Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 234 BRENTWOOD CIRCLE 4/30/2018 (6)
a 2348RENTWOODCIRCLE 2101064.0.0052-0000.0 1 � Ap t Date .�.�/� ............. 7' TOWN OF NORTH ANDOVER PERMIT FOR WIRING S`YAC U This certifies that A,��c pill 4- C- Aj �P- k) 4z has permission to performj ....................... .......................................................... wiringin the building of............................................................................................................... atL , North AndoverMass. FeeLie.No. ................. ...................... .............................................................. L*E'*C-T' '-'I'C-A'L-INSPECTOR--- ...... R Check I I Official Use only Permit No. aCJelarsr�metst o�.yxre.3snrire3 Occupancy and Fce'Checked BOARD OF FIRE PREVENTION REGULATIONS ev.1/071tjai ehlank ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to W performed in accordance with the Massachusetts Electrical.Code(MEG),S27 CMR 12.00 (PLEASE PRINTIN INK OR TYPE ALL INFOR1l 77OA9 Date:(= �------ City or Town of'. 1 )o � AALhTv the Inmpector of}fires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 2 3 c i?t'AaIND t 1 Ow ✓/ ner'or Tenant (^/I C aA� V f M_ _ Telephone No.�7l a' �l� Owner's Address —" .,cwt Is this permit in conjunction with a building permit? Yes filo a (Check Appropriate Boz) Purpose of Buildings - Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Metiers New Service Amps / Volts Overhead 0 Uudgrd[] No,of Meters Number of Feeders and Ampacity F Location and Nature of Proposed Electrical Work: �,,Q S'�jvl� �3lal �I? Ci4Ai1/�r t�` Completion o the ollowfn table be waived b the Ins for o Wires. e.pf Total No.of Recessed Luminalres No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above n- o.o mergency Lighting No.of Luminaires Swimming Pool ❑ d, ❑ Butte Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o,.o et cting D!and Initiati Devices Tolm, No.of Ranges No.of Air gond. Tons Nsl of Alerting Devices No.of Waste Disposers ea obP ul ber Tons o.o e f Conti tied Detection/Alerting Devices Municipal No.of Dishwashers Space/Area Heating KW kcal❑Connection � Other \ security ystems:* No.of Dryers Heating Appliances ICVY No.of Devices or Equivalent No—of Water KW No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent \ Teleeamrtromcations 'ringg: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or uiva-tent OTHER: Attach additional detail if deslred,or as required by the Inspector of Wires. Estimated Value of Electrical Work: ()U~ (When required by municipal policy) Work to Sdar � ea 11 Inspections to be requested in accordance with MEC Rote 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 irssserano including"completed operation"rnverage 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 9 BOND [I OTHER ❑ (Specify:) f certify,under the pains and ties of perjury,that the information on this application k true and complete. FIRM NAME: ri s Electrical Service and CGor,trols LLC _ uc.No1.5650a Nor and Michaud = y� �_ ',NO.: 4 Licensee: Signatu.'�_ _ _ _"••_ ' {If applicable,enter"exempt"in the license number line.) Bus.Tet.No.: q 9 8 6870544 Address: 290 Broadvav suite 117 Methuen ma 01844 AlL TeJ.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. 1 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/AgentPER1VfIT FEE:$ j-- Signature Telephone No. _ it t h 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 Legibly Name(Business/Organization/Individual): / %j(�1 j �l(= j�/�/� / <2,K I ,(17(Jb Address: 21(2 City/State/Zip: JL:"Ea I 61 U y Phone#: Areyon employer?Check the appropriate box: Type of project(required): 1. 1 am am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction i employees(full and/or part-time).* have hired the sub contractors 2.❑ I am a sole proprietor.or partner- listed on the attached sheet.$ [J Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor in an capacity. workers'comp.insurance. Y9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[:]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' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t14omeowners who submit this affi davit indi cating they are doing all work and then hire outside contractors must submit anew 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.#: by C 1 0 Expiration Date: 1 Job Site Address: 03'1 B&6A-97u6Qb CAP City/State/Zip oil 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 I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. i F Si ature: Date: } Phone#: l � I i Official use only. Do not write in this area,to be completed by city or town official. I City or Town: Permit/License# Issuing.Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person, Phone-#: t 1 } ,90MMONWEALTH OF MASSACHUSETT `� o o • o o SOAR Of ELETEI(.I ANS t°SSUES THE.. L LOW!NG 1 CENSE A� RECz15TERED MASTER E-LECIRICTAN Nf 1�1 P'N0 D M I CHAUD iz t ij 'W 13 S Ili RD " 12 {t 6 1\ tJ :f J NfINAM NH 030 87 22 i'S z �56507/31./::?:6>. . 36166 COMMONWEALTH OF MASSACH S E1 ECTRIulANS ISSUES ,HE FOLLOWING 'LICENSE AS A REG JOURNEYMAN ELECTRI,CIl W . NOR .ND D MI CHAU>j '13 'S I MSON:'RD ;W lNbNAM NH .03087-22Tj j 3459+ E 07/31/16 3667 . 6 J . Date.......n"�...-.�:.......y........ &OR TPI `3a; oL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING `rSACHUs� This certifies that ....... /% ,Z/uv� ....................................................................... has permission to perform ..l?.�.....14........<��0.. ............�1! ................ wiring in the building of............. ? �x..!�i /.��rZ....................................................... �1 ...AEiCTR�I�CAZL Nrth Andover,Mass. Fee.-S .............Lic.No. ..