-} TOILET # - _I __.f - URINAL =_A_ ___j — .J .......__J ___.__} .---__...f WASHING MACHINE CONNECTION ( ! .- _ . _J _..-_ _ I WATER HEATER ALL TYPES WATER PIPING ( f (....__.. ( I _ i ._...__ I _. _ f OTHER _._ I I i I j f _ -�, _ ._._..-_-.� ._..___J _ _I --_..__I ._.__.._1 __.-_I ._._.._I _.J _f ___ I F-1 ...___J __.( __ ( INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES . -f NO IF YOU CHECKED YES, PLEASE INDICATE TH PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I OTHER TYPE OF INDEMNITY n__i BOND D 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 01 AGENT ID 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 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.�.-- PLUMBER'S NAME LICENSE # a _ { SIGNATURE IMP JP DI CORPORATION R1 # PARTNERSHIP LLC a COMPANY NAME �a/�l, �pLy�r b,'�� j ADDRESS CITY STATEA _� ZIP Q 06 TEL FAX �t CELL �� EMAIL a I o z dEl w Ix Lii w LL- �. ik •� The Commonwealth of Massachusetts Department of IndustrialAccidenis Office of Investigations 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): MA- / �C Z a /I �/ ow9 J l% r Address: r%mwaod Ayn City/State/Zip: 50',JguS W26 G Phone #: % % ^ 77 S Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 1211 Roof repairs 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 aie 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Offccial 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 #' Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased 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 -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the 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 "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner 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: The Gominonwealth of Massac mets Department of Industrial ,A,ccidents Office of Investigations 600 Washiugton Street Boston., MA 02111 Tel, # 617-7274900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax # 61.7-727-7749 wwwmass.govfdia Commonwealth of Division of Registn Board of Plumbigg J JOSE 22 ELM SAUGUS, 4 " Master PIu PL16016-M 05/01/2014 005105 License No. Expiration Date. Serial No. Liberty Mutual. INSURANCE January 24, 2013 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 21 Fuller Meadow Rd, North Andover, MA 01845 Policy Number: H3521833763440 Underwriting Company: LM Insurance Corporation Claim Number: 024534604-0001 Date of Loss: 10/29/2012 Attn: Town/City Official Pursuant to M.G.L. c. 139, � 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, § 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, § 3A & B, or Mass. General Laws, Ch. 143, � 9, or Mass. General Laws, Ch. 111, 5 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Kristen Hart Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Ext. 70417 E-mail: Kristen.Hart@LibertyMutual.com N to Ul -(D 0 c W 2 z o X D;+ 0 IJ z N pp Q1 O (D W - (D r+ to j � � z f S .a. Independently owned and operated 1, - FORM U - LOT RELEASE FORM c` 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** 11 C0N,ohC*(3V APPLICANT --,I AA-, 5C- L,`e //A,/ LOCATION: Assessor's Map Number y SUBDIVISION /// STREETy <ler /' i `P 2 O kj / c -f' PHONE PARCEL LOT (S) ST. NUMBER I*****************************************OFFICIAL USE ONLY*********************************** RECOMMENDATIONS OF TOWN AGENTS: 1 /VFEOS TO FSE *0770F UFZV7i: 7' - ex„Sano 15-c4 :l” - FLO&Fr AVVn CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED 11-6-01 COMMENTS TOWN PLANNER COMM FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 im TE TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1LPPLICATIO 3U LDING PERMIT NUMBER. 3IGNATURE: -i- CTTA TNti nT?MATTnN I DATE ISSUED: of Buildings Date s>, �mTnwr FAMILY .DWELLING 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Nurpber Parcel Number t 1.3 Zoning Information: 1.4 Property Dimensiobs: toning District. Use Lat Area: Prong " ii 1.6 BUMI)ING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide reda.. Provided Required Provided 1.7 Water Supply M -G -,G LC.40. 54) 1.5. Flood Zone Information: Zone outside Flood Zone 0 1.8 Municipal Seweiige Disposal Sysiem 0 Oa Site Disposa System ] ?.blit ❑ PrivateM0 SECTION 2 - PROPERTY 6WNERS1HP/AUTHORIZED Ai��NT 2.1 Owner of Record SHi I T A N S H U J -H/} p�, 1 �1%bt-- lG i. i n Name (Pri t) Address for Servt i ,'.'.0 JA1iUC uMZA38 qUO; Signature Tt lephonq l "? • -a ,$�,` C.c l o S '� . P 2.2 Owner of Record: �ifTcl CiiU �TO� A V t Name Print Address for Service: rs'j 1 SECTION 3 - CONSTRUCT -ION SERVICES I 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Y 0 31 Signature Teleph ne 3.2 Registered Home Improvement Contractor FOUR SEASONS SUNROOMS Company Name 285 Newbury Street, Route 1 North PEABODY, MASSACHUSETTS 01960 Address Signature Telephone Not Applicable 0 UU/ License Number lir a Expiration bate Not Applicable 0 H77111 Registration Number p rl n Expiration Date -- / ' |. / � / . SECTION 4 WORKERS COMPENSATION (MG.1 C lk § Bt(4) Workers Compensation tsurance affidavit must be completed and s bm' ed '* in the denial of the issuance of the -building permit. p Ica ute to provide this affidavit ivill result Si ned affidavit Attached Yes K....0 N New Construction 0 Existing Building Repair(s) 0 ,AJieratiorns(s) 0 Addition Ali Accessory Bldg. 0 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: / / .Item Estimated Cost (Dollar) to be t 1. Building Bu. I ding Pe t F8`6 2 Electrical (b) Estimated T6W GDstof 5 Fire P! ion SE 72i OWNER AUTHORIZATION TO B . E COWLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING 1PERNUT FOUR IM 0 er/Authorized Agent of subject property Hereby authorize Cre0w &nqmn, kr. to act on My behalf, in all tters relative to work Si nature of 0,Am 11101 Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION property as OWner/Authorized Agent of subject Herebv declare that the statements and information on the foregoing, application are true and:a ur te, to the bes of in Print NameSignature of Owner/AeentY J I BASEMENT OR SLAB SIZE OF FLOOR TIMBERS ST SPAN NSIONS OF SILLS DIM]ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION - SIZE OF FOOTING MATERIAL OF CHIIVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ' %' The Commonwealth of Massachusetts 1r, ='= ( Department of In dustrial Accidents Office ofinyesUgallow 600 Washington Street g Boston, Mass. 02111 Workers' Compensation Insurance Affidavit im ocaun: I'! �V phone M J ! am a homeowner performing all work myself. I] 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. omnanv naine: FMNA20MSWMAA1uQ 285 TOL (978) 5i di ii�t City: (VO)S'm1 phone #: insurance rn_ h I (1 iY'�) �U �I�A I __ -__..,.L✓f%'% -PIC'--? I am a sole proprietor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company nnme: V t'Yent, 1 i. :,dress: ),V 1'�t12T7�, .4, - Uv company name: address: city: phone a Failure to secure coverage as required under Section 2SA of MGL IS2 can lead to the imposition of criminal penalties of a fine up to 51,500.00 andtor une years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. t understand chat a cupy of this statement may be forwarded to the Office of Investigations of the DIA for coverpge verification. l do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct. SignawreCl^tab)U �I�J�n U0 r�� Tht d�, t��� t ���'�""�}, � ",�,$( to2120/01 Print name s As �1]t »,✓r i Phonc orficial'use only do not write in this area to be completed by city or town official city or town: permit/license p riBuilding Department C]Licensing Board O check if immediate response is required C]Selectmen's Once [3Health Department cuntact person: phone q; MOther HOME IMPROVEMENT CONTRACTOR 0 Registration:107741 Expiration: 08/05/2002 Type: Private Corporatio CREATIVE SUNSPACES, INCORP ,! duArd Klee, Jr. �S Newbury Street ADMINISTRATOR Peabody MA 01960 I y1w v 641YI�t04tlUECllIiG O . GGQ4d tUGCw BOARD OF BUILDING REGULATIONS .icense: CONSTRUCTION SUPERVISOR Number: CS 043518 Birthdate: 01/11/1962 Expires: 01/11/2003 Tr. no: 6394 To: 00 JOHN H SEVERINI 19 DODGE RD AMHERST, NH 03031 00 - 35,000 d enclosed space (MGL C.112 S.001.) 