HomeMy WebLinkAboutMiscellaneous - 224 CARLTON LANE 4/30/2018 / 224 CARLTON LANE \
2101107.A-0203-0000.0 \`
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9 7 3 1 Date.... e�0 1
f NORTi{�
3?°..�``°.,•�,"�o4L TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
o
,SSACHUs� .. ---7
This certifies that ................. . �. .�..... �t�..L. ..............................
has permission to perform ......................... .....rex.......................................
wiring in the building
sr of............. q.6.s.................................................
at........ .................... .North Andover,Mass.
Fee..... 1.®�Lic.No.(?.3.. r.A�. ....... .Wit. .. . ..
• LECTRICAL INSPECTOIt�• i•
Check # Z-
IJ P t.U//1!/lUI1WCQILII U/ 1'10DD0WILIDCLLJ ---- - ---
Permit No.
--
Department of Fore Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /D?b — / b
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his gr her intention to perform the electrical work described below.
Location(Street&Number) ?7 y C 4 r M0 -� � � I✓F,
Owner or TenantV/"C v e Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes � No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps 7—_OZZ
OVolts Overhead ❑ Undgrd X No.of Meters I
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
,
Completion of the following table 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 75 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o Emergency Lighting
rnd. rnd. Batter 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
Ranges No.of Air Cond. Total No.of Alerting Devices
No.of Ran
g Tons
No.of Waste Disposers Heat Pump I.Number Tons KW No. of Self-Contained
P Totals: Detection/Alerting Devices
No. of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other
P g Connection
No.of Dryers Heating Appliances KW SecuriNotof Devilc:or Equivalent
No.of Water No.of -No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNo.of Devices or E uivalent
OTHER:
-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
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 pains andpenalties\ofperjury,that the information on this application is true and complete.
FIRM NAME: t-i C v t c t LIC.NO.: 123►�Y2
Licensee: Signature " LIC.NO.: l 2-S 61%>2
(If applicable,enter " i t"in the lic se num r line.) �11 Bus.Tel.No.:Cab3'R U,. sa�1
Address: q,,001 '#'146 d 4 A=4e�Yt Polis ��' o�sYy Alt.Tel.No.:l�31g18-1ro69�'J
*Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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
Owner/Agent PERMIT FEE: $
Signature Telephone No.
t
OP-
y
r
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
aQ sY•• www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address: qn 0 a S+A6&
City/State/Zip: FA is rsv�iyYhone#: 6'3
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and 1 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. E]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 I Ln Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs
insurance required.]f employees. [No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 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.
lContractors 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: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify nder thepains an enaltie of perjury that the information provided above is true and correct.
Si ature: _,_ Date:
Phone#: l2 3 Z tr 3 )
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#:
Uornmonutea(lh of Ifla-ijaclrueell-iOfliciul fisc 0111y
Np.rintenl o/ ire serviczs Permit'140. 7 �/1
� r/
A'bOARD OF FIRE PREVEj�FION'R5*GULATIONSL.l OccupanEy�Snd Fee Checked
Rev. 11/99] (leave blank) Y—t
APPLICATION FOR PERMIT TO PERFORM/[ ELECTRICAL WORK
All work to be performed in accordance with the Mussachusetts Electrical COdc(NIEC),527 CI11R 12.00
(PLEASE PRINT IN INK OR TYPE:ILL INFORMA7_10N) Datc: 7�a�1 bs
City or '1'own of: _ ' iY(dpy� V To the Inspector of JY'ires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Locative (Street R `lumber) o2oZ �
Owner or Tenant b7 V t G (A(� ��
Telephone i\o.
Owner's Address
Is this permit in conjunction with a building permit? Yes E] No
❑ (Check Appropriate Box)
1'ur pose of Building, Utility Authorizaliun No.
Existing Service rinrps ! Volts Overhead
❑ Undgrd ❑ No. of deters.
New Service Anips, / fulls Overhead
❑ UnJgrd ❑ No oClleters:
Number of Feeders and Ampacity
Location and Nature of Proposet' Electrical Work: Qr)U ;
�- �llyl l Sl'(. 't Cn Civ( (4..�.