�.. Z..................... ....... ..... ' ......... INSPECTOR Check# D , X27 i` ti amnentweaa o/!I/aur {auaetCs Official Use Only �Jeparfmote�o�}!re Permit No. 12, -,2 5—' Jarvicea BOARD OF FIRE PREVENTION REGULATIONS eev. 1107]Y–(leand a Checked (cave bteiilc APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in aaordeaoe with the Massachusetts Electrical Code P 527 CMR 12.00 (PLEASE PRINT N INK OR TYPE ALL I FORiYlATION) City or Town off. A? A:vV e Imo- To the Inspector of Wires: By this application the undersigned Vives of his or her intention to perform the electrical work described below. Location(Street a Number) et--t W d ped (2 1 ilC J4- Owner or Tenant C-kkW 41kTJ j`A 1Vi AW1 Telephone No, Owner's Address 5 'P.— Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building U Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 001 lit) ,5e-&,1 i a j-cr A& COMPlefion Of the ollowin table may be vah-ed by the or q f Wires, No.of Ra essed Luminaires Na of Cell.-Susp.(Paddle)Fans o.of Total Transformers KVA No.of Luminaire Outlets No.of Slot Tubs Generators KVA In- ofti Na of Luminaires Swimming Pool nd Above ❑ rad. ❑ Batfe Uni Emergenty ng No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners °'austection an Initiating Devices Tol No,of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Pump Number _ons __ o. on T.-Ma 'Iotahr: _ Detection/Alerting Devices ni No.of Dishwashers Space/Area Beating KW Local❑ u Connection crPal ❑ Otter, No.of Dryers Bleating Appliances KW Pia of ems:vices or Equivalent No.o KW o+o a o Data M%*: Heaters Signs Ballasts No.of Devices or EquMflent No.hydromassage Bathtub No.of Motors 'Total HP ecommun ons r Na of Devices or Equivalent OTHER: Attach additional detall if desired,or as required by the Inspector of K es, Estimated Value of.Bi• ical Work: ��t�- (When required by municipal policy.) Work to Start: K /q 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 )0 BOND ❑ OTHER ❑ (Specify:) I c rdtjy,stndw the pdtts and penalties of perjury,that the iafotmadon on this appJkaUon is true and complete. ��� FIRM NAME:qT'AT El. .e:T0. _i,i Nt EL 't.A— t�N i✓ LIC.NO.:�7_La Licensee: D V%�X-,V �• :Z A w N 4 7—ti Signature )• LIC.NO.: q5-0 ({japplicable,enter'exempt"in the license number lint,) Bus.Tel.No..Ct)11 61912- h 3S Address: /it1 c�5u.v �i lLf�A , t'1 �-'T14 Uf tom', �`7 U'�tt`t Alt.Tel.No.':(Mg.R1i-?is V *Per M.G.L.e.147,s.57»61,security work requires Department of Public Safety"S"License: Lie.No. OWNEWS 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)D owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE.$ f �Gu� ��G //-/z_/Lj c� Fold,Then Detach AbapM Peelorabona TH OF ISS THE FOLLOl�1 CEN " ELECTRICI 47 9 ROCPI. H z (� IES Ot844-2�b 4 ! � x b 26 Fold,rm Deteah Along AM PeAoratbne * - ' ISSUESfOLLt}kltNG' SEED LECTRICI :; LIME ELEtICAL INC" 110 J S7 ,> 640 " STATE-2 OP ID:AA oRal~ CERTIFICATE OF LIABILITY INSURANCE DATDDIYYYY) 08/19114 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 781-914-1000 NAME: Cheri Rossetti TGA Cross Insurance,Inc. PHONE 781-914-1079 FAX 401 Edgewater Place,Suite 220 A/c No Ext: (AIC,No):781-246-2601 Wakefield,MA 01880 ADM E3S:crossetti tgacross.com Dianne Werbner INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Co 21415 INSURED Stateline Electrical Service INSURER B;Hartford Insurance Co. 02231 Phil lannazzi 110 Jackson Street INSURER C: Methuen,MA 01844 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'LTR TYPE OF INSURANCE ADSL SUB POLICY NUMBER POLICY NW Y EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY SA1391715 06/01/14 06/01/15TO RENTED PREMISES a occurrence $ 100,000 CLAIMS-MADE FKOCCUR MED EXP(Any one person)_ $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 X binkt addl insure GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 1-1 POLICY I PRP LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 (Ea accident $ A ANY AUTO BA3573696 06/01/14 06/01/15 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS er accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE 5J1391715 06/01/14 06/01/15 AGGREGATE $ 2,000,000 DED X RETENTION$ 10000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIEfORIPARTNERIEXECUTI-F—] NIA OBWECCF4394 06/01/14 06/01/15 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space is required) CERTIFICATE HOLDER CANCELLATION TOWNAN1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE Dianne Werbner ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i ti The Convnonweat'th of Massachrasetts Department oflndastrtalAccidents Office oflnvestigations 60013ashington street Boston,.7t2A.02111 vww.mass.govldia Workers' Compensation.Iasuranoe Affidavit:Butilders/Contractors)Electrzciam1pluxnbers :Applicant Information Please Print Lep-ribl� c— I Name(B.usinessiorganization/Individual): )TAT a L.i N g S tf-WV44/1'x. �M G Address: °XACA54N St - iItCA L City/State/Zip: x p t,-4 M,fit 01814 Phone#: OR ' 68 Z- S 2 t.S Axe yon an employer?Check the appropriate box: 'Type ofproject(required): [2. I am a em Io ex with 4. ❑I am a general contractor and IP y 6. ❑New constructionemployees(full and/ozpart time) have hiredthesub-contractors[( I am a soleproprietor or partner- listed on the attached sheet? 7. ❑Remodeling . ship a-adhaveno employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.til rran ce. 9. Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions required.] officers have exercised their 3.❑.I am a homeowner doing all work right of exemption per MGL 11.E]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' 1311 Other comp,insurance required.] *Any applicant that checks box in must also fiII out the section below showing theirworkers'compensation policy fidmiation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. -Taman employer that isproviding workers'compewa&n insurance for my employees Below is the policy and job site information. ,/ Insurance Company Name: 1 1,T i o Ral ex Co Policy#or Self-ins.Lic.