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HomeMy WebLinkAboutMiscellaneous - 21 SUMMIT STREET 4/30/20180 0 OD 0 b 0 CA Q 0 0 0 0 b BOARD OFFIREPREVFM70NREGU A770M5rutfR1Zw c16 Occupancy &Fees Checked VAPPucmm FOR PERW To PERFORM ELE=CAL WORK ALL WORK TO BE PERFORUM tN ACCORDANCE wrm THE MASSACIiussn ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To -the Inspector of Wires: Location (Street & Number) Owner or Tenant Owner's Address Ce,YY1 t" – Is this permit in conjunction with a building permit: Yes o No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground ED No. of Meters New Service Amps—/.V OHS Overhead Q Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work z�e/i No. of Lighting Outlets No. of Hat Tuba No. of Transfotmen Tom KVA No. of Lighting Fixtures Swimming Pod Above M Below Generators KVA gromd ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal a Other No. of Dryers Heating Devices _ KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• - limratoeCo�er.tge PL�ntbtheregtitargtsafMae®d>t>se�C�taalIaws _ _ a , ilmeaimnadm&ptmfafsmneiDdz06i= YES [A NO FIRMNAME 3tWgi% W ® YES No Ifjcuha%edodWYES,PICMM *thetApeafaouWbS'dta*%Ibe om EVWmD* E9in*dVAzofE mica Wait S Fz* Final Liastisee r� l�4 l / %�r.Y�y/�lenlle %/�/ ( ��iyl-��"{ I�oaneIYo � Blrsit=TdNa�� �Y .•r,av= � Al<TdNaN6 OWNER'SMURANCEWAIVER;IanawaletbaticLimmhmdz*mrrareta►weertss talegli tasrecllaedb!'N Gerealiaws andthatmysigiftwortfis n*appk9mV"*,z isMV*M r t (Please check one) Owner Agenty� i Telephone No. PERMIT FEE $ 7-,'/- D s 1 i-121 110 M.W. Damour, Electrical Contractor LLC. 6 Moody Street North Andover, MA 01845 (978)975-3726 To: North Andover Electrical inspector From: Michael Damour, Master Electrician Re: 21 Summit Street North Andover, MA 01845 A' 1 �i `v To Whom It May Concern: 1 r All smoke and heat detectors at 21 Summit Street, North Andover have been tested and u are compatible. Sincerely, Michael Damour oepartrrsent of Pubf c safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No._4LQ Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527.CMR 12:00 (Please Print in ink or type all information) To the Inspscj& of Wires: Town of The undersigned applies for a permit to perform the electrical work described below. �— ' �•, I, Location (Street & Number !,- &j OA VIA' t �-- Owner or Tenant Owners Address , Is this permit in conjunction with a building permit Yes 1�-' No 0 (Check Appropriate Box) :�© 5 Purpose of Building ( P S I A o , I,( Utility Authorization No, Existing Service -2 Ampsvolts ' Omtiead,,Ili Undgmd 0 No. of Meters New Service Amps Volts P Overhead 0 Undgmd 0 No. of Meters Number of Feeders and Ampacity ! 7 l �� �A 2 d Location and Nature of Proposed Electrical _781 era Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Abbve 0 In 0 No. of Lightrig LightingFixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.'of Emergency Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and i Total 2_ No. of Ranges No of Air Cond Tons Initiating Devices I Heat Total 7 Total No. of Di I No. Pum Tons KW No. of Sounding Devices NoJ of Self Contained No. of Dishwashers SpaWArea Heating KW Detection/Sounding Devices 0 Municipal 0 Other _ No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW signs Bailases Wiring No. Hydro Massage Tuds No. of Motors Tota! HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremenSts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESY NO.C, have submitted valid proof of same to the Office YES 0 NO; If you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE 0 BOND C% OTHER c, (Pl770 ciM Estimated Value of EI rice WOO$ (Expiration Date) Work to Start? Inspection Date Resquested W,a CC, Rough Final Signed under the Pen KI of perjury: FIRM NAME LIC. NO. Licensee Signature LIC. NO. Bus. Tel No. Address Pit Tel. No. OWNER'S INSURANCE WAVER: t am aware that the Licenses does not have the Insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my_gWmturgjm4_ls permit application waives this requirement. Owner Agent (Please Check one) r� of Owner or No. ` '7�� ' �% MIT FEE �-�(o PCPP 4 1 � -(; -� 6 ��til4-L 614v 41d Cb (_ 2.a_05-- PJB k e T r 7 � � S�4takE d ��� 2s eAl ��� /1, 1 w-- s7" I''( it 44- <<C 7* - w7"d ion b #/of LvU/e -t4 - zoo 8L0 0 3 Date.......` `...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... l�—U 7 has permission to perform .... .. i!` ... - 1 !r c ................. 