HomeMy WebLinkAboutMiscellaneous - 210 ROSEMONT DRIVE 4/30/2018co
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I
Date....... ...............
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSIrALLATION
This certifies thj� .... . .....
........... ...... ............ .... ...... .
has pennission for gas installation ....... �2—
..............
in the buildings of ..............................................................
at ...... 2 -to North Andover, Mass.
.....................................................................................
Fee ... Lic. No.151.�P ...... ...........
GASINSPECTOR
Check #
9616
C",
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
U'N IV(>rA MA DATE PERMIT#
JOBSITE ADDRESS iewsc'nl E'/r� D( OWNER'S NAME
OWNER ADDRESS TEL FAX
TYPE OR
PRINT
OCCUPANCY TYPE COMMERCIAL F] EDUCATIONAL E] RESIDENTIAL kl
QN
CLEARLY
NEW: RENOVATION: REPLACEMENTA PLANS SUBMITTED: YESE] NO F1
APPLIANCES FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
(a)
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liablilly insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YEV�'NO El
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY gy OTHER TYPE INDEMNITY C] 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: OWNERE] AGENT [1
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 ccurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application vAll be in compi 'th all Pertinent pM�nsion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME �7WPL4wtt's LICENSE # SIGNATURE
MPgp MGF [I JP [1 JGF El LPGI n CORPORATION 0 # PARTNERSHIP # LLC #
COMPANY NAME14U-1-L9L-& j3e—o�, PIL�A) ADDRESS r- r<!�-
CITY 39/),
STATE zip //)4 �7L TEL <—
FAX CELL EMAIL L
A. I
rA
CL z
ui
I--
Division of Professional Licensure: License Search http://Iicense.reg.state.tna.us/public/PubLicenseQ.asp?board—code
The Oftal Website of the Office of Consumer Affairs and Business Regulation (OCABR)
Division of Professional Licensure
Mws,GovHwne StateAgerrJa A-ZTopcs
Home) Division of Professional Licensure)
Check A Professional License
By the Division of Professional Licensure
LICENSEE
Name: EDWARD J. MATHEWS Ill.
MELROSE, MA
NEW SEARCH
—This Licensee has, additional. Licenses, click here to view them.**
Licensing Board:
PLUMBERS ft GASRILERS
License Type:
MASTER PWMBER
License Number:
15180
Status:
CURREN
Expiration Date:
5/1/2016
Issue Date:
11/28/2006
Exam Date:
11/28/2006
School:
This web site displays disciplinary actions dating back to 11993.
This license has had no disciplinary actions taken during this time.
The page above has been generated by the Division of Professional Licensure web
server on Tuesday, October 21, 2014 at 9:37:13 AM.
0 2007-2011 Commonwealth Of M88mchusetts
ONIZ4E SFXVICES
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Professional
online Address Change
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Glossary of License Status
Codes
Mko f e .
Date....,/ — /'�- - /,--)
..............................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ............................................................ ................................
has permission to perform . ................................................
wiring in the building of ...
.. .............................................................................
at
............. ..
. ........................... North Andover, Mass.
............ Lic. Nogr�&'� .................
EL ICALIN PECTOR
Check # --Ze9�712--
I
P_
—A
Official Use Only
Commonwealth of Massachusetts
Department of Fire Services Permit No
lOccupancy and Fee 'Cbec�ked Q-36
BOARD OF FIRE PREVENTION REGULAT11ONS .[Rev. 1/071 t(lea,,blank)
APPLICAT111ON FOR PERMIT T 0 :F'-'s�-7!n-x-iL"%n..#iO%'!*W'mI E-LECO I
AM work to be perforniedin accordance with the Massaebusetts Electrical Code (MEC), 527 CW 12.00
(PLEASE PP"T X INK OR TYPE ALL rNFORMA TION) Date:--)//) 116
By this appliLtion the undersignedgives notice of his or her intention toperform the e I iectrical work described below.
Location (Street &Number) �16 R0S^"4,T- OR
ir; ilLis--ses, Cldl4" -�- 1YIel--3A, 114 ss�- 77 j j j; j ; ;.7, j
0wner�s Address
is thispermit,m conjuncton. --,.;th;a bual—ding ___;+9 v— I i v- F-1 ITi'mck A
IM I ""' I , %
Purposeof Building 41--r(7eC4T1o1L11 Utility Authorization No.
Existine'Service Amns I Volts 'Overhead F1' Undgrd'F] No. of M,t,,s
Numberof Feedersand Ampacity
IQ -M.A.1 111-4-
40P A/e— L,!�&r I;v 041rltpoom
04 Z- 'r 04 ^r /1470 a - / " I 1-0V/1
'Com
pletion of the. follow ing taYle �mcn, �be wa ivedby the Inspectorof Wires.
Attach additional detail i(desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 'When required by municipal policy.)
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
T 7._1 7 7z-;
CHECKONE: INSURANCE BOND Lj OTHER H (Specify:)
J certify, under the pains andpenalties ofperjurvy that the information on this application is true and complete.
py".. T!, %Tfi
Licensee: fjrj?/j�L (fvf?r1_-v Signature PAV- 114 LIC. NO.: 003/
(Ifopplicable, enter "exempt " in the license nuniber line) Bus. Tel. No.,;8/- 5
Ad d 1 e Q_ s - TO, Nn. -
C. 14 /, S. ') /-o i, security worK requires liepartment ot Putil ic 1.iatety "!S- License: Lic, No.
-.1
OWNER'S INSURANCE WAIVER: T am aware that the Licensee does not hm,e the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. T am the (check one) E] owner F-1 owner's agent.
Signatur�' Telephone No. I-EKM I FEE:
MA af TOP!
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
PAM Above In-
No. of Emergency Ljiffiffig
INo. of Receptacle Outlets
]No.
of Oil Burners
'IFIRE ALARMS ]No. of Zones
l_ - -
1-4 0. of Switches
1
1-1 __ -
HNo. of Gas Burners
Mo. of Detection and
No. of Ranges
jNo. of Air Cond. ilij
Tons
No. of Alerting Devices
I
No. of Waste Disposers
Heat Pump
Totak:
J:Nqro�r K�Y.
I
jNo. f Se f
0 1 -Contained
fiDetection/Ale-fing Devices
1no. or insnwashers
13paCC/ArCa neaung ww
ioca, L -i Conneition L -i kAncr
No. of Dryers
Heating Appliances KNV
I
ISecurity Systems:*
I No. of Devices or Eallivalent
Attach additional detail i(desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 'When required by municipal policy.)
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
T 7._1 7 7z-;
CHECKONE: INSURANCE BOND Lj OTHER H (Specify:)
J certify, under the pains andpenalties ofperjurvy that the information on this application is true and complete.
py".. T!, %Tfi
Licensee: fjrj?/j�L (fvf?r1_-v Signature PAV- 114 LIC. NO.: 003/
(Ifopplicable, enter "exempt " in the license nuniber line) Bus. Tel. No.,;8/- 5
Ad d 1 e Q_ s - TO, Nn. -
C. 14 /, S. ') /-o i, security worK requires liepartment ot Putil ic 1.iatety "!S- License: Lic, No.
-.1
OWNER'S INSURANCE WAIVER: T am aware that the Licensee does not hm,e the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. T am the (check one) E] owner F-1 owner's agent.
Signatur�' Telephone No. I-EKM I FEE:
I,- � - - .. � , �. I I - I
'A
-C-\ The Commonwealth of Massachusetts
Department of Lndustrial Accidents
Office of Lnvestigations
Washington Street
Boston, AL4 02111
W'"w.massgovIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LegibI
Name (Business/Organizafion/Individual):_ ( (x- E Iff _�T -, C A Crk) T -r^ C 1�1 A_/I
Address:— LIS Mem - 7F A -i c�
City/State/Zip:_ &P,�, +ree- Phone #: 9 f- s9ci - -2,9,-s r)
Are you an employer? Check the appropriate box:
1. Z3 I am a employer with O'�
4. F� I am a general contractor and I
employees (fiill and/or part-time).*
have hired the sub -contractors
2. 0 1 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. 0 .1 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.] t
employees. [No workers'
COMP. insurance required.]
Type of project (required):
6. 0 New construction
7. 2] Remodeling
8. E]Demohtion
9. 0 Building addition
10.E] Electrical repairs or additions
11 -[1 Plumbing repairs or additions
12.0 Roof repairs
13. 0 Other
.1 'Lpy— Dim. t-�- Mus! also IIII Out the sec -ton below showing + 'h-;- wo`rl`= ' COMP —Sat -011 P01 0), mformation.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers 9 compensation insurancefor my employees%. Below is the policy andjob site -
information.
Insurance Company Name:- PAC+
. _�4 . WC fzet�;.
Policy # or Self -ins. Lic. #: C) Qo W (-! (_ _ D 0 P,� I Expiration Date:
Job Site Address:—@Lle)- Rrg-mnu-� ST )k City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the D1A for insurance coverage verification,
I do hereby6ertf& under the pains andpenalties ofperjupy that the information provided above is true and corre—
A cf.
Phone #: 78, t -,�c5 Vq - 7 OL30
11 Official use only. Do not write in this area� to be completed by city or town officiaL
City or Town:
PermitfLicense #
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
V�
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-contractor(s) 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 ci-, or town that the application -'or the permit or license is being rea sted, not -.he Department of
U Vie
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 bum 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 addr-ess, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-8 77-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
wwm%mass-gov/dia
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This -1 certifies that P� (A.C. A .... OA
.. ............
- da
has permission to perform .2nd.J-7-00��.A'4,4 ..............
plumbing in the buildings of .....................
at.2.10. . pok-.-e�. on. .� .................. North Andover, Mass.
Fee.E.Z/50. Lic. No.. . .[2 -k -V ......................... 4.
PLUMBING INSPECTOR
Check #
8329
Ar
MASSACHUSETTS UNIFORM A-PPLICATION FOR PERMIT' TO DO PLUMBING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
131107
Date
Building Location
Permit #
Owner Amount
New Renovation Replacement Plans Submitted Yes 0 No
(Print or type)
Installing Company Name
Address C- e4 -1-C4,41 14
- Ar., ---7 -
Check one: Certificate
D -Corp -
Partner.
Firm/Co.
Name of Licensed Plumber: -A
Insurance Coverage: Indicate the type of innzrance, coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity Bond
Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature Owner Agent El
I hereby certify that all of the details and information I have submitted (or entered) in above application ire I true and accurate to the
best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Plumbing Cod �apter 142 of the General Laws.