#: V W EC -C F 43 TY . Iixpiration Date: 04/01 11-C Job Site Address: 0�2& �ePvilvj CL ani r e- City/StateMp: i,••fi dJ PZ Iq 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 maybe forwarded to the Off ae of Investigations of the DIA.for ins ante coverage verification. :Idohereby ert nderChep dpenalfies of erju that the information provided a eve i�true and correct.tuxe• Date: /� Phone#: q la Z' Official use on y Do not write in this area,to be completed by city or town ofi7eld City or Town: Perrot icense# Issuing Authority(circle one): I.Board ofHealth 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Impector 6.Other ContactPerson: Phone#: P Date. . A/ 89UU Of TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSAtMUs� This certifies that . . . .�`Q .l". 5. . . . .� has permission to perform . . . . . . . . . . . . . . . . plumbing in the buildings of . _.5.k\wo--q . . . . . . . . . . . . . . . at. . . 9 . . . .�i.-!L`i.�A)V 6.�. . . . CI!r. . ., North A doverr`, M-ass. Fe.��'.SO. .Lic. No.3�.� . . . . . . . . ./. ant", �. ... . . . . . . . . PLUMBING INSPECTOR Check y _ MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ICWWJ City/Town Oy�� /Qy[fl (�� 'MA. Date• Permit# Building Locatiom. L! ��� �/j�a ��l Owners Name:ii= .2 64 Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residentiac New:❑ Alteration:❑ Renovation:[ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED W Tx - SYSTEMS z 1 w > W Ln Ln LU V) a z_ F Y Q Vf Q LU QCQ' Z y. Z H W Z �"' Ln V1 0 Z r=.. Ar IaA W Iwo Cc= O H QLn LU LU u IZ— x Oa 0 3 cxi z a " a Y z ~ W ai o 3 F F�. mmO = ' > 0 = Q Q Q Q F- U Q3 3 In N = 3 3 3 o <SUBBAST F2 °3RD F4'F5T"F 6 FLOOR 7T"FLOOR i3 4FLOOR 9 Installing Company Name: Check One Only Certificate# �( `S /L/hihi.� �j ❑Corporation Address: �� m 5 _ City/Town:--,X&1A1zC41 Stater // l ❑Partnership Business Tehll /�6 8�'G7 3S Fax: ll ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy [ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the j Massachusetts General Laws,and that my signature on this permit application waives this requirement. i Check One Only ❑ Signature of Owner or Owner's Agent Owner [:] Agent I hereby certify that all of the details and inforrnation I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title ❑Plumber Signature o Licensed Plumber City/Town ❑Master d APPROVED OFFICE USE ONLY [-]Journeyman License Number:.,?/ a O LICENSED AS A JOURNEYMAN .P1-UMF3C ISSUES THE ABOVE LICENSE TO. LEOANDY GUZMAN i= 138 PELHAM ST ' �N. APT 7 MA 01844-2045 METHUEN } 78832 31728 05/01/12 j CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY) 5/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OHOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IM cert) c hot er is an ADDITIONAL the policy fes) must be endorsed. U A N the terns and conditions of the policy, certain policies may require an endorsement. A statemerrt on this certificate does not coMeEDrigsu jt t too }}� certificate holder in lieu of such endorsement(s). PRODUCER reANE RANDA HADDAD 978-682-1409 R. HADDAD INSURANCE AGENCY (ac'NO� (AC,Ho)o978-682-1560 ADDRESS: randa@haddadinsurance.com - 9 WAVERLY RD N.IANDOVER, MA 01845 CUSrOMER ID#: .... -- INSURED -------" —•- NSUtER(S)AFFORDING COVERAGE NAIC#_ I4EOANDY GUZMAN NstaRA;THE TRAVELERS INSURANCE AGENCY DBA: PLUMING 6 HEATING INSURERS: 138 PELHAM ST #7 INSURER C: t INSURER D: ....-- METHUEN, MA 01844 _. INSURER E INSURER r: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICES 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T,SSR .__ —.._...—qP - YPE Li GENERAL Uill ABiUT OF INSURANCE POLICY NUMBER - ( I - .-_,__�....,..,.— LIMITS EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LMAGETiTREpTED PREMISES(Ea occurrence $300,000 CLAIMS-A1ADE MED EXP(Any ogre person) $5,000 A 680-0383P391 01/12/11 01/12/12 PERSONAL a ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPL POLICY IE T PRODUCTS•COMP/OPAGG $2,000,000 aTraLroalLE uAan,nv COMBINED SINGLE LIMIT ANYAUTO Iacciderd) S ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULEDAUTOS BODRYINJURY(Per acclderd) $ HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON-OWNED AUTOS - — 3 11MBREliq LIAR $ OCCUR EXCESS LLa9 EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETEMION $ VA FJ(ERS CCMPENSAnOH $ AND EMPLOYERS'LIABILITY YIN TORYLMITS X ER A ANY PROPRIETORIPARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? ElNfA Ek.EACH ACCIDENT $ 100,000 (Mandatory In NN) UB-182BX21-8-10 12/20/10 12/20/11 E.L-DISEASE-EA EMPLOYEE $ 100,000 If yes,descvitre undar DESCRIPTION OF OPERATIONS Win—E.L.DISEASE-POLICY LIMIT $ 500,000 DESCWTiON OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addtional PArr Ma SO*",if mme all Is re*dred) CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCIISED .POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF N. ANDOVER ACCOROANCE WITH THE POLICY PROVISIONS. REPRESENiATJyE I / 1988-20 9 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD t `s 0008 Date.... y� .......... f NORTp 7 3:;•_tom`` "°o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHU TL� �,7 This certifies that has permission to perform ej,;i" /tl. wiring in the building of........... C...... ✓ii 2�.. Z-:.......................... . w.............. 37ZW. ....... North Andover,Mass. at................ .... Fee... � Lic.No.1. 7.t7 ......... .......................;i1...., _ ELECTRICAL INSPECTOR� �'•..- Check # j Commonwealth ®f Massachusetts Official Use Only Department of Fire Services Permit No._ �t90 BOARD'OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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 (PLEASEPRI MLVKORTYPEALLINFO TION) Date: d3• ' ZD City or Town of.