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Miscellaneous - 221 BOXFORD STREET 4/30/2018 (2)
/ 221 BOXFORD STREET 210/106.A-0253-0000.0 1 OUILUIN. 9 FILo Cunningham Lindsey U.S.,Inc. P.O.Box 703689 �L1Il�.ln haul va Dallas,TX 75370-3689 L1ndSey Telephone(888)738-8714 Facsimile(214)488-6766 CLCAT@CL-NA.COM **************"********AUTO**3-DIGIT 018 . 798 T3 P1 95000058988 Building Commissioner or Inspector of Buildings 120 MAIN STREET North Andover,MA 01845 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS Ch. 139, Sec 3B Claim Number: 1339383 Policy Number: HP1339383 Company Name: MERRIMACK MUTUAL FIRE INS co 0) Cause of Loss: ICE DAM U) Date of Loss: 2/19/2015 0 Insured: Dorothy and Richard Varga Property Location: 221 Boxford St IIIIIIII� Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Section 313. No insurer shall pay any claims(1) covering the loss, damage, or destructions to a building or other structure, amounting to the one thousand dollars or more, or (2) covering any loss; damage or destruction of any amount, which causes the condition of a building or other structure to render section six of chapter one hundred and forty-three applicable, without having at least ten days previously given written notice to the building commissioner or inspector of buildings appointed pursuant to the state building code,to the fire department or arson squad of the city or town and to the board of health or board of selectmen of the city or town in which the same is located. If at any time prior to the payment the said city or town notifies the insurer by certified mail of its intent to initiate proceedings designed to perfect a lien pursuant to section three A, or to section nine of chapter one hundred and forty-three, or section one hundred and twenty-seven B of chapter one hundred and eleven,the said payment shall not be made while the said proceedings are pending; provided, however, that said proceedings are initiated within thirty days of receipt of such notification. Any lien perfected pursuant to section three A, or to section nine of chapter one hundred and forty-three or section one hundred and twenty-seven B of chapter one hundred and eleven, shall extend to and may be enforced by the city or town against any casualty insurance policy or policies covering any loss, damage, or destruction pursuant to which the proceedings to perfect the lien were initiated. No insurer shall be liable to any insured owner, mortgagee, assignee, city or town, or other interested party for amounts disbursed to a city or town under the provisions of this section, or for amounts not disbursed to a city or town under the provisions of this section. 'i On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. Cunningham Lindsey Catastrophe Department cicat@cl-na.com 800-867-3885 Date..... ......... VIORT#j TOWN OF NORTH ANDOVER PERMIT FOR WIRING CU V.......... ......... .....y... ................................... This certifies that ..... ...... ... f. has permission to perform ..... ............................................................. wiring in the building of..................... .............................................................. S7- -North Andover,Mass. at Z..... ..........*......*,,*,*,,*,*,*,,***,*,,**,**....... ,P 6 Fee...-5-Z-:4—..Lic.No. ................. ...................... Check# t Commonwealth of Massachusetts Official Use only Department of Fire Services Permit No. I?' Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I('t,t- I L� City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ?:,)-\ 6 M Owner or Tenant Qk,,C�K U�,,r�,r,, Telephone No. c,70-211(4-33/0 Owner's Address 'ate\ -Nai rA SL Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service -,C)O Amps `t-ao /`}ilG Volts OverheadUndgrdA No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: w�rc ��� U'� d- AL 61i-.1JC rcc.eP�µc,<C Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting rnd. rnd. BatteryUnits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal E:1 El Other Connection No.of Dryers Heating Appliances KW SecuriNo. f Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: y g No.of Devices or Equivalent OTHER: f Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: t 50 0 (When required by municipal policy.) Work to Start: jt-q -tL\ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 'IbJ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties of perjury,that the information on this application is true and complete. FIRM NAME: V a«e'l cC�lTnC-- LIC.NO.: t 9,oA Licensee: Nr Signature 6�1 LIC.NO.: (If applicable,enter"exempt"in the license 6mber line.) � I AA Bus.Tel.No.