1A - Masonry only 1 G -1 & 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Administrator DIG SAFE CALL CENTER: (888) 344-7233 --114� LOT 49 MORTGAGE INSPECTION PLAN N/F BALDWIN )T 151 THIS FMN 5 MED ON A TAPE 8URvEY (NOT AN INSTRUMENT SURVEY) AND IS To eE USED FOR MORTGAGE PURPOsE8 ONLY. THEREFORE, THE OFFSETS AS BNOwN SHOW) NOT a¢ USED TO ESTABLISH rROrERrY LINES. A F -Sl !gx COUNTY 01� DEED REFERENCE: PLAN REFERENCE: PLAN OF LAND PL NO.'3LIQ7I N BK. qlo PG. 8 PL.BI PL, -ERT NO. BK PG. NORTH ANDOVER I hereby certify that the exi3ling 3truclures are located approximately as shown and PREPARED FOR: were not in violation of the zoning by laws at the time of Construction, or are exempt Tp from vlolatlon enforcement action under, Ch8pter 406 Section 7 of the Mass. U-5 Goneral Laws. The 8tructure3 are located in ZOne(according to the fallowing N -H TTA N S H U THA O Rjju C -E u PT -A f". NA map. Note: Zone C represents areas of minimal flooding. FLOOD HAZARD COMMUNITY NO '7505098 BOUNDARY MAP NO -000-75, EFFECTIVE 2 � IJ 93 SCALE I IN.= 80 FEET THOMAS �(r C. ^ BAILLIE & COMPANY SAILLIE LAND SURVEYING & RESEARCH ...� - 10.38032 33 HOWARD STREET REGISTERED LAND SURVEYOR A0f ttON�.. READING, MA, 01867 '' y'IaBuavE�'0e PHONE: FAX: (781)1844 61 12 7 DATE r7 1 � rr pe m 1 l I > >C u.i r a Z o J O 4m - . p to tc._ .49 J Z �l To e (So e o 0 Y W w Lr M LL W ti .04 r" I 1 �.1 . � a., ? . Q `p w y V: 4 re. U Lu > >C u.i L-41 oth 0 O Z N M-0 0 a N Op Ur Z ? a • QV o mr� a� SYSTEM 4 CONSERVATORY EXPLODED DRAWING (FH -FULL HEIGHT MODEL WITH TRANSOMS SHOWN) GLAZING CAP A•4GC8 INSULATED GLASS TRAPIZOID CLASS CASTING POST BALL ASSY RIDGE CAP 4230 y A•4 COMPRESSION RING COVER SAVE COVER A•Sci 5' DENTIL SILL MOULDING CW4228 A•7CS tI10ER 1�1RT M0` ° "o PART b• ^— END FLASHING RK45689 DOWN 11F 7K7�t70f IF SPOUT 2'- 11• mom 11F 7MIA3611FI F 7K76M7611F 7K7SSA60 7KAMAXIIF KIT 7.999 r-6' rlNoors 7K761A70„F 7K 71StATOIIF 7K7�11F 2 FT. HIGH KICK PANELS (FX do FT MODELS) M5 UNDIA PART No.tt 45' CORNFI MUNTIN CAP 3 RELEMLU -6-96 RC A04UXB 1 FT. HIGH KICK PANELS FH MODELS GABLE tI10ER 1�1RT M0` ° "o PART b• ^— END FLASHING RK45689 ww" 11F 7K7�t70f IF 2'- 11• mom 11F 7MIA3611FI F 7K76M7611F 7K7SSA60 7KAMAXIIF r-6' rlNoors 7K761A70„F 7K 71StATOIIF 7K7�11F 2 FT. HIGH KICK PANELS (FX do FT MODELS) M5 UNDIA PART No.tt � ►MI'0011'S 7K1atA7022F fM W"71f761A6022F 2 it'ruavo 7I�761A.T622F'6' ENO CAPS C•8110 WINDOW dt 10• HIGH TRANSOMS PART j CODE 20 GLASS RIDGE VER � Twwsw T _ REM 6 FT r►NDOrS PAR NO. P ART T—mo. MOM FT OM 2 2'-10' 71r 7.501 2 2'-6' 71x110 GLAZING BAR r- 11• rnoolrs r-6. r�N0ow5 1.202 r -1o' 7WM /''" A•4GBA 5 FT WINDOWS /LA! 4HBA HEAVY BAR 6 FT WINDOW MODELS 7no1 2'-6• 7f1210 ,tldlldIlGL do MUNTIN INSERT A•4MT 9•9 H -CHANNEL A7.111 WALL BAR A•6WB l- GUTTER ENO CAP TRUSS KIT EAVE/GUTTER ASSY •7 TRANSOMS WINDOWS t KICK PANEL # NOTE: SPECIFICATION HEIGHT HAS BEEN INCREASED 1 1/8' SO THAT SOLID DKICKPANEL CAN BE REPLACED BY STANOARD CLASS TRANSOM. COMPRESSION RING 10' GLASS EAVE / GUTTER SPLICE PLATES OR 6' FRENCH INSWING DOOR OR OUTSWING DOOR TRANSOMS H -CHANNEL BELOW A7.111-pliF WINDOWS Ar�l TRANSOMS r�l /it PTI SEE CHART rI1 I 5'OR6' rI i ill r�l DDOOR G r�l r N i j 1 FIXED LITE .NI' �v 111 -0, 0F2AwN By RC SCALE NONE FOUR SEASONS SOLAR PRODUCTS CORP. CHECKED ITr cm Dwc/4C_01 5005 VETERANS MEMORIAL HIGHWAY * 0 HOLBROOK• NEW YORK. 11741 DATE 3-6-96 PACE j OF DESIGNERS AND MMUFAMRES OF FOUR SEASONS SUNROOMS 5' OR 6' SLIDING WINDOWS ALUMINUM INSULATED KICK PANEL err ^-..,..- REVISION BY 3 RELEMLU -6-96 RC ADDED 4118A VT 2 7-25-96 RC i f�SYSTEM 4 CONSERVATORY PLAN VIEW & ELEVATIONS ISOMETRIC VIEW 4_ UNITIjNGN �35/8' FOR 36' BAYS 3o0 s/e' FOR 30* BAYS SHM SHY GLAZI 4GC8 10-24 1 1 1/2' PP AIS NS f 10 1/2' O.C. FMN -2- l FRONT ELEVATION ITAwN Ry .RC SCALE NONE CHECKED BY CM DWG/ 4C-06 DATE 3-6-96 PAGE 1 OF 1 7/8' INSULATED GUESS UNT GABLERK4568 HIN —,' LJ I� 3/4' SHIM I Ox NO GABLE END SECTION OR 6 18 SCREAMS INTO H—CHANNELS 3-16DE 3 -OUTSIDE ®D BOTH SILL � Eat CLOSED 7 3/8' DIA STEEL FASTENERS MHTH MASHERS 12. O.C. TYPE AND EMBEDOMENT INTO E)aSTNG STRUCTURE TO BE EVALUATED SEPARATELY WALL BAR DETAIL SECTION'S' UNIT WIDTH /TT UNIT p � HEIGHT Q . 1 1 . FOUNDATION OR DECK --� SILL DETAIL SECTION DC' FOUR SEASONS SOLAR PRODUCTS CORP. 5005 VETERANS MEMORIAL HIGHWAY HOLBROOK. NEW YORK, 11741 DESIGNERS AND MANUFACTURES OF FOUR SEASONS SUNROOMS 0 3/8' DIA STEEL FASTENERS 12' O.C. TYPE AHD EMBEOOuE£ INTO CaSSTING STRUCTURE TO BE EVALUATED SEPARATELY EWS 18' O.0 IMUM Q 3/8' DAA STEEL FASTENERS WITH WASHERS 12' O.C. TYPE AND EUKDOWENT INTO DasT1NG STRUCTURE TO BE EVALUATED SE&ARATELY 21 REVISION BY RELEASED 1. 3-6-% RC 2 l7wTS--96 RC I F - CONSERVATORY VERTICAL SECTIONWALL F ay—STEM 4 ' L�nl , ,, y :•IIT gwl y ,I/ In • 1 '� t 18 : 1/2- TEK SCREWS SEE PACE 14 EOR SPACING 80 15/16' EaVE HEIGHT DRILL 1/4 - PACE 1 DATE 10-11-96 lOF 1 WEEP HOLE 58. o�• AT EACH SEALANT ROOF fG AZ W6i00W SUOIHO AR HEIGHT WINDOW oHEIGHT 80 9/16' 12 H -L 80 5/8- 1 CORNER HEIGHT THE LEG OF THE SILL MUST BE BROKEN AWAY A MINIMUM OF Of 1/2' TO 80 5/8- PREVENT WITH WEEP • ' ' • - SLOT COVER (BASEWALLMODELS ONLY) 22 }/4' SOLID%HEIGHT ' . ,. 22 /' WALL • WOOD OR . .. " • ' , BRICK um Wm OR IENCTH FOUR SEASONS-] SUNRO MS SYSTEM 4 CONSERVATORY VERTICAL WALL SECTION "E" 1/4* WEEP HOLES INC ATfOF IX4ZBARS % 5/16• H-CHANIQ R CORNER mow 80 15/16- EAvE HEIGHT ORLENGTHTLENGNGTH I O OWC NO. 4C-16 PACE 1 DATE 10-11-96 lOF 1 • , • 0 ---�'�- ®ENGINEERING & STRUCTURAL LOADING INFORMATION O � ' ' FOR SYSTEM 4 GEORGIAN CONSERVATORIES WITH ALUMINUM ROOF AND ROOF TRUSS SYSTEM EFFECTIVE DATE: 1-01 YSTEM 4 BX MODEL BH, BT MODEL FX, , MODEL r I MUYR GEORGIAN RUSS 8 GLA21 RAFTER LOWA EXPOSURE EXPOSURE EXPOSURE EXPOSURE ir.nNsqFRVATORY AR O.C. SPACI BAR TYP ROOF LOAD B C D B C D B` C, " D ` ; ( + n hI 1005 1008 2-4 aa- 2' .6 616" ..... 4GBA 75 1010 --j7. 6 518" 4GBA 76 1013 21.6 518" 4GBA 76 1016 1016 —7.6518- 2' • 6 618" 4GBA 4GBA 65 60 1206 6LB6 76 1209 SLB6 76 1212 3-.0518-6LB6 76 1216 1218 075/8" 6LB6 6LB6 75 Bb 1221 3' - 0 618"_ 5 Bb 65 #1608�2' - 8 SIB" 4HBA4GSA1f 40-6618" 4HBA 404GBA 402'-6616" ,„s« in 1615 2'.4518"-. 40 30 1618 T- 36 20 1620 2'- 1809 T. 0 518" 5Ltl5 (H 1812 3' - 0 518" 6LB6 60 140 126 11 1616 T. 0 618" 6LB6 60 126 110 10 1816 3' - 0 618" 6LB6 46 120 105 91 1821 3' _ 0 518" 5L86 35 120 105 91 1824 Y- 0 BIB" I 6LB6 35 120 105 91 NOTE: EXPOSURE B - RESIDENTIAL AREAS, EXPOSURE C - OPEN Ljt/11'1 q Of«Lf(I f9 ;$ ,rJH 11'1 IICI t 111 Y fl S°'7 I•`?f 1 uwnex:[ 1 nnuullu ne _ 3 231 ! � eau.E IIn111u Xo.,y w.,< 1b.1i,(M.1� , Ayfj .,..•1.40`� . ALABAMA ARIZONA ARKANSAS CALIFORNIA COLORADO TERRAIN AREAS, EXPOSURE D - AREAS WITHIN 1500' OF OCEAN 1• +lanae � Nn 10268 t, {w[aL � ` •f/�/ .f(�r"«tio *�iF�eMXB BFbLE F1b4 CONNECTICUT DELAWARE FLORIDA GEORGIA IDAHO �+' +�,, xa\n u4/ lo6u/ Iar \.I .. , 3: r ,..•."...'.r^s4\ti, � ",q".,.'",.."Y. /.:.. ,_ .•UfE i_5�4 •. ` // �� � r� '�+� ,SS['f •Xs. 1� 4MiW art''. •,,,,,",,,.Yrww,I.. / .:,.�� /y�.. ��(� _•/�x'�, y_�, 4 ti� 6.' , C J I luw3 •?/ r.crf • �;.n,,,,, ��.•�_ U�c.al:urt3 �ff� M6 I [ I� w�S«S 5 � y(If � .. Y""- 0 •i��.