- By £By this application the undersi ed gives no " To the Inspector of Wires: �g his or her intention to erforin the electrical work described below. Location(Street�&Number e� Owner or Tenant q j 601 Ar M Owner's Address $F6**A Q Telephone No. Is this permit in conjunction with a building permit? Yes Purpose of Building X No 0 BLDG PERNUT# Utility Authorization No. Existing Service Amps _ / volts Overhead ❑ Undgrd[] No.of Meters New---- Service Amps / _volts Overhead El Number of Feeders and Ampacity Undgrd[� No.of Meters Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total. No.of Luminaire OutletsTransformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Z. Swimming pool Above In_ o,o mergency ig tIng No.of Receptacle Outletsnd' rnd. Batte Units Z No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches ,3 No.of Gas Burners No.of Detection and No.of No.of Air Cond. Total Ranges Initiatin Devices eatPum Tons No.of Alerting Devices No.of Waste Disposers p Number Tons KW No.of Self-Contained Totals: _.._.................................................... No.of Self-Contained Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal No. of Dryers Connection EJ Other Heating Appliances KW ecurity Systems:* No, of ater KW o.of No.of No.of Devices or E uivalent Heaters Data Wiring: Si s Ballasts No.of Devices or E uivalent o.$ydromassage Bathtubs No.of MotorsTelecommunications Wiring: Total HP ' OTHER: No.of]Devices or E uivalent �V Attach additional detail ifdesired, oras required by the Inspector of fres. Estimated Value of Electrical Work: ?00. (When required by municipal policy.) Work to Start:A$ 1 i1 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 substautial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CBECK ONE: INSURANCE 'BOND ❑ OTHER E] (Specify:) d cert, under t4paws,arzd penalties ofper'ury,that the information on this application is true and completes FIRM N : J TAT E 1• i+v i� V-L C O t t.s Q L LIC.NO.:` y TZ� Licensee: �� =pyVp/^LZ Signature Wapplicable,enter exe "in a license n ber line.) LIC.N®•:�bNso� Address: yCN��4 di e a N Bus.Tel.No.. t-y I *Per M.G.L c 147,s S7 61,security work requires Department of Public Safe S Licen Alt.Tel'No.. 1 / OWNER'. INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityLIC.rance cove required by law. $y my signature below,I hereby waive this requirement. I am the(check one)❑owner co❑og enormally 'a g nt Owner/Agent Signature Telephone No. PERMITTEE:,$ .� ELECTRICAL PERNIIT NO. INSPECTION REPORT: PORT: ELECTRICAL,INSPECTOR-�1�lM�fi 1.ROUGH INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'-.Siguature-no initials) Date Z.FINAL INSPECTION; Passed— Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date M 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) - Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[- Inspectors'comments: (Inspectors'Signature-no initials) . - Date III `,• ..• A', ' . t �•� ' DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfigations Uf 600 Washington Street Boston, MA 02_711 www mass-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: i QACC 5O/V 'ST - A�k City/State/Zip: h'1 ►�eN M A OJ 134Y Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1..( -ram a employer with _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. F1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet I 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9 ❑Blinding tion [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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' COMP.insurance required.) 13.[:]Other '.-.ay agplicaat that che^�s box rl must also:'dl out the section below Yhorju•*their work=' t n. Homen:vners who submit this affidavit indicatingthey are ' ' compensation must bmit a new e}' aping all wodt and then hire outside contractors must submit a nes affidavit indicating such. $Contractors that check,this box must attached an additional sheet showing the name of the sub coaetrns 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: Pe J.e-S S ---rN SW/t,v c 6 420 Policy#or Self-ins.Lie.#: C -3 Expiration Date: ° Job Site Address: 23 LI Sf1[er, w OOQ 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 - g 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' ce coverage verification. I do hereby edify nder th� its and penalties of perjury that the information provided above is true and correct Siffiature: Date: �� •3i 2��t Phone#: D,ficial 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#i: 1 Date. 874E "ORT11 OF NORTH ANDOVER p pf� `w 13 LA PERMIT FOR PLUMBING a Brio.N`tb SSACMUSE� This certifies that . . . . . . . . . . . . . . l`. . . . . . . . . . . . /? has permission to perform . . . . plumbing in the buildings of . .. . . . . . . . . . . . . . . . . . at . . . 7. . . North An over„Mass Fe . 0.0 . .Lic. No.. !::Y.t PLUMBING INSPECTOR Check # l MASSACHUSETTS UNIFORM APPLICATION FO, OERMIT TO DO PLUMBING City/Town: � 4iP!c'____— MA. ,Date:_1l'_"=Z. —/�Permit#--------------- Building Location: _ �J/�f �`/�� (;r/ Owners Name: 7u� �?_— Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional❑ Residential C,94- New: ❑ Alteration: ❑ Renovation:❑ Replacements Plans Submitted: Yes❑ No'R, FIXTU RES z to O Y U U) n� z z Y Q W Q V W O W Z cn = w W W Z F w Z I- N O a O m W W o Q � z W W z LU N O a U. O LL H Q W w w Q W O OO 0 W N J J Z w L) F=- = (L O U) V > > O O O z Z to H F- = W Q Q N N J Q O t- 'Q Q O = J Q W Q Q Q 0 Q m m 0 0 LL f 7 2 J J IY N cn I— O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 1 H FLOOR 8 FLOOR /J Check One Only Certificate# Installing Company Name:_ `���= ���.v� ? �---- -_ c_-_ orporation �` ,- ty � !!! ------ Address:F��'_-� r�f��l_��ci /Town:� State: _ ❑Partnership Business Tel• Fax: - � --T- - -------- ❑Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy A Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement.', Check One Only -- Owner El Agent ElSi nature of Owner or Owner's Agent 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 1 of the General Laws. By-------------- --- Type of License: i r� Title lumber ig ature of L'censed.Plumber Cit (Town__— _ aster y y - - License Number: APPROVED OFFICE USE ONLY ---- ❑Journeyman ---- FINAL INSPEC'CION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONS) FEE: S PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER LICENSE NUMBER: PERMIT GRANTED DATE: PLUMBING INSPECTIOR. 