WW
By: _ 0;;::� ���
Signature 51 Moen= k1jum=
Title Type of Plumbina License
City/Town
1APPROVED (omm usF- oNLY 3-1cense NuMM"' Master Ef" Joumeyman
led
The Commonwealth of Massac husetts
Department of rndustrial Accidents
Office of Lnvestigations
6,00 Washington Street
Boston, AL4 02111
Workers' Compensation In' www-massgovldia
surance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Informatio Please Print Legibi
Name (Business/Organization/individual):—j6 /C-/ 4
Address:
C'tY/State/Z'P:— 0/r Phone#:
Are you an employer? Check the appropriate box:
LEI I am a employer with
4- 11 1 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-
kship
listed on the attached sheet I
and have no employees
These sub -contractors have
working for me in any capacity.
workers' c0mp. msurance.
(NO workers' comp. insurance
5. We are a corporation and its
required.]
3.7 1 am a homeowner doing all work
Officers have exercised their
right Of exemption per MGL
myself. [No workers, comp.
c. 152, § 44), and we have no
insurance required.] t
employees- [No workers,
cOmP. insurance required.]
Type of project (required):
6. [] New construction
7. El Remodeling
8. Demolition
9. Building addition
10. Electrical repairs or additions
1 L Plumbing repairs or additions
12.0 Roof repairs
13.0 Other
I �, - __ — .. — ..., — — =-- 5co-Lion Umoltv sn0v`M,-, their workers� compensation pol;cv information.
Homeowntn who submit this affidavit indicating they are doing all work and then hire outside contractors must -submit a new affidavit indicating such,
�Contractors that check- this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
am an employer that is providing workers'compensation inszirancefor MY employee& Below is thepolicy andiob site
information.
Insurance Company Name
Policy # or Self -ins. Lie. #:
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 required under Section 25Aof M*GL 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
Inve stigations of the DIA for insurance coverage verification.
I do hereby cert�&.under the Pains andpenalties wf,�perjurjl that the I information provided above is true and correct
Q Si ature:
Date:
Official use only. Do not write in this area, to be completed hy city or town official
'� 11 City or Town:
Issuing Authority (circle one):
L Board of Health 2. Building Department 3
6. Other
PermitiLicense #
CitY/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
Contact Person:
Phone #:
N
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 whoemploys 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 coxnpliance 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 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 �eing 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 bum.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 Ma&sachusetts
Department of Indusffial Accidents
Office of InvestigatiGns
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE
Revised 5-26-05 Fax # . 617-727-7749.
vmmr.mass-gov/dia
��.TWOF'UASSACHUSETT%
IN 0-'L�U,M-',&EAI�A�NAD�G SIFITTE,RtS
T�
F
�R
ENSED AS PLUMBER
ISSUES THIS LICENSE TO
RICHARD B M:U RP H Y
26 SCHOOLIHOUSE LN
BILLERICA -MA 01821-443.,,
12838 05/'01/10 9-83,05
f.
I.i
Date. 3.13 ... ...
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
,has permission for gas installation I. .........
in the buildings of 7-7—
..................................
at v.—.67 ............ Torth Andovpr, Mass.
Fee,Z�—.— . Lic. No.. Y�?
GAS INS C�O
6eck # 1/ 7 2-
6711
a
0, z . of
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
A/ Avno Vamass. Date 0,5z
- �'f' "e'rui'
Building Location--c�j-�00 �!9,61no�,V �6.Owner's Name—A-L-,6j ' �)9-SS �E-�
Owner Tel#- Type of Occupancy.. RES
New o Renovation 0 PlanSubmitted: Yes 0 No C�/
FIXTURES
Installing Company
/ �>,b LF -7 -() /,3
M Pr, A) _q Check one: Certificate
S 0 Corporation
0 1 119 1-/ �
Business Telephone # 3 o'(/ - -3 6 o 6
Name of Licensed Plumber or Gas
Apzv/'�u
0 Partnership
111-11'rMIC0.
INSURANCE COVERAGE:
I have a curren9obility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes UK No El
If you have checked ygs, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity o Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner 0 Agent 0
I hereby certify that all of the details and information I have submitt—ed (or entered) in above ap I' fio are rue and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issued hi c tioln wil . in compliance with all
a a rlicE
Rertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge S.
B Type of License: Z -Z"-/ /
-Plumber Si§natute of Lioensed,-Plumbfr or (gas Fitter
Title -Gas fitter
-Master License Number �Yoo
Cityrrown -Journeyman
APPROVED (OFFICE USE ONLY)
L�
_.cQm
cpm
LICENSED
AMU
KWAL
P, ARPPR
IN
com
MON 4-T,
�ICEW.ED N
4.
-M ICHA,�:*
WIN
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mmv� saw
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ACORP. CERTIFICATE OF LIABILITY INSURANCE
DATE MMIDDNYYY
1 01/ 1 06/2009
PRODUCER (973)922.22$8 FAX (979)922-2731
Appleby & Wynam Insurance Agency Inc.
152 comat St.
Beverly, KA 01915
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED N i F P INC
140 SOIVU MAIN ST
MIDDLMN, MA 01949
INSURER A: N1 �ge Insurance Co. 14788
INSURERB:
INSURER 0:
INSURER D:
INSURER E:
;;F -m
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ADM
hm
TYPE OF INSURANCE
-
POLICY NUMBER —
2ml=
LIMITS
GENERAL LIABILITY
BPOM43
01/05/2009
01/05/2010
EACH OCCURRENCE $ 1'"0' -
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED 3 50,600
CLAIMS MADE M OCCUR
MED EXP (Arri one Person) $ 3,
A
PERSONAL& ADV INJURY $ l'"0'8"
GENERAL AGGREGATE $ a, 0", no
GEN'L AGGREGATE LIMIT APPLIES PER:
—PRODUCTS - COMPIOP AGG 2,00'"o
PRO -
POLICY M JECT M LOC
AUTOM013LE LIABILITY
111909M3
01/10/20"
01/10/2010
COMBINED SINGLE LIMIT
$
ANYAUTO
(Ea accident)
ALL OWNED AUTOS
X
BODILY INJURY
$
A
SCHEDULED AUTO$
(Perperson)
X HIREDAUTO$
X NON-OWNEDAUTOS
BODILY INJURY
(Per amwent) $
PROPERTY DAMAGE
$
(Peraccident)
GARAGE LL481UTY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTOONLY: AGG $
1EXC SSIUMBRIELLA LIABILITY
CU086943
01/03/2099
01/05/2010
EACH OCCURRENCE $ 1'0"'980
OCCUR CLAIMS MADE
AGGREGATE s 1 1000
A
FDEDUCTIBLE
xIRETENTION 111 10,004
VIODS943
01/05/2M
01/05/26-1-0�STATU-
1 10
I
EMPLOYERS' LIABILITY
_a
E.L. EACH ACCIDENT S
A
AWNOYMPCROMPRCIEOTMOPRE/PNASRATTNMER/JEWXDECUTIVE
OFFICFRIMEMBER EXCWDED?
E.L. DISEASE - FA EMPLOYEE $ 5"10"
" yes, descAbe under
E.L. DISEASE - POLICY LIMIT $ 500,
SPECIAL PROVISIONS below
OTHER
DESC 90 1 T NS I LOCATIONS I VEHICLES I EXCLUSONS ADDED 13Y ENOOMEMENT I SPECIAL PROVISIONS
SHOULD ANY OF THE ASM DESCRIBED POLICIES BE CANCELLED 13EFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER VALL ENDEAVOR TO MAIL
— DAYS VOUTTIEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE No OBLIGATION OR LIABILITY
proof of 11asurance I AUTHOR99D REPRESENTATIVE
AtAMU 25 (ZUU11U5) OACORD CORPORATION im
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m CERTIFICATE OF LIABILITY INSURANCE
PRODUCER (978)OZZ-3288 1 01/06/2009
FAX (078)922wN_31 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
APPlebY III Wyman Insurance Agency hm. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
152 CO21111st St. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Beverly, KA 01915 ALTER THE COVERAGEMFORDED By THE POLICIES BELOW.
ffi&
INSURERS AFFORDING COVERAGE NAIC #
INSURED
140 S mm Sr
NIDDIM", N4 o1949
NSURERA: N&tj :�ii _�"Sur�ame C�0- 14738
INSURER 8:
INSURER C:
�IR�A'Q
11/01/2W16
INSURER D:
A
INSURER E:
C0V9RAr,1:_q
MFOO2521
nya orcri ioaumv w I tit wsum:Eo NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUi�EMENY,_fiiM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. Ai4REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ffi&
TYPE OF INSURANCE
POLICY NUMBER
Mrjr.CMM
311/01/29"
�IR�A'Q
11/01/2W16
LIMITS
A
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS MADEF'j OCCUR
MFOO2521
-
EACH OCCU RENCE 1,000,
NT E5
=4 TO!R—EE
q IF, p=183000)_ $
MED EXP (Any one person) $
PERSONAL & A1YV INJURY $ 1.
GENERAL AGGREGATE $ 2, on,
7EN'L AGGREGATE LimrrAPPLIES PER:
POLICY r---1 PRO-
I LJECT M LOC
PRODUCTS - COMPIOP AGO $
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINED SINGLE LIMIT $
(Ea accident)
ALL OWNED AUTOS
BODILY INJURY
(per Pe")
SCHEDULEDAUTOS
HIRED AUTOS
BODILY INJURY
(Par accwent) $
NON-OWNEDAUTOS
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY
ANY AUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
AUTO ONLY: _AGG $
R
EXCESSIUMBRELLA LIABILITY
OCCUR CLAIMS MADE
EACH OCCURRENCE $
AGGREa�_ $
$
HDEDUCTIBLE
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LL48MM
_T H -
OrTR
ANY PROPRIETOR/PARTNER/EXECUTWE
OFFICER/MEMBER EXCLUDED?
E. L EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE S
If Yes, describe under
SPECIAL PROVISIONS below
OTHER
E.L DISEASE - POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSKM A-DDED BY �ENDORSEMIENT I SPECIAL PROVISIONS
FICATE HOLDER LLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA14CELLED BEFORE WE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
— DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOnW SHALL IMPOSE No OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES.
Proof of Insurance AUTHORIZED REPRESENTATIVE
k/CflMSCI
Marc Slffs
Arnan lit iinn4mat
1--, CACORD CORPORATION IM
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ADDRR. CERTIFICATE OF LIABILITY INSURANCE
I DATE (Mmar"M
01/06/241111119
PRODUCER (978)932-2298 FAX (978)922-2731
Appleby & Wyman Insurance Agency Inc.