��•`• ♦ � }� �•^•..1f1i1 "+ µ 1 :,�XA•4c qun\�` 4a" MiiviA\ .e ommMAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA ILLINOIS IOWA KAN AS KENTUCKY LOUISIANA .yu G NIY / ,NCE piss, ,, ��1N CAIp(/,5 �.i 1. � {•� �L �f J'�.+°�"fdk i ".,��\, ywn[xt[ vw[efL[ s f9CX a, °fOa �n.F!, •Y � • . ►. .` (, m , .. ? � ...,w. � 'f • elm r`,.'. 41r(07t�' � .wf�• Mh f sc -•�4Y�it�Syr `, M1cre,e,•'' J,"Oxt\\♦«`anMY f. [„3hunnm••, NORTH CAROLINA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NOTES: tNGC FIs t0 �I1!,x" �—.: F" M!W1 't�tcfni`y M1i *R 4�pi3On•( N 1) ALUMINUM ALLOY FOR GLAZING BARS 8 TRUSS Y ING:xILRJ rxcnsvci ;.qua` nsc•fX L iuM�olu.%!1 ..`.IG` -°L° • CHANNEL IS 6005-T5. (+:: ,E.!• �\ iil� I l OXf GOX in ""'.'.ia '' �� �� 2) DEAD LOAD OF ROOF SYSTEM IS 7 PSF ORTHIOP,FO~ 'flints«x X•4 �'w� ' 'ICE��� N ' X f G+ �Xm,wIM NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA PUERTO RICO 3) THIS SUMMARY PERTAINS TO THE STRUCTURAL INTEGRITY OF .USIA [iNC[ rPLµCE'( J♦ .�-P!'Ltiip �yrtr, L OUR UNIT UP TO THE CONNECTIONS TO THE EXISTING f� ;,,".'•"'+'y -OM1 ./"• � uF"+�z STRUCTURE AND/OR ANY NEW CONSTRUCTION. THE Xo,:fm'e' CONNECTIONS TO THE EXISTING ANDIOR ANY NEW CONSTRUCTION MUST BE ANALYZED ACCORDING TO CONDITIONS aL,,,ci �'0 ^••a".,�,."/ `,;� ,h«,�,N SPECIFIC TO EACH JOB, BY OTHERS. .•.• </� 1�� a n.. SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT ,iw*>•c:••, 'GE ry. . •NCOX[µ 1 f'j 0f ,I( 4) ENGINEERS CERTIFICATION: I LAWRENCE FISCHER CERTIFY THAT 1111 T°. w eyes a+ " fEY; * + «�;n • 4� .fn 4C#' 8�` THESE ENGINEERING SPECIFICATIONS HAVE BEEN PREPARED %% s J tx j/nwu 3 s Y UNDER MY DIRECT SUPERVISION AND THAT I AM A REGISTERED ,rXr,0. enxn I `. 1 (ml PROFESSIONAL ENGINEER IN THE STATES SHOWN. �"' �'J �C �8/OXI�'��, �•f10Xwl� 0` f1,1bYM0 �t40YA\t� VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING D.C. FILE ROFENG2I.CDR A136 .9822 *'- { NORTH O 9 SSACHUS� Date.......1 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ...........1. Iel.....5�p(/ has permission to perform ...., <1 /h%F ....--., 1 P ..... ? X 1..,12. 6 wiring in the building of ..........4-:.t...5o54................................................... ... G fO�.A? VP... ... No dover Mass. Fee 3a� a '"'."'... Lic. No... .e ..................... .......................�iJ ELec7 itt AL ItaspEcroa Ij / Check # '� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. p Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank 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 IN INK OR TYPE ALL INFORMATION) Date: 11-26-10 City or Town of:a ��._ To the Inspector of Wires: By this application the undersigned gives notice o his or Tier intention to perform the electrical work described below. Location (Street & Number) a j Owner or Tenant Ao / 16 r S 4 / Telephone No. SI--- ($r— 345— Owner's Address ,fz ",0 Is this permit in conjunction with a building permit? Yes P-- No ❑ (Check Appropriate Box) Purpose of Building mn; Utility Authorization No. _4 6 e L� v Attach additional detail if desirec4 or as required by the Inspector of Wires. Estimated Valuer6ple0i*york: 7�4,Pq (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 vthe licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The 3�dersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. HECK ONE: INSURANCE x BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and penalties ofperjury, that the information on this application is true and complete. 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: saAIMi lift C, /w,_ Ze A! Asa /� sy /CJOC,rlr•7 Cmmnlotinn ofthe fnllowinv table may be waived by the Insoector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o ota Transformers KVA Tr No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above ❑ In- ❑ Swimming Pool g rnd.: rnd. a o Units Emergency Lighting Bette Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners cti o. o eteng D an Initiating Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices eat Pum umber ons KW No. of Self -Contained No. of Waste Disposers P Totals: ......................... .... . ...... ........_ . Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑Municipal El Other Connection No. of Dryers Y Heating Appliances KW ecNo. ystems: No. of Devices or Equivalent No. of Water Kms, No. 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 10 R: Q /r^p tI 7JP-- FIRM NAME: Local Electrical Services Inc LIC. NO.: 736 MR Licensee: 10,9 A C �s C 40— Signature /���_ �� LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.:, 978-392-2260 Address: P.O.Box 734 Westford Ma,01886 Alt. Tel. No.:800-448-9205 *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 PERMIT FEE: $ YY" Signature Telephone No. d 1:5�^ j 11R,�c ( Z — la (-� --, •Jl 7 Location No. Date AORTN TOWN OF NORTH ANDOVER "00F? �� '. O 9 Certificate of Occupancy $ Building/Frame Permit Fee $ b cHUs.�' Foundation Permit Fee $ U mer Permit Fee $ / 1 Sewer Connection Fee $ ;z a.� Water Connection Fee $ ry TOTAL $ _ Building Inspector I, 6 Div. Public Works PERMIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. ,c PAGE 1 MAP h40. LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK :PAGE I. ZONE SUB DIV. LOT NO. LOCATION'll PURPOSE OF BUILDINGAA OWNER'S NAME OWNER'S ADDRESS NO. OF STORIES SIZEAL BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME�• SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS POSTS DISTANCE FROM STREET��11 DISTANCE FROM LOT LINES — SIDES,c `` `` � r_w / f6 REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR FEE PERMIT GRANTED 3 PROPERTY INFORMATION LAND COST EST. BLDG. BLDG. COSTT 066 EST. BLDG. COST PER SQ FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY SUILDINO INSP[CTOR OWNER TEL. k CONTR. TEL. # CONTR. LIC. # H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S'OHIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE B t 2 13 CONCRETE 81. K. BRICK OR STONE HARDW D PIERS PLASTER DRY VJAII _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, 1/7 1/1 FIN. ATTIC AREA N_O B M T HEAD ROOM FIRE PLACES MODERN KITCHEN _ _ 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING CONCRETE EARTH HARD!✓'D COMMCN VERT. SIDING _ ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. d FLOOR I_ CONC. OR CINDER BLK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIOR I I POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I IP BATH 13 FIX.) _ GAMBREL MANSARD TOILET RM. (2 FIX.) FIAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ to 13rd ELECTRIC NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. s 5 810 siias 1HO'dSSVW `aONaNMI'I' iaaNIS NOW Hinos 60 ' Na.LNaO 100.cl ODNIWIrlIfYlS � � l z < 1 ;N J %-wwz >09:a. ZxWofOt xrm;r Y. JW Q W j t •- of L a O 1, _'Qe U ivwQ3 ~WO u J r co W W S � O Oi Oi < J � O OI OI O z O w Q O 0� _ xLm;r- J oC IV O O O O p U Lo Q 'v I O O O a ►- ::. a U r � ;r r :• ,. O j ui r IJi. Q 0 O 0 O J F h b I n I J a I n m b I O h 1 p x Zz < }J a< J �J ZZof x x x x to Z Qu a ri � � l z < 1 ;N J %-wwz >09:a. ZxWofOt xrm;r W X 0 S F L i �, i 7 0 C l C r y4J( W— I- x t L v 'S Y. JW Q W j of O W OJ w5zJ Q� �Q� " p' -aa w a O 1, _'Qe U ivwQ3 ~WO u J oC < ofH J < J �m30 CZ�FQ—QO %.uma F —woc I x ° z O w Q O 0� _ xLm;r- J oC > h �7 io -J. Q T p U Lo x IL w O ;-re W f- .,,� W_ a ►- ::. a Z z z :• ,. O j ui r IJi. i to F Zz < }J a< J �J ZZof to Z Qu a W X 0 S F L i �, i 7 0 C l C r y4J( W— I- x t L v 'S I cz W o 12 L2 J) 94 OH P4 c� M w° a�' U m w od O P4 O co a O W w Q. c v O � y C A 44 CD CM 9 w 0 0 FEE4 0 V1 rld I E; CD E F cu W � L O O co C Q. c v O � y C O � CD CM y 0'00 Vi •O m m a Sqo CD a� �. C cc m C G o :s o �: a Oca U m ++ Cc Cc EQ •ca s m U1 CD y V W� : C CD O a �+ CO _c E c o m CL c w 0 0 s ts m cmE a CD cc :mom �m a C N 3 N x: CD ca a o m A =C y . N O C O m ev aCD cm : COj m L L O pm •_ X; y O•CZ m �a�or V y O CD C1•�Z O C O rm � r•+ a C a COD C MM LL rC M)ccm •at O PN •E N Z o Vuj m p m C y = n' m 'O p :5 .0Oy'� O cyv z ca.