• 9-19- M--?130 Address: �� �a�A k)f— (sir-AA ra !�I Alt.Tel.No.: y79)-37f,,- lt6 *Per M.G.L c. 1461,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)[],owner ❑owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. r4/ aCOMMONWEIILTH OF MASSACHUSETTS . III kyj Porel N Ions - e e BOAR�:`O� ELfURICI ANS , ISSUES THE FOLLOWING L.ICE'NSE AS A= REGISTERED MASTER ELECTRICIAN 1� UALLYELECTRIC. i NC �� 'W BRIAN A WRISLEYiN 21 NYATT AVE' B.Ft'AOFORD KA o1835-82D' 20180 A 07/31/1;6 163131 •� tile 8. In accordance with the provisions of NLG.L. 1;. 143 § 3L, the permit applica- tion form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the rescribed form. �'1 .tai �. . •i�� e t seq f ecl -.. iE ".III"I111LLL... � 7 f o , rDate.................................. 40RTFj °` Alk ° TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SS.tLNUS� � This certifies that ��E has permission to perform �� 5t �' .;....�:�...................../....... wiring in the building of l/ �'R at.... ....... d ........ ..b..........3...:.............. 4-North Andover,Mass. Fee..................... Lic.No.............. O�`t.J............i ..... ....... ELECTRICAL INSPECTOR V Check 7577 -� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 7 '7 <� T BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g-15-07 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives tinotice of his or her intention to perform the electrical work described below. Location(Street&Number) 9oZ o-f-f Eva S+ Owner or Tenant 2 g h VOA�CI+G` Telephone No. Owner's Address 51,hlk-L Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: uQ) V) ; 1p l 15h O yl SCAkLVt-_ Dyc-� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- Elo.o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets kD No.of Oil Burners FIRE ALARMS No.of Zones No.of SwitchesNo. of Gas Burners No.of Detection and a Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers eat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.,of No. of Data Wiring: t CcLbu— Heaters Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: y Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless I the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The 1 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. I CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) /certify,under tl:e airs and penaltiesof perjury,that tl:e information on this application is true and complete. l� FIRM NAME: (,CL�C� I C— C.hL�L LIC. NO.: 6Ad0,A Licensee: l GW- \(cu 0,l Signature LIC. NO.: 31 1731 C (/f applicable`inter "exempt"in the license number lin .) �Q �� Bus.Tel. No.' Address: t Alt.Tel. No.: *Per M.G.L c. 147, s. 57-61,security work requires DepaNment of Public Safety"S" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ i Put K, c94 443 - 1 (o- 7 P/� C;L S 6=-n l i e C.- 2-.7 t The Commonwealth of Massachusetts 1 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Name (Business/Organization/Individual): �<<a,Y-ct Address: 4 �_5� City/State/Zip:�S(?�,Il 1\ 1 A 0 Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.1� I am a employer with q 4. ❑ I am a general contractor and I 6. �q New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. EJ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs ' insurance required.] t employees. [No workers' 13.E] Other comp. insurance required.] v *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t 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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: O� �GX�oY S City/State/Zip: W A�w f_e V k Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: q 11- ELM- M� q Official use only.DDo not write in this area,to be completed by city or town official l City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other 1 Contact Person: Phone#: 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with theprovisions of M.G.L.c.143,§.3L,the permit application form to provide notice of installation of wiring shall be.uniform throughout the Commonwealth,and applications shall be filed " on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application.Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shallbe limited as to the time ofongoing construction.activity,and maybe.deemed by-thexnspector_of_Wires abandoned_and_iunlidafbe_. or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the.permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote joh growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its othrwise applicable expiration date,any permit or approval that was r "in effect or existence"during the qualifying period beginning on August 15,20.08.and extending through August 15,2012. L ule 8—Permit/Date Closed: —��— �� ***Note:Reapply for new permi� 0 Permit Extension Act—Permit/Date Closed: Date I2 ) I Z TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies .147. f..►m�c► . . . . . . . . . . . . .has permission to perform . wiring in the building of . . . G--- . . . . . . . . . . . . . . . . . . . . . . . . . 2Z 1 �c��( at . . . . . . . . . . . . . . . . . . . . . .�. . . . . .,. . . . . . . , N h Andover, Mass. Fee . . Lic. No. ELECTRICAL INSPECTOR f Check# 11042 Commonwealth of Massachusetts Official Use 1 Permit No. G Department of Fire Services Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned givjes notice of his or�her)intention to perform the electrical work described below. Location(Street&Number) OFi( Owner or Tenants ,-c.AC P` r' Telephone No. Owner's Address 6C►'ytt- Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building des 14mi Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No,of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Natureof Proposed Electrical Work: :.,hs fcf/ /!')�G//Uc4..-civC� C-� 7`SU mow° /e 1°V CQty/1�/& AL r-/® Z:* C h c h S e IVC Gni 'i�] Completion of the following able may be waived by the Inspector of Wires. of No.of Recessed Luminaires No.of Ceil:Sus addle s Total P � )Fans TransKVA No.of Luminaire Outlets No.of Hot Tubs Generators KVO' No.of Luminaires Swimming Pool Above ❑ In- ❑ o.oTEmergency Lighting rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local --I Municipal Other P g Connection Dryers Heating Appliances KW Security Systems:* No.of Dr y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total IR Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: /'OQC� d (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the ns and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Ccr6l" Z/C C,&-, C— LIC.NO.: 0k0 .zC� Licensee: �,lG 9,-cc,-c/,' Signature LTC.NO.:� (If applicable, enter "exempt"in the license number line.) f Bus.Tel.No.: /-/ 7 7 Address: !e-/-Cjlt Y S�� �'� &55y-S ►'''1�' �f�"� Alt.Tel.No.: �`+� - �/ *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)[]owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. C r _ aw �C�{A��.�{t �'�ssea�-�j � - �a�e8-�j � �e-uzspeet�oxtz'e�uzxetlr(��'O.OD)�j � �nspectoxs'�aannxe�ats: • (rasp ecp-axstizgaatuz e o rr itials} �aEe �n�ectora'cokn�ents; , (T'nspectors',signature-)iohalfials) Pate assed--j aztet -j Re-imp Betio-repirea($90.00)Hj ] quectoxs'comments, � [lnsp ectoxs',�zgnatuz e o?r�ifias) pate . V 01 CAYA-'r`?bN. +ONA3 C-9 ;; Mal :. r rsec1--j I +ailed--jenseconxequire ( O.OD) j oectbxs9 eo�nm.eufs; . QCuspectors'ftgture-io jnitials) hate roof.tCXXON•-()MR., ' :Ctox�9 CDIri?]�e77.t5: _ sp ecioxa'WjnaWe••oto fnifiais) Xiate ' D'P TA GN,,Q A P*F,TO*R'W,'T..rf T,'PI)O)TT AM T,'R,' `Tr ADV qT`7 R,,'W TFW,.ARV,A,TO BE INSPECTUD Z•q NOT r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): PCL cc)' E � L Address: 0-( - City/State/Zip: ,rte. v q Q So Phone#: -2 d- X37, Are ou an employer?Check the appropriate box: Type of project(required): 1 T� am a employer with_ L, 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition `working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its equired.] officers have exercised their 1 lectrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 Plum ' repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractols 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 insurance for my employees. Below is thepolicy and job site nform(tion. nsurance Company Name: (�(Y� 'olicy#or Self-ins.Lic.#: k,,Q)EExpiration Date: 11712 Z' iZ 7 'ob Site Address:'Z� ���� 5� City/State/Zip:000 ,,-, IPWIC -1�.