U
Com telion of the folluivin¢table may be n•nived by dee lits cctor o! vires_
No.of Recessed Fixtures No.of Ccil_Susp.(Paddle)Fans No.of "Total
Transformers KVA
No. of Lighting Ou11cIs ESivininiing
Ilot"Tubs Generators IiVA
No. of Lighting Fixtures Pool Above ❑ ln- o.o mergen1, rg rung
onrd. end- ❑ BatteryUnits
No, of Receptacle Outlets. ( � No.of Oil Burners FIRE ALARA \o.of Zones
No.of Switches t v No.of Gas Burners No.of Detection and
�-� Iuitiatina Devices
i\'v.otRanges No.of Air Cond. Tota!
Tons No.of Alerting Devices
\'o.of Waste Disposers / Heat Pump Number "tons KAY No.of elf-Contained
Totals: — Detection/Alerting Devices
No.of Dislrirashers ( Space/Airea Healing K%V Local ❑ ltihunicipal
Connection Other
No. of Dryers Heating Appliances Key Security Systems:
No.of Yater No.oI be or]Equivalent
;�DY t\o.of No.of Data Wirina-
hlcatcis Sins Ballasts
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of tllotors Total HP 1'elecommunicatrons �tiirittg:
OTHER:
No.0 of llevices or E uivalent
Attach additional detail ifdesired,or as requiredbr the Inspector of Wires.
1NSUIZ4.NCE COZ-EIL41GE: 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: INS Rj%NCE ❑ BOND ❑ O.17IL-R ❑ (Specify:)
.
Estimated Value of Electrical Work: (When required by municipal policy.) (Esptration Date)
',Voik to Start: )nspeciions to be requested in accordance with NIEC Rule 10,and upon completion.
I ecrtif•, ttnde•r the pains nerd penalties of peijur),that the inforuration oil this altplicatioll is trite and complete.
FIIL•11 NAME:
LIC.NO.:
Licensee: RI C{2 Signature_�� LIC.iv O.:
(If applicable. eider "'exempt"ire[lie licensemmnberlitre.)
` Address: C V (LI Ont Q c�_ 5� AA (,y-"S A41L Q PQ& Bus.Tel.\o.:
OWNER'S INS UIL-\; Cl;lVA1VER: I am aitiare that t ie Liceiuee docs not have thAlt.Tel.No.: E/ 1e liability insurance cov-eraae normally
required by law. B\ my signature below,I hereby waive this requirement. I am the(check one)❑owitcr El on ncr s a��ent.
Owner/Agent
Signature Telephone No. Pj:Rt111T FEL: $ c
Location ` r �t + , • f _�
No. " r_' Date r -
MORTh TOWN OF NORTH ANDOVER
9 Certificate of Occupancy $
+ FIG& ; # Building/Frame Permit Fee $
s�CMU rtc�' Foundation Permit Fee $
Other Permit Fee $
,�gwer Connection Fee $
ater Connection Fee $
AUG
99 � TOTAL
Building Inspector
H t }
�J. L'vrLF �
68�
Div. Public Works
PERMIT NO. , 333 APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
SS LOT NO. 7� 2 RECORD OF OWNERSHIP DATE p O PA�f
ZONEI SUB DIV. LOT NO. Y,C-�
OCATION G � S PURPOSE OF BUILDING �rUD�
OWNER'S NAME���,� i C` A p C O^�— NO. OF STORIES / SIZE _') // C•• ��
OWNER'S ADDRESS 12A4 —CaAI.maj I �,NL.t_'• BASEMENT OR SLAB SL,q6 — �/ Cel
e
ARCHITECT'S NAME �JU�U !l L C SIZE OF FLOOR TIMBERS 1ST y jC) 2ND /.� 3RD
BUILDER'S NAME /d SPAN
/E/`
DISTANCE TO NEAREST BUILDING • �U DIMENSIONS OF SILLS (�
DISTANCE FROM STREET i POSTS /J!�n �/)/►�/ �07 ^X�, � /9 /
DISTANCE FROM LOT LINES-SIDES �`'� MIN REAR /a� �NI� GIRDERS ;,!?rf�
AREA OF LOT 41,112
12 5r v FRONTAGE V HEIGHT OF FOUNDATION.2 9&j6- 664,D ICKNESS /v
IS BUILDING NEW 1 .�10 SIZE OF FOOTING �C) /Il1s (aO m CX
IS BUILDING ADDITION O MATERIAL OF CHIMNEY �11/1
IS BUILDING ALTERATION hlf,£ nC� �C`�u�L IS BUILDING ON SOLID OR FILLED LAND /
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE JL IS BUILDING CONNECTED TO TOWN WATER y�s
BOARD OF APPEALS ACTION, IF ANY �DN� (C• IS BUILDING CONNECTED TO TOWN SEWER MO
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES EST. BLDG. COST 17, '?�Q
PAGE 1 FILL OUT SECTIONS 1 - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM
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 APPRR�OVED BY BUILDING INSPECTOR
VD%FI�ED (P
BOARD OF HEALTH
RE OF 6V7 OR AUTHORIZED AGENT
OWNER TEL.