41 r wiring in the building of ...... ........... .............................................. at..... ............. .......... , Norah Andover, Mass. E[.EMUCAL IW" ECTOC Check # 59L0 DFPARTMENTOFPIIBLICS4MY Permit No. l0-0 BOA RDOFFIREPREVEIY170NRWU AT10M527CVfR12.00 416 Occupancy &Fees Checked 'FM4PUCAHONMiff TO PERFORMaECMCU WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACIiussTs ELECTRICAL CODE, 527 CMR 12:00 y3` (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Date,L To the Inspef Wires: Owner or Tenant Owner's Address Q-Yy Is this permit in conjunction with a building permit: Yes No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs Ra# Fara) SrgwdtatdW& altla perpay No. of Transformers �.. Total FIRMNAME Lioalsee .Zr l� KVA No. of Lighting Fixtures Swimming Pool Above Il Below ©t ��S �4 A1tTe1Na Generators andthatmy*s ancnlhispan teppiirbatwaiusdflste*&Mtat (Please check one) Owner a KVA ground ground Telephone No. PERMIT FEE $ No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices LocalMunicipal Connections a Other No. of Dryers Heating Devices KW No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHE kM rdtoeC M3W Prtgattot4leraquimuz Ctmaliaws � M Ih &embinftdv&ptod'ofs=iotheOffm YES i[RYANCE ® BOND k sChe aWarilsstiutattalav%mt YFS NO NO r--1 (fjwharedniodYES plemm&mthet W fmcmWbydzckirgthe OriE1FIt a (I'=��5� EVilWmD* E0n*dVahedEl t XdWodc $ WorkooStnt C h pxfrnD*RegljsWd Ra# Fara) SrgwdtatdW& altla perpay �.. LizwNo► FIRMNAME Lioalsee .Zr l� �- BushwTel.TdNNa ©t ��S �4 A1tTe1Na Ad. m.. OWNER'SWSuRANCEWArVER,tanawatethattteLioaset mid theirstranea or9ss>+rdiirlegl�iatasrt�c}tiedbyMa�dt t",ataalLaws andthatmy*s ancnlhispan teppiirbatwaiusdflste*&Mtat (Please check one) Owner a Agent El -v i Telephone No. PERMIT FEE $ A a ( a 9 ( 03 Date.................................. NORTI{ °t,"`°:•�"a TOWN OF NORTH ANDOVER p PERMIT FOR WIRING I slow This certifies that . .. �. .......... ...........�......................................... has permission to perform ice'-'"`..�. J N ....................................................................... wiring in the building of ....11.....� �..�.. �.................................................... at ..... � .!.....5 v wt . VA. I...!...... ..................... . North Andover, Mass. ELECTRICAL INSPECTOR ti G I Check # 465 _t Depamnent of ftbfic Safety BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Official Use Only Permit No.� Q >� Occupancy & Fee Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) To the 1nsDect6r of Wires: Town of The undersigned applies for a permit to performm the electrical work described below. Location (Street & Number �_? j Owner or Tenant Dw o -e- ✓ Owner's Address Is this permit in conjunction with a building permit Yes ©---, No 0 (Check Appropriate Box) Purpose of Building (Ps t L n AA, c e. Utility Authorization No. Existing Service % R 7 Amps 2 `f O Voits Omtieadkg,--- Undgmd 0 No. of Meters l New Service Amps Voits Overhead 0 Undgmd 0 No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESW, NO C have submitted valid proof of same to the Office YES C% NO� H you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE 0 BOND 0 OTHER 0 (Please Specify) Estimated Value of EI rica • Works l s -y i . ` ` (Expiration Date) Work to Start `Inspection Date Resquested W l ; L'G.1 � Rough Final Signed underthe Pen tti of perjury: FIRM NAME LIC. NO. Licensee Signature LIC. NO. Bus. Tel No. Address Aft Tel. No. OWNER'S INSURANCE WAIVER: f am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my_jJgnatuTon4hls permit application waives this requirement. Owner Agent (Please Check one) of Owner, or qiL7 —&� .— l_ RM me No. IT FEE E � Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above 0 In 0 No. of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No. of Emergency' Lighting No. of Receptacles Outlets No. of Oil Burners Battery Units No. of Switch Outlets No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and i Total No. of Ranges No of Air Cond Tons Initiating Devices I Heat Total Total No. of Diposal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers SpacelArea Heating KW DetectiordSounding Devices 0 Municipal 0 Other _ No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No. Hydro r e T uds No. off Motor Taal HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YESW, NO C have submitted valid proof of same to the Office YES C% NO� H you have checked YES please indicate the type of coverage by checking the appropriate box INSURANCE 0 BOND 0 OTHER 0 (Please Specify) Estimated Value of EI rica • Works l s -y i . ` ` (Expiration Date) Work to Start `Inspection Date Resquested W l ; L'G.1 � Rough Final Signed underthe Pen tti of perjury: FIRM NAME LIC. NO. Licensee Signature LIC. NO. Bus. Tel No. Address Aft Tel. No. OWNER'S INSURANCE WAIVER: f am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws. And that my_jJgnatuTon4hls permit application waives this requirement. Owner Agent (Please Check one) of Owner, or qiL7 —&� .— l_ RM me No. IT FEE E � -iL' Dcationc-,�Z v No. Date I TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ CIO TOTAL $ Check # 30 Z.Z 1 3 ! ? Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: PE ® DATE ISSUED: SIGNATURE: 0& Building OffimissionerflEELwor of Buildings Date SECTION 1- SITE INFORMATION 1.1jj Property Address: 2 t S-) vut Vv\, i 1.2 Assessors Map and Parcel Number: Map Number Parcel Number NAM O l � X'T ! � 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RequiredProvidedReqWred Provided 4 1.7 Water Supply M.G.L.CAO. 54) Public ❑ Private ❑ Zone 1.5. Flood Zone lnformahon: Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT •2.1 Owner of Recorder 1 (/ � � i I �e.✓'� 'flame Print I' `Z � ��� wv. �' � N �_�_ rpt/ Address for Service Signa re 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 {� ( I l i Int. W IS }} � � MAD 1) ­7 !!v Expiration D&JL. iBu MING DEPAR-rPmErq 3.2 Registered Home Improvement Contractor Not Applicable __ 0 i Company Name Registration Number Address Expiration Date Signature Telephone au �J i z M O mn ic M z^ P) 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 rmit. affidavit Attached Yes .......❑ No ....... ❑ -Signed SECTION 5 Descri tion of Proposed Work check aIl applicable) New Construction )W Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: i - �r X [ � , i vl YX,CL of l_' iL a Til z �1 to V \govv,,_AGr«S SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com 1 ted by permit applicant 4;!FFICIAL:USI': ONLY . . . . . . . . . . . . 1. Building (a) Building Permit Fee Multiplier `Imp !7 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1. 1 as Owner/Authorized Agent of subject property 2 ( wt c S /�% �v✓ Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief i�^q i, e- n Print e7_4__ t Si atur o Owner/A nt Date niffialm WWWW'. IN WE mom NO. OF STORIES 1 SIZE x BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2ND 3 RD SPAN DR%4ENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from - Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. FILLS OUT THIS App, ICA a IrQ�t'IWi PHONE LOCATION: Assessors Map dumber_ �� PARCEL (32) SUEDIVISION LOT (S) STREET 2 1 9�'� MAJ SJ— ST. NUMEER '`*OFriCIAL USE O;,JLY REENDA T ION % CON SEPATIO`N ADM! COMMENTS TOWN PLANNER COMMENTS AGENTS: g'�tg' Sh\ -ck tN re&' 'A A- 5' PrIa . pr*�ep %( LtAms. TOR DATE APPROVED DATE REJECTED \J. -'�f ,-,to _.J/1� io�� DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUELIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVE, EY EUILGING ii ISPECTO Revised 919; im opb's_,�_e RUT MAR 2 2 2000 I BUILMNIG DEFAi- T iAENT DATE BUYER.- Stephen D. Pt Tamv M. Tarlieri �-� vire w 11 �oe 6 � � � v,AA l SUMMIT STREET r2 m THE ( Assurance Mortc*aFe Corp, of America, Inc ) AND ITS ,1,,.E INSURERS. MORTGAGE INSPECTION PUN IN I CERTIFY THAT THE BUILDINGS SHOMM Do ( ) CONFORM TO SETBACK REQUIREUENTS LWAIM I.E (FRONT, SIDE, t REAR SETBACK ONLY) OF NpT+} N 0 R T H A N D n V E R � � � �ON IP7, � ODMWI ENNFODRCEl1ENT outside UNDER MASS G L_ ��CHUSETTS SGEon1TeEE]L]LXX outside I FURTHER CERTIFY THAT THIS PROPERTY IS Not LOCATED IN THE ESTABLISH® FLOOD HAZARD AWA` OOMMUNITY PANEL NO.: 250098 0003C DATE: 6_2_93 DEED 11539 THIS COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT 70 THE RECORDED BOOK DATE OF THE LATEST DEED OF REOORD. PAGE 6o **NEVER BUILDINGS ARE SHOW LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED THAT A MORE PRECISE SURVEY BE MADE M VERIFY THESE MEASUREMENTS THIS CERTIFICATION IS BASED ON THE LOCATION OF SURVEY MARKERS OF NOT T A PROPERTY SURVEY. VERIFICATION OF SURVEY MARKERS U MA BE ACCOMPLISHED OHLY BY AN AOCURAIE. IN37MARNT SURVEY. � Ti115 CERTiFlCAT10N TO BE USED FOR MORTGAGE P C to S ONLY. OFF�,' AS SHOW AREO TO Bs E�ESTABU M' USED F R ESTABLISHMENT OFROPER • E6dWWUGCOl1liAS M 5 CERT. NO. PLAN BK. PAGE W. TID WIP013261 DATED t?arch. 24 BRADFORD NGINEERING CO. P.O. BOX 1244 HAVERHILL MA. olmi a o C; O w e v cn � O z z z _ 5 w mO w L U o C x a 0 v W m p u: ca G x � o w WW O w v cn G w p � U a O a! G w w d a v cn z �i . cn v Op E cn P: a� 0 E Q O Z O Q CA A .E CLO L C O Q 0 Q ra7 L O V co CL CO) C co Cm C CD O Q� cc m INA R C O � c w 0 y Q O y c V V �:•C 0: m c • CD : H � EQ CD c CD o ms .Y a z tmcm�E �m D o VJ tm3 Z L r y cm E- : m -9 c �� �'_Cc y :2 :2 O S t C C m s:mo aC �i m y m ' = o cm R c rm Nip O t5 c a o c m CO) r c y O �v � •y rte.+C MO � .� � LU •`m d� C m .y ca cm Z O tam V� = tZ A m —O i H O F-- a m a a� 0 E Q O Z O Q CA A .E CLO L C O Q 0 Q ra7 L O V co CL CO) C co Cm C CD O Q� cc m INA R W ui Ir W IrW LU Cn C 0. y Q R W ui Ir W IrW LU Cn PL fi X a F L R rr D N SIIf� A/®* rH AAra OVZN MASS. S OR vE,Y-,D FOR ®RoOPCVIJ / CO&lAfrRY J40119S S rowBR5 9ssoc/pr,-s rxc. Rrc• LpNo S URYiryoAs D-ccx f.4R 1998 P?R's S. S � Mfr SrR�.�r �. oetJs s>+owM p.re �xc Lor .1 SHOWN �w NORYN FSS1sN R�4/STRY cP D,stD$ k .l �L*ocation Z/ . �U X717- 7-41dc. 414c.