-_ kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby cert'under the pains and penalties of perjury that the information provided above is trace and correct. ;i nature: Date: hone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: e 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 city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. j 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 homeowner 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 Massachusetts Department of;Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-7274900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 kevised 5-26-05 www.mass.gov(dia Location ! No. _ Date d- � NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ BLlilding/Frame Permit Fee $ ��b'^'•°•''t�' Foundation Permit Fee $ / /) SSACM 1. fi e -M4'Permit Fee $ •sV �.t Sewer Connection Fee $ Water Connection Fee $ AAY 21 9Q — y �OTAL $ t q®. Andover Collector 'Bui. - — lding Inspector Div. Public Works Location No. ' ~ \ Date �6 \`1 -r1d Of NOQTh,+. -`TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ '21\0.00 sACMUs t� Foundation Permit Fee $ Othdr Permit Fee $ Sewer Connection Fee $ PAID 13Y ME-0 nection Fee $ TOTAL $ "fit,^ 00 17 loco Building Inspector No. Andover CoI125dor Div. Public Works f _ Location .•� -��: . No. tv NQi Date LVS0 . r 199 r NORTH TOWNIORTH ANDOVER f C, 1���L y"W1 �� d p cate of Occupancy $ Building/Frame Permit Fee $ Foundation.Permit Fee $ .n� s�cMus Other Permit Fee $ Sewer Connection Fee $ c Water Connection Fee $ r TOTAL Building Inspector Div. Public Works &.1rIT NO.` ", . l APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER MASS. / / � J J PAG1;'t—— MAP K�O�C/� I LOT NO. (J RECORD OF OWNERSHIP DATE BOOK PAGE 2 ZONE +SUB DIV. LOT NO. LOCATIONZZ! PURPOSIE OF BUILDING OWNER'S NAME �/-- NO. OF STORIES SI 1 OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST S y 2ND3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST BUILDING - kjl DIMENSIONS OF SILLS DISTANCE FROM STREET jf POSTS �/ 11 DISTANCE FROM LOT LINES-SIDES i}�/ REAR,,,W - GIRDERS AREA OF LOT71 1!9 lAlp5r FRONTAGE >�r-/ HEIGHT OF FOUNDATION THICKNESS /h / IS BUILDING NEW L ps ` / J SIZE OF FOOTING d /I X IS BUILDING ADDITION no MATER:AL OF CHIMNEY r�L IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND ,17 ` 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 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST ��- PAGE 1 FILL OUT SECTIONS 1 - 3 BLDG. y�j+L ,DGPERMIT FEE EST. BLDG. COST PER SQ. • r PAGE 2 FILL OUT SECTIONS 1 - 12 ��,� �� LESS FDA FEE. EST. BLDG. COST PER ROOMSEPTIC PERMIT NO-,4/D ELECTRIC ME%wPS MUST BE ON OUTSIDE OF BUILDING DUE FRAME PERMIT r 0D 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 5c)'o 0 .R a .PLANS MUST BE FILED AND APPROVED Y BUILDING INSPECTOR DATAFD--/ i BOARD OF HEALTH SI TORE dF OW OR AUTI4,0RIZEO AGENT FEE �N\,o •iX3 PERMIT FOR FOUNDATION ONLY PLANNING BOARD PERMIT GRANTED �L G LL.ATD DY PARA: 114.5-S.B.C. FEE PAID: BOARD OF SELECTMEN BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY S�CRIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION _ 8 INTERIOR FINISH CONCRETE _ d 1 2 13 CONCRETE BL Ko PINE BRICK OR STONE HARDW D PIERSPLASTER _' DRY V.'}�.LL —_ UNFIN 3 BASEMENT AREA FULL FIN. B 'T' AREA 1/1 % FIN. ATTIC AREA NO BM'T FIRE PLACES HEAD ROOM MODERN KITCHEN 4LLS ,� ' FLOORS CLAPBOAR /i B 1 2 3 DROP SIDINGCONCRETE �_ - WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE r STUCCO ON MASONRY STUCCO ON FRAME ERIC N MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER ELK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR POOR _ ADEQUATE I NONE 5 ROOF 10 PLUMBING GABLEHIP BATH (3 FIX.) - GAMBREL MANSARE) TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN: TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS -G '7 NO. OF ROOMS ASOI L B'M'T 2nd _ ELECTRIC Ist 13rd I NO HEATING e� fit' ';, . i TOWN OF NORTH ANDOVER LOT RELEASE F011M SUBDIVISION ASSESSORS MAP SUBDIVISION LOT(S) PERMANENTADD^ SSSIGNEU BY U.P.W. STREET APPLICANT „� �,� PHONE DATE OF APPLICATION TOWN USE BELOW THIS LINE PLANNING BOARD DATE- APPKvvt:D `lD TOWN—PLANNER DATE REJECTED CONSERVATION .COr ISSION � DATE APPROVED CONSERVATION ADMIN. DATE REJECTED BOARD/ H LT DATI, Al PIME'll) H ANIT AN 'N. . d D TE REJECTED DEPARTMENT OF PUBLIC WORKS DRIVEWAY PERMITP �3ic C y G/90 1 0�c nn 47�6�9d SEWER/WATER CONNECTIONS �e ��,..� p✓ c�,c� ct �r'i�s 0 V FIRE EPT. �� �(nt tg' _ cf G 5 OV&6ridgg • RECEIVED BY BUILDING INSPECTION DATE This form shall be signed by the agents of the Planning and Ilealth Bonrds, ,the Conservation Commission prior to the issuance of any building permits -for the subject lot. This form shall not releive the applicant from the compliance of any applicable Town requirement or bylaw. �,N � \�\ " _0 1 a O i �4 `¢ -7 .n EXIS c� T t . 