r--- CONTR.TEL.#
FEE CONTR.LIC.#
PLANNING BOARD
PERMIT GRANTED Q
I 19
BOARD OF SELECTMEN
BUILDING INSPECTOR
BUILDING RECORD
1 OCCUPANCY 12
SINGLE FAMILY SiORIEs I 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 I 8 INTERIOR FINISH
CONCRETE B 1 2 13
CONCRETE BL K. PINE
BRICK OR STONE HARDW D
PIERS PLASTER
_ DRY WALL
LIN FIN.
3 BASEMEyT
AREA FULL FIN. B M TAREA _
7, /_ 1/ FIN. ATTIC AREA _
NO B M FIRE PLACES
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS X I B 1 2 3
DROP SIDING CONCRETE ��_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDW D _
ASBESTOS SIDING _ COMIACN X
VERT. SIDING A&Rtl.TILE _
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY ATTIC STIRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR Iii POOR
EQUATE
ADNONE
5 ROOF 10 PLUMBING
GABLE I HIP A BATH 13 FIX.) Ti
GAMBREL MANSARD TOILET RM. 12 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY _
WOOD SHINGES KITCHEN SINK TX
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIP-LESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. &.COLS. STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS AIR CONDITIONING R
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T O 2nd _ ELECTRIC
1st 5' 13rd I NO HEATING
h
INAL
� N -r`19r`
6.. OL
Andover
Tqojlv V A of N 333
o.
DRIVEWAY ENTRY PERMIT - �....
A
C MI MEWICK
r er, Mass., A �S � _199 )
- �V
oR QP
SS
BOARD OF HEALTH
PE11M1 LD
THIS CERTIFIES THAT......
...............N........................................................................
W o y y¢ d����� // = BUILDING INSPECTOR
haspermission to erect ..........o ........ buildings on .......................................h ............. Rough
to be occupied as............tNC ..,L, J?,,/S(!N. ....4.�4= 1............................... 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
UNLESS CONSTRUCTI Rough N S RTS Service
Final
BUILDI�6iPE oR GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Final
Display in a Conspicuous Place on the Premises
Do Not Remove Burner FIRE DEPT.
No Lathing to Be Done Until Inspected and Approved by Smoke Det.
Building Inspector
FORM U
TOWN OF NORTH ANDOVER
LOT RELEASE FORM
Y
SUBDIVISION
ASSESSORS MAP
H
SUBDIVISION LOT(S)
PERMANENT ADDR S ASS�NED BY D.P.W. i,
STREET
APPLICANTp C Cow PHONE
DATE OF APPLICATION
00 Y it 9�
TOWN USE BELOW THIS LINE
PLANNING BOARD
hd DATE APPROVED
TOWN PL NER DATE REJECTED
CONSERVATION .COT ISSION � yy
DATE APPROVED I
CONSER ATION ADMI DATE REJECTED
BOARD OF HEALTH
DATE APPROVED 7
HEALhr SANITARIAN DATE REJECTED
zr 7-o 6 cis .4
DEPARTMENT OF PUBLIC WORKS
DRIVEWAY PERMIT L / I, -
SEWER/WATER CONNECTIONS
FIRE DEPT. c
RECEIVED BY BUILDING INSPECTION
DATE
This form shall be signed by the agents of the Planning and Health Boards,
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.