- 3 Date i ' &ORT H TOWN OF NORTH ANDOVER T Certificate of Occupancy $ L Building/Frame Permit Fee $ � ss�cNusE Foundation Permit Fee $ • •�� Other Permit FeeF(\PPCA« $ � �• .35 Sewer Connection Fee $ lo�o�'o o Water Connection Fee $ /cz• o TOTAL $ 0 6� -- lv, rr dBui in nspe or 1,251 2 11l16/9B 0B:55 9B Div. P Iiworks Q i z q Gam' C L., C D 1 c l� n Q XI C w r M Q L� aLU LLI r� x LU r! Q \^ j QQ Ln 0+4 W 74 - < - - �3 v Q LLJ = z q Z Z Q Z a Z C - Z z O z z z C Q t Z Zz C LLI i z Z Z Z t 5 5 C m i i z q Gam' C L., 1 o l� z ¢ y s9 r Z - = < z_ 9 _ ) /n a N - - i z C z ¢ y s9 r Z - = < x - x a/do 00� x 6 r C�'�a a� oco k !- S- c2 (v s3 3 X26 X36 = c�3(0 Cl— �A O o 1000 13. qj , vbt o rt,f I r 4 P 9. 310 �1� r JJ SO -3 /i%/3 /1B Rue- P.0 AN O F I R v0 /N IVO RT'H ANDOVER /vlASS. FR--PsgR-D Fog .B1400Kvixw cOvNTRY )-/O pf s SCPjLx 5row.eRS RSSoCIPTAS 2"NC, REG. LR ND SuRvzYORS /V o y x /-I aj! R,S . y� GEORU Ns N /9-37 N I FROPOS.L'D � N DwF,t1iNG I Q I V � � I ¢ o� I I �4 a C I N Q � h I i N V �i a Q -LOCLS SH -WH 13-le1NG .Lor I SNoWr! o N A/ —17. F?. D. P). j�? H -0 /3 2 Z / Growth Management Bylaw Exemption Statement Town of North Andover Building Department This fort shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information as requested below. N. a of plicant/o 8uiloing Per it (below) Address of Property for Permit (below) �Qdilt�,l C °'��C'� ri S ,1 SI ', i Ave Map and Parcel: P rpose c Application (check below) PI4�pfN" r of�4Tyft JJ_t� Single Family _ Two Family I the// undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the Building Permit. Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building Department and is only officially accepted when the Building Permit i4 issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in the building permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark. This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in existence as of the effective date of this by-law, provided that no additional residential unit is created. The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning Bylaw. This application is for dwelling units for low and/or moderate income families or individuals, where all of the conditions of 8.7.6.care met and/or represents Dwelling units for senior residents, where occupancy of the units is restricted to senior persons through a property executed and recorded deed restriction running with the land. For purposes of this Section "senior"shall mean persons over the age of 55. This application is a part of a development project which voluntarily agreed to a minimum 40% permanent reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently designated as open space and/or farmland. The land to be preserved shall be protected from development by an Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism approved by the Planning Board that will ensure its protection. This application represents a tract of land existing and not held by a Developer in common ownership with an adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the parcel. This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and commissions have been received and the project is in compliance with those permits), and the Development Schedule does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per Development until such time as the Development Schedule accommodates issuing building permits. Applicant must supply approved form U with this EXEMPTION. Please provide any and all information that would assist the Building Department in making a determination' that your application is allowed one or more of the above EXEMPTIONS. By signing below I attest to the accuracy of the information provided and that the attached building permit is allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or inaccurate informal' , r the c ecking ff of an above item which does not comply, whether done to my knowledge or no, gr unds refusal y e Swilding Department to issue a Building P�rmit` Signature of OWr or Authorized Agenfwho signed the Attached Building Permit Da This form must be attached to the Building Permit upon application for such permit 9 FORM U - LOT' RELE ASS FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION* �( APPLICANT '(0 0 (it ii "lu l Q • Ae 5 PHONE LOCATION: Assessor's Map Number D PARCEL /3 SUBDIVISION I/Mm , / , 4//C LOT (S) / STREET SUM m , •0q ve ST. NUMBER -r------..,*,..,,*.,•*„***"****"*"*****OFFICIAL USE ONLY`**'""'" RECOMMENDATIONS OF TOWN AGENTS: ERVA ION ADMINISTRATOR DATE APPROVED DATEREJECTED_ COMMENTS TOWN PLANNER COMMENTS cinc FOOD INSPECTOR -HEALTH VSEPT,)Z IMSPECTOR-HEALTH JU1n COMMENTS DATE APPROVED DATE REJECTED - DATE APPROVED DATE REJECTED IJATE APPROVED DATE REJECTED_ PUBLIC WORKS SEWER/WATER CONNECTIONS /0 — DRIVEWAY PERMIT —r57—&t) /"% r Z9 - FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE GEORGE PERNA ! y r TOW^; OF NORTH ANDOVER. MASSACHUSETTS DIVISION OF PUBLIC WORKS 304 OSGOCD STREET. ldt DRIVEWAY PERMIT r Telephone (508) 685-0950 Fax (508) 688-9573 Date: 0 �g LOCATION: BUILDER: phone: OWNER: �jl©B�v�e�J(,e��t�i 14yx� phone: X38 - 6559 The North Andover Superintendent of Highway Utilities & Operations MUST be notified of the grade and set -back from street established in any driveway entry onto any street or way maintained by the TOWN. Call the Highway Superintendent's Office, before finish grading and surfacing for approval of such entry. FAILURE TO COMPLY AND OBTAIN APPROVAL VOIDS THIS PERMIT. ■ Remarks: Approval: MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2.0 CITY: Lawrence STATE: Massachusetts HDD: 6235 CONSTRUCTION TYPE: 1 HEATING SYSTEM TYPE: DATE: 11-8-1998 or 2 family, detached Other (Non -Electric Resistance) DATE OF PLANS: 11/4/98 TITLE: PROJECT INFORMATION: Lot 1 Summit N. Andover, Mass. COMPANY INFORMATION: Brookvew Country Homes. P.O. 531 N. Andover,Mass. COMPLIANCE: PASSES Required UA = 421 Your Home = 378 Permit # Checked by/Date Area or Insul Sheath Glazing/Door Perimeter R -Value R -Value U -Value UA ------------------------------------------------------------------------------- CEILINGS 864 30.0 0.0 30 WALLS: Wood Frame, 16" O.C. 1972 11.0 3.0 151 GLAZING: Windows or Doors 330 0.350 115 DOORS 42 0.350 15 FLOORS: Over Unconditioned Space 864 19.0 41 BSMT: 8.0' ht/7.0' bg/0.0' insul. 116 0.0 26 HVAC EFFICIENCY: Furnace, 90.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections 780CMR 1310 and J4.4. Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.0 DATE: 11-8-1998 Bldg. Dept. Use CEILINGS: 1. R-30 Comments/Location WALLS: 1. Wood Frame, 16" O.C., R-11 + R-3 Comments/Location WINDOWS AND GLASS DOORS: 1. U -value: 0.35 For windows without labeled U -values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: 1. U -value: 0.35 Comments/Location FLOORS: 1. Over Unconditioned Space, R-19 Comments/Location BASEMENT WALLS: 1. 8.0' ht/7.0' bg/0.0' insul., R-0 Comments/Location HVAC EQUIPMENT EFFICIENCY: 1. Furnace, 90.0 AFUE or higher Make and Model Number THERMOSTATS: Adjustable thermostats required for each HVAC system. AIR LEAKAGE: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air -tight assembly with a 0.51' clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -values, and heating z z equipment efficiency must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure -sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4.4. MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only)------------------------- I✓�ze %�azn»zoozrueall� a� :1�t'rrJJaCI [IJCCIJ ; DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Expires: Birthdate: CS. ji.,, 606693-01/1312M 011131954 RestrlEted To , 00 i OAVIO A KINDRED yr OrAs/ 36 MIll POND POBX 531 t N ANDOVER, MA 01845 156635 Restricted To: 00 @@ - 35,000 cf enclosed space MGI C.112 SAL) I IA - Masonry.only r 1G - 1 5 2 Family flomes Failure to possess a current edition of the f Massachusetts State -Building Code ! `' is cause for revocation of this license. No 1356 APPLICATION FOR SEWER SERVICE CONNECTION North Andover, Mass. 40c 172g 19 1 Application by the undersigned is hereby made to connect with the town sewer main in So wwi`1" Street, subject to the rules and regulations of the Division of Public Works. The premises are known as No. 2� 2 wmtl� Street or subdivision lot no. �C60LU to 0 C00J'-,f "e'5 Owner V Address Contractor Address A" pplica ' ignature PERMIT TO CONNECT WITH SEWER MAIN CotThe Division of Public Works hereby grants permission to b r0'qL tl L�?o to make a connection with the sewer main at subject to the rules and regulations of the Division of Public Works.. Inspected by Date Street Division of Public Works By See back for rules and regulations N0- 845 ,' APPLICATION FOR WATER SERVICE CONNECTION North Andover, Mass. v a 19 jb— Application by the undersigned is hereby made to connect with the town water main in &W)hf�L Street, subject to the rules and regulations of the Division of Public Works. 7 The premises are known as No. �� �C� LLiiZc/ Street or subdivision lot no. Owner Contractor ('C/ 6 7. � g;,7 -op 8 Address Address 7Z, t6 pplicant s Signatur PERMIT TO CONNECT WITH WATER MAIN The Board of Public Works hereby grants permission to _)), 061L to make a connection with the water main at '�50 kH ` subject to the rules and regulations of the Division of Public Works. Inspected by Date f Street Board f Public Works By ZY See back for rules and regulations 0 O E=4 ..� w a c o w ) a cn �z O z z ° .� o w m o a -C U G x czAG O o w cz G w w U o w ca C w" p a U o a' o ur. 