- am I E; CD E F • W � L O O Cl) Q. O � y C CD CM y 0'00 Vi •O m m a CD G o 1J ++ Cc Cc •ca CD Z s U1 CD y V C _c CL TR 2 2 f. ,FORTH pf4 eco ,•1ti t • Date?.1.." f .� ...... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .. �!/1E . �(. ... 4 J r , <. �%� ,C ... • ... , . has permission for gas installation .. To. in the buildings of .?!q l . at ..,,. .l...F,.. L. t :fi-.n. P � North Andover, Mass. Fee ..�� . . .. . • 0?/03� 09� ID' AS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING r� (Print or Type) .fA ��� , Mass. Date 66 7 19 / 6 Permit # Z Z t y Building Location Owner's Name`r' e . Type of OccupancyPC-(, 7 Y)f_,Jtl�J�[ , NewX Renovation O Replacement ❑ Plans Submitted: Yes❑ N01 Installing. Company Nameyankp z r;ag �. n; , Address -140 S0. Main • Street Middleton Ma. 01949 Business Telephone 5Qt3-?7.A1276n Name of Ucensed Plumber or Gas Fitter w; i i i am R ua rri Check one: (k Corporation O Partnershlp ❑ Flrm/Co. Certificate ,# 1030 INSURANCE COVERAGE: , I have a current liability Insurance policy or Us substantial- equivalent which meets the requirements of MGL Ch. 142. Yes Q No O . If you have chocked+,Les, please Indicate the type coverage by checking the appropriate box. If 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: Signature of Owner of Owner's Agent Owner❑ Agent [I I hereby certify that all of the details and Information l have submitted, (or entered) in above application aro true and accurate to the best of my.. . knowledge and lh, at all pi 6mbing work and Installations performed under the permit Issued for this ap Icallon will •com Ilance,wilh all pertinent provisions of the Massachusetts State Gas Code and ChoLeapter 142 of the GI laws. , L" r 'Y T o of Uconse: Pluntbor Signa ure o censePlumber or ,as filer Tills _ Gasfillor ----- - Maslor License Number 3785 ly/To Journeyman H a W N N N u V X OC N cc N W OC WW J N W O V O W N f" X � = n l7 xo w 10- H .t CC o r W 99 W 0 W 1- Sx W W o r- 0 w a C ii H W W 0J N 0 z j x 1z a x W d W O ~ W > N w x V) 0: V t- x J P X �: W W,z W O > U. t- W a J {. W •C w> 'x a W a x. 1 Cr o o W o o x o u x w a o J u a> a o SUB—SSMT. BASEMENT 1ST FLOOR 2HP FLOOR ' 3RD FLOOR 4TH FLOOR y 5TH FLOOR aTH FLOOR TTHFLOOn aTH FLOOR Installing. Company Nameyankp z r;ag �. n; , Address -140 S0. Main • Street Middleton Ma. 01949 Business Telephone 5Qt3-?7.A1276n Name of Ucensed Plumber or Gas Fitter w; i i i am R ua rri Check one: (k Corporation O Partnershlp ❑ Flrm/Co. Certificate ,# 1030 INSURANCE COVERAGE: , I have a current liability Insurance policy or Us substantial- equivalent which meets the requirements of MGL Ch. 142. Yes Q No O . If you have chocked+,Les, please Indicate the type coverage by checking the appropriate box. If 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: Signature of Owner of Owner's Agent Owner❑ Agent [I I hereby certify that all of the details and Information l have submitted, (or entered) in above application aro true and accurate to the best of my.. . knowledge and lh, at all pi 6mbing work and Installations performed under the permit Issued for this ap Icallon will •com Ilance,wilh all pertinent provisions of the Massachusetts State Gas Code and ChoLeapter 142 of the GI laws. , L" r 'Y T o of Uconse: Pluntbor Signa ure o censePlumber or ,as filer Tills _ Gasfillor ----- - Maslor License Number 3785 ly/To Journeyman 00 Date. /) .. /).-.`. /. �'.��•:�� TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that............... . has permission to perform plumbing in the byildings of ..?....'.'.......................... atI!.`........, North Andover, Mass. Fee .. Lic. No.. / '.:. .......� .. rl :.. t. , . ......... 'PLUMBING INSPECTOR Check # 1 5iit7� r Installing Coml Address Business Telephone Name of Licensed Plumber_ Elel; l< Check one: Certificate U Corporation L ) Partnership H--Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes 0, No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy O—" Other type of indemnity ❑ Bond ❑ OWNERS 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 ❑ 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 installatioQq performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Wate Plumbina Code and 01haotar 142 of the General Laws. By signature of Lwnnae❑iumger Title Type of License: Master L� City/Town License Numberourneyman ❑ �/�� APPROVED OFFICE USE ONLY) �—"—' 2 >� MASSACHUSETTS UNIFORM APPLICATION (Print or Type) FOR PERMIT TO DO PLUMBING t )-66 VC -4 Mass. Date ��3��GG/ Permits Building Location .'9[%ULL Owner's Name Type of Occupancy New ❑ Renovation ,.0 Replacement 2-'- Plans Submitted Yes ❑ FEATURES +- No Q— u7 �� z z z z j cri LU y -' W z u) w z� ¢ rn z Z) w w 0 0 m I1 U W m U)= CE CrC) U)D CEQ W Y _Z Q V) LO g` Z Z Z rl H < M w O w w= Q= Q L 5 O m 0_ Q w Z J U) o¢ m °C a Q Y ¢ O LL a: C)- Q g Q 3 v=i cwn Q O z p p_ W z z tL w F- 0 x w Y m ca o z cJn u-' °C o a O a r= - o 9 K3RDFLOORn 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR'' innv N�mofiE'/S aeiJ t�/ate �% Address Business Telephone Name of Licensed Plumber_ Elel; l< Check one: Certificate U Corporation L ) Partnership H--Firm/Co. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes 0, No ❑ If you have checked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy O—" Other type of indemnity ❑ Bond ❑ OWNERS 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 ❑ 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 installatioQq performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts Wate Plumbina Code and 01haotar 142 of the General Laws. By signature of Lwnnae❑iumger Title Type of License: Master L� City/Town License Numberourneyman ❑ �/�� APPROVED OFFICE USE ONLY) �—"—' Location 021 /{f fdoLU 4 No. �i �(% Date ` - U ? TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # "/ 3 tl 6 0f& - Building Inspector ' TOWN OF NORTWANDOVEIR BUILDING: D PARTMENT APPLICATION TO CONTRUCT.RIaPAI RENOVATE, .OR DEMOLISH .A ONE 0R TWO FAMILY DWELLING ..................... . 3UILDING PERMIT NUMBER: DATE ISSUED: iIGNATURE: Building Commissioner for of Buildin Date "RCTION t - SITE I NVoRMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �l Fv►1JQr MeitiQ�l� %l�� � � Map Number Parcel Number 1.3 Zoning Information: 1.4 Properly DirnEn$iohs: ; • �hV i toning Distrid — %Use — LtR':tlrea: i rontk it L6 BUILDING SETBACKS. ft Front Yard Side Yard Rear Yard Required Provide ' r Provi .. Required Provided v + t.7 Water SupplyM.G.LC.40. 54) oistion: 1.5. Flood Zone Wm ?oma Outside Flood Zone 0 1.9 Municipal Sawer*'D�isposal Sysiem 0 Ou site Disposal Sy4fem. ?ublic 0 Private 0 SECTION 2 - PROPERTY OW NERSIHPIAUTfiOR[2<EA �MT 2.1 Owner of Record Name (Pri t) 'cc: Address for Servs f�Vloak5 . AU104 Signature Telephopq}„p 2.2 Owner of Record: 41Tv GlUPrq AVL Name Print Address for Service: Signature ! 1Qig A, pe . v SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construct n Supervisor: /9 Address yL0 31 - Signature ITeleph ne , 3.2 Registered Home Improvement Contractor FOUR SEASONS SUNROOMS Company Name Cgeow oul-lopaluumo it P4- 285 Newbury Street, Route 1 North PEABODY, MASSACHUSETTS 01980 Address signature �L a� �( Telephone "—T I d -L Not Applicable 0 My License Number—T hc Expiration ate Not Applicable 0 M ? 