152 comant St.
Beverly, U 01915
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDEPL THIS CERTIFICATE DOES NOT AMEND, NO OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED Iteevie Parma
DBA: C/O NW
140 S Main Street
Middleton, MA 01949
INSURERA: National li�ruuge 109graace Co. 141788
INSURER B:
INSURER C:
INSURER D:
INSURER E:
r-^VC0Af--CQ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
N
a
OF INSURANCE
POLICY NUM13ER
MWAMMIMIN=
OF ANY OUND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES,
LIMITS
Proof of Insurance
_TypE
GENERAL LIABILITY
TU
01/01/ZN9
01/01/MS
EACH OCCURRENCE $ 1,00,0W
X COMMERCIA GENERAL LIABILITY
DAMAGE TO RENTED $ see,
CLAIMS MAD E f X I OCCUR
MED EXP (Any one pemon) $
A
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEWL AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG $ 2, on, on
M POLICY M JeRCOT M LOC
AUTOMOBILE IIJABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea awdent) $
BODILY INJURY $
(Per person)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Peraoc4dent)
HIREDAUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE 3
(Persocident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTOONLY: AGG $
EXCESSIUMBRfiLLA LL488JIY
EACHOCCURRENCE $
OCCUR CLANS MADE
AGGREGATE $
DEDUCTIBLE
S
RETENTION
WORKERS COMPE14SATON AND
I TAGRYS� JUTH-
FMPLOYEfW LIABILITY
ANY PRQPRIETORIPARTNER/EXECUTIVE
E.L. EACH ACCIDENT 1 $
E.L. DlSFASE - EA EMPLOYEj $
OFFICER/MEMBER EXCLUDED?
If yes. degrAbe under
SPECIAL PRaViSIONS below
E.L. DISEASE - POLICY LIMIT 1 $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY MOORSEMENT I SPECIAL PRtMONS
i%=p"me%Av= um nco 1'AIMf%r-I I ATRW
ACORD 25 (2001108) "CORD CORPORATION IM
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATON DATE THEREOF, THE IISSUING INSURER VALL ENDEAVOR TO MAIL
- DAYS WRMEN N0710E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAPL SUCH NOTICE SHALL IMPOSE NO 013LIGATM OR LIABILITY
OF ANY OUND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES,
AUTHORIZEDREPRESENTAYM
Proof of Insurance
mam Siorsky/caml
ACORD 25 (2001108) "CORD CORPORATION IM
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-U"k
Department ofIndustritil Accidents
Office of Investigations
600 Washington Street
Boston., MA 02111
www.mass.govlaa
Workers' Compensation Insurance Affidavit: General Businesses
ApM§:cant Information Please Print LegLbil
Business/Organization Name:
C-6- /' N E F P
Address: 4�iql�d ST—
Ah 617 Phone #: 7 S' - ;I�;�S
City/State/Zip: 1,i) 1>4E
Are you I r? Check the appropriate box:
a: emp oye
a employer with /;;L- employees (full and/
or part-time).*
2.0 1 am a sole proprietor or partnership and have no
employees working for me in any capacity.
[No workers' comp. insurance required]
3.0 We are a corporation and its officers have exercised
their right of exemption per c. 152, § ](4), and we have
rl no employees. (No workers' comp. insurance required]*
,4. We are a non-profit organization, staffed by volunteers,
with no employees. [No workers' comp. insurance req.]
*A.- 1;_� 4- -L -" 1-
Busm*m Type (required):
5. B-Reta�il
6. 0 Restaurant/Bar/Eating EstaWishment
7. E3 Office and/or Sales (incl. real estate, auto, etc.)
8. Non-profit
9. Entertainment
10-C] Manufacturing
I QD Health Care
12.0 Other
Iwo, e 01 must umo W, out the section below showing their workers'con4aLsation policy inibimation.
"Ifthe corporate officers have exempted themselves, but the corporation has other employees, a workers, compensation policy is required and such an
eManization should check box #1.
I am an employer that Isproviding workers'compensadon hmrancefor my employees. Below Isiftepolicy Informardon.
Insurance Company Name; --,aPPLE6V
Yfi?p-,/,3 -MstjC.,9A)cc
L—po C
Insurer's Addn
City/State/Zip:
Policy # or Seli
Attach a copy of the workers' 'compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -yew 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 PlIgar insurance coverage verification.
I do hereby cerd
. fy, t/n del the
Phong 79 2-,;Z S — / 3 0
�perjury that the informa&a provided above is owe and correct.
(2 / /J.F /0
OVEW&I use only. Do not write In this area, to be completed by ci& or town officiaL
City or Town: PermittLicense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Ucensing Board 5. Selectmen's office
6. Other
Contact Person: Phone
VVWWjU=.g0V/QLa
Date ....... .. .....
. ................
TOWN OF NORTH ANDOVER
0
0
PERMIT FOR WIRING
lo
C14U
This certifies that .................... ... ........ I .....................
has permission to perform .... 6/1 ....... . . ........... ........................
wiring in the building of ..................
Z�
..... . North Andover, Mass.
........................................... 6 ...... 6 .....................
Fe e —.12 V. /1) .... Lic. No . . ......................... 6 ...................................
ELECMCAL MpEcrOR
Check #
5332
TBE COAMOATWE4UH OF Al2
DEPARTAIEATOFPUBLIC
BOARD OFFIREPREVEMONR81
APPLICATIONFORPERMITTO
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE P
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
Town of North Andover
The undersigned applies for a permit to perform the electrical irk d
Location (Street & Number)
Owner or Tenant
V
SE M Office Use only
Permit No.
527CM12.W
Occupancy & Fees Checked
FORMELE=CAL)�ORN
JSSTS ELECTRICAL CODE, 527 CMR 12:0(
I ate A
To the pector of Wires:
below.
Owner's Address , T,4114 t
Is this pen -nit in conjunction with a building permit: Yes El No (Check Appropriate Box)
Purpose of Building �Jkgt—� W -F Z, C4 Wd Utility Authorization No.
Existing Service Amps Volts Overhead Underground M No. of Meters
New Service Amps Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work ��Ag,-1 wit I u I//
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
No. of Lighting Fixtures
v
Swimming Pool Abo e
Below
Generators
KVA
ground
0
round
g 17
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 Zone
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
Local Municip�l
Other
No. of Dryers
Heating Devices KW
ElConnections
No. of Water Heaters KW
No. of No. of
Si ns
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER-
kM I MWGDNerdg�. RM=tDdiemVmTrMofM&whiscmGffiaa]I-aws
lbaNgaamemLmbflttykiwranceFbltcyiwkdTCmipkleOL=ftorisCc)verageor&,atsUiUegrmkit YES NO
lbawabnimdvandpwofofsmiebtbeOffica YES fyoulnwded,&dYESplea�emdpc&&VA)eOfCDVwwby
cheJdngthefflxTL L
NSURANCE [—,I BOND OUTER ftaTSpe*)
EVitafion Date
Esffn&dValwcfEkr"Woik $
Wodc to Start JnspoctionDaleReque-sled Rough Fmal
FIRMNANE rft� Al Ak T , �JUH;-,4'IrY IicmseNo.
11=soe VMMM � kffln,a sigraire Licfflsp-No 0 Ty 6
V Business Tel No.
Addrms.—,? YU02-K-62-1— 2d WbA VIAI -AtTel. No.
OVvNER'SINSURANCEWAIVEP,,IamawmdiadieL;c�wdoesrmtba�ved-emarar=oDvaa&eoritsaigmfiaI asrepWbyNbssachusenCtnedLaws
and thamysignAireon thisperrnitapplication waives this requffierixm
(Please check one) Owner Agent
Telephone No. PERMIT FEE $
Signature of Uwner or Agent
L 'at!6n-.—
ot.
No. 02 io Z,/ Date 1_-dZ - X
40R 4
-TOWN OF NORTH ANDOVEFJ
-Certificate of Occupancy $ 64&12
2
uIlding/Frame Permit Fee I 'M1,17 -7-v c
Foundation Permit Fee
AC U
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
'TOTAL 0
BuildFng inspector
�-,32 7405
Div. Public Works
TOWN OF NORTH -ANDOVER
Certificatd-of Occupancy
$
k
Building/Frame Permit Fee
$
Foundation Permit Fee
$ eq, z!)
CHU
Other Permit. Fee
Sewer Connection Fee
Water Connection Fee
$
TOTAL
C)
7.5 3 BulldirYg inspector
T91; 0 7297
70
Div. Public Works
Locatio n
No. Date
4/'
TOWN OF NORTH ANDOVEN
Certificate of Occupancy $
Building/Fr6me Permit Fee
Foundation Permit Fee $
2
Other Permit Fee
Sewer Connection Fee
water Connection Fee
TOTAL
r7
.6970
s
s
Div. Public
A- Ctxer,-,
PER111T NO. APPLICATION FOR PERMIT TO BUILD.- NORTH ANDOVER, MASS. _:?/IPAGE I
A j��6 —
MAP 11-40. LOT NO.