4� F�, a- o . a 24' '� p 127' OT ^, &0 57, 119 1�1/� Sf � N THIS PLAN IS INTENDED FOR ZONING PURPOSES ONLY. IT WAS COMPILED FROM EXISTING PLANS AND RECORDS WITH \— BUILDING LOCATION CONFIRMED IN THE FIELD. IT SHOULD NOT BE USED FOR PROPERTY LINE DETERMINATION. 1 WE HEREBY CERTIFY THAT WE HAVE EXAMINED THE PREMISES AND ALL EASEMENTS, ENCROACHMENTS AND BUILDINGS ZONE: R ARE LOCATED AS SHOWN. ALL REQUIRED SETBACKS: BUILDINGS SHOWN CONFORM TO FRONT 30" THE ZONING LAWS OF THE SIDE 30' MUNICIPALITY WHEN CONSTRUCTED. REAR 34` THE BUILDING IS NOT LOCATED IN AN ESTABLISHED FLOOD CERTIFIED PLOT PLAN AREA. L OT 7, lG 0XF0PG 57, IN Norw woven 'yN 0 s�� \ AS PREPARED FOR FL.INTLO�K, 1N' .`` o MA ch�oNaA \, SCALE 1 .- 90 DATEf Ir <. % MARCHIONDA & ASSOC., INC. �(s. ENGINEERING AND PLANNING CONSULTANTS " F peri 'r� - " J✓ 80 MAPLE STREET R.F.D. 16 PAUL A. MARCHLQ L), -E-rP STONEHAM, MASS. 02180 MANCHESTER, NH 03103 �� �ji (617) 438-6121 (803) 434-8725 • t I CER0070FICATE OF USE & OCCUPANCY I Town of North Andover Building Permit Plumber 121 Date AUGUST 2 , 1990 I. THIS CERTIFIES THAT THE BUILDING LOCATED ON `"LOT #7 BOXFORD STREET (221) MAYBE OCCUPIED AS SINGLE FAMILY DWELLING, 2-CAR GARAGE IN ACCORDANCE UNDER UNFINISHED UP WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. NORYM I i " Ofttao a•f4'O CERTIFICATE ISSUED TO Flintlock, Inc. • ADDRESS P.O. Box 531 , No . Andover , MA ,JSA USES c Building Inspector PLA I IVr� FINAL' I S SORT OW, n 0 dover L - - 0 DRIVEWAY ENTRY PERMIT ... �A COCWCME WICK I` .j BOARD OF HEALTH UA THIS CERTIFIES THAT...'.. .. �!:a!e. :": ... 1�� U� rr BUILDING INSPECTOR has permission to erect .... . . ... buildings on .�:°1.. .. 4�........ Rough O` v� «�. .�... �ti��` b • • J C h i m ne)l� � C) to be occupied as.... Final e o provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING I)QSf fCTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Rough �•�r`�� ' ` y % ' Buildings in the Town of North Andover. PFPMIT FOR FOUNDATION ONLY VIOLATION of the Zoning or Building Regulations Voids this Permit. Ili: ATED BY PARA: 114.5-S:B,C♦ uK o �� PERMIT EXPIRES IN 6 MONTHS ` ==- FEE PAID' v k-�' I ELECTRICAL INSPECTOR PER �'. ROUgh d� FOR FRAA4E/B �� r�� Service �!d`�tS CONSTRUCTION STARTS DATE. :`�-ct� .P Final \ �.-• �-- FEE P`AID• : ., ...... . ...... .. . . B LDING INSPECTOR GAS INSPECTOR 3C. c C;ORough Occupancy Permit Required to Occupy Building Final Display in a Conspicuous Place on the Premises ® FIRE DEPT. Do Not Remove Burner ' No Lathing to Be Done Until Inspected and Approved by STREET No. Smoke Oet. .L - Building Inspector a4 OIII(;litiOI~ � I;�cl �l.lill �;llc•c•I -, � 7", hl(al�"I'AI �1, 1)0VLItNi)III, :�1lcl(„fr. ,' 1:ititi u-IICIs;c•IIti(.(:ONti1-'It Vii-1 1ON I I1\'I`;I1 IN(W Ili 1 i)l 8 i 4 775 5 Ill Al.'I I I OLANNIN(; 1'1,y1.NNIN(; R (:Of�11111!Nl"1'1' 1)l;�'1:LO1'1111:N"1' N 1I.I '. NI:I .tiI )N, 1 )11WCI ( )It CHIMNEY APPLICAII0N AND PERN11- DATE - ' ' ' IeL LOCATION p S i OWNER'S NAME: BUILDER'S NAME: MASON'S NAME: —a MASON'S ADDRESS: a e c--(- 6- z`' MASON'S TELEPHONE:_ �� S, MATERIAL OF CHIMNEY: � <<� d � INTERIOR CHIMNEY: B IERIOR CHIMNEY: NUMBER AND SIZE OF FLUES: THICKNESS OF HEARTH: ' ` Witt eEu: iney on. ()i epeaee eon()onul .to ,tile ne�Iu,vle�llell.t:ti v( .01Q code a)Id I1ctVe Au.CU and negutati-om been ucet.ved: DATE.: SIGNATURE OF MASON: PERMIT GRANTED: 2�-2 —157( I.'EE ROBERT NICETTA BUILDING INSPECTOR IWECTED: REMARKS: SOLID BLOCK RE'OUIRED THIS PERMIT MUSV BE DISPLAYL-U 014 IIIE PREMISES Location No. Date pe NOS"T" 1ya TOWN OF NORTH ANDOVER C , Certificate of Occupancy $ IL +i ; • Building/Frame Permit Fee $ g AGNUFoundation Permit Fee $ JS t � Other Permit Fee $ Sewer Connection Fee $ CU Water Connection Fee $ TOTAL $ 2-2E3 N 16e43, c Lo , Building Inspector �''- 10764 — Div. Public Works PERMIT NO., O APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP d40. LOT NO. n"f 2 RECORD OF OWNERSHIP :DATE BOOK :PAGE ZONE I SUB DIV. LOT NO. �- LOCATION �a f j �+ PURPOSE OF BUILDING �A + OWNER'S NAME 1 / � NO. OF STORIES SI E OWNER'S ADDRESS ^ V BASEMENT OR SLAB ARCHITECT'S NAME ✓cS''_.1� _.o SIZE OF FLOOR TIMBERS IST Z ®�J2ND 3RD BUILDER'S NAME 1rv� (_ SPAN -�'` i �� DISTANCE TO NEAREST BUILDING w DIMENSIONS OF SILLS DISTANCE FROM STREET 2A.0 + "' POSTS j !, DISTANCE FROM LOT LINES-SIDES REAR i i�/l + GIRDERS l�-l AREA OF LOT A r.