1/1 Registration Number Expiration Date SECTION 4 - WORKERS COMPENSATION (1VLG.Ty C 152 § 25ee(t;; Workers Compensation Insurance affidavit must be corppleQ4d d sobrrtltted with in the denial of the issuance of the huildinv nrrm;t plication, 'Failure to provide this affidavit will result z!a c.izuty vescri tioh J117M sed Wont:' crieclialf:a . i cap e,: . New Construction ❑ Existing Building Repairs) 0 A ierations(s) ❑ Accessory Bldg. DDemolition ❑ Other ❑ Specify Brief Description of Proposed Work: � I r 11Crm It d tf rd SECTION 6 - ESTIMATED CONSTRUCTION ('OST.S Item Estimated Cost (Dollar) to be Co nq letedb rnut a licant 1. Building; / p -(-A O N (a) Btirlduig Permit Pio 7 W I .. tilt t I t 2 Electrical (b) Estirriated T otal C cat of 3 Plumbka _.. Building Permit fee,(b) -� 4 Mechanical . HVAC. S r 5 Fire lyrotection 6 Total „ 1+,2+3+4+5. Check; • ,. �. ; .... SECTION 7a (}WNE t AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR, CONTRACTOR APPLIES FOR BUILDING PERMIT 1, SHIT- SHU TWA FM SM a 0 is &YAer/Authorized Agent of subject property Hereby authorize t kr. to act on My behalf; in all tters relative to work authoriz �� 2,1�0� Si nature of Own Date SECTION 7b OWNER/AUTH.ORIZEDAGENI DECLARATION I, PITC) U as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing. application are true and accurate�to the best of my knowledge and belief Print Name /! _ Signature of Owner/Agent Date 13A.SEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN NSIONS .OF SILLS DIMENSIONS OF POSTS Di1vlENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS RD SIZE OF FOOTING X MATERIAL OF CFMVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 5 q- 12-- oZ FORM.- U -. LOT RELEASE FORM INSTRUCTIONS: This form is used. to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT 54 t4 ;�N S �6 -X- � A PHONE � ��©� b �`� ` q y ASSESSORS MAP NUMBER t d W LOT NUMBER C (-:� SUBDIVISIO�N- j I ^ LOT NUMBER /l�1 NruFF'r 1-(�ll�li JoCli 14011 Q ............................................::............................... OFFICIAL USE ONLY RECO TION s me TOWN AGENTS ..mems . an newsmen .......................................... ........... DATE APPROVED CONS I IYVAtiON AhIfiISTRATOR DATE REJECTED CONIR IEN TS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONRvIENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTTutENT DATE REJECTED CONI ENTS RECEIVED BY BUILDING INSPECTOR DATE -.00� L OT45 MORTGAGE INSPECTIONL N/F BALDWIN • �J� )T 51 THIS PLANS BASED ON A TAPE AURVET (NOT AN INSTRimENT SUW MIO IS Tote U3EO FOR NORTOAGii f URPOSES ONLY. Tt+t:rtEFORE. THE OFFSETS As SHOWN sHouLo NOT se usGo To E9TASLtlH Morel Tr UNES. I✓ SS 9)( COUNTY DEED REFERENCE: PLAN REFERENCE: PLAN OF LAND PL NO: IN BK. 4(o PG. A L PL.BK PL p ERT. NO. PG. NORTH ANDOVER I hereby certify that the existing structures are located approximately as shown and PREPARED FOR: were not in violation of the zoning by laws at ft time Of construction, or are exempt r' C_5 D from violation enforcement action under. Chapter 40q Saction 7 of the Mass. 0 T1(� l�-- ' 1 General Laws. The structures aro located in Zone__according to the following_N 17"AN S H l) TH A arJo R i T 1 C7ll� F.E.M.A map. Note: Zone C represents areas of minimal flooding. FLOOD HAZARD COMMUNITY NO '250098 BOUNDARY MAP NO 000'75 -EFFECTIVE 2 1493 SCALE I IN.= 80 FEET �H OF THOMAS �r� BAILLIE 8 COMPANY BAILLIE LAND SURVEYING & RESEARCH tio.38032 33 HOWARD STREET REGISTERED LAND SURVEYOR 4 or t ��v READING, MA. 01867 '' y�DffllavE�'0e PHONE: FAX: (781)1944 61127 DATE `q w z z / h o C DO � F Z m ti_ •Y O � W o � Q a Y K a7 Z to Lt w z z / h w DO � F Z m ti_ � o � Q a Y K a7 to Lt M #.s z VL z Q' —I X O Y Q ti sheud Y ¢ Q Z 3 w cl Q r R7 U w z z w I, oW o0 O c m�6 N vmn 0 CO) g N2U N on • L. io1 sZ0o :L cm IL 0 SYSTEM 4 CONSERVATORY EXPLODED DRAWING ' A 'T (FH -FULL HEIGHT MODEL WITH TRANSOMS SHOWN) MOULDING CW4228 MUNTIN CAP SFT tlt►rDOMS GLAZING CAP M4MX8 A•4GC8 1 FT. HIGH KICK PANEL$ FH MpDELS � GABLE OWL u R pm N0' PAW W INSULATED END FLASHING GLASS RK45689 I" w>Do�S 7MIA2011F g 7K781AGO1tF M7e�A7oIIF ncn IIF M764A6011F MMSA6011F WINDOW do 10* HIGH TRANSOMS PART 2'- 11' 1 01r5 7K761AT61tF 1MN00119 M761AX11F M764AT6tiF 7K M7QSAT611F T�+tJOtiF M765A1011F /II7t1Q ^ BOOM TRAhVXW TRAPIZOID CLASS END CAPS C•8110 • ` � I� u11 �V / RIDGE A•BfRG CASTING CRESTING 8' POST BALL ASSY ®- RIDGE CAP CW4230 y A•4 COMPRESSION RING COVER EAVE COVER A 'T 5' DEN 11 SILL MOULDING CW4228 A•7CS SFT tlt►rDOMS 4711tmogi 7KJ6�A6022F DOWN 2'- tt' tNNppRS SPOUT 2'-6' tMNOONs KIT 7.999 WINDOW do 10* HIGH TRANSOMS PART CODE 20 GLASS FR5 OVER BOOM TRAhVXW oRAwH BY RC SCALE ONE CHECYEO BY CM DWG14C-01 DATE 3-6-96 PACE 1 OF 1 �n d, 5 45' CORNER 7.118 7 2 FT. HIGH KICK PANE L$ (FX $ FT MODELS) FITS UI om PART NO• PART NO. PART NM � M400R5 M1e1A7O22F M7bM7022F 7�?< SFT tlt►rDOMS 4711tmogi 7KJ6�A6022F 2'- tt' tNNppRS M7a1A3622F M73"36Z?F 2'-6' tMNOONs M1tltAJ022F N 3027 WINDOW do 10* HIGH TRANSOMS PART CODE 20 GLASS FR5 OVER BOOM TRAhVXW FT DOMS Na PART tq. pjE � � 7.6Ot 5 S FT t1wDOt15 2 _2-10- h 7•SpI 2 2'-6' TR210 Y- tr Mnoo■s BAR r�2 r -to• 7.290 -6. BOOMS 7'20t 2'-6• 7tIZ10 S FT WINDOWS HEAVY BAR 6 FT WINDOW MODELS $ MUNTIN INSERT R•4M1 —CHANNEL 7.111 SILL A2 WALL BAR A•6WB /\B GUTTER ENO CAP VSS KIT EAVE/GUTTER ASSY A•7 TRANSOMS WINDOWS c KICK PANEL * NOTE: SPECIFICATION HEIGHT HAS BEEN INCREASED 1 1/8' SO THAT SOLID 1 KICKPANEL CAN BE REPLACED BY STANDARD GLASS TRANSOM. COMPRESSION RING 10' GLASS i TRANSOMS H -CHANNEL BELOW � EAVE /GUTTER A7.11 i -011 f tll WINDOWS 5' ORIE SPLICE PLATES STRANSOEE RT /II 111 PTI FRENCH INSWING 5' OR 6' DOOR OR SLIDING DOOR OUTSWING DOOR SII I ,II (I 0 FOUR SEASONS SOLAR PRODUCTS_ CORP. cam, 5005 VETERANS MEMORIAL HIGHIFAY HOLBROOK. NEW YORK, 11741 DESIGNERS AND MANUFACTURES OF FOUR SEASONS SUNROOMS 5' OR 6' SLIDING WINDOWS IINUM INSULATED PANEL crr REVISION BY 1 3-6-96 RC 2 ADDED 4HBA 6FT 7-25-96 RC SYSTEM 4 CONSERVATORY PLAN VIEW & ELEVATIONS ISOMETRIC VIEW s — SIDE ELEVATION tcE H l� 40-20 FRONT ELEVATION RAWN By RC SCALE NONE CHECKED BY CM OwG/ 4C-06 DATE 3-6-96 PAGE 1 OF +--Z UNIT LENGTH �36 5/8' FOR 36' BAYS 30 S/8' FOR 30' BAYS 3/4. SHY GIAZIN�CB� 10-24 : 1 1/2' PP YS NSA t 10 1/2. O.C. I 7/8' INSULATED GLASS GABLE RK4568 I 3/4' SHU I / NO GABLE END SECIION'A' WALL BAR DETAIL SECTION'S' UNIT MOTH a 1e scaEws INTO H—CHANNELS ` 3-PODE 3 -OUTSIDE BOTH Al SILL I ® NO EAvE CLOSED Ell 7 3/8' DIA STEEL FASTENERS WYTH WA90M 12' O.C. TYPE AND ElfiXO L+EHT INTO DaSTING — STRUCTURE TO BE EVALUATED SEPARATELY E FOUNDATION OR DECK --� SILL DETAIL SECTION OC' FOUR SEASONS SOLAR PRODUCTS CORP. SODS VETERANS IMORIAL HIGHWAY HOLBROOK. NEW YORK. 11741 DESIGNERS AND MANUFACTURES OF FOUR SEASONS SUNR00MS rAl 3/8' 01A STEEL FASTENERS 12' O.C. TYPE AND EWBEOOwE� INTO E»T>HC S?iaJCTURE TO BE EVALUATED SEPARATELY DaSTTNG STRUCTURE EwS 18' O.0 ANY Q 1/8' ON STEEL FASTENM WITH WASHERS 12' O.C. TYPE AND EWBEDOIJENT INTO EXISTING STRUCTURE TO BE EVALUATED SEWATELY I\ REVISION BY 1 W3—i EA . RC 2 � m RC ' �r.711 • .'fl•�'� tiJ DRILL 1/4' WEEP HOLE AT EACH L SEALANT ROOF GIAZK 8AR 80 5/8- 58' AIDING WINDOW HEIGHT 22 3/4' SOLID HEOIT FOUR -SEASONS � SUNROOM3 ie = 1/2• TE1H SCREtrs SEE PAGE 14 FOR SPACING 80 15/16' EAVE HEIGHT 80 9/16' H-CHANNM t CORNER HEIGHT �a v ' .d UNIT MOTH OR LENGTH THE OUTSIDE LEG OF THE SELL UM 9E BROKEN AWAY A MNeWY OF OF 1/2' TO PREVENT INTERFERENCE WITH WEEP AOT COVER MODELS ONLY) T_ 221 /4' WALL WOOO OR BR1Cx 58' AIDING WINDOW HEIGHT SYSTEM 4 CONSERVATORY VERTICAL WALL SECTION "E" 1/4' NEEP HOLES AT£OF GLAZING BARS 58 5/16' H -CHANNEL d; CORNER HEIGHT 80 15/16' EAVE HEW C4 