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A0CNV. }11�!lON SNI `�1� 0�11N1�1� 111 J U O � o z� Z U Q LU z ago W U- LUF Q Who Q ZXz � Cooz LL � 00� F� o Lu a d �O z >— N LU a zUl 1 Z OQa z rn u 0 Q s g I Y. '1 fY '��o-f ' L♦ , i' H • X37 ,`t Fte ysi " I . �,� ' Leh El�=�)Lt. 4d• 4i t . .. = 1 S 4 s -2s9 i �J k Y 1 F� o Lu a d �O z >— N LU a zUl �' OQa z rn u (CERTIFICATE OF USE & OCCUPANCY Town of North Andover Building Permit Number 04,043 THIS CERTIFIES THAT Date �- a; ply THE BUILDING LOCATED ON CV MAY BE OCCUPIED AS V , 7)IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO (4&f Building Inspector �dpl to U 0 0 m co') CO 4-N co trCO) CD CO > co UCL cz 0 CL CL =)< 0— Cc Cc EL 0 Z CZ) 0 CL cc cc -CZ u LE UU) x ln4 U) L*" m Cf) cn �dpl to U 0 0 m Ir f co') CO co trCO) CD CO > co UCL cz 0 CL CL =)< 0— Cc Cc EL 0 Z CZ) 0 CL cc cc Ir f 0 O a i r AC TOWN OF NORTH ANDOVER APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION ADDRESS/LOCATION OF PROPERTY:— SUM `yf. DATE REQUESTED FILED/READY FOR INSPECTION 7 �3 %7 Y / CLOSING DATE ON PROPERTY:3D 77 4. 4 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND PERMIT SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTI E OF TWENTY DO CHARGED IF THE , JJ(;TURE DOES NO SIGNED ROUTING CONSERVATION F1 -61 PLANNING 1-1 DPW - WATER METER F-1 ,RD $20.00) WILL BE EET ALL APPLICABLE CODES. S NOTE: DPW MUST INDICATE THAT WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST DPW Signature NORTk 1�.1 .:•� O - p TOWN OF NORTH ANDOVER "AC APPLICATION APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION ADDRESS/LOC ATION OF PROPERTY:- DATE REQUESTED FILEDIREADY FOR INSPECTION `� /-3) CLOSING DATE ON PROPERTY:`' 7 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND PERMIT SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-INSPECTI00 E OF TWENTY DOLLARD $20.00) WILL BE CHARGED IF T} HE 'U TURF DOES Nk�T/MEET ALL APPLICABLE CODES. SIGNED G ROUTING CONSERVATION PLANNING F1 DPW - WATER METER F1 NOTE: DPW MUST INDICATE THAT WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYIINSPECTION REQUEST DPW Signature Location 7)/ No. Date C Check # A TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Z4-1 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building inspector,/ TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING {_.. -.�r .. ..,?,7�jZ�1 __ _ BUILDING PERMIT NUMBER: / DATE ISSUED: SIGNATURE: /'vG 161t, Building Commissioner/InELxctor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property A 1.2 Assessors Map and Parcel Number: Map Number Parcel Number /% k `© J E p 1.3 Zoning Information: Zonin g District Proposed Use 1.4 Property Dimensions: LA Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided J 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service: Signature Telephone 2.2 Owner of Record: _ J <I pc-) Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licens struction Supervisor: 27 ' n 4&) / S O� Address S ?--D iU C F- (fin LAfA V Si a Telephone Not Applicable ❑ 3 � License umber 7"/O " O 4- Expiration Date 3.2 Registered Home Improvement Contractor 60c,J�� Not Applicable ❑ Company Name aol-/J /% S _ Registration Number 3/Z r z p S' Expiration Date / Ad ess 7 7T ` ,37� / Si nature Tele hone T M X Z O r- - SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 6 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: SECTION 6 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant {)F CiALVSE�ONM 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction / yq Q 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUH.DING PERMIT 1, 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 Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DINIENSIONS OF SILLS DIMENSIONS OF POSTS DIIv1ENSIONS OF GIRDERS IIEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE M pl JT k /+r p ��! S UR vF•Y.ED �oR �ooxv�ti✓ �Oi�vrRY'oM,� Cli.tl :;��}� S7`owBRS i�SSoCipr,Es zxc. R:'C• LANf> 5 uRvXtYaRS,. f !-wArF 0!.v ya-4 19.37 RRXA= ks.✓3D0; EXiSrIIVC - �:FaVNDp770N 'N I 4� M S n r R jr r 'K 7' L occas S>.,0Wv arF ,vc .Lor I SHDwni ow NoRrW Esssx RzG)sritY cF D,esas FORM U - LOT RELEASE FORM -i a; 0s 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 APPLICANT LOCATION: Assessor's Map Number SUBDIVISION STREET�� v4 t44 i PHONE%�z �O 2 0 PARCEL J LOT (S) ST. NUMBER Z/ ****************************OFFICIAL USE ONLY************************ CONSERVATION TOWN AGENTS: TOR DATE APPROVED DATE REJECTED COMMENTS t' TOWN PLANNER COMMENTS 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 INSPECTOR Revised 9197 jm TE APPLICANT INFORMATION Location: Cit; The Commonwealth of Wa=Ch=e= (Dep==nt of Ind•.ts�rial., a de= Of= ofInvat =ions 600 Washing Street Boston, XX 02111 workers' Compmsatim bmurance Afrdavit Please PRINT LeQibiv Telephone M-921 C--P,9-z~ T a zxp C I am a homeowner