!2 2,
I
2 RECORD OF OWNERSHIP IDATE
BOOK
;PAGE
ZONE SUB DIV. LOT NO. ZZ 2,
LOCATION 2/
0
PURPOSE OF BUILDING
OWNER'S NAME
NO. OF STORIES
en SIZE
Vjl,?�f
OWNER'S ADDRESt3/,.,7 r
6-.,, P�
BASEMENT OR SLAB
416 3!Plj'
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND
aX/o 3 R D
BUILDER'S NAME
SPAN
176
DIMENSIONS OF SILLS
POSTS
!�',
DISTANCE TO NEAREST BUILDING
DISTANCE FROM STREET
DISTANCE FROM LOT LINE. SIDES REAR D
GIRDERS &,
AREA OF LOT rWV - FRONTAGE
HEIGHT OF FOUNDATION IF to
THICKNESS
IS BUILDING NEW
SIZE OF FOOTING _? 10
X
IS BUILDING ADDITION
MATER:AL 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 SEWE R
IS BUILDING CONNECTED -
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SIECTIONS I - 3
PAGE 2 FILL OUT SECTIONS I - 12
BLOG.KRMITFEE- Z?YL-00
LESS FDA FEE __ 242 0- 1 C2 d
DUE FRAME PERMIT $ I/ J-1 S - 0 c)
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
t -DATE FILED �X,2- 1"9 5-
6 IGNA
F E E
TURE OF OWNER OR AUTHORIZED AGENT
0 0
010 -- 6' 0 0
PERMIT GRANTED'
19
7
WAY 2 7 1994
OWNER TEL. 4
CONTR. TEL. #
CONTR. LIC. # Ctf 1: - -39-1
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
a INSP
BUILDING RECORD
OC
.5,L,LPANCY 12
�INGLE FAMILY STORIES SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMIL FFICES THIS
APARTMENTS LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION "S INTERIOR FINISH
CONCRETE a 1 2 13
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER AP
DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B M*T AREA
V, 1/2 1/1 -FIN. ATTIC AREA
t!O 8 M T FIRE PLACES
HEAD ROOM MODERN KITCHEN
_77-7
4 WALL$ 9 FLOORS
CLAPBOARDS -0 1 3
DROP SIDING ETE
WOOD SHINGLES EARTH
ASPHALT SIDING �TARDVJ 0
ASBESTOS SIDIiZ_ —COMIACN
VERT. SIDING ASPH. T) LE
STUCCO ON MASONRY
STUCCO ON FRAME '301ju
BRICK ON MASONRY ATTIC STRS. & FLOOR
BRICK ON FRAME 9-1 ,
CONC. OR CINDER ELK. -33 A, i '431
STONE ON MASONRY WIRING
V#_�E g� FRAME
SUPERIOR POOR
No�
NE
ADEQUATE NONE
5 OF 121 10 PLUMBING
GABLE HIP BATH 13 FIX.)
GAM811JEL MANSARD TOILET RM. (2 FIX.)
FLAT SHED WATER CLOSET
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK
SLATE NO PLUMBING
TAR & GRAVEL �Z'_STALL SHOWER 000
ROLL ROOFING— ODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING I I HEATING
WOOD JOIST PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER EMS. & COLS. STEAM
STEEL EMS. & HOT W T R OR VAPOR
WOOD RAFTERS AIR CONDITIONING
RADIANT H'T G
UNIT HEATERS
7 NO. OF ROOMS AS
12"
B'M'T 2nd ELiCTRIC
Ist 3rd 11 NO HEATING
6 .
FORM U - IDT RELEME FORM
J� .
INsTRuCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this ser -tion*****************
APPLICANT: TV Phone
L40CATION: Assessor's Map Number Parcel
Subdivision A-k)&',H A&%10 -e,, E6_7F,7r4 Lot (s)
22 -
Street St. Number -2-0
Use only************************
RECOMMENDATIONS OF TOWN AGENTS: Date Approved
Conservat--on Administrator Date Retected
Comments
VNe) G411AQ Date Approved
Town Planner Date Rejected
Comments
Food insrec--or-Health
.�- Sepz�c Inspector -Health
A - -
Comnents
-� Public Wcrks
I - A -W- -; V a T.7 Im 1p�.
<
Received by Building Inspect -or I rn r,, —I Dar -e
MAY 2 7 1994
A Fire
- sewer/water c
Date Approved
Date Rejected
Date Approved
Date Rejec,:edi
4 41
1
All
'*0
IV owl
4C * -7-
vIwo
.01
ol
0'
o
oe,
7
IN
L 0r
.01
M)APAP
00,
14
'�v "eol-I
Vt.- ALL UTJUTY L.00A"noNS ARE 'ro BE FIELD 'VTRlFlEC) By THE
SITE CONTRACTOR.
C: '2 .55 - 2
LAND FLANNING
rNC'Dru_xDic & !IuRvry
167 RApTnTo AvXMM FrUM40KAX VA Mig
(50B� WC -41M yLX (&O.B) "6-6054
GRADING / SITE PIAN
W"M At
LOT ?- 2 -
NORTH AnOVER MSTA7ES
lqof(TH ANWVM WA
POW AM F"
TOLL BROTHERS, MC.
1800 wm PAM DFU"
WISTBOX0. hu 91"1
-------------------------------------------------------------------------------------
`:111 9
a III
:Oman
a am
W
it.Ane 2, 1994
Building Inrpector
120 No. Main Street
No.cLh haidovQr, mA 01845
Attn. Walter Cahill
ne: Foundation Hole Inapcction
Lot 22 North Andover Estates
To whorn it my concern,
on June 1, 1994, our office inspected tht founddLion hole
tur Lot 22. The interit of the inspection was to determine if the
soil conditions where adequate foz: Lhe inLended ui3e. Thv.
intcndcd u5c, bcing �A tooLing baGe fol Lhe Cuii,-3Liij(:tiori of 'jingle
ramily dwelliny of the typt! ueeri elsewhere on site.
our observations were that the entire foundation hole had
btz-�en excavated Lhcough fIlled ,,ull ouid ux,-iyirid1 topsoil & subsoil
into tho underlying firm -�ilty gravel soil. The underlying soil
is adf&cjuALaly uuwp4cLed.
It io our opinion that the foundation hoie wa5 adequately
preparo��d &nd is capable of provided Lhe nt!Qtebi:�dzy bcaring
pressure Eor the con6truction aro planncd.
r Kom=
a.
WILL
CIVIL
NO. 31887
T E 9
Sinverel�,,
9)0 --?4V1
Norman C, Hill,
�P-f -
V. E.
one Orept tor) u0mmon 167 Hertfor,d Avo luu Gunnys;cie A �-enuc S90 Mompor)rmtt Stroat
Cv,efton, MA 01519 Selling�*m. MA 02019 Holder I, MA 01520 Helifox, MA 02338
508 539-9526 bL)w 906-4130 E508 829-OC306 617 294-4144
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CERTIFICATE OF USE & OCCUPANCY
a 11
Town of morth Andover
'Mc-
,rvv�% Q�km-m' f-- I rzF- X��, -C--Qsu &6 �� I yo Iv, -G- /t,. re Ho.,�
4;._toV6-
Building Permit Number Date lo
IF
THIS CERTIFIES THAT
THE BUILDING LOCATED ON Lp� 01 'R69t_=VSA 0;Z7
MAY BE OCCUPIED AS bweLU M'Q7- W - IN ACCORDANCE
&-twervet—s
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
I< -0f T
CERTIFICATE ISSUED TO
X 0'%
`-k ki c"' VALLIti
ADDRESS
Building Inspector
-4�
i'A
Location e pinq T DiCiVC
No. Date
t j
TOWN OF NORTH ANDOVER
Certificate of. Occupancy $
Building/Frame Permit Fee $ 760-00
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 7&0
Check# loefo
17425
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
"PLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
g; _3
BUILDING PERMIT NUMBER: DATE ISSUED:
7 9-a te 30 04�
SIGNATURE: vt
Building CommissioneAnspector of Buildings Date
SECTION I- SITE INFORMATION I
Property Address:
C � � — L?—C,- �
1.2 Assessors Map and Parcel
V a 13
Map Number
Number:
V. ocsvy
Parcel Number
2.1 Owner of Record
1.3 Zoning Information:
Zoning Di��ct Proposed Use
1.4 Property Dimensions:
Lot Area (sf)
Frontage (ft)
1.6 BURDING SETBACKS (ft)
Telephone
Front Yard
Side Yard
2.� Owner of Record:
�-77-
Rear Yard
Required Provide
Required
Provided
Re gwred
Provided
9 2&
Sigiib4 Telephone
1.7 Water Supply M.G.L.C.40. 54)
Public 0 Private 0
1.5. Flood Zone Information:
Zone Outside Flood Zone 0
1.8
Municipal
Sewerage Disposal System:
0 � On Site Disposal System 0
SECTION 2 - PROPERTY OWNERSHW/AUTHORIZED AGENT
Historic District: Yes No
2.1 Owner of Record
Ly
Address for Service
Telephone
2.� Owner of Record:
�-77-
Aqj�v-?"Do
t
Address for
.1t)L4
Service:
9 2&
Sigiib4 Telephone
SEUION 3 - CONSTRUCTION SERVICES
3. ction Supervisor:
Not Applicable 0
Licensed Construction Supervisor:
0S
License Number
AddFels
�7"e
-,;2 30k)
Expiration Dite
Sirnature 6/- Telephone
3.2 Registered Home Improvenif7t Contractor
Not Applicable 0
V46 3�01
Company Name
Registration Number
-C7L .1-66
Addrm /
Expiration W
Signature Teleplione
Ma
I SECTION 4 - WORKERS COMPENSATION (MG.L C 152 4 25c(6) I
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 ....... 0 No ....... 0
SECTION 5 Description o Proposed Work JE!jeck applicable)
New Construction 11
Existing Building JD�\
Repair(s) 0
Alterations(s)
Addition 0
Accessory Bldg. 0
Demolition 0
Other Specify
Brief Description of Proposed Work:
4*56 41,67�
SECTION 6 - ESTIM[ATED CONSTRUCTION COSTS
Item
Estimated Cost (Dollar) to be
Completed by permit 22licant
n.- C&iL7,""'SE,0NL
VW611
Vt po'
I . Building
L — 1
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction
-3 Plumbing
Building Permit fee (a) x (b)
-01
Check Number
-4 Mechanical �HVAC)
Fire Protection
-5
-6 Total (1+2+3+4+5)
SECTION 7a OWNER AUTHORIZATION; TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BURDING PERNUT
I, as Owner 411�� t of subject property
Hereby authorize J�- � to act on
MY a Atters relati k authorized by this building permit application.
M, :�
11M�l 0
Si2Lt4e4 bwner Date'
SECIYON 7b- OWNER/AUTHORIZED AGENT DECLARATION
1, As *MmVAuthorized 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
om%'M e Date
-NO. OF STORIES 1144 SIZE
BASEMENT OR SLAB -� =1
SIZE OF FLOOR TIMBERS I sr 2N13 3RD
SPAN
-DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
-DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION TTIICKNESS
SIZE OF FOOTING X
-MATERIAL OF CHDvINEY
IS BUILDING ON SOLID OR FELLED LAND
FIS BUILDING CONNECTED TO NATURAL GAS LINE
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 134690
Expiration: 1/4/2006
Type: Private Corporation
COLONIAL VILLAGE DEVELOPMENT CORP.
CHARLES PISCATELU
1049 TURNPIKE ST.
N. ANDOVER, MA 01845
Administrator
�, 17-k
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS�-. 053181
Birthditi). 11/14/1941
Expltai� 11/14/2006 Tr. no: 11206
Restrlcted� 00
CHARLES J PISCATELLI
1 FLASH RD
NO READING,
MA 01864 Administrator
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 134690
Expiration: 1/4/2006
Type: Private Corporation
COLONIAL VILLAGE DEVELOPMENT CORP.