4 8, Date.f . a s Gf`'ho, All TOWN OF NORTH ANDOVER C Is PERMIT FOR GAS INSTALLATION SACHUSEt This certifies that . A �!1�- . . .... . . .. . . has permission for gas installation .. ?n/ /-C . .. . . .. .. . .. . . in the buildings of . . . . . . . . . . . . . . . . . . . .. .. . . atI . . ., . . f� .Noh JrtAn ver, ^s, Lic. No.. NOGASISPECR Check# �p? MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: 2'l��_ MA. Date / Permit#__—_____—__—_ Building Location: Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential [i New: ❑ Alteration: ❑ Renovation: ❑ Replacements Plans Submitted: Yes❑ No[�! FIXTURES tY to zULUa N U3 V O (n 0 to m x Lu O (9 w >. z to W W C7 . O W W z m w p W O X U) > W z w Q x v a W Cn Q W W z9 U) = Cl)w w o X UJ > W W z O J F- H 0 z J 0 � N � Z F- F- HLU LU W = z ul 5- W cn a s to u, O z 0 o W = a W ut w a > 0 a 0 W z W a a a � 0 0 U. 0 0 x x J 0 M W tY t- > > � � � 0 SUB BSMT. BASEMENT 1 FLOOR 2 No- FLOOR - 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 1H FLOOR 81H FLOOR Check One Only . Certificate# Installing Company Name: �Lv � t __ + --___ 1 ��/ ,�- ,/ Corporation . Address 4ry��-/-"';`I _ City/Town Cf3'�ss°f�% State: / °_ ❑Partnership p ------------ Business Tel:. Z_" � Fax: —_c ❑Firm/Company Name of Licensed Plumber/Gas Fitter: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yeslo❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only --------------------------- Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and C r 142 of the General Laws. T of License: /r° BY__ - - ---------- lumber --- . f-- - G - ------------------------- Title as Fitter Si a of Lice sed Plumber/Gas Fitter aster City/Town _ Fliourneyman License Number: APPROVED OFFICE USE ONLY) ❑LP Installer - ^ ----- FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S) FEE: $ PERMIT# APPLICATION FOR PERMIT TO DO PLUMBING NAME&TYPE OF BUILDING LOCATION OF BUILDING SKETCH PLUMBER LICENSE NUMBER: PERMIT GRANTED❑ DATE: PLUMBING INSPECTIOR. #r .t = �--� Date..........�.................... Of NORTH 1b , FTOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SS�cM05� 1 This certifies that ......, ....,.--' ,":`'`'.................................................... has permission to performo...... .. .:..... .................... ..................................... �.�. wiring in the building of,..-.. :............. I....................... ..3 �{ �.�`w-c E� � ... North Andover,at........... ... ...�... .......................�"................ ...... ass. Fee.:. ......... Lic.No--�Y.*Yz......... ... . .... ...... . .. ELEcrRicAL IMPEcr& r Check # ~ Commonwealth of Massachusetts Official Use Only -4 Department of Fire Services Permit No. 696,F0 Occupancy and Fee Checkeder BOARD OF FIRE PREVENTION REGki ULATIONS [Rev. 1/07] Qeaveblank 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 ININK OR TYPE ALL INFORMATION). Date: 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) a3,L1 'I EkyTL,ajj 0 K Owner or Tenant K1{Z+Q S 64 UJA �, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes TW No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: j,ty � N ► 1� �1 Completion of the fo/lowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans N0'°f Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Laminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig g d. rnd. Batt- Units No.of Receptacle Outlets _30 No.of Oil Burners FIRE-ALARMS No.of Zones No.of Switches I No.of Gas Burners No.of Detection an Initiatin Devices No.of Ranges No.of Air Cond. Tones No.of Alerting Devices No.of Waste Disposers Heat Pump Number ons KW No,of Self-Contained Totals: _."..`�.._.. r .._._... Detection/AlertingDevices No.of Dishwashers _ Space/Area Heating KW Localunicipal ❑ Connection ❑ Other . No.of Dryers Heating Appliances KW Security Systems: No.of WaterNoof No.of Devices or Equivalent . Heaters KW No.of Data Wiring: Si s Ballasts. No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications iring; OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: ��, �f'U''� .(When required by municipal poIicy.) 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 th 'ns and penalties of perjury,that the information on this application is true and complete. FIRM NAME: GLI O [ IL LIC.NO.: Licensee: I 1 A0 919LRt'r"D Signat i e LIC.NO: �j 0 P,(If applicable, enter"exempt,,in the license number line. Address: ,c 1- i V�.N lua 0 nn!�a� MA Bus.TeL No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.Alt.TeL 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 Signature Telephone No. PERMIT FEE:$ `�-."_ ,� 3 � !�� ��� fit; y 7 0���. '� �- The Commonwealth of Massachusetts ! Department of Industria!Accidents Office of Investigations W. Ji 600 Washington Street st,� Boston, MA 02111 { i www.mass gov/dia . Workers' Compensation Ins trance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblyly _ Name(Business/prgmiza6on/individual) Address: City/State/Zip: � 1J(ty �•,�� 6)g l3 Phone#• 06-7) Are you an employer?Check the appropriate box: Type o 1.U I am a employer with —D4. ❑ I am a general contractor and I f project(required): employees(full and/or part-time),* have Hired the sub-contmaors 6. ®New construction 2.❑ I am.8.soie proprietor or partner- listed on the attached sheet. 7•-�Remodeling Them ship and have no employees Thesub-contractors have 8. ❑Demolition' working for mein any capacity, workers' comp.insurance. [No workers'camp.insurance 5. El We are a corporation and its 9' ❑Building addition required.) officers have exercised their 10.El Electrical repairs or additions I❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself[No•workers'comp, c, 152, §1(4),and we have no insurance required.]t .employees. [No workers' 12.E]Roof r epairs comp. insurance required.] 1311 Other *Ar1Y BPPlic:M that checks bo)m must also fill out tho section blow showing their workers'nom g penaation 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, tCoatractors that check this box mustattachad an addition=l sheer showing the rarr_of thT sub=,^otttr^tors and their worms'comp.policy information. 