ORLENGTHTLENGNGTH DING NO. 4C-16 PAGE 1 DATE: 10-11-96 OF 1 ®ENGINEERING & STRUCTURAL LOADING INFORMATION p 4k a al "pil i FOR SYSTEM 4 GEORGIAN CONSERVATORIES WITH ALUMINUM ROOF AND ROOF TRUSS SYSTEM EFFECTI. IVE DATE: 1-01 VIRGINIA WASHINGTON WEST VIRGINIA FILE ROFENG21,CDR NEW HAMPSHIRE NEW JERSEY NEW MFAIL;u Ncvv Mce �:+�� ' 1 NOTES: 1) ALUMINUM ALLOY FOR GLAZING BARS & TRUSS ING(I�If110 I �c M CHANNEL IS 6005-75. \ Ri �t4� O 2) DEAD LOAD OF ROOF SYSTEM IS 7 PSF PUERTO RICO 3) THIS SUMMARY PERTAINS TO THE STRUCTURAL INTEGRITY OF OUR UNIT UP TO THE CONNECTIONS TO THE EXISTING u•+* STRUCTURE AND/OR ANY NEW CONSTRUCTION. THE 'm CONNECTIONS TO THE EXISTING AND/OR ANY NEW ANALYZED ACCORDING TO CONDITIONS CONSTRUCTION MUST BE SPECIFIC TO EACH JOB. BY OTHERS. A136 4) ENGINEERS CERTIFICATION: I LAWRENCE FISCHER CERTIFY THAT THESE ENGINEERING SPECIFICATIONS HAVE BEEN PREPARED PUNDER MY DIRECT ROFESSIONAL ENGINEER `IISION AND AREGISTERED N THE STATES _- - - Th e Common wealth of Massach usetts "Ilii . - _:- Department of Industrial Accidents Of/Ice 911nyestIffAfts .r 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit mc: ounQn pv phone Ji ! am a homeowner performing all work myself. ❑ 1 1 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. a n v nam : RM, s:imoomS fr7tlf■OtN 2" NWMPjY 8tfsK ROUES i NorM Tel. (878) b968�Pi v l aQV may. fi11t(>oTB� x36':461 %% {{ ii N ) phone +t insurance co, /^jt7tiy'Ir)r /liAP1�AI noliev:ii:W2���%��'�sS�/�Ut'1fi'.(i/I I am a sole proprietor, eneral contracto or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: Vit V e r f'i i ')t AriaIiiit d .tddress• lel NJ.iIZ2u -04-t1G2V6V6, -6-00 m nnv name. nddress: c tY' phone #@ Failure to secure coverage as required under Section 2SA of MCL 152 caa lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or une years' imprisonment as well as c14il penalties in the form ora STOP WORK ORDER and a fine of 5100.00 a day against me. 1 understand that a cupy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. do hereby terrify under the pains and penalties of perjury that the Information provided above is true and correct i I M, %/ Li.. 'rl. I /. /i official'use only do not write in this area to be completed by city or town official ciry or town: permit/license q FiBuilding Department Q check if immediate response is required Licensing Board C3Selectmen's OfTice Health Department cuntacr persun: phone q; rnOther ,IC -4 7/95 PJA) O ce ESO 06 o2,0) ccY 0 Vt fn mcr: CO) Zcm4• ON-U� �UZ�CO o to co LL NQv a O t z 0 w w a 0 AN a� O E O cc 0 z O 0 cn M CDh- CL CD Q O co V CL N 0 U .N O V cv Q CA ,�M—1 i 0 U CD y CO o, C mm v 0 U) LLJ U) W W ccw LijW lz W a 0 U ow A U c1f) z a A u C y W Cu 'ti •„ g a ai b x a G onE —0 o o x a A. bD i� o a "'� 'Cno W o c ao o c w v i � w w cn w 0 U 4 u: w cG chi ii rx w CO cn V) z 0 w w a 0 AN a� O E O cc 0 z O 0 cn M CDh- CL CD Q O co V CL N 0 U .N O V cv Q CA ,�M—1 i 0 U CD y CO o, C mm v 0 U) LLJ U) W W ccw LijW c c� Ucy 9► to C . v 2 m o NJ mL9 -44 O .:C.3.0 �t; cm C� _' m C M H 3 :50 4: .S: N ecv O c vEm — ry -COL o 0 Q, s cs �N m m cc _� OCD �p 'coC c N: C N Q Uu y C —; Z :`a`� O = m✓:moo o y map.. H No m WCDAD t r .y O ~ E dt C E - N z ui cm Qo y d 0:2OI J =4-aZm� z 0 w w a 0 AN a� O E O cc 0 z O 0 cn M CDh- CL CD Q O co V CL N 0 U .N O V cv Q CA ,�M—1 i 0 U CD y CO o, C mm v 0 U) LLJ U) W W ccw LijW November 15, 2012 Town of North Andover Attn: Building Inspector 120 Main Street North Andover, MA 01845 Liberty Mutual Insurance New England Region Central Property Unit 75 Sylvan Street Danvers, MA 01923 Tel: (800)566-0323 Re: Property Address: 21 Fuller Meadow Rd, North Andover, Ma 01845 Policy Number: H3521833763440 Underwriting Company: LM Insurance Corporation Claim Number: 024534604-0002 Date of Loss: 10/29/2012 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 313, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, 5 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, §99, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, 5 3A & B, or Mass. General Laws, Ch. 143, § 9, or Mass. General Laws, Ch. 111, § 127B. This letter should not be construed as a waiver or estoppel of any of the terms, conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address, policy number, claim number, and date of loss. Sincerely, Kristen Hart Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 Ext. 70417 E-mail: Kristen.Hart@LibertyMutual.com N° 3 4; 4 Date...../ /'-/� �!; TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies thatU. '...........r /7 .................... ........................................... has permission to perform ....... �.1.. r 1.c�.....; l {%..................................... wiring in the building of ................... r�..,...................................................... _ / q 1 at........................................t.......................;....... ��. Orth Andover, Miss. Fee ...t� / UC� . Lic. No........ ��............ :...�1...r.....;........:.: f..... ELEMICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 'r ne Co17 monweala, l f ��G� GCjIuSCt � 'tc. u,. a,l, Dcycirnncnr of Public 5.ojert, 'Il BOARD OF FIRE PREVtNIION REGULA-noI;;5,7 Cr.iR 1Zt� 1/90 11 Fay. Glint) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All w,k to ba periorrncd In 4ccuid4ncc w•illl the Ma.cochutctu L'laculcal Cock, 527 CMR 12:00 (YiE,SE PRINTTN l OR TXT 1~ sLL JNl'ORtiSI.IC�It).._ Dace u Ifl� f.. kr. A L1Gy0I'Toltpt 0'f A �{ " L( 1/�' + M 1 r c 70'�hR lhspecdor oE'Nlres,'n Ire ulotrsigntd applies';�or 13'peTmiC CJ•P41LVrq Clic`"tlectricil'liorx dC��cib�a'Orldw, �+-,w.. i ; L,sC-4CIon (SCrLte b Humber) �/ /-(JLL�� '"���.JjDGJ /`✓ Cnlner Jr TLClanc/j�/,i�/�Sii u Owntr's Address Is this permit in conjunctlon with a bullding perZDit; 'its ❑ No 1�r (Check Appropriate Box) Furst of BuildLng Ucilicy AuChorizacion N0. k :Ls ting `.zrvlct .kAps / Volts ch'echcad ❑ Undy>rd ❑ No, of Mecers Ncw arvi.-e Amps / 1'olcs Crvtnc�ad ❑ Undg-rd ❑ No, of deters tic=Ler of Feeders and &wpaciry LDCacioA and tCarure 04 Proposed Eleccrt"l Work No, of :sighting Outlets ilo, of floc "Pubs No. of Transforuers Tocal KVA No, of Lighting Futures Tn= '- Swhauing Pool Above 11 ❑ grnd. rnd, g CeneraCors KVA No. of 4--cepcacle Outlets No. of 011 Burners No. of Emergency Lighting Bacte Units No, of Switch OUtleES ---7— No. of Gas Burners FIRE ALARtIS No, of Zones No, of Da.teecion and No, of Ranges Total No. of Air Cood, tons Initiating Devices No. oI Disposalstio. Of 1129C Total TOCaI FWDP5 'Pons K14 No. of Sounding Devices No. of Self Contained No; or Dishwashers Spacc/Arca Heating Detection/Sounding Devices t, t1o. of Dryers Haacing 0eV14a9 k^� 1^`'cal ❑ HunnnecPlonDicial O�er Of to. O� NJ, of dater Heaters KKWNol lens Ballasts LJw Voltage W1rin No. Hydro 14assage Tubs No. of t�zicors Tocal NP OTThTR INSUTW CE COVERAGE: NrSUARC Co the requlremants of htassachusetcs Ceneral La; m I have a current L1 "ilic Insurahcc Folicy including Completed Operatlons equivalent. YES Q I Coverage or its substantial [� have submi_Cted valid proof of same to this office. YES Q NO 0 If you have checked YES, please indlcatt the Cype of coverage by (Mb cking the appropriate box. INSURo CE Ca BOND ❑ OTKER ❑ (Please SpE:clfy) Estimated Yalue of Electrical Work S Expiration ace Work to Scarc Inspection Dace Rt'juested. Rough Final Signed 4 -ler the penalties of perjur;: FIRM MME Licensee =LffW 6�2c Signature_C�J--M. NO. Ri�Jfiik�'it%c-g A.ddrta3 •�. AI G4V CLE_ �� BU9, Tel. No, ���d� ��li �✓77_ir Alt. Tel, No. C%WZR'S I.HS MkNCZ WAIVER: I am aware that rhe Licensee doe4 not have eha insurance coverage or cs sub- acantial equivalent as required by ttassachvsetcs Ceneral L wsaha that my signacure on this permle application walve3 this requirement. Owner Agent (Please check one) �. Tclephona No. PERMIT FEE S (Signature of Owner or AdencT- Location Mo. Date AOWTN o�,,t'o TOWN OF NORTH ANDOVER ••,ho- OL p Certificate of Occupancy $ Building/Frame Permit Fee $ �+ss„ �MUs Foundation Permit Fee $ Other PermitFee $ � U SeW err Cg nnection Fee?Vl $ !" ater Connection Fee $ _ . TOTAL $ /114 ✓ 4. / 7 Building Inspector Div. Public Works PERim NO. 7 I 1 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. ' PAGE 1 MAP 4-40. LOT NO. 12 RECORD OF OWNERSHIPDATE BOOK ;PAGE i ZONE SUB DIV. LOT NO. �I LOCATION/�j�/G���D� �� civ PURPOSE OF BUILDING ' OWNER'S NAME i1i NO. OF STORIES SIZE1/� 7 !" OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME /fyJ`�/1 �A/L)rn//A17/� SPAN --- DIMENSIONS OF SILLS POSTS DISTANCE TO NEAREST B-UILDING 1 MBrv�v DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR �O '� GIRDERS AREA OF LOT /�p�r1.