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STUDY F &ATT 4 rl a�• 9�
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Town of North Andover
BUILDING DEPARTMENT
Homeowner License Exemption
(Please print)
DATE -7Zz ( 91
JOB LOCATION 22 rAKL-Mf4
Number Street Address Section of town h
HOMEOWNER''-Pu0-Liga, 5 — Z O Z — 6 I
Name ome Phone Work Phone
PRESENT MAILING ADDRESS e M
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
ethat 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 aid/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
Note : Three family dwellings 35 , 000 cubic feet , or larger , will be
required to comply with State Building Code Section 127 . 0 , Construction
Control .
47,
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Date.. .......................
r10RT1{
`° '•�"° TOWN OF NORTH ANDOVER
A PERMIT FOR WIRING
qL
SACMUSEt
This certifies that .... ............................................
has permission to perform sr. ...........................................
wiring in the building of `.
r ..
at ...... .North Andover,Mass..
Fea 3. ..... Lic.No -�:-.......-............
ELECTRICALI pECTOR
Check #`;6
-- Uornnwnwea(th of /1Ias-4achuielb Oflicial fisc Only
IPA
CJeParinren�o� fire Services Permit No"
BOARD OF FIRE PREVENTION REGULATIONS ( Occupancy and Fee Checked ', Ear
Rev. 11/99) (leave blank) --
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordancc with the Massachusetts Electrical Code('•IEC),527 CAIR 12.00
(PLEASE PRINT IiV INK OR TYPE-ALL ItVrORjVL-1 TION) Dale: 71a�l
City bJl-
or 'Town of: �I/< gl'(QjOVy To the Inspector-of bYir-es:
By this application the undersigned gives notice of}its or her intention to perform the electrical work described belo.v-
Location (S(reet & Number) 2Q � `f l
Owner or Tenant �!l( G w�ct
Owner's Address Telephone iVo.
Is this permit in conjunctiutz .vith a building permit? Yes ❑ No
❑ (Check Appropriate Box)
I'urpusc of Building Utilit}'t\uthurizativn�Iv.
r
Existing Service .\nips 1 trolls Overhead
❑ Urrdbrd ❑
No.of;\leters'-
t`leiti•Service Anips / Volts Overhead
❑ Urrdgrd ❑ No.of Meters:
Number of Feeders and Ampacit_v
Location and Nature of Proposer'Electrical 1York: Qyx�
m l SK- t b CW((V
Cone lesion o%the olLmin�
No.of Recessed Fixtures [able gray Ge n nivcrf by the Lis cctor o%Wires_
No.o[Ceil_Susp.(Paddle)Fans No.o[ 'Total
Transformers KVA
No. of Lighting Outlets No.of Ilut"Tubs Generators KVA
No_of Lighting Fixtures Sti.immin�Pool Above ❑ ln- ❑ o.o mergency rg rttrrg
arrrd. rnd. Battle Units
No.of Receptacle Outlets. �' No.of Oil Burners
FIRE AI.ARb•IS \'o.of Zones
t; No.of Switches �O No.of Gas Burners 1N0.of Detection and
Iuitiatina Devices
No.of Ranges No.of Air Cond. Total
Tons No.of Alerting Devices
of Waste Disposers / Heat Yump rNumber Tons K1Y No.of Seli-Contained
Totals: — DetectiovdAlertina Devices
--------------
r No.of Dish)'sashers SpacelArea Heating K1V Local ❑ ryl-urricipal
Connection Other
No.of DryersHeating Appliances KWSecurity Systems: -
t No. of WaterNo-of Devices or Equivalent
.C,,, No.o[ No.of
Heaters Data W.rino:
Signs Ballasts ,
No.o[Devices or E uivalefft
No.Hydromassage Bathtubs No.of Motors Total I PTelecommunications 11'iring:
. OTHER:
No-of Devices or Eq
uivalent
Attach additional detail if desired,or as required by the hrspec[or of Wires_
INSUR-SCE COI-EIL\GE' 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 issuino office.