CHARLES PISCATELU
1049 TURNPIKE ST.
N. ANDOVER, MA 01845
Administrator
T,own'of North -Andover oRT
0
Building Department 0
27 Charles Street
North Andover, Massachusetts 0 1845
(978) 688-9545 Fax (978) 688-9542
0 ave,
SSACHUSO
'.DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40 s,54, and- a condition of
.Building permit:# ' ' the debris resulting from the work shall be disposed
of in a properly licensed solid,Waste disposal facility as defined by MGL c 11, s I 5Oa.
The debris will be disposed of in /at:
Facility location
e6
Date
cant.
e
NOTE: A demolition permit from the Town of North Andover must be obtained for this
.1project through the Office of the Building Inspector.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
Please Print
Name:
Location:
ci!y Phone
71 am a homeowner performing all work myself.
= I am a sole proprietor and have no one working in any capacity
[2'(am an employer providing workers' compensation for my employees working on this job.
(-nr"r%nn%Y mnma- 0� ^ /A A ) 1'e -A i U ti I ( 12 e) IP () &- J & � I tn,1D n) I-,-, -�- C
Address
City: A) YeO� n CA 6 Q e Phone #: 2 7Fr- to R2 - 3ab
insurance Co. T� e,—Elf/AUC �Z5 XaJOgitylL P`Olicv U 7 3�3 /I Vo -6--6 3
Company name:
Address
Ci!y: Phone *
Insurance Co. Policy #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00
andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I
understand that a copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification.
I do herby certify under the pains and penaities of))eijury �qpt the inform n provided above is true and correct
. lb
Signature.
r1o]
Print name py, Phone# I
Official use only do not write in this area to be completed by city or town official' C] Building Dept
MCheck d immediate response is requxed Building Dept C] Licensing Board
Selectman's Office
Contact person Phone C] Health Department
% Cl Other
FORM WORKMAN'S COMPENSATION
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5 Sewer Connection Fee $
Water Connection Fee $
TOTAL $ (00
ION
Building Inspector
Div. Public Works
Location
No.
Date
—7 C) IC(S
.'0
TOWN OF NORTH
ANDOVER
Certificate of Occupancy
$
Building/Frame Permit, Fee
$ C)
Ano A
Foundation Permit Fee
$
A.mU
Other Permit Fee
$
5 Sewer Connection Fee $
Water Connection Fee $
TOTAL $ (00
ION
Building Inspector
Div. Public Works
PERAIIT NO. 2444
APPLICATION FOR PERMIT TO BUILD—NORTH ANDOVER, MASS.
PAGE I
MAP 4-40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
PLANS MUST BE FILED AN AP;� ED BY BUILDING INSPECTOR
BOOK '.PAGE
ZONE
SUB DIV. LOT NO.
LOCATION
Zse,-Q;�E -
PURPOSE OF BUILDING �JeUj A�: I ,
OWNER*S NAME
NO. OF STORIES
OWNER'S ADDRESS .2.) 0
BASEMENT OR SLAB
ARCHITECT'S NAME
4,
SIZE OF FLOOR TIMBERS IST 2ND
3RD
BUIJ�DER'S NAME �jo
Kevi'!.,
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LI NES - SIDES REAR
GIRDERS
AREA OF LOT z FRONTAGE 7&
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING / 0 ZAV x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
b J,
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE jes.
IS BUILDING CONNECTED TO TOWN WATER t/05
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED -TO TOWN SEWER . kf
e,.s
IS BUILDING CONNECTED TO NATURAL GAS LINE
Y"
INSTRUCTIONS
SEE BOTH SIDES
PAGE I 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 AN AP;� ED BY BUILDING INSPECTOR
'J�DATE FILED_ 7
SIGNATURE OF OWNER OR AUTHORIZED
F EE
PERMIT GRANTED
19
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST r
coo
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
OWNER TEL. #
CONTR. TEL. #
CONTR. Lic. # 7
H.I.C.# /04�6671/
Ad -
t �
BUILDING RECORD
I OCCUPANCY 12
SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMIL �1�1 —FI C E —S LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA -
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
-c
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
a 1 2 13
PINE
CONCRETE
CONCRETE BL*K._
BRICK OR STONE
HARDW D
PIERS
PLASTER
DRY WALL
-5-N—F I —N
3 BASEMENT
AREA FULL
FIN. B M T' AREA
1/1 1/2
ATTIC AREA
�LO 8 MT
HEAD ROOM
_LIN.
FIRE PLACES
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
-CONCRETE
—E—ARTH
B
1
2
3
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WOOD SHINGLES—
ASPHALT SIDING
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STUCCO ON MASONRY
STUCCO ON FRAME
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BRICK ON FRAME
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WIRING
STONE ON MASONRY
STONE ON FRAME
SUPER102
T, _POOR__�
NONE
ADEQUA NONE
5 ROOF
10 PLUMBING
GABLE
11
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GAMBREL
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FLAT
SHED
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LAVATORY
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KITCHEN SINK
SLATE
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TAR & GRAVEL_
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
_LILE DADO
6 FRAMING
HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER EMS. & COILS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T G
UNIT HEATERS
7 NO. OF ROOMS
AS
L
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FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards'and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requir�ements. I
****************Applicant fills out this section*****************
APPLICANT: Phone
.6ch ? A-,) & B (0 - ee C�?
LOCATION: Assessor's Man Number
Subdivision
Street 7-1,9
RECO I F
9N 7
�7 AGENTS:
Conservationw-Administrator
Comments
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Parcel
Lot (s) -42,-
St. Number P -JO
use Only************************
Public Works - sewer/water connections
dr_1veWay p7elt
Fire ------
Depax ent
f
Received by Building Inspector
Date Approved?
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date
VJ
L
.�o P Elm
PA
L_ - 2-15. 0 5
I CERTIFY THAT THE STRUCTURE SHOWN IS LOCATED
ON THE LOT AS SHOWN ON THIS PLAN AND THE
LOCA11ON DOES CONFORM NTH THE FRONT, SIDE,
AND, REAR SETBACK REQUIREMENTS SET FORTH IN
THE TOWN'S ZONING BYLAWS AT THE TIME OF
CONSTRUCTION. I FURTHER CERTIFY THAT THE
STRUCTLIRE:IS NOT LOCATED IN THE SPECIAL
100 YEAR FLOOD ZONE PER HUD COM#
MAP# &C DATED 2- /..9
PIP;
.71 it
NO. _344U
PLC> --F
Zz�
19.
ZONE: R F: 2 O'S: go'
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210
IVOR77,Ll
IASM PILIAJ)�G
MODOXEM 6 BURM
=J"WUJ* Lff K"NOW-Aft NOW (80) 006-4t=
GRArf'Olk ONE 024"ON COMM D1519 (806) 830�-""
HUDD& 80 RMNUMS AV& 01M (50) 90-0"
H"AR SSG VDNMWM ff. OM (W) "4-41"
DATE 7- -551 SCALE/,=, 46 1 I -JOB: B
The Commonwea&h ofiVassachusefts
Department of Industrial Accidents
amp f1bresffAwffAff
600 Washington Sireet
Boston, 31ass. 02111
r; rV k)e-j. 1pmrq— nhnnf! i Z, 9 -7 7 OG 5/
...... ........ ......... ..
citv-
n6ne 9:
F2ilure to secure coverage as required under Section Z -15A of MGL 152 can lead to the imposition of criminal penalties of 2 fine up to S1.500.00 and/or
one years' imprisonment 23 Well as civil penalties in the form of a STOP WORK ORDER and a flue of MOM a day against Me. I understand that 2
copy of this statement may be forwarded to the Ofice of Invescigarioas of the DEA for coverage verific2cion.
I do herebY
Print name
and*4les of
J.
th= the infar"sarion provided above is true a� co,Te
'9.""
...... �Date . 7// 1.�
Phone;$ 19 -7 — 7 (No
official use only do not write in this area to be completed by city or tow official
city or town: r -,Building Department
[]Licensing Board
C check if immediate response is required aSelectmen's Office
CHeaith Department
contact person: pboac nOther
(ft-wd 31" PJA)
"Locatio . n 10 tseA-A MA—
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fq��
s :5"b
Sewer Connection Fee
$
Water Connection Fee
$
41:4 -I'\
TOTAL
Building Inspector
.07/13195 13:31 97- PAID
Div. Public Works
PERMIT NO.
0
APPLICATION FOR PERMIT TO BUILD - NORTH ANOOVER, MASS.
PAGE I
MAP +40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION �o A
PURPOSE OF BUILDING
.212(
OWNER'S NAME SIMW Z-�'�40
NO. OF STORIES SIZE
OWNER'S ADDRESS
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 90
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT 24" -.1 u F
r7
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW IF
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL 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 I 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
D
SIGNAfURE OF OWNER OR AUTHORIZED'AGENT
F E� E
'PERMIT GRANI ED zk
C4,
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST o o
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
ou
0�j
OWNERTEL.# 6eL6111�'9
CONTR. TEL. # lom —k-?() �,
CONTR. LIC. # olc)330
H.I.C. #
0 wKfi�cpc,
BUILDING RECORD
OCCUPANCY 12
SINGLE FAMILY
STORIES
MULTI. FAMIL
�_O FFICES
APARTMENTS
I
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
- - a 1 2 13
PINE
CONCRETE
CONCRETE BL
BRICK OR STONE
D
PIERS
_t!ARDW
PLASTER
17N FTN
3 BASEMENT
AREA FULL
FIN. B M T' AREA
1/1 1/1 1/1
FIN. ATTIC AREA
INIO 8 M T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
4 WALL$
9 FLOORS
CLAPBOARDS
CONCRETE
EARTH
a
1
3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
HARDW D
COMIAC;N
_ASPH. TILE
STUCCO ON MTSONRY
STUCCO ON FRAME
It
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOPR
CONC. OR CINDER BILK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIO!,
T I __� 200H
NONE
ADEQUA NONE
5 ROOF
10 PLUMBING
GABLE
I
HIP
BATH 13 FIX.)
GAMBREL
A
MANSARD
TOILET RM.�(2 FIX.)
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY�
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOFR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNArE
FORCED HOT AIR FURN.
TIMBER BMS. & COILS.
STEAM
STEEL BMS. & COLS.
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOM$
AS
OIL
B'M'T
-3rd
NO HEATING
lo 1
- I
THIS SECTION MUST SHOW EXACT DIMENSIONS'OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS_1 WITH PORCHES. GA-
RAGES, ETC. SUPERIMPOSED. THIS REPLAC,ES.PLOT PLAN.