-e- FRONTAGE `I��l•,J� f HEIGHT OF FOUNDATION THICKNESS t � IS BUILDING NEWw 1l�,� ` SIZE OF FOOTING , % IS BUILDING ADDITION \� �/ MATERIAL OF CHIMNEY IS BUILDING ALTERATION 7 `�i\ IS BUILDING ON SOLID OR FILLED LANDL�,/1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE '�y IS BUILDING CONNECTED TO TOWN WATER +, 1�� ✓ BOARD OF APPEALS ACTION. IF ANY {J rl 6- IS BUILDING CONNECTED TO TOWN SEWER 1yNC� 1 4/ IS BUILDING CONNECTED TO NATURAL GAS LINE Nd INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST f/� '3�� - W PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. + EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 3 d(,� BUILDING INSPECTOR SIGNA R�OFNE:R'rTHORIZ E T F E E mcp Q2 OWNER TEL.A � PERMIT GRANTED CONTR.TEL.# 19 CONTR.LIC.# H.I.C.# CJ 1 gs-1 6-7 .23YO' BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE -4d 1 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDW"D i PIERS PLASTER_ DRY WALL UNfIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA '/. 1/7 l/. FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS KB 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARD11✓'D ASBESTOS SIDING _ COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STIRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING r STONE ON FRAME SUPERIOR I I POOR _ AOEOUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH 13 FIX.) GAMBQEL MANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. &COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st _I 3rd NO HEATING FORM U --VERIFICATION 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: Phone if ` S_5 3 LOCATION: Assessor' s Map Number 1b Parcel D S 3 Subdivision (� Lot(s) Street a2-� o`}— � J'iy�A_A� St. Number ************************Official Use Only************************ RECO ' � �A�IO . �F; TOWN AGENTS Date Approved Conservation Ad inis ator �\ P Date Rejected Comments Date Approved Town Planner Date Rejected Comments Date Approved Food Ins, to --Health Date Rejected -�✓"� Date Approved SeptZc Spector-Health Date Rejected Comments Public Works - sewer/water connections - driveway permit Fire Department Received by Building Inspector Date f NEW D.H. WINDOW5 O TO MATCH EXISTING (TYPIGAL) N N NEW PAIR r �- 2 '-a" WIDE NEW WALLS FRENCH DOORS SHOWN SHADED P I N I N6 (TYP I GAL) 50L-1 D 4 X 4 2-2 X 8 P05T UNDER HEADER HEADER END5 36' MIN. - (TYPICAL) RAILING EXTG FAM I L Y G.O. Room N EAT I NG L I NE of AK EA PROVIDE TRIPLE FOUNDATION (2ND FL J015T) WALL BELOW HEADER © REMOVE EXI5TIN6 IS. GABLE END WALL DOWN O (SHOWN DOTTED) NEW HALF WALL z WITH WOOD GAP KITCHEN ir, N SIIV REF NEW GL PANTRY 5P GAD FARa 5T3 ED I I��T F -OOF FLAN TREATED WOOD STAIRS TO FIN15H GRADE i PLANS ffOF EX 15T I NG PROP05ED MIS . MKS . 1z I GHAKi� A�'C 221 BOXFOID STREET TREATED WOOD DECK NORTH ANDOVER , MA . PER OWNER TREATED WOOD RAILING SCALE - I /4" = 1 ' - 0" MAf;GH I °117 MIN. 3�" HT. L RIDGE VENT I X 6 GOLLAR TIE AT 32" O.G. A5PHALT 5HIN6LE5 TO MATCH EXISTING 2-2, X 6 COLLAR TIE BEAMS SPACE AT THIRD POINTS 2 X 4 STRUT USE GALV. GONNECTORS/THRU BOLTS EACH J015T 5EGURE TO DBL RAFTER 2 X 1 0 ATI 6° 0.C, I /2° GDX PLYWOOD ROOF DECKING /2' GWfl ON i X 3 AT 1 6' O.G. 2 X 8 AT 16" 0,G, R-30G FIBERGLAS INSULATION ALLOW I ' AIR 5PACE ABOVE R-30 INSULATION USE "PROPA-VENTS" OR EQUAL MATCH EX15TfN6 EAVES DETAILS MATCH EXISTING CEILING HT. - - - - DOUDLE TOP PLATE 2-2 X 8 HEADER GONTINUOUS SOFFCT VENT TYPfGAL TYPIGAL EXTERIOR WALL; TYPIGAL INTERIOR WALL: 51DIN6 TO MATCH EXI5TIN6 2 X 4 AT 1 6° 0.G. 1 /2' GDX PLYWOOD 1 /2' GWD EA SIDE TSF TYVEK INFILTRATION WRAP 2 X 4 AT 1 6" 0.6. 3/4" T46 PLYWOOD. R-11 FII>ERGLA5 INSULATION NAIL � GLUE TO POLY VAPOR BARRIER FRAMING 1 /2' GWD T4F MATCH EXISTING I ST 2 X 1 0 AT 1 6° O.G. FLOOR ELEVATION - 2 - 2 X 6 TREATED SILL SLOPE FINISH GRADE TO DRAIN ANCHOR BOLT/STRAP AT 6' 0.0, Q III=III=ITI=111=III=III=III � '=III=111=111=III=11f=III=III=III-ul � III-III_III-III-III=III=III=1l1.III=11t LL R-I F I DERGLA Q �`'-- DR I DG I NG AT CENTER SPAN IN5ULATION Z DAMPROOFING Zt,, CONFIRM PROPER DEARING SOIL POURED CONCRETE REAM 3 - 2 XFOOTING 4 FOUND- IN LINE FRAMING ATIONS U5E J015T HANGERS 5L�GONGRETFARGXGTO GONGRETE FILLED STEEL 24" X 24" X 12g' COMPACTED G RAVEL GOLUMNS AT 7' + , - O.G. POURED GONGRETE FOOTING AT EACH PLANS FOIA COLUMN Mfg , MR5 . R I CHARD '�Dj 221 .BOXFORD STREET NOKTH ANDOVEK , MA . TYF 1 GAL GIzO�� �EGT I ON 5GALE : 1 /4" = 1 -0' MWG • 37 - - =- 1.0 4./SiJ..FV -_._. _-. ROS._._ r, P.