performing all work myselL C I am sole proprietor and have no one working in my capacity I am an employer providing workers' compensation for my employees working on this job Company Name:, ,G1��N e4 W—=* Address: ZO y V` A N (S O64 ` t� City: 5,-�A o A-/. ad /fel oo Telephone o:_ 7 i is % Jam% Insurance Company: RA299Ek ��� Policy: Ii(�j� ❑ I am (circle one) sole proprietor, general contractor or homeowner and have hired the contractors listed below who have the following 1: workers' compensation policies: Company Name: Address: City: Telephone M Insurance Company. Company Name:_ Address: City: Insurance Company; Policy?,: Telephone #: Policy r: Attach additioaai sheet if necessary Failure re to secucoverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to 51,500,00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. I understand thatz=py of this statem be forwarded to the Office of Investigations of the DIA for coverage verification. I do he under the pains p'enaities of perjury that the information above is true and corre Official Use ONLY - Do not write in this area o Building Department o Licensing Board PermitlLicense M City or Town: o Selectmen's Office o Health Department D Check if Immediate response is required 0 Other iNF oRmATION & iAISmucnONS Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation I or their employees. As quoted from the' law" an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, -association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of.a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, 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 section 25 also -states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or -to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the, commonwealth nor any of its political subdivisions shall enter into any contract for the performance of- ublic work until acceptable evidence of compliance with the insurance requirements of this chapter have beenpresented fo.the contracting authority. . Applicants Please fill in the workers' compensation affidavit completely, by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the. Department of Industrial Accidents for,conf rmation 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in. advance for your 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 02111 Fax # (617) 727-7749 Telephone # (617) 727-4900 ext. 406, 409, or 375 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is -that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A._ The debris will be disposed of in: C� we�Z —0 (Location of Facility) Signature of rmit Applican z s 203 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through. the Office of the Building Inspector D O b h G z 4 A O u u o u2 n Ui U '-a O `° w° a�' U m x U A. o u: w" a w w o w ca C w" p a z Cd w w c o ui am CD cm O 2 O O �E Ca m CD ow CL ♦.r co O � 3� O C O L CL �Q y C CD O � C ev .Q O c Z CL C.3 CO) � c C C cc CO) o m c O y �c C O V V C. C O C t c mcil O � y tt a 1 m 0 a� .��v EE ` ,r cm m c E CDm a o C m ID m� y CID = C ta A y C f�. 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L O .• U O d O (0 O n O OUOLLE0 N N O m U U O1 mO� C O1 O O i N C N N f0 'j74 f0 `O L (7 C9 w (D N F- 3 `m �0 `o 0 N # N N U 7 N a p C y O N @ N N y N@ O uo m ° eo a ep c o 3 c o c v O N O U O C .� .� co C 0 C C 0 C UlLL 0 Ua cmU- N D7 C C EL c �f0a � O` -0 N OO U o rn �' 5L T �En AX U a N a O 'U xU� Xy aXic a 0.6 �� lO! A f0~ N !a) NN O C X .. C ?� t/7 N m X O N •- 3� O LJ d 6 0 N N O O E C l0 l0 N N N C O k3xu��nv�35 "' $ o N v E � N J E C7 3 O X O N CON C F-rrF- U 75 7 O �U n N n > X>.� u) O X y N C Q CL U F--- m W a)?oN E rnii r O 9 X y X r l6 Tx X N N O C a, Li lONVN �L %3O 3 V d pl O T N _CN NU 4) C'D C== f6 NLL� C N Yinin�xcncnu>�5 „gib -,9 c E L � N U J w - N O M O C !0 m � E N C m O 3 O� o � 3 v N > O O m N X E Uy Na, O C L VL U = r)•3mmy N N O p O C v O a C M a z O y O N , O. L O .• U O d O (0 O n O OUOLLE0 N N O m U U O1 mO� C O1 O O i N C N N f0 'j74 f0 `O L (7 C9 w (D N F- 3 `m �0 `o 0 N # N N U 7 N a p C y O N @ N N y N@ O uo m ° eo a ep c o 3 c o c v O N O U O C .� .� co C 0 C C 0 C UlLL 0 Ua cmU- N2 22,12 Date ..... 1/f :,./� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ P .. �'.h.� ...... .............................................. has permission to perform ...... ..................................... wiring in the building of ....... .... (.0, ......(........./............ wiring X 141.� at ....... .......................... No�7rthdo e ass. Ir . �Vl ....... . .. Fee l.:�U,.