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OPEN,
PA c- F-
L- 2 15- OS
I CERTIFY THAT THE STRUCTURE SHOVM IS LOCATED
ON THE LOT AS SHOWN ON THIS PLAN AND THE
LOCATION DOES CONFORM WITH THE FRONT, SIDE.
AND,:, REAR SXTBACK" REQUIREMENTS SET FORTH IN
THE TOWS ZONING BYLAWS AT THE TIME OF
CONSTRUCTION. I ' FURTHER CERTIFY THAT THE
STRUCTURE IS NO'T"LOCATED IN THE SPECIAL
100 YEAR FLOOD ZONE PER*HUD COM# asoo'5.a
MAP# 49C, DATED 6/2�/.-qs
L-0 -r P L- /',I
-9
ZONE: R 2- F: 2 o', V.9',R: 2 o
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RAWAX W UNPOWIff ff. ($If) ft4-"
DATE - ---5- 8405+
7-5 5=/�-'40'jJD5
COMMONWEALTH DEPAIIII'MENTOF PUBLIC SAFETY
OF OHE ABHOORTON PLACE
—BOSTON,"MA 02110111—
MASSACHUSETTS
L 15 E N S E CAUTION
E Mill W ION UA I L CONSTR. SUPERVISOR
FOR PnOTFC-1 ION AGAINS V
LFFEG I IVL UA rE LIC -NO,
I 1Y �/WIIT 1611V 11 T) IEFT, Pl) r I'll(l) I I I I II.IMI I
PI IIN I IN APPI IOPAIA I C
NONE 06130/1993 010330
BOX ON I -K, _NSF
WILLIAM C POULOS
290 111 AcTING UPHIA101l';
MI VERNON ST
S 020 -5z -i`733 LAWRLNCE MA 01843 [If 01`0
1. F
'too. QU ki I y YX U UN Ill OWWOO NY 1.111AHVIIII A0400"CIA1 I Y
II[IClHT: MANI()
L�011.
07/19/1960
LICENSE
I corilly undur Iho poruiltifla of popflufy that to tho beat of?ny knowlix1go gild bek0l I Ildvil 11100 fill
stillo tjjA rol;juinand paid WI olala Woo requited urx)w low.
Z.
'NOT E: LICE N SE WI L1 NOT BE ISSU F U UNLESS THIS ATTESTATION HAS 8 L L N COM PL L I L ANU !JIGN L 0 Ll Y
ME APKICANT. (Authoilly C. 62C, 3. 49L, MGL. as amended by Chaviur 233, AL13 Of 108:3)
RETURN COMPLETE FORM. DO NOT TEAR OFF STUB.
, v 5
-_-__---_---_----__--_�-_-__-_-___--
�
HOME IMPROVEMENT CONTRACTORS REGISTRATION �
80ard of Building Regulations and Standards '
One Ashburton Place - Room 1301 �
Boston, Massachusetts 02108 '
I10111 IMPROVEMENT CONTRACTOR
RegiaLration 118204 Expiration 02/12/97
TYPe - PRIVATE CORPORATION
HOME IMPROVEMENT [ONTRAO08
KoVixbadon 110204
FAMILY POOLS - PATIOS INC�
7ype - PRIVATE CORPORATION
WILLIAM C. GIAN0POULO5
Expiration 02/12/97Y2 S BROADWAY ���� �
LAWRENCE MA 01843
FAMILY POOLS ' PATIOS INC
WILLIAM ANOPUUL06
6L4f/S BROADWAY
LAWRENCE HA 0043
/
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section*****************
APPLICANT: - SZAA C --)AJ Phone 49Y�
LOCATION: Assessor's Map Number Parcel
Subdivision
Lot (s)
Street row, St. Number
************************Official Use Only************************
RECO14MENDAT77OF AGENTS:
7/7
conservation Adminis+tra�t
07
Comme
I I /�- 5
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Date Approved
Date Rqjected
Q Ule�Nj J 6-14
Public Works - sewer/water connections
- driveway permit
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Fire Department
Received by Building Inspector Date
The Comnwnwealth of Massachusetts
Departnwnt of IndunW& Accidents
jyffcv 8/18795ftwas
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
INT �Mil,.Mlrw
go mw# VA - __ -
r7 I am a homeowner performing ale work -myself.
r7. I am a sole proprietor and have no one working in any capacity
r7 I am an employer providing workers' compensanon tor my empiovees working on this job.
. ... . .....
. ...... ...
h AA f. A IQV::
. . . ... ....... ..... .... .....
......... . . .................... ... ..... ..
.. ... .. ...... .. ........ .....
. ..... ... . . .
� � -------- --- ...........
....... ...
surance co, .. ... .
Fa i I u re to secu re coverage as req u i red u n der Sectio a 25A o f N IG L IS'— ca m I cad to the i to position of cri M iM121 pen2i ties of a fine up to S 1 -500.00 a nd/or
one years' imprisonmen7as well as civil penalties in the form of* STOP WORK ORDER and a fine ofS100.00 a day against me. I understand that a
copy of this statement May be forwarded to the Office of Investigations of the DIA for coverage verification.
Idohereb.vc * under the pains and penalties of ' i�y thar the infor"aadon provided above is true and correm
Signature L4Y\_ 1,)OA;c __Date 117- ,;)- - 11-7 S
Print name -:S-Rs a F1J WAg C) t ivOLY :B�oLphone 4 C-,R�43o? -
ofricial use onlv do not write in this area to be completed by city or to— oMcial
ciry or town:
0 check if immediate response is required
contact person:
(r�iwd 3M PJA)
permivucenw il riBuilding Department
C2Licensing Board
C]Selectmen's Office
C]Hexith Department
pbone it, r-,Otbcr
Location 2 t ci—�
No. 361
Date
e
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ -
Building/Frame Permit Fee $ -
Foundation Permit Fee $
Other Permit Fee $
Sewer Connection Fee $
Water Connection Fee $
TOTAL -e'-\ $
-fS7V06/%14:36
8298
130--
- Building Inspector
130. 00 PAID
Div. Public Works
PER11IT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE I
'A P 4-40.
LOT NO. 2 -
, L-
2 RECORD OF OWNERSHIP IDATE
BOOK 'PAGE
I-
ZONE
SUB DIV. LOT NO.
I
I
OLOCATION
-2-/0
PURPOSE OF BUILDING
Ff I ��
OWNER'S NAME
NO. OF STORIES SIZE
OWNER -S ADDRESS
,$ -7— / 0 4.�5 A—L ov%,t 1) r
BASEMENT OR SLAB
ARCHITECT'S NAME J, 4
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER' S NAME Kev '-N S�- 4�
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
POSTS
DISTANCE FROM STREET
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT 2- 41, 07.0 SK FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL 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 I 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 INS ECTOR
DATE FILED 1hy z
SIGNATURE OF OWNER OR AUi'kORIZED AGrfNT
F E E
PERMIT GRANTED
(2-
4
N
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. cosr
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
OWNER TEL. # -62&
CONTR. TEL. # &OS7-70& 5-/
CONTR. LIC. #
H.I.c.# . 1055
B U fLAD 1, , NG RECORD
I OCCUPANCY 12
ry -
SINGLE FAMILY
SFORIES
MULTI. FAMILY
OF FICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
PI NE
3
1
2
13
CONCRETE BL'K.
BRICK OR STONE
�ARDW D
PIERS
PLASTER
D RY WALL
TNFIN
3 BASEMENT
AREA FULL
1/1 1/2 1/1
NO BMT
HEAD ROOM
FIN. B M*T AREA
FIN. ATTIC AREA
FIRE PLACES
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
NCRETE
TARTH
B
1
2
3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
HARD\!,/'D
COMMCN
-�SPH TILE
VERT. SIDING
STUCCO ON MAiONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR_
CONC. OR CINDER BLK.
WIRING
STONE ON MA
STONE ON FRAME
SUPERIO POOR
% -NOiNE
5 ROO;
10 PLUMBING
GABLE
I
HIP
BATH Q FIX.)
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
FLATJA-�HED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
ODERN FIXTURES
ILE FLOOR
-LILE DADO
6 FRAMING
11 HEATING
WOOD�JO�ST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER EMS. &
STEAM
STEEL BMS..&,COLS.
HOT W'T'R OR VAPOR
—
WOOD RAFTERS
AIR CONDITIONING
—
RADIANT H'T G
UNIT HEATERS
7 NO. or Rooms
L-
As
IL
----------
B*M'T 2nd
3rd
lELECTR C
L
-
NO EATING
THIS SECTION MUST SHOW EXACT DIMENSIONS OVLOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF 'BUILDINGS. WITH,PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
:44
(Print or Type)
T
19 Permit #
Mass. Date
Building Location 2-10 124-serhwint 1110 Owner's Name- r2t- 7-1-eAbi
er lWq
At 0, G n d oy Type of . Occupancy ee S / -den r
New Renovation 0 Replacement 0 Plans Submitted: Yes CD No D
FIXTURES
Installing Company Name AIAI �e P4-ocic P rP Check'one: Certificate
Address 110Y, ZZ e XCorporation
A n d o yer 4 1w q. 0 Partnership
Business Telephone 9 7.5 9 0
I �) c e
Name of Li ensed Plumber P -Ob er+
INSURANCE COVERAGE:
I have a cur liability insurance policy or its substantial equivalent whs4 h wwq the requirements of fvIGL Ch. 142.
Ves No 0
It you have checked yes. please indicate the type coverage by Lhe(kint Ow apprnprior lbox.
A liability insurance policy Other type of indemnity 0 &wwj
OWNER*S INSURANCE WAIVER: I am aware that the licen&m does nof k4re fl,� m -wince coverage required bv Chapter 14 2 11 rtw ".I-.
General Laws, and that my signature on this permit application waivei thit
Check (ww
Signature ol Owner olowner s Agent Owner �j Axrnl
I C" -N OW all 1W 0- dM& -i% and —470— ' i"j— 'Ub-'"d 1� — 11 ) - 0- Ih— 'IV"— — —� 11'. �,, 01 -Y b—W d A -d fte 0 --- -- —
lmd pron—ed unciro ~ �-1 ns—o 6� rh� - if t- 00 lhf)-- h S46V On�fw4 C odr —d I
I —.j I — -
8, S-9-- - I-, --d P1 --
11r. 1W i—
Date ..........