1 am an employer thivis providing:workers'compensation insurance for my en tp►r loyees Below is the policy and job site information Insurance Company Name: vv7 UZU�9 L Policy#or Self-ins.Lie.#: p Expiration Date: .11,L.- 1 (j Job Site Address:_ City/State/Zip: N i`WZWCA_ r A 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 under the pains and penalties of erjury.that the information provided above is true and correct S_imture: Date Phone 3-15 0 �1 Officialonly, Do not write in this area,"Eo be completed by city or town nfficiaL n: PermittUcenseority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical inspector 5.Plumbing inspectorson• Phone#: Information a lid 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 decreased employer,or the receiver or t ustee of an individual,partnership,association or other legal entity,employing employees.'However the owner-of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence.of compliance with the insurance'coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation.affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also'be sure to sign and date the affidavit. The affidavit should, be returned to the city or town that the application for the permit or license is being requested,not'the Department of t Industrial Accidents. Should you have any Questions regarding the law or if you are required to obtain a workers' oornp==tion policy,please call the Department at the nur-riber listed below. Self-insured companies should entre t±tir 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 Cornmonwe, . th of Massachusetts P Department of Industrial Accidents Office of Investigations 600 Washington Street (. j Boston, MA 02111 1�2 d ` Tel.#617-7274900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax 4 617-727-774 www.mass.gov/dia q F Njt 2 Silver Ledge Road, Newbury, MA 01951 Offirw q7R-dfi7-d_1R1 • fall. q7R-q73-9166 • Fax• q7R-dF)9-F,F9R • amail- ifixnrnmragt net April 9,2008 Inspector of Buildings—Town of North Andover 1600 Osgood Street North Andover,MA 01845 Re: Residential construction at 234 Brentwood Circle,North Andover,MA Dear Building Inspector: 1 recently made a site visit to the residence at 234 Brentwood Circle in North Andover' to observe the construction of the renovation. During my site visit I observed that the roof framing and the attic framing appeared to have been constructed in general accordance with the design drawings, prepared by registered architect Brain A.Libby. I did not observe the framing renovations below the attic floor level since this work was still under construction. If you have any questions,please feel free to contact me. Sincerely, tw i SEPH P. FIX p STRUCTURAL No.34051 ,e0seph P.Fix,P.E. p4,��rsfFt�io �g�NAt tot, Date...�./ / N°RTM 3? O TOWN OF NORTH ANDOVER F • . X PERMIT FOR GAS INSTALLATION ' 'y,SSACHU`'Et This certifies that ... . . . .. . . . ��. .`. . . . . . . . . . . . . . . has permission for gas installation . . .FE. ) l "q... . `. . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . .. . . . . at r. '- . . . . .. North Andover, Mass. s Fee. . . Lic. No..Pt G.? .G Y . LD. . . . . . . . . . . . . . . G�S INSPECTOR Check# 6379 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS G (Type or print) Date Qg NORTH ANDOVER,MASSACHUSETTS Building Locations 2,34 .. Vek, Permit# 7 Amount$ 3, o Owner's Name New Renovation Replacement Plans Submitted � w ' U � a o , "CA x ,z Z o a 0 z a v w x > a N z e x W z W w W a Z, Q W e a .N. H rA 0 Z O LQ W > rsl Z Q cz d d O O w 9 O W x O x 3 c c7 .a u a > o a O SUB-BASEM ENT BASEM ENT 1ST. FLOOR 2ND. F L 0 0 R 3RD. FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR ` 8TH . FLOOR (Print or Type)( Check one: Certificate Installin Com an Name__ f dd'u L- S PL-U�bl g P Y Corp. Address 404 �'p S�• � Partner. ' Business Ie ep one Firm/Co. Name of Licensed Plumber'or Gas Fitter 4 Wn 1C?C\n 9 INSURANCE COVERAGE Check one: I have a current liability Insurance,policy or it's substantial equivalent. yes [:] No[] If you have checked ves,please indicate the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity D Bond 13 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 Agent 0 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 S Gas Code And Chapter 14 he Gaficral Laws. By: Signature of Licensed Plumber Or Gas Fitter Title 13 Plumber City/Town: © Gas Fitter License Numoer Master APPROVED(OFFICE USE ONLY) Journeyman Date. . 0 "o°T:1�0 TOWN OF NORTH ANDOVER Y s PERMIT FOR/PLUMB i ss�CHus� This certifies that . . . . . . . . . has permission to perform . . . . . e.t.t 1). . . . . . . . . . . . . . plumbing in the buildings of . . -2. . . . . . . . . . . . . . . . . . . . at. .:? .3. 170 r.'.. .�. .l. . ., North Andover, Mass. Fee IV!(. Lie. No. . . . . . . . . . . . cb . � n. . . . . . . PLUMBING INSPECTOR Check * ! r c 7689 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS tt r Date � Building Location 5q �,�-F�t 000 G�2, Owners Name %rt &,x 4z- Permit# Type of Occupancy j/�cf'r Amount ��y�M r/S New Renovation Replacement ' Plans Submitted Yes No FIXTURES p O a U A a A w O U q A a SMME s�9INEIT i " ,R RDM M RaR mKfm 1 1 t 4IH RfJOR 5II3 FIIOCit 6M I10M 7M RJOM 9M R OOR (Print or type) Check one: Certificate Installing Company Namejr S Ptum d lu' 4�� El Corp. Address V Gab f. 1:1 Partner. I-Itly&'hill, r7V 01p,30 Business Telephone �Finn/Co. Name of Licensed Plumber: / / qa( r 1Od- Insurance Coveraee: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El ❑ 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 Massachus St I bi ode 1 42 of the General Laws. By: bignatUrC o icense um er Type of Plumbing License Title r& City/Town icense um er Master Journeyman ❑ APPROVED(OFFICE USE ONLY ,12 3741 NORTti TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING mus � This certifies that t .~. . . . % �.