CHECK O WJE: iN'S�iZ\NCE ❑ BOND ❑ UI•IIER ❑ (Specify:)
SA Ir-
Estimated Value of Electrical Work: (When required by municipal polio-") (Expiration Date)
\cork to Start: Inspections to be requested in accordance.with NIEC Rule 10,and upon completion.
I certifj•, mide•r the pains nerd penalties of pe'tjrrry,that the infor•nration all this application is true acrd complete.
F11L•11 NAME:
Licensee: P10? U"� C.g ve( ( Signatures LIC.\O.
it%applicable,enter- 'erenrpt'•ire the license number line.)
Address:_ G�((l S( }n - rl SCI AAI )q/f-- Q(C�'Q(O
Bus.Tel.i1o.: a 5
r Alt.Tel.No.: 8
'�011'i`IER'S 1tNSUIZA! CE 1YAIVER: I am a,�are that t re Licenses does not have the liability insurance coverage normally
"•quircd by la..•" BY my signature below,I hereby%vaive this requirement. 1 am the(check one)❑Owncr ❑ o..'ner-s a�Ient.
ucr/Abcnt
'Ature Telephone No. P-Rtl11T F--CE- S 3a —
1
Date'
J o 0
< 7'0
,
• • ' � OWN
F N
ORTM
'sSACM�sss PERMIt FOR P ANOO
�ER
This certifies ��Me1NG
that • ,Gtr
has PermisSio
+� Plurnbing in n to
Perform
at. .2. y. buildin {\ • S
gs of _
Fee �p y. kit.
rtY.
Che .Lie. NO• . c , N
ek ;9 � 3 C� orth Andove r M
I UM
•�'• • ..�_� ass.
ff � � PLBI NG N ,E� • • • • •
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Type or print)
NORTH ANDOVER,MASSACHUSETTS
Date -7
Building Location (� L/� ` ��� Owners Name I ' w/`/T ` e Permit#
Amount ?��-
Type of Occupancy
New Renovation Replacement ❑ Plans Submitted Yes No
FIXTURES
BASEU f
i
MR"
M ROCU?
2M]HIOCIR
4IH)HIDCR
$IH FIDCR
6I ;FD
7M i4 BM
SII3 FWM
(Print or type) Check one: Certificate
Installing Company Name m,1G,4 ❑ Corp.
Address f'4Mjf1hc44 iqlor Partner.
3 4�q El
Business TelepTone Firm/Co.
Name of Licensed Plumber.
Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box:
Liability insurance policy Other type of indemnity 0 Bond E
Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above
three insurance
Signature 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 Massa sets tate m ing C e and Chapter 142 of the General Laws.
By: Signa u o is nseriumoer
Type of Plumbing License
Title A-�O,3 14 C
City/TownicL"r'i se umBer Master Journeyman (�-
APPROVED(OFFICE USE ONLY
1
r �/
Date. .. .. .. .. . ....
a
M
# 40RrN TOWN OF NORTH ANDOVER 9
L
p m
PERMIT FOR GAS INSTALLATIONS
ui
SSACMUSEt�
. .
This certifies that . . . f.+. .'. .:: `` ` `". . . • • . • • •' . . . . . . •
has permission for gas installation . . . . . .�.
in the buildings of . .: . .'. . ^. .': .�%�.. . . . . . . . . . . . . . . . . . . . . . . • •
at '... . . . . . . . . . .. North Andover, Mass.
Fee:.: . . . . . . Lic. No. . . .... . . . . . . . ... .... . . . . .