4'ORT#q
It TOWN OF NORTH ANDOVER rE
PERMIT FOR PLUMBING
CHUS r
F I -ce ifies
l -tis"' rt -that ... llilx�A,*e A. �Rl /'.9.
CU
hasTer-mission-to perform ........................
plumbing.in the build
ings of olcl ................
X
at.'-2/05� .15. q sc.h' "'�i -1 ............. .... North Andover, Mass.
FeeR477.....Lic.. No.,J.�91.? .. ..... ..... . ............
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
L7� I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO IDO GASFITTIN'G
(Print or Type)
NORTH ANDOVER Mass. Date '�?IISAO'K
�uilcling Locatlon4z� Zoiewl,,tz Permit #/
—Owners Name
n Replacement r
New .7 Renovatio _] Plans Submitted 0 24
F I X T U R =_ _1z
Business
Name of
Telephone: ;7,7
Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the pe of insurance coverace by checking the
appropriate box:
Liability insurance policy type of indemnity Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Check ne: Certificate
Corp.
Partner.
Firm/Co.
Signature of owner/agent of property . Owner 17 Agent F7
I hereby ccray that aU 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 initALlations pctfommd under"Permit ijSL-ed for this application will -be In compliance with all pertinent
Provisiocu of the Idassachusetts State Cas Cude and Chaptel 142 of Lho General LAwa.
By
Title
Ci-ty/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
Plumber
?Ga5 f itter-
ter
ja0usrneyman
Siq[natidre
Plumber o
ice,nse
of Licensed
Gasfitter
er
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I ST FLOOR
2ND FLOOR
3110 FLOOR
4TKFLOOR
STHFLOOR
6TH FLOOR
7TK FLOOR
EST�FLQOR
Business
Name of
Telephone: ;7,7
Licensed Plumber or Gas Fitter
Insurance Coverage: Indicate the pe of insurance coverace by checking the
appropriate box:
Liability insurance policy type of indemnity Bond
Insurance Waiver: 1, the undersigned, have been made aware that the licensee of
this application does not have any one of the above three insurance coverages.
Check ne: Certificate
Corp.
Partner.
Firm/Co.
Signature of owner/agent of property . Owner 17 Agent F7
I hereby ccray that aU 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 initALlations pctfommd under"Permit ijSL-ed for this application will -be In compliance with all pertinent
Provisiocu of the Idassachusetts State Cas Cude and Chaptel 142 of Lho General LAwa.
By
Title
Ci-ty/Town:
APPROVED (OFFICE USE ONLY)
TYPE LICENSE:
Plumber
?Ga5 f itter-
ter
ja0usrneyman
Siq[natidre
Plumber o
ice,nse
of Licensed
Gasfitter
er
, --! LL
The Commonwealth of Massachusetts
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12M
Permit No. . Office Use Only
Occupancy & F" Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All umrk to b�e performed in accordance with the Ma6sachusetts Electrical Code, 527 CMR 12:00
(PLEASE: PRIM IN = OR TYPE ALL INFORMATION) DAte 7-2
,�— 9
City or Town of A) AJZI,0014� To the Inspector of'Wires:
The undersigned applies for a permit to perform the electrical woiCk described below.
Location (SLreet'& Number)
Owner or Tenant .2
Owner's Address
0
W
a.
LL
0
IL
Is this permit �n.c . onjunction with a building permit: Yes Uj--'NoE] (Check Appropriate Box)
Purpose of Building ___jtility Authorization NO.
Existing Service Amps Vol'ts Overhead F] 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
No. of Lighting Outlets
7-
No. of Ho t. Tubs,
Total
,No. of Transformers KVA
No. of Lighting Fixtures
Ab e I
Swimming Pool griov rnd.
. [I g n- ET
Generators KVA
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 Detection and
Initiating Devices
No. of Sounding Devices.
No. of Self Contained
Detection/Sounding Devices
E] Municipal —
Local ConnectionD Other
No.2,of Ranges
Total;
No.-ol Air"Cond. tons. , ..
. .
No. of'Disposals
i - —
No. o I f Heat Total� Total
Pumps Tons' KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No,�:of No. of
Si ns Ballasts
Low Voltage
Wiring
No. Hydro Massage Tubs
No�. of -Motors Total HP
OTHER: �2
INSURANCE COVERAGE: Pursuant.to the requirements of Massachusetts General Laws
I have a current Lioility Insurance Policy including Completed Operations Coverage or i substantial
equivalent. YESEr NO [] I have submitted valid: proof of same to this office. YESE NO F-1
4-W,
If you have qhecked YES, please indicate the,type of coverage by checking the appropriate box.
INSURANCE 0�(BOND [-] OTHER [] (Please SpecifJ
Estimated Valu e of Elec�rical Work S
Work to Start Inspection Date Requested:
Signed under the penalties of perjury:
F I RM NAME l',,?,,,7 /-- L/ �/- Irl -11- r-1 , hF-,
Licensee
ignature
(Expiration,Uate)
Rough A0,;V44ZZ Final lw-,,�Zel
-LIC. NO.
, _
LIC.
Address is. Tel. No. 77-&/- _;71
Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and-tHat my signature on this pe 't
application waives this requirement. Owner , Agent (Please check one)
Telephone_No.. PERMIT FEE S46 C
,Sign ure of Owner or Agent)
C
INSPECTION RECORD
Date Notes— Remarks Inspector
. 'JL-.t;A'
Ow�
Date .....
2434 ...........
,,ORTH
0
S ,S4 U
.,S4 US
S" US
This certifies that
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
6 ............ ............................ .........
has permission to perform ..... k..A- 4 1 '�-- /r 1 1, 4�
.............................. .......
wiring in the building of ...... ...... .................................. I ................
at ....... ......
....................... ....................... . North Andover, Mass
Fee.... 2" ...... Lic. No.: ..........................................................
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Date...
,,ORTN TOWN OF NoRrH ANDOVER
0 PERMIT FOR GAS INSTAL� "10
S
This certifies that ....... .....
has permission for gas insfallatio . .... .... W2
in the buildings, of .....
at Mass'.
Fee. t��ic. No.�?-�I.7. . ..........................
A GAS INSPECTOR
WHITE: Applicant -AITAAY:*B Uding Dept. PINK: Treasurer GOLD: File
0.
I A 4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO! GASFITTING.
'(Print or Type)
Q*J-
-2 '2 Permit # 2 -
tam Nat, PhdONler Mass. Date 4, - � q7 19 1
Building Location 2./d 1201; elywy n Owner's Name
-�*'Ala, Andriver-w-g Type of Ocpupancy f--esedenee
AP"*#j New 0
Renovation Replacement 0
FIXTUkES
Plans Submitted: Yes 0 No t
Installing Company Name WHITE ROCK PLUMBING & HTG2.
Address P.O. BOX 728
NORTH ANDE)VER, MA. 04846
Check. one:'.
gcorporation'
0 Partnership
4-2 qq
Business Telephone 975 OFirm/Co.
jL
Name of Licensed Plumber or Gas Fitter Pablel /gllc 4
Certificate
09 C
INSURANCE . COVERAGE:
I have a cur I liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
if you have checked yes, please indicate the " coverage by checking the appropriate box.
A liability insurance policy Other " of indemnity 0 Bond 0 it
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 walves this requirement.
Signature of Owner or Owner's Agent .
Check one:
Owner 0 Agent 0
I h"ebV cerlity that all of the details and infonnation I have submitted (or enteredl in the above application are true and accurate to she best cd rny krowledge and that all plumbing work
flafions perlonned under the Permit issued lor this application will be in cornpliarce with all pertinent provisions of the Massachusetts Stm Gas Code &W Cha"w 142 al the Gwwal Laws.
T ol License:
Title 5ignaium of Lkensed Plu rber or Gas Fltw
rneyman
Citvftown License Numb"
APPROVED 1OFFICE USE ONLY)
BASEMENT
IIIIHIM, �
MIT=
mvrwf Mee
Erff VMS
111110 1"s t
Installing Company Name WHITE ROCK PLUMBING & HTG2.
Address P.O. BOX 728
NORTH ANDE)VER, MA. 04846
Check. one:'.
gcorporation'
0 Partnership
4-2 qq
Business Telephone 975 OFirm/Co.
jL
Name of Licensed Plumber or Gas Fitter Pablel /gllc 4
Certificate
09 C
INSURANCE . COVERAGE:
I have a cur I liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No 0
if you have checked yes, please indicate the " coverage by checking the appropriate box.
A liability insurance policy Other " of indemnity 0 Bond 0 it
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 walves this requirement.
Signature of Owner or Owner's Agent .
Check one:
Owner 0 Agent 0
I h"ebV cerlity that all of the details and infonnation I have submitted (or enteredl in the above application are true and accurate to she best cd rny krowledge and that all plumbing work
flafions perlonned under the Permit issued lor this application will be in cornpliarce with all pertinent provisions of the Massachusetts Stm Gas Code &W Cha"w 142 al the Gwwal Laws.
T ol License:
Title 5ignaium of Lkensed Plu rber or Gas Fltw
rneyman
Citvftown License Numb"
APPROVED 1OFFICE USE ONLY)
2512
&OR TOWN OF NORT
0* ""o 14, MAN DOVER,;
0
PERMIT FOR GAS liNiSTALLATIOW-
US
j
ert
This c ifie§ that Ar. . . .
has permission for,gas installatio'n- I
t t
in the b .....
uildinks-of'.. .1... R.
No t .'A M �a
at 1?(d J.f� r h" C[4nm ss
Fee../.'�'.'7�. Lic.,NoJA.?? .. ........... ..............
AS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK:j.realsu re� GOL : D: Pile-
2886 Date. .
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTAL
This certifies that .... 11� .......... ... ..................
has permission for gas * ;tallation ...........
cc
of . .
in t 'c" ......................
at . .................... �North AndcV -Ma%
Fee. . U.,... Lic. No... .7 .......
GAS INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
LASSACHUSETTS UNEFORM APPUCAT N FO ERMIT TO DO GAS FT=G
or print) Date 19 �v
iNvK f H ANDOVER, MASSACHUSETTS
Building Locations
New 0 Renovation F1
's VA &v-%- Permit #
Owner's Name Amount $
Replacement Plans Submitted
(Print
Name=?V&APL-�+ [A98N
' A L�, -�,
L)
Addres , �8qe—
S A /if -- A-1 Al) j
Business Telephone , 15,>7pe—
Name of Licensed Plumber or Gas Fitter
2, -
Check one: Certificate Installing Company
11 Corp.
ElPartner.