�. . . . . . . . . . . . . . . . . has permission to perform . .,.V ! !p t- . . . . . . . . . . . . . . . . . . a plumbing in the buildings of . . .PC'. Y: d. . .S"e!41yz. . . . . . . at. t3J ���w.u.o ct. C t .. . . . . . .. North Andover, Mass. Fee.0/12 . .Lie. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR 06/24/98 08:36 52.50 PAID WHITE:Applicant CANARY:Building Dept, PINK:Treasurer 9L\ MASSACHUSETTS UNIFORM APPLICATION FOR RMIT TO DO PLUMBING ype or print)NORTH ANDOVER,MASSACHUSETIS Date Building Locations Ar eAg L� �n CI K. Permit Amount $ Owner's Name �Aht'/ Sl" New M Renovation ❑ Replacement ❑ Plans Submitted n FIXTURES wuna ;D rA r1A 41 F p� w W a w p4 A a A a w w F F d a+ G>» d Q E, SMBM &�S1T'D�iI' ISE fli" M HOR I 2 1 1 3M HDM 4M FUXR 5IH NJ" 6M FI" 7M ROM gm FIDQZ (Print or type) RAJA n // Check one: Certificate Installing Company Name Pyr JA f��lni{�l�g Ol� An ❑ Corp. ` Addresskil ❑ Partner. W Business Telephone ❑-Firm/Co. Name of Licensed Plumber: A J A - 1AJQ " Insurance Coverage: Indicate the type of insurance coverage by checkingtheappropriate box: El insurance policy Other type of indemnity Bond Insurance Waiver: I,the undersigned,have been mdde 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 Massachus S l m in Code an Cha r 142 of the General Laws. By: --- -jignatureI n um er Type of Plumbing License Title City/Towntt MM MUM Master Er Journeyman ❑ APPROVED(OFFICE USE ONLY Date. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING �ssACHUS� This certifies that t :.V. . . e . . . �'�.1 .4 . . . . . . . has permission to perform plumbing in the buildings of at. North Andover, Mass. - � Fee/,..i. Lic. No:.,!7 st4, L. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR a/21195 14:33 15.W PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Pont or Typal fa NORTH ANDOVER, Masa. Date Building ^ Permit # �/ k Location�`1' Name New Cg/ Renovation ❑ Replacement D Plans Submitted: Yes❑ No-❑ FIXTURES st w wz W w01 • Q Z = r r W W J w t V M r 7 O M i i w Z V i Y e ~ 16 M' 0 = O O i j { V Y ajr O ~ s s ai O V s 0 ► i .� a 's i °i a o sue—ss�T. ��sat~�NT 161 FLOOR i IND FLOOR Si10 FLOOR ITN FLOOR STH FLOOR STH FLOOR 7TH FLOOR STH FLOOR — Check one: Certificate Installing Company Name ❑Corp. Address _'� ❑ narshlp D vlar /Co. Business Tefephon -,001—L .Name of licensed Plumber INSURANCE COVERAGE: acx a I have a current liability Insurance policy or Its substan(W equWant. Yes No ❑ It you have checked yn, plesse/Indicate the type coverage by checking the appropriate box A Itabllty insurance policy Cther type or kidemndy ❑ Bond ❑ OWNER'S INSURANCE WAVER: i am aware that the licensee does not hate the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on Chia permit application waives this requirement.. Check one: Sionowner ❑ Agent ❑ azure of Owner a t?+vner s ent I hereby certify that all of the details and htamatlon I have eubmdted for entered) application are true and accurate to the best of my knowlodge and that a1 plumbing work and installations podormad under the De I for this tkm wnl be in eampHanee with to pertinent provisions of the Massachusetts Slate Plumbing Cada and Maptar 142 0l Genwal 8y 0 natero cense umbar Title Ucense Hu nbeir w3 .(? t ty/Tewn Type of Plumbing Ucenss: Master ❑ / Mf'S1UlED(OFFICE USE ONLY) Journeyman [� N2 1 913 �( Date..... -';. �............... NORTH `° '•'"� TOWN OF NORTH ANDOVER F , p PERMIT FOR WIRING ��SS�cHusE� Ascertifies �. .... ........................................................... has p7mission to perform-e.'4 � ................... wiring in the building of:..-_.` ..........`.: ;::*? ................................. 1&t!...... �� Q ,North Andover,Mass. S Fee!............... Lic.No3 ............................................................... ELECTRICAL INSPECTOR 06/26/98 15:15 75.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer V ��f LIICIIrii[IIlIUI'.i!.�1 Uf � c�55�iC�Ua�fttS Office Use Only Department of Pubiic Safety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy S Fee Checked/_ 3/90 (lave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be periormed in accordance with rhe,vtasaachusetts Electrical Code,ill C%%R 12:00 (PLEASE PRINT IN INK OR(T�YPPE ALL INFORMATION) Date City or Town of "_r NQC) E. , To the Inspector of Wires: The undersigned applies for a permit ttto erioorrm tth�e'electrical work described below. Location (Street & Number) 0n-3 1 t �� ��` ��pQn ^fQ e"�`'+� Owner or Tenant S1�\� 0 ,1y1 z—+ Owner's AddressL- Is this permit in conjunction with a building permit. * )3Gj Yes Nu (Check Appropriate Box) Purpose of Building DDMrnC~\ Utility -\uthorization No. Existing Service Amps Voits Overhead ❑ Undgrd ❑ No. of Meters New Service :nps i Volk Overhead ❑ Undgrd ❑ No. of imeters Number of Feeders and Ampacity G^ Location and Nature of Proposed Electrir.al Work V I �_ f G1J� 2an4KtIJUI '' TOTAL No. of Lighting Outlets No. of Hot Tuhs No.of Transformers KVA �buve In• No. of Lighting Fixtures Swimming Pool ernd. ❑ ernd. ❑ Generators KVA No.or Emergency Lighting No. of Receptacle Outlets C�d No. at Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARNIS No. of Zones Tota No. of Detection and No. of Ranges No. of Air Conditioners Tons Initiating Devices Fleat Total Total No.of Sounding Devices / No. of Disposals No. of Pumus Tone KW No, of Self Contained j Delection/Sounding Devices No.of Dishwashers SDace!Area Heatine KW t �unicipal Local❑ Connection ❑Other No. of Dryers Healing Devices KW No. or No. ut Low Voltage No.of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP _ OTHER: :!INSURANCE COVERAGE: Pursuant to the requirements of.massachusites General Laws I,have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES O NO :have submitted valid proof of same to this office. YES '_ NO C Rf you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE a BOND- ❑ OTHER (Please Specify) Iry81L) TY (Expiration Date) Estimated Value of Electrical Work 5 Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NAME ,,;� (� LIC. NO. '� licensee l fa T �R1MC) /�Siignature \ LIC. NO. I — Address )0) HAVC�J-} iLL RD y4 rat�S67112 'Y 1�A Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER:1 am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws,and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE$ (Signature of Owner or Agent) N° 2437 Date.r:. .. ......... r Ot HORTM�� t�``° '• o TOWN OF NORTH ANDOVER ' PERMIT FOR WIRING ,SSACMU5� )2 This certifies that ... ............. '... ..................................... has permission to perform ..r' y -M^- c'........................................ wiring in the building of................... -�- ............................................... ........ North Andover Mass. Fee .............. Lic.No. ...�./ a �_EL . r......................... f/ EGTRICAL INSPECTOR Check # r (' WHITE: Applicant CANARY:Building Dept. PINK:Treasurer ��C LDQIrilDIllllC:!',�1 Ut � �c155:ICfjU5tt15 Office Use Only 9 Department of Ptubtic Safety ���? BOARD OF FIRE PREVENTION REGULATIONS 527 G'OR 12:00 Permit No. �` � Occupancy S Fee Check 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORtA ELECTRICAL WORK All work to be performed in accordance with the,maszichusem Electrical Code, 327 C.�iR 12:00 i (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Oate City or Town of r% i�WC- To the Inspector of Wires: The undersigned applies for a perm" l �1�ls� i permittoeiform tthu electrical work described bellow. Location (Street & Number) QJ 1 z4P/11>r'�E Owner or Tenant ��� _ N E°`,Aa'1 Z- -- Owner's Address _ Is this permit in conjunction with as building perorit: Yes 9i No ':t�?t7 (Check Appropriate Box) Purpose of Building 1�T/� y �uv -------__-_U6hi,/ >uihorizanon Nn. Existing Service Arnl), v,)is O•erhe'id ❑ Undgrd (❑�� No. of,.serers New Service ---- �:,rhs __---i--___-- Vnits Overhead f lu Undgrd ❑ No. of,urete(s Number of Feeders and Ampacity Location and Nature of Propo<ed Electrir:al wort: TOTAL No. of UO)on,2 Outlets No fit Hor fuh< .No. of Tran,iormers KVA lhuxc' In• No of Likh(ine Fixtures Q jwunmine Pool 2rnrL ❑ ernd. ❑ Generators KVA No. or Emergency Lighting No. of Receptacle Oudets Q No. of Oil Burners Batten Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones [L)tjl No. of Oeteclion and No, of Ranges No, of Air Cnndi'ioners Tons Initiating Devices Fleas Total rural Nn, of Sounding Devices No. of Disposals No. of Puriios ton. KW No. of Self Contained 0election/Sounding Devices i No. of Dishwashers Su.1ce!Area t-ir:atme �runicipal No. of Dryei5 Heating Devices Kw Local❑ Connection ❑Other t No. Cl No. ur low Voltage ,N'o. of Water Heaters KW Sign: Ball,tils Wirine No. Hvdro ,`tassage Tubs No, of lvlotors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements ui 'AWsimhusltCs General Laws e I have a current Liability Insurance Policy including Completed Opera000i Coverage pr is substantial equivalent.YES 0 NO :have submitted valid proof of same to this office. YES NO 0 If you have checked YES, please indicate the type,of coverage by )checking the apprropfilate box. INSURANCE 1:1BOND ❑ OTHER-M (Please Specify) L tq8i)LJ TY 6 ' (Expi(ation Date) Estimated Value of Electrical Work 5 �Q Work to Start Inspection Date Requested: Rough — Final Signed under the penalties of perjury: O FIRM NAME S� � �n 1p�-� G l ��� LIC. NO. / P liceniee �Z ���� \tln��Ju _ Signatures = _ LIC. NO.�1D02/J `-r 1\ - Address I r�) F� � S J }UL I e)i�� --Y�� Bus. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have die insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on (his permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE S (Signature of Owner or Agent) 3466 Date. . .�' ......... ...... / „ORT#j TOWN OF NORTH ANDOVER Of 3r ' F PERMIT FOR GAS INSTALLATION F 'rr,9SSAC.NUSEt< This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .. . . . . . has permission for gas installation- ¢.f .. . .. . • • . in the buildings of -� . . . . . . . . . . . . . . . . .. . . . . • North _Andover, Mass. Fee! ` Lic. NokA'/'. . . ._... . . . . . � AS INSPEO 0, WHI E:Applicant CANARY: Building Dept. PINK:Treasurer s > MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING Type or print) Date _ NORTH ANDOVER, MASSACHUSETTS Building LocationsPermit 9 Amount S �S Owner's Name Plans Submitted New❑ Renovation 6—j Replacement ❑ ❑ JvI Ld A r M :+J s. . Z Z Z C sd n Ca w Z S Ua-B,► S E ,YI EN T 8ASE .YI ENT 1ST. FLUOR 2ND. FLOUR j JR D . FLOUR a'CII . FLOG R ST if FLOUR 6T If FLUOR 7T If FLUO R YTII . FI. 00 R i Nameor rypl��l S ��`'►'` �` CheckCor . Certificate Installing Company p. i Address ❑ Partner. "Jeri' 4. Business Telephone ❑ Firm/Co. Name ofLicensed Plumber or Gas Fitter �- INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ j If you have checked ves,please ind'cate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver. I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the .'.;44 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 pertbrmed under Permit Issued for this application will be in compliance with all pertinent provisions of the iNdassachtts StareG s Code and Chapter 1 2 of t General Laws.in Pc ;j $y: Signature of Licensed Plumber Or Gas Fitter Tide ❑ Plumber (� CityiTown =Gas FitterIL—censZ�ivumoer ❑' Master ATPROVED(OFF!CF.USE UKY) ❑ Journeyman Date. U D N2 4473 NORTH TOWN OF NORTH ANDOVER 0 OHO+i��+o 1 9 PERMIT FOR PLUMBING SA U ` .i _amu This certifies that ..- • • • • • • • • • • • • • • • • • • has permission to perform. ". . . .. . . . . . . . . . . . . • • • • • • plumbing in the buildings of .t�. ..� . . . . . . . . . . . . . . .7Z at .c •3.y `' T .•tA- hAndover, Mass. Lic. No.�rl!P. 7. . C• !`PLUMBI�n� ECTOR Check # \i i WHITE. Applicant CANARY: Building Dept. PINK: Treasurer (Type or print) MASSACHUSETTS UNIFORM APPLICATION /PMIT DO PLUMBING NORTH ANDOVER,MASSACHUSETTS woo Date Lae. Building Location 7 t 6&&V-6&W0 6K, Owners Name sckj yc-1 Penn► d Amount 30 Type of Occupancy :S