(P Lic. No. -37R* .... ... . ... ............... CAL INSPECTOR >�� I r, / 12199 14:52 250.04 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 7 ECOWONWE4L7HOF f4 ' r CHUS= Office Use only DEPARTMDTOFPUXJCS4FM Permit No. AR 19, BOARD OFFIREPREYF. W0NREGUL4TI0A SV70V 1Z0 -- UV2dPPUCATI0NF0RPEMff Occupancy &Fees Checked TO PERFOR ff ECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date,f°°���` Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes [MNo a (Check Appropriate Box) Purpose of Building Existing Service Amps / Volts .moo New Service O -u Amps .X / -A,,GVolts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Utility Authorization No. IM7-2y� Overhead a Underground ID Overhead Underground M No. of Meters No. of Meters _ Nc/Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 171 ground Noiof Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Bumers FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Locala Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis N� Hydro Massage Tubs No. of Motors Total HP OTHtR IIISUWKeCOrQa laws Ihaeaa>naYLiabkhu==PthL,ye idTCaTO& CoA-dWortsWvartd MNalatt YES �— NO Ihaw%bn9&dvalidptoofof§wvotheOffmYES IfjwhaedwdwdYFS,plmatLii *thet}pecf'amVbydxdatgthe I CSE M BOND a O VIER a (Pl =Spedfy) Expit�atI?a� `"` ` htspectimD*Re��ed ES Vaktecf hialWodc$ w«kms�t Sighed irtd Tc Nnalties cfpajtay: FIRMNAME iyllCLc u -t /� aw%1�y�- .Clcc % Feral Lio=Na Y` -/2l o lic� : - Sigrtarine ��. % �c fir_ LimrlsseNo i BisirmTel.Na Sal C. A,ddi .�A r3+r2-� s T �o � Alt. TeLNa f OWNER'SINSURANCEWAIVER;IanawatethatdrLj ase theituuraioeoo►►erW"ab rtalegt da>tasm*mWbyMas a GenaalLaws andiatmysigtmUncntlispemtaVficad V4ik4Mft a*W-Mian (Please check one) Owner Agent ® C, jj Telephone No, PERMIT FEE $ 5 V �0 Date..' i 3891 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...... ........... has permission to perfor .0C-9q---',00' plumbing in buildings of .. .....................� . at .�� . .. .. ... ........ , North Andover, Mass. Feed.. Lic. No .61�2Dc;;L-� .............................. PLUMBING INSPECTOR WHITE: App?cagf 11'21CANARY: 207g Dg�t=n PINK: Treasurer (Type or Print) NnRTN ANDOVER Building Location Owners Name New Z?__ --Renovation ❑ • Replacement Plans Sybmitted Wt 90 (Print or Type): Check one: Certificate Installing Company Name,:, Corp. Address Partner. Firml Co_ Business Telephone Name of Licensed Plumber: _ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy F] Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware - that the licensee of this application does not have any one of the above three insurance cciverageso " Signature of ownerlagent of property Owner Agent\� ❑ ', I ( bca:br ccstifr Uut all of Uta dcuila and in(oeouiion I leas submillcd (ot entacd) in &twos semimlioes soe lore Jr Wstd to Use bell d ag kAawkd&c sad that all plumbing •oek sod installatinnt lra(nemcd undce rceaoit i%sucd roe this sppliatiat wiu be i• cowptisotp 1"k dl patisook pwy tlilolu of lbs bebauac4awttt Slate ilua►biag Codc and Cluptcs 142 a( tltc Genual Lars. • , .. 44 By Title. City/Town: . - - - / 1 0 r r% � Signature of Licensed Plumber 0. Type of Plumbing License C�qr7 License Number ❑ Master ❑ Journeyer MASSACHUSETTS tltZiF(3nrA A>i'p'i.. CATIOM.F011 PERMfI, O.DtO O UMBittd10 'j i•ype or Print) :•: NORTH ANDOVER ,Mass . Date: • %� , �/ �� Building Location pZ Ii LLV A I j ..,Permit l 91• Owners Name (Print or. Type) Creek one:Certificate Corp.' Installing Company Name Address_ ( Partner., %_J UV �� �� �6�— �1 Firm/Co. Business Telephone e l -3 Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage us checking the ' a ro riate box • v� - ey ® x w .-1 Irrn • Y i3 4 x d , 4t a x as d ce U x x = _ Q a 0 w U, C* m Fa- .Q F to a 4 O O x CC o C2 o c t» d co >- re :Ed w ? tri x ccQ ..t z o a cc- . Q 's W X tu O z Y 0 h 4 cc ' h Ac o> F' d -It O 0� N d rn d h O Q. O t p .a a s 'Q ? tt '- Ct W trr F- Q O O U� d h -1 fLt 03 0 [s J X F to U. O a Q 4 cL as O s 111-:e s rn�. BASEMENT IST FLOOR 2"DFLOOR 3RD FLOOR 4TH FLOOR s'i't'! FLOOR &.Ttf FLOOR 7TH FLOOR 8`YH FLOOR (Print or. Type) Creek one:Certificate Corp.' Installing Company Name Address_ ( Partner., %_J UV �� �� �6�— �1 Firm/Co. Business Telephone e l -3 Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the ' a ro riate box • - PP P Liability insurance policy � Other type of indemnity ElBond insurance Waiver: 1, the undersigned, have been tirade aware that the licensee:..of this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner Agent 1 hereby certify that all of the details and infoentation t bare %ubmittcd (or entered) in above applicotion are true and accurate to the best of my kiiowltdge and that 211 plumbing work and instsilstions performed under rern,it itsucd for t}tis application will be in eontptianoe with all pertinent pro- tisiom of tim Piassacim%etts state riumbin Code and C luptct 182 of the Grncc at Laws- _ Title: City/Town: APPROVED (OFFICE tis[ ottLY) �t Signature of Licensed P1fmber Typeof Piumbin License r is mber t•S�stQr Journeyman