El Firm/Co.
f,NSURANCE COVERAGE Check 2ne:
I'Jiave a current liability Insurance policy or it's substantial equivalent. Yes rtl-' No[3
If you have checked yes, please indi e coverage by checking the appropriate box.
Liabilitv insurance policy EEj�� Other type of indemnity
M Bond El
Owner's Insurance Waiver: I am aware that the licensee does nat'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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat
,VQj%C5jdjeand Chapter 142 of
_ttS CwAie=I-Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
5iglTature of I
Plumber
as
,;G� �sF I e r
aster
aster
Joumeyman
sed Plumber Or Gas Fitter
� Z2 z
License Num0er
z
U
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C
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SU B-BASEM ENT
BASEM ENT
IST. F L 0 0 R
2 N D . F L 0 0 R
3R D. F L 0 0 R
4T I -I . F L 0 0 R
5T H . F L 0 0 R
6T 11 . F L 0 0 R
7T If . F L 0 0 R
ST If . F L 0 0 R
(Print
Name=?V&APL-�+ [A98N
' A L�, -�,
L)
Addres , �8qe—
S A /if -- A-1 Al) j
Business Telephone , 15,>7pe—
Name of Licensed Plumber or Gas Fitter
2, -
Check one: Certificate Installing Company
11 Corp.
ElPartner.
El Firm/Co.
f,NSURANCE COVERAGE Check 2ne:
I'Jiave a current liability Insurance policy or it's substantial equivalent. Yes rtl-' No[3
If you have checked yes, please indi e coverage by checking the appropriate box.
Liabilitv insurance policy EEj�� Other type of indemnity
M Bond El
Owner's Insurance Waiver: I am aware that the licensee does nat'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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts Stat
,VQj%C5jdjeand Chapter 142 of
_ttS CwAie=I-Laws.
By:
Title
City/Town
APPROVED (OFFICE USE ONLY)
5iglTature of I
Plumber
as
,;G� �sF I e r
aster
aster
Joumeyman
sed Plumber Or Gas Fitter
� Z2 z
License Num0er
The Commonwealth of Massachusetts Pi. N.. Office Use On1%
Occupancy & Pve Checked -5
Department of Public Safety 3/90 (leave blank)
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12M 740
I � 9-tw I �
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK -
All work to he performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00
(PLEASE PRINT IN INK 0 TYP ALL, IITFO ION) Date
City or Town o 7/7- PA A42-,� To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical w rk described below.
Location (Street & Num§,er)__ to
O,wner or Tenant -A2, "') /71 RA,(,< -
Owner's Address JL6
v
Is this permit in conjunction with a building permit: Yes V-3, No F1 (Check Appropriate Box)
Purpose of Building Z�/ _ Utility Authorization NO.
2
Existing Service ---------
Amps
of Hot Tubs
Volts
Overhead 11
Undgrd
No. of Meters
New Serv-ice
Amps
Generators KVA
Volts
Overhead E]
Undgrd E]
No. of Meters
No. of Emergency Lighting
Battery nits
Number of Feeders and
Location and Nature of Proposed Electrical Work
No.
of Lighting Outlets INo.
of Hot Tubs
Total
No. of Transformers KVA
No.
of Lighting Fixtures
Swimming Pool Above
grnd.
in-
grnd.
Generators KVA
No.
of Receptacle Outlets 19
No. of Oil Burners
No. of Emergency Lighting
Battery nits
No.
of Switch Outlets 7
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No.
of Ranges
No. of Air Cond.
tons
Initiating Devices
No. of Sounding Devices
No. of Disposals
No. of Heat Total Total
Pumos
Tons
KW
No. of Self Contained
Detection/Sounding Devices
Municipal Other
Local 1:1 Connectioll
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No.
of Water Heaters KW
No, of . No. of
Signs Ballasts
Low Voltage
Wiring,
No.
Hydro Massage Tubs
No. of Motors Total HP
OTHER:
L
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES(@ NO C] I have submitted valid proof of same to this office. YES& NO C]
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE Z] BOND E] OTHER r-1 (Please Specify) 9/16/95
(Exp ration DateT
Estimated Value of Electrical Work S
Work to Start
Inspection Date Requested: Rough Final
Signed under the penalties of perjury:
FIRM NAME CONTINO ELECTRIC & CABLE INC. LIC. NO -A 119 8 3
E 2 a '17 8 8
Licensee LOUIS. CONTINO ignatu LIC. NO.
42
L - Bus. Tel. No. t 508 )36--T--5T=
Address 1 DONOVAN DR. WEST NEWBURY, X'01�98n' �
. -Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sW;;-
stantial equivalent as required by Massachusetts General Laws, and that my signature an this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S
(Signature of Owner or Agent)
0
Office Use Onlv
The Commonwealth of AfassachusettS Pennit No. 4r� _32!�
Occupancy & F*e Checked
Department of Public Safety 3/90 (leave blank)
BOARD OF FIRE PREVENTION REGULAnONS 527 CMR 12:00
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All vmrk to be performed in accordance with the Massachusetts Electrical Code. 527 CMR 12:00
(PLEASE PRDU IN INK OR TYPE ALL INFORHMON) Date Z'.30,Zg_,r
r
City or Town of—&ORLY To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) 9/0 1201!5Z�21YZ_ -Dk,
Owner or Tenant 9114r-2" A RALEA
Owner's Addres
Is this permit in conjunction with a building permit: Yes 12 No (Check Appropriate Box)
Purpose of Building 5 1 HC=L E E4111LY 60=44C Utility Authorization NO.
Existing Service ________&mps Volts Overhead F] Undgrd El No. of Meters.
New Service Amps Volts Overhead 1:1 Undgrd F-1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Pr osed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
Total
No. of Transformers KVA
No. of Lighting Fixtures
Ab ve [] in- [:]
Swimming Pool grnod. gr-nd
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond. tons
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
[j Municipal Other
Local Connectiono
No. of Disposals
No. of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating' KW
No. of Dryers
Heating Devices KW
No, of No. of
Low Voltage
No. of Water Heaters KW
El
Siens Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES[@ NO[] I have submitted valid proof of same to this office. YESE] NO C]
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE R1 BOND E] OTHER F-1 (Please Specify) 9/16/95
(Exp raEio_n7D_a_t_eT
Estimated Value of Elect�rical Work S
Work to Start — Inspection Date Requested: Rough
Signed under the penalties of perjury:
Final
FIRM NAME CONTINO ELECTRIC & CABLE INC. LIC. NO -Al -1983
E2o788
Licensee LOUIS. CONTINO Signatur LIC NO
Address 1 DONOVAN DR. WEST NEWBURY, ;& 01985 L Bus. Tello. 00�
-.-Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage -or
,its sub-
stantial equivalent as required by Massachusetts General Laws, and that my si nature on this permit
application waives this requirement. Owner . Agent (Please check one)
Telephone No.-- PERMIT FEE S,3:_C1,00
(Signature of Owner or Agent) A 6-Fq,—
.............
2379
TOWN OF NORTH ANDOVER
59 0 PERMIT FOR WIRING
SA US
This certifies that .......... .... . ................................. ..........
has permission to perform ... .-n
...................................
wiringin the building of .................... ..............................................................
........................ . North Andover, Mass.
tv
FeeA!�� Lic. No.ylil),I.�'.2 ...............................................................
ELECTRICAL INSPECTOR
i-, i- f- " r--- I-, �-
1 14 -: - <�e -7 '
WHITE: Applicant ,CANARY: Building Dept. PINK: Treasurer GOLD: File
Date ...... 49:70�.
To
2522
VORT"
TOWN OF NORTH ANDOVER
oo 0 PERMIT FOR WIRING
US
This certifies that
has permission to perform .... ...
.......................................
wiring in the building of ....... ............... ........
at.,z;�/o . ...... . . . ... ........ ... -,,,North Andover, Mass
... dK�. :. M.. ..
00
Fee.P?5..:,�.... Lic. N,,4. .. mv��? .........
iL si�"Iloz le.:!.:
09/ Y� ildi "gept PAID
4'
4
WHITE: Applican�t AiN A R I d PINK: Treasurer GOLD: File
The Commonwealth of Massachusetts
Department of Public Safety
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Oniv
Permit No. 3 g�o
Occupancy & fee Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All viork to be performed in accordance %vith the Massachusetts Electrical Code. 527 CMR 12:00
(pLEASE MINT IN INK OR TYPE ALL INFORMATION) Date ZlaAi 17
City or Town of_1Vba7-1( -4 H-pot14-12- To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) /2 tR 0 5 E41 62 /V 7— >
O;---ner or Tenant ry
Owner's Address E
Is this permit in conjunction with a building permit: Yes NoEJ (Check Appropriate Box)
Purpose of Building 6IM6�LE /-/0
oAf 67 Utility Authorization NO
Existing Service Amps Volts Overhead Undgrd
New Serv-i6e Amps Volts Overhead U,dgrd
Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work
No. of Meters
No. of Meters
No. of Lighting Outlets
No. of Hot Tubs
Total
No. of Transformers KVA
No. of Lighting Fixtures
Above In- -
Swimming Pool grnd.El gr-nd . 1-1
Generators KVA
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 Detection and
Total
No. of Ranges
No. of Air Cond. tons
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Municipal Other
LocalE] ConnectionD
No. of Disposals
Heat Total Total
No. of Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
KW
No, of No. of
Low Voltage
No. of Water Heaters
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
I
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES 0 NO[] I have submitted valid proof of same to this office. YESE] NO [3
If you have checked YES, please indicate the type of, coverage by checking the appropriate box.
INSURANCE f7i BOO E] OTHER F� (Please Specify) 9/16/95
(Exp ration DateT
Estimated Value of Elect�rical Work .$
Work to Start . — Inspection Date Requested:
Signed under the penalties of perjury:
FIRM NAME CONTINO ELECTRIC 6, CABLE INC.
Rough
Final
LIC. to -A11983
E2-7RR
Licensee LOUIS, CONTI - NO Signatur LIC NO
0�)�61_-54=
Address 1 DONOVAN DR. WEST NEWBURY, �K 0198�, Bus. Tel.
-.—Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or M Sub-
stantial equivalent as required by Massachusetts General Lawsp and that my signatute on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S
Signature of Owner or Agent)
-V
Z
..............
Date..
,,ORTH
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
SA U,
This certifies that ......... �(/-o
... ................................... . . .... ........................
T
has permission to perform .................................................
...............................
wiring in the building of ........ .............
........................ ............................
.......... C ... ..................... North Andover, Mass.
....................
...............................................................
Fee ......... :7=... Lic. No.
ELECTRICAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File