�.I �-t. 'o-:. u_ . .c�-: ciLEI rr , i -- — ------------ - -----._...---- -------- Al t 37 i j T � INN 0, � 34 � 6 �f a� 1 17 5, o(DI 1 --------------- Lb: l_ .C � „sem of G. AT dZ�i c� __._..._EP.M, IT Tom__. lJ. �... .._ --- �2 C)=+�1TR, .t_rJCILLETT ' CH ET — - c� - -- U GQGGNt(V ti /���'�`�/Vr” • �• .t.�,�� . 'c�\�:�},•.�1�7'f.^:,,,gyp . r►ORT F � e 0VM Of h over No. /30 - m * z - O _ dover, Mass., 19 9i " s•.- LCAKE A '9 COCHIHE WICK`y~''�•` '9 4�R4 TED S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System Ri-r—W.4-se-3 BUILDING INSPECTOR THIS CERTIFIES THAT................................................... .........VA.R.G.-.6....................................... Foundation has permission to erect..........401.�../.4DN. WittiWon 0.. X..�a.� �?........S ...........�r�..�...... �. .. ..77 Rough to be occupied as............................ ............:,—A4 l....� . r. Chimney provided that the person accepting this permit shall in every respect confor o the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough ............. .... . ... .............................. Service ......................................... .LDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. _ D 6 Smoke Det. Location' No. Date �oRTM TOWN OF NORTH ANDOVER .adawaAUp Certificate of Occupancy $ f0 Building/Frame Permit Fee $ 1690 Foundation Permit Fee $ s�CHust �: Other Permit Fee $ Sewer Connection Fee $ ° 19Water,Connection Fee $ �t $ v TOTAL` l 1991 _ x' Building Inspector Div. Public Works PER311T NO. D �7 l APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. f PAGE 1 MAP d40. LOT NO. 2 RECORD OF OWNERSHIP ;DATE BOOK ;PAGE ZONESUB DIV. LOT NO. FI LOCATION r PURPOSE OF BUILDING v: OWNER'S NAM \ NO. OF STORIES OWNER'S ADDRESS iC BASEMENT OR SLAB I ..AjLf ••c ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST t' D 9 %e1 3RD BUILDER'S NAME �u,� SPAN /!5- 1 DISTANCE TO NEAREST BUILDING /t/ it DIMENSIO S OF SILLS / DISTANCE FROM STREET A/ f'TM POSTS DISTANCE FROM LOT LINES—SIDES <T REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION 114 THICKNESS IS BUILDING NEW �/'� ` SIZE OF FOOTING /// X IS BUILDING ADDITION 'v I/�^ S Lam,'` - •bj� Tyyl`S� MATERIAL OF CHIMNEY IS BUILDING ALTERATION 'C 'T'" IS BUILDING ON SOLID OR FILLED LAND „s1 WILL BUILDING CONFORM TO REQUIREMENTS OF CODE f/ C IS BUILDING CONNECTED TO TOWN WATER `l�o�� BOARD OF APPEALS ACTION. IF ANY X J IS BUILDING CONNECTED TO TOWN SEWER �A O IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION /�/ -y-y�- �f �� d� LAND COST SEE BOTH SIDES 64001 4e—I /Z r L� •.!`" ^, C� R� � �O � EST. BLDG. COST ✓C�nl PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. C/ EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED /ICLI, y y BOARD OF HEALTH SIGNATURE 0;06WNEW OR AUTH IZED AGENT I l` ['� L FEE © U a„ PLANNING'BOARD PERMNkGRANTED CI TEL ..� A5�} — BOARD OF SELECTMEN CONTR.TEL0 ,•J Lr CONTR.LIC.0 BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 so _ SINGLE FAMILY STORIES THIS SECTION MUSTSHONIV-0toACT-DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT LZ ,�,.OF BUILDINGS. WITH PORCHES, GA- APARTMENTS RAGES, ETC. SUPERIMPOtSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 8 INTERIOR FINISH CONCRETE B I 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW D — PIERS PLASTER _ DRY WALL _ tl UNFIN. 3 BASEMENT il AREA FULL FIN. B'M'TAREA _ 1/1 r/} l/, FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH. TILE —{I_ STUCCO ON MASONRY �— STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC. OR CINDER BILK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIOR I� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH )3 FIX.) _ GAMBREL MANSARD TOILET RM. 12 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. _ STEAM STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ ELECTRIC 1st 13rd I NO HEATING c " 9 Y . t s Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption ;'' (Please print) f DATE S JOB LOCATION � jY Q sy Number Street Address Section of town ' ""HOMEOWNER" � Name Home Phone Work Phone ' PRESENT, MAILING ADDRESS 7?,Ok�wC Q 7-tV ey 5 City Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license , provided that the owner acts as supervisor. (State Building Code , Section 109 . 1 . 