� _ FRONTAGE d6D HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE SEE BOTH SIDES PAGE 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 INSTRUCTIONS ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING i ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED .AND � AAPP�1PROVED BY BUILDING INSPECTOR 0ATE+IIED �j OR AUTHORIZED AGENT F E E ey.S 0 PERMIT GRANTED nn OWNER TEL. # % 4' CONTR. TEL. 6a�-1196� CONTR. LIC. #_ Olf'3 S M 6m d'3d'G Aww-9-t 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST 7- MO.- 0-0 � - 1 EST. BLDG. COST PER SQ. Ff. `' EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN A�e&lz�wl MYIL Imu IPNBP=GTDR BUILDING RECORD 1 OCCUPANCY, 12 SINGLE FAMILY S'OkIES \ 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. 5 ROOF CONSTRUCTION 2 FOUNDATION GABLE HIP GAMBREL MANSARD FLAT SHED 8 INTERIOR FINISH CONCRETE ASPHALT SHINGLES WOOD JOIST LAVATORY PIPELESS FURNACE WOOD SHINGES CONCRETE BL K. KITCHEN SINK _ PINE TIMBER BMS. & COLS. NO PLUMBING STEAM BRICK OR STONE STEEL BMS. & COLS. STALL SHOWER HARDW D ROLL ROOFING WOOD RAFTERS MODERN FIXTURES _ PIERS _ PLASTER 7 NO. OF ROOMS GAS _ DRY WALL UNFIN BMT 1TRIC 3rd I _ 3 BASEMENT AREA FULL s FIN. B M T AREA '/ 1/2 1/1 FIN. ATTIC AREA _ NO B M T FIRE PLACES _ _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B I 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME 5 ROOF SUPERIOR POOR ADEQUATE 7 NONE 10 PLUMBING t = GABLE HIP GAMBREL MANSARD FLAT SHED BATH (3 FIX.) TOILET RM (2 FIX.) WATER CLOSET _ _ ASPHALT SHINGLES WOOD JOIST LAVATORY PIPELESS FURNACE WOOD SHINGES KITCHEN SINK _ SLATE TIMBER BMS. & COLS. NO PLUMBING STEAM TAR 6 GRAVEL STEEL BMS. & COLS. STALL SHOWER HOT W T OR VAPOR ROLL ROOFING WOOD RAFTERS MODERN FIXTURES _ 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W T OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T G UNIT HEATERS 7 NO. OF ROOMS GAS OIL BMT 1TRIC 3rd I NOHEATINGlft s ~ C,7 Z D � � C7H�w O2 Q. 7 F 00mo CC CL �ir(L U O- QZ V �—Dzo d Zz x Zo > Z OramCc LLF m� `i z ` iL '• '. 3 O 2 N ci a w lw GOLD ALONG LINE Z� O H ((f H � Q C x co t` 4.) 14 (n O H (Y) OD 0 -0 0 W C Of of E N 00 cr C of (n O O 4.) H •1 1 4) Q tt1 O U1 ~ M -C Z 0) -4 U o�am C (p F- m 0 (6 Z C 4-) E W -4 L E -0 3 w W-4-0 r- > .,4 -C >..it 0 O O 0) 4.) am¢o H 0 C CO W p O E m O Q] e„as�. 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N.H. 03079 Date (508) 686-2917 KT. 9 ,1992 (603) 894-6902 Proposal Submitted To Work To Be Performed At JIM PALUCH Name 21 fffttER ��ADOW ROAD Street City State Street City Date of Plans State Architect Telephone Number 508-794-8283 We hereby propose to furnish all the materials and perform all the labor necessary for the completion of PROVIDE PRESSURE TREATED DECK AT REAR OF HOUSE 16' X 14' OF # 1 GRADE DUMBER WITH (1) SET OF STAIRS 8' TO GRADE, HANDRAILS TO HAVE 2" X 27 BALLUSTERS 5-1," APART WITH 5/4" X 6" TOP RAIL. DECKING TO BE 5/4" X 6" A 1 GRADE PRESSURE TREATED DECKING INSTALLED AT 45 TO HOUSE- RFMOVF. AND DISPOSE OF EXISTING DECK. ALL NEW FOOTINGS TO BE 12" SONOTTIBES 4' BELOW GRADE OF 3000 PSI CONCRETE- A.T. PERMITS AND INSPECTIONS BY BUILDER, BUILDER TO DISPOSE OF AL.L. WASTE MATERIALS - All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of Dollars ($ 2 , 700.00 1. with payments to be made as follows: $1,500.00 UPON ACCEPTANCE AND $1,200.00 UPON COMPLETION. Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by Curran Construction Co . Inc MASS BUILDERS LIC. 043575 MASS REMODEL LIC. 108386 Respectfylty!pbffiitted Curran Construction Co., Inc Per—',-*"* e Note — This proposal may be withdrawn by us if not accepted within days ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Accepted Signature Date Signature CURRAN CONSTRUCTION CO., INC. err, e-3 PA LV C.4 9, 8 Stone Post Road • Salem, N.H. 03079 • (603) 894-6902 • (508) 686-2917 W co x m v xa $ w e a CM) A c o LE o a4 v U G w a O w a o o a5 c X � O w W o 04 ch c X. O o a c w w x w c n cn ° z cn o E cn _ o :•m c O C- CaL m A 1CD CD.05= :r s �I caIDv r =D r V r N %Ec r CO3 o o E m c r � o m a c •- c o .m O _ = Ap1=0 N m O •�. O CD O : CLU m t r o os CD's Q : M U. ED 0 ldc�o c Q y m C •C S m e 3o N F- o CL m VD r m Z r m y=-. r 25 • h CL.:5 m5 Z M E -o 'N o oma g N_ d m� � O S eyv m moo LON CL:Oa- y 'O O IN O v" m I Com_ CO) G O A O O 'r= CO Co t O � Cm O O� R O d CL CMQ O � � CO) C Z CD 0 CL V y C !D C d CO2 J Z LL_ Z O Q 5 cc LU U) Z 0 U cc w H Z W Q 0 ME. 3 'Zf.- N 0 L Q LO U; z �- U') g a 0 M„Ob 73.81 uo w. h 0 /o o \ N oh- 6 � aNt�l13M cor \0X N o O00�y s0 V, ww o w e/ 0) �y I b w� i\ 14- LU 4- W N p M � Z A z~ in U N N f`O 6 9� N i B ow , Itt 50"E c Q LLI UC) W = N —Z U7�� o w 0wQ w �U- ~U) ul 3 Z ag S w z 0 CL w Q o m O w C Z -)c U) z Q c Date...:/. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..........f ..n. �.....`! c = .. CI iP c—,I.....!........................................... has permission to perform ... J '............................. , wiringin the building of ..........!....Q........................................................... ( `� (If R M -fqo/ �� ' .. , North Andover, M at .............................................................. ............. Fee .A. .S )...... Lic. No.�L. iS.7S................ .:..... � � ... , .....:... LECTRICALIN PECTOR Check b �— Corr R'0!: ;,oealfh of Masa chuseffs Departmeo , f Fire Services BOARD OF FIRE PREVENTION REGULATIONS I'll Use Only Permit No. -34�f-` dL Occupancy and Fee Checked ; [Rev. 11/99] ((clue 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) Date: S�.?y�r/� City or 'Town of: _2244 ki dal C4 To the Inspector of Wiles: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) -�-�r�,' 1�'y l �t ✓L vtt �4 c✓C w �C � Owner or Tenant No. Telephone Owner's Address p Q%g-Gg�- 9y42 Is this permit in conjunction with a building permit? Yes ❑ No EK (Check Appropriate Box) Purpose of Building ) ty e- It i wan 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: w l t° X20 O✓V) C', ... ,,.,; , . _.. Attach additional detail if desired, or as required by the Inspector of Wires. 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 covera a . in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (Expiration Date) (When required by municipal policy.) Work to Stan: j 2 Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: , tic It l (" _ 14 '4�,L.IC. NO.: Licensee: _jkL (If applicable, enter Address: OWNER'S INSI required by law. Owner/Agent Signature Signature " in t}tglieense quniber line.) RANUE WAIVER: I am aware that the Licensee doe By my signature below, I hereby waive this requiremen t. Telephone No. LIC. NO.: �y Bus. Tel. No..,7R- 3 Alt. Tel. No.:9�f> s not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT WE: $ 0 . d �.. v ane vu"wui -"u mu ve wawea o the inspector o wires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures 1 Swimming Pool B�ove o. o mergency ig tng r. Battery Units No. of Receptacle Outlets No.. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Dcti atiDc i es No. of. Ranges No. of Air Cond. ons Tot No. of Alerting Devices No. of Waste Disposers Heat Pump I NumberTons _.__...._ KW No. of Self -Contained Totals: --------- ....__..._..._. Detection/Alerting Devices No. of Dishwashers Space/Arca Heating KW Local E] Municipal Connection ❑Other No. of Dryers Heating Appliances KW SecuritySystems: No. of Devices or Equivalent No. of Water Heaters KW o. o o. o 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. 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 covera a . in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (Expiration Date) (When required by municipal policy.) Work to Stan: j 2 Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: , tic It l (" _ 14 '4�,L.IC. NO.: Licensee: _jkL (If applicable, enter Address: OWNER'S INSI required by law. Owner/Agent Signature Signature " in t}tglieense quniber line.) RANUE WAIVER: I am aware that the Licensee doe By my signature below, I hereby waive this requiremen t. Telephone No. LIC. NO.: �y Bus. Tel. No..,7R- 3 Alt. Tel. No.:9�f> s not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT WE: $ 0 . d O 40 Date.,/, : . `.� G ( TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s This certifies that .. /4/�. ! ff?.. �f �S. ! .��� ..... has permission to perform ... ....................... . plumbing in the buildings of...../�%9......................... at. ./. Ur r t� . North Andover, Mass. Fee.p�.%,.�.. Lic. No..TS .%1 .i.. ....... C�.�.L �,� ....... . / PLUMBING INSPECTOR Check # L( ) I 5274 1 pi 01% MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) r A At ass. Date Permit # J I Building Locatiok—sh f'���Sjj� � Own Namc //C[J����'�%P�c��v[r�K�%_ V Type of Occupancy Residential New f _.I Renovation 1 1 Replacement 4 Plans Submitted: Yes U No ❑ FIXTURES Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Certificate Address 35-P-easant Street [X Corporation 714 Stoneham, Ma 02180 F) Partnership Business Telephone_ _7£31=4-3-8-7_Z776._-__ f-1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V] No L] If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 3 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 ❑ Signature of Owner or Owner's 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 Code and Chapter 142 Qf the General Laws. By Signature o1 Licnso !'eumbo@ Title _ _ City/Town Type of Liconse Master IX Journeyman F APPROVED—T�ICE�SE ONLYI License Number 8 3 2 2 TU, z tU J7 :L J N r U .( f �� Z 7 0 rn 141 Q 34 ii i-) Q) z 4) 6 m o' T. � n< O u z Z z 4 �1 t1 �-I Ln s¢ f _ U w x n – a 3 Qi aj (d S� V Z M O co 7 a N wt Q w — 0 R N` Q 1 cc r 3 x a "f w f- O a r o= z> x o a a O a a cc a s O Z �.�► S4 3 C J W fn O O J i = f- N LL U D J 1( i L_ H) 111 — ----- — — — --- — --- V SU11-13SM7. -- — — BASEMENT 1ST FLOOR 2NDFLOOR ARD FLOOR 4TH FLOOR STH FLOOR 6TIt FLOOR 7TH FLOOR :H±FIT I 6TH FLOOR I Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Certificate Address 35-P-easant Street [X Corporation 714 Stoneham, Ma 02180 F) Partnership Business Telephone_ _7£31=4-3-8-7_Z776._-__ f-1 Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes V] No L] If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy 3 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 ❑ Signature of Owner or Owner's 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 Code and Chapter 142 Qf the General Laws. By Signature o1 Licnso !'eumbo@ Title _ _ City/Town Type of Liconse Master IX Journeyman F APPROVED—T�ICE�SE ONLYI License Number 8 3 2 2 r J z O w w U_ LL LL O oC O LL 3 O J LU x N w U F - w Y N N z O F- U w a N z J Q z' LL, w LU LL O z O J m LL O, w CL r N W X Q z O F U W a N _z c� z CL I I Location-,�/.,�—�'� rum►-�- �r1 No. X60 Date 6--17-02 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL Check # �� a 116395 C Building Insp6Stor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING Adm =Tli Segos for +Dlaiiciat:Use bnl ,'`` x - BUILDING PERMIT NUMBER: DATE ISSUED: p w SIGNATURE: BuilfWg CommissionedI for of Buildings Date SECTION 1- SITE INFORMATION 1.1 �Plr�ofpe�rt/y rpA�+ddress:�l rt/�� //�� .V F -K LFT\ / 1E6VOW Y\p6 1.2 Assessors Map and Parcel Number: y Map Num Parcel Number 1� D F.Td __ A P 0 O F -K _ 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard RegWred Provide ReqWred Provided Roqtlired Provided 1.7 Water Supply M.G.L. 54), 1.5. Flood Zone Information: Public ❑ Private . _ 0 x _ Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY 6*NERSHIP/AUTHORIZED AGENT 2.1 Owner of Record S H I LMSl1 li, 7- ?tame (Print) Address for Service /1%, 111 Da r/ER Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor D h y t CAST ) C o%Y Not Applicable ❑ `� .D Company Name ? ,9(;o S Ll TroV / ST .q—S a / '%f-- Registration Number Signature Telephone Expiration Date G J 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 ......:2 No ....... ❑ SECTION 5 Description of Proposed Work check applicable) New Construction 0 Existing Building Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition 0 Other 0 Specify �. A Brief Description of Proposed Work: R c PLA CF-t4FwT W iA I?n Les I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to he Co5pleted by permit applicant OFFICIAL USE ONLY 1. BuildingI J b O `-� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) AJIQ 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, , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf; in all matters relative to work authorized by this building permit application. Signature of Owlter Date SECTION 7b `OWNER/AUTHORIZED AGENT DECLARATION I, DA V ( .� h S 111 C. 0 hias 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 S TA I Co ALE Print ame , 1) r 13,762 Signature of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE. OF FLOOR TIMBERS 1 ST2 3 KU SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS IP--IGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL, OF CHR%4NEY IS BUILDING ON SOLID OR FILLED LAND IS BUIJDING CONNECTED TO NATURAL GAS LINE 4 A 0. 6 z 6 a a W x z z A or. b x wa°' a 0 a x w x 0 a C CD w V C3 •dam w a w v w� 0 zbdD V) v Q i U) E CE H �O i CA C cm 7 m C: c" c m 0 cm Sc N co Z 0 z 0 g cz Am. 0 O 4 a. O O O CD L O s Z a) Q. O H D � CD cm I O � O 0 y m O �E m m CLCD Z O� 3� L O a o. CMCC CA O 0- CcC �'v ts �. Z ai V y O C C CL ev � CO) c c m c :=o c t o � c ` O N C CD V C3 •dam a C A m C ;L O O � Ea '-w o _ o «. o a EE "t o� :C0 t; cm CLy C41 c" �3 m C � C � � m H A C,* E m o aC.3 O ; t c0a CL Of 0 :Raz c � o CD Q m C y n _ m .ora CL. 0 WC LU CD •H � � dr C E 7 +"' CD ti LU m g 00 0 c a C,* m� o� N=� 2 lyp CL *-cc E CE H �O i CA C cm 7 m C: c" c m 0 cm Sc N co Z 0 z 0 g cz Am. 0 O 4 a. O O O CD L O s Z a) Q. O H D � CD cm I O � O 0 y m O �E m m CLCD Z O� 3� L O a o. CMCC CA O 0- CcC �'v ts �. Z ai V y O C C CL ev � CO) f ✓/ee Z�anvmovuueal a�✓�Czaaac%.�aelia._ Board of Building Regulations and Standards j - HOME IMPROVEMENT CONTRACTOR " Registration: 7.1.04569 Expiration:: -,7h4/2004 i __:'.Type: -Private Corporation DAVID CASTRICONE ROOFING; S 6419 tastricone 7 Hillside Road Boxford, MA 01921 Administrator License or registration valid for individul use on before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 Not valid without signature