GAS INSPECTOR
WHITE:Applicant CANARY:Building Dept. PINK:Treasurer
MASSACHUSETTS UNIFORM APPLICATION FOR, PERMIT TO DO GASFITTING
(Print or Type) �•
NORTH ANDOVER Mass. Date a
/
� .� � •' • t§uildin 9 Location �5� ���L�it/ �it/,� Permit # 11311007
ers Name
New
Ow
s '� Renovation Replacement P
.r
_ D P �Plans Submitted D
FIXTUR=,-z
� W
3L Z tL •
V1
ttf t7C 0) CC p jLU 0
N =
W tu V r x
sr t- C - z = O r CC
tu
or W
Z m N h' rz O O O x F—
ft W 1 W W 0 � 0. a W 4
0 W x W
W z: O y W
_ ac oc D
t7 F� 2 h Z `. W W C 0U. I..
Y W < M .. f. y. N m "' O 2 W O N Y
a 'x O Wi' ter. Q tC7 V y a 00. ►W- O
SUB,-MSNIT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
t+
4TH FLOOR
STH FLOOR
6TH FLOOR
TTH FLOOR
STH FLOOR
(Print or Type) Check one: Certificate
Installing Company.',Name ANDOVER PLBG. & HTG. CO. , INC® Corp. 2122
Address 5731 SO. UNION STREET Partner.
LAWRENCE , MA. 01843 Firm/Co.
Business Telephone: 978 685-8383
Namee,,of,License�d4riPK(mPr or Gas Fitter GEORGE ILAROSF
Insurance C6Verage. Indicate the type of insurance coverage by checking the
appropriate box:
Liability insurance policy Ef Other type of indemnity Q Bond �(
1 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.
Signature of owner/agent of property Owner 17 Agent
1 1 hereby certify that aU of the deuUa and ittfotmation I have submitted (or entered)in above apptintion ate true and accurate to the best of my
lowtcdge and that all plumbing worts and InsaUations performed under Permit issued for this appliotion will-0e in compUsnoo with all pertinent
visions of the Massachusetts Slate Car Cade and Chapter 142 of the General Laws. '•• .
YPE LICENSE:
Plumber
Gasfitter' Signature of Licensed
^gown: Master Plumber or Gasfitter
Journeyman 9983
'ED (OFFICE USE ONLY) License -Number
Date.. :. .
T� 4047
e� No o7h 1h TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
,SSACIIUS��
This certifies that . -0' A -9: .- .�. . . . . . . . . . . . . . . . . .
has permission to perform . ., -= � • %. .! , , , , , , , .,
plumbing in the buildings of/'�.Q V . . . . . . . . . . . . . . . . . . . g
at. OA:;? . . . . . . . .. North Andover, Mass.
PLUMBING INSPt(
i
i
WHITE: Applicant CANARY: Building Dept. PINK:Treasurer
.. •••,•..•.. a—i"s i.a usrsr'vr11A AYr'LJVi' iw" r u" rrcrtnna e a v 16—A •-�
-. (rrini at Iyp4j e l
NORTIJ ANDOVERDate_ J1 � ip 9?
_. � . Mast. ..
Budding /�� /� -Permit arY
Location 4/� ,
owner's
Na %G f�
� Na/me
New Cl Renovation ❑ neplacement Q Plana Submitted: Yea Cl No ❑
FIXTURES
Z
ss < .
be W
M0 10
= ea i iR A1 w s O = s 0
• el .. IL
V = O ~ ~ t X ! ~ A 1 = K o a.
s
4t .4 >t�u. > � o M M : o $ ! x ai o v "
ti NA A ■ H el A D A -we / tY M
IUB—fffMT.
fAffMfMT y
1-1-
IST FLOOR
SM0 FLOOR
D
SAO FLOOR
4TH FLOOR
ITH FLOOR
4TH FLOOR
1TH FLOOR
•TH FLOOR
Check one: Cettklcate
Installing Company Name ANDOVER PLG . & HEATING CO. , INC. p'6otp. 2 12 2
Address 573 1 /? SO_ I1N I ON ST ❑Parinetship
LAWRENCE , MA. 01843 ❑Firm/Co.