1) DEFINITION OF HOMEOWNER: ' Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is , or is intended to be, a one to six family dwell- ing , attached or detached structures accessory to such use and/or farm structures . A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official , on a form acceptable to the Bulding Official , that he/she shall be responsible for all such work performed under the building permit . (Section 109 . 1 . 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes , by-laws , rules and ''regulations . '.' 'The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements . HOMEOWNER' S SIGNATURE APPROVAL OF BUILDING OFFICIAL ,., N'ote: Three family dwellings 35 ,000 cubic feet , or larger , will be ,required to comply with State Building Code Section 127 .0, Construction , Control . MAR F til EDP�pM 3 10 ftD K60M # 4 Ilb X 11(0 100 X lfto tr r I l b x 110 Iqb x I I(o 3 �E/--OND FLOM f I NN TOTAL Ct 6`� �j f � 9 Town of 6 0 ndover No. ; ° , . V" , .. r D R IV "VAY E q T F1 P EE.71,��IT -- = er, Mass., *96 S 19 oCK oQ Q�,.. SS PERMIT T 0 BOARD OF HEALTH • THIS CERTIFIES THAT..A.C.r. !! ..... .. ...`... ..�.......................... BUILDING INSPECTOR has permission toeco ..o- . buildings on .� .�..�.��.Q. .. ... ..�t Rough to be occupied as..APA;�.S ..Xse.f5r �... ..d d, . . Chimney ........ ..... ........ ........... Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in PLUMBING INSPECTOR this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Rough Buildings in the Town of North Andover. Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS CONSTR TION STARTS Service 47 Final • BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous 'lace on the Premises ® FIRE DEPT. Do Not Remove e Burner No Lathing to Be Done Until. inspected and Aproyod fey Smoke Det. Building Inspectar <\ .( 0107 Q!!�P �ddi►tttlhlUt�ltlf u! llttl»;��Idiu,�lrtt,� arnre Ll.e only bepddrI rlf of PutUc Wety Permit No. bOARb OF FIRE hlINIENtION REGULATIONS 527 CMR 12:00 occupancy ree Choc`? X0 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code,527 CMR 12:oo (PLEASE PRINT IN INk OR TYPE ALL INEORMAtION) Date V/2 V 1 City or town 0(_.,_.�Q The Undersigned applies for a perm(t to perform the electrical work described below. To the !c sector of Wires: LbcatW (Street & Number) _;P a / .do„ -rf®I Owner or Tenant A VQ ✓a ,c Owner's Address N.E Is this permit In conjunctlon with a building permit: / Yes No Check Appropriate Box' Purpose of Building _S%nJ o/e, y r%c,c/ -f- `�,'A/q Utility Authorization No. Extorting Sewlce Amps / Volts Overhead ❑ Undgrd ❑ N-j. of Meters New Service Amps 1 Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampaclty e Location and Nature of Proposed Electrical Work `� "ti D cc.-+7 j No.of Lighting Outlets TOTAL No.of Hot Tubs Above n- No.of Transformers KVA No.of Lighting Fixtures Swimming Pool Rmd. 1:1rnd. ❑ Generators KVA No. o Emergency ig ling No.of Rec tacle Outlets No.of Oil Burners Batter: Units No. of Switch Outlets No.of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Alt Conditioners Tons Initiating Devices No.of Dis IsHe7t" Total No. of Pumps tons KW No.of Sounding Devices. No. of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal ((��'' No.of Dryers Ileatln bevices KW t.nral�� Cnnne:tion E10ther of No. of LNo.of Water Heaters kW Signs Ballasts ow o forge -Wiring No. Hydro Massae Tubs No.of Muton Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusties General Laws 1 have a current Liability Insurance Policy including Completed Operations Coverage or Its substantial equivalent.YESX NO O 1 have submitted valid proof of flame to this office. YES XNO O If VW have checked YES,please Indicate the type of coverage by checking the appropriate box. 'E INSURANCE 23 BOND ❑ OTHER (Please Specify) Eslimaled Value of Electrical Work$ (Expirallon Date) Work (o Start > Inspectlon Dale Requested: Rough 471112 a/P 5 Final Signed under the penalties of perjury: FIRM NAME L • ''t_., /l e �. c 71" J__ 9/C LIC. NO. .Licentlee L e 0-7d-n l / /.`t�7 P � Signature LIC. NO. -a d Address __ y661 .� P a ,✓ �v ,LaO c wi r lr , �G /I/ Bus. Tel. Nn:S'DY All, Tel. No. .OWNER'S INSURANCE WAIVER:I am aware that the licensee Joki hol Itave the Insurance coverage or IIs substantial equivalent as required by Massachusetts .Cenral laws, and that my signature on this parmlt application waives this redulrement.Owner Agent (Please check one) telephone No. PERMIT FEES f6) do (Signature of Owner or AgenU