Duslneis Telephone 508 685-8383
Nerve of Licensed Plumber GEORGE LAROSE
INSURANCE COVERAGE: ecx OW
I have a current Ilabilty Insurance policy or Its Substantial equWenL Yea 19' No ❑
If you have checked In, please Indica(e the type co"ierage by checking the appropriate box
A Itabrlly Insurance policy Other type d kidemnfty ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee dost rn4t have the Insurance coverage required by
CivarAer 142 c4 Ithe Masa. General Laws, and that my algnalme on this permit application waives this requirement.
Check one:
owner ❑ Agent C1nalurs o Gomm a Omar s ens
I haiaby csrtlty that aA of the doWs and Intormallon I have subrMlad bt entered in abort appflcatbn us twe and acauale to the best or my
knowtedpe and that as plumbing "k and Inalallallona Wofnwd under the p*m-A Isswd rot this application will be in compRancs with aA
pertinent provisions of the A.Iassaehuseth State Plumbing Cods and Chaplet 112 of th4 General Ums.
Dy
Signattxe
TNte
Lkens. wmbw 9983
city/Town
Type of P%"Wng license: Maslen ❑
N'('1"AD it !K,E USE 011t-Y) Joutneyman ❑
Location j rnA fZ l ZU,
No. S� Date to ay p
f
NORT1y TOWN OF NORTH ANDOVER
? �. • O
FO. �
9
Certificate of Occupancy $
Building/Frame/Frame Permit Fee $
J�cMust 9
Foundation Permit Fee $
Other Permit Fee $
► TOTAL $ 040'0
r4
Check # • ` .�
i
G3 j b
✓Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �1�1
1UNecNae the rn
BUILDING PERMIT NUMBER: S DATE ISSUED: Z/6X
0
SIGNATURE:
Building Commissioner/I or of Buildings Date z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
' - -�
(`� t Map Number Parcel Number
1.3 Zon ng Information: 1.4 Property Dimensions:
Zonin District Proposed Use Lot Area Frotrta R
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
",red Provide Required Provided Required Provided v
l.7 Water S iy M.G L.C.40. 34) 1.3. Flood Zone information: 1.8 Sewerago Disposal System:
Zone Outside Flood Zone Manicipat ❑ On Site Disposal Sys
Public private ❑ i l; i. i i,;
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
.A w�
N e(Print) v Address for Service
2- '-1.312
Signature Telephone
2.2 Owner of Record:
0
Name Print Address for Service: z
r
M
Si ature Telephone 90
S CTION 3-CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supery or. k
License Number ";n
Address k l2,� D:
Expiration Date
Signature VTelephone
3.2 Registered Home Improvement Contractor Not Applicable ❑
Company Name
Registration Number r'
n
Address ( I ! b& J
-�✓r�`��
Expiration(Date G)
Sig tura: Telephone
SECTION 4-WORKERS COMPENSATION(N.G.L C 152 § 25c(6)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes...... No.......�7
SECTION 5 Description of Pr sed Work check aH appUcalik
New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition
Accessory Bldg. ❑ Demolition 0 Other ❑ Specify
Brief Description of Proposed Work: /
44
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY
Completed by permit applicant
1. Building
(a) Building Permit Fee
Multiplier
2 Electrical
------ ` (b) Estimated Total Cost of
Construction
3 Plumbing Building Permit fee(a)x (b)
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5 ) D-i/ Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, L as Owner/Authorized Agent of subject property
Hereby authorize
to act on
behalf,iall n fifers relative to work au o ed by this building permit application.
_ lj ( tLlo"�
nature of Owrrer Date
SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION
1, , "" �` '
property as Owner/Authorized Agent of subject
�
Hereby declare that the statements and information on the foregoing application are Lyre and accurate,to the best of my knowledge
and belief
rlV� i
int e
Si ature of Owner/.A en Date
NO. OF STORIES SIZE t
BASEMENT OR SLAB ( ,� &',o LA
SIZE OF FLOOR TIIvIBIRSii' 2ND 3KD
SPAN t
DMIENSIONS OF SILLS
DIMENSIONS OF POSTS r
DUVIENSIONS OF GIPMERS
HEIGHT OF FOUNDATION �'4 THICKNESS ( p' I
SIZE OF FOOTING X S
MATERIAL OF CHDANEY
1S BUILDING ON SOLID OR FILLED LAND L o
IS BUILDING CONNECTED TO NATURAL GAS LINE
DI
The Commonwealth of Massachusetts
Department of Indusbial Accidents
ORlce of Inveogatlona
Boston, Mass. 02111
WorkersCompo=Um Insurance ArFdavt
Herne Pleese Print
Locdon: 22`-t
� N�..`1.`. I��dttiti..... Pttame * ��� -��3•
I am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capaft
I am an employer providing workers'compensation for my employees working on this job.
Address
Cft 2-� �. ,�_...._., �� Phone!: �,A y-.A
Inssuratcs.Co. 1_�-s C,v PokV S /� v �-C- ( 2,'� (��
Comoanv narrte:
Address
Cft Phone t
Irtflstrr'arlofa Co. PO&W a
FAVO to sacro coverapa m re*dm d ardor 3edon 23A or MGL 152 can lead to dukromOm d aknk panadlss d.a fina up to$1,300.00
andlor om yens'lWbarmant.w.vAd.n.cbA4soadasJn h@f=dA S l WDRK ORDERAndA f m d,(SlW M-aAq apddt ma I
wxbratond that a copy of this ddwr ant may be fonwnded to the Ofrloa of Invsstipatlons d the DIA for coveraps vwft don.
I db hereby pains and olP@dwy Md Wxft provkW @bow h bus and co►rrc�
signature Date l� D
�;T
Print name - au Phone I>!
Offldal use only do not writs in this area to be campWW by dty or town dfidal•
CRY or Town Pant�itr amino
❑ BuHdMA Dept
[]Check X lmmedlafa msponse/s requ*W ❑ Lkenft Bofd/d
❑ Selectmen's Ofte
Contact person: Phone trr ❑ l-leE DOP&* nt
❑ OUW
odJt,-Q
4 y-
FORM U - LOT RELEASE FORM v5- 1 0
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
APPLICANT FILLS OUT THIS SECTION
APPLICANT �u.� PHONE
LOCATION: Assessors Map Number 3 tZ PARCEL �.
,� _Q___U 3
SUBDIVISION LOT (S)
STREET C!L�IST. NUMBER_Z-2,k
OFFICIAL USE ONL
N 1 OF-TO GENTS:
C NSERVATION ADMINISTRATOR
DATE APPROVED
DATE REJECTED
COMMENT
TOWN PLANNER DATE APPROVED
DATE REJECTED
COMMENTS
FOD IINSPLECTbR-
POR-HEAL H DATE APPROVED
k —BATE�REJECTED
U /
EP C DATE APPROVED
DATE REJECTED
COMMENTSk, r
vrr U`17 0
PUBLIC WORKS-SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR DATE
RevhW 97 Jm
NORTH
Town of _ Andover
dOw
SOO0 lq E o dover, Mass.,
COCMICMEWICK
ADRATED
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
THIS CERTIFIES THAT R ....... ...Am-v..................�......... Q �..�
. ...............................................
BUILDING INSPECTOR
........ . . ...
Foundation
has permission to erectlip.�.X.I...T....�.......... buildings on ..7da y.......0A. ,tl. �!N...... .A 'f• Roust,
to be occupied as... p tt.!�y r�a,.....I...,�c.1. a' /ef 1 ' F X p. W/o) 04VA) WC Chimney
.................... . .................................... ...............................................................
provided that the person accepting this permit shall in every respect conform to 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. 107*4/A 03 PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Roush
PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTRUCTION STARTS ELECTRICAL INSPEC"POR
C "g
.......... ,..... ... ....... .................. .... .... ....................... Service
% BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Display in a Conspicuous Place on the Premises — Do Not Remove Fina
No Lathing or Dry Wall To BeDone FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
J
♦♦♦`\' OUTLINE O-17L'CK C APOVI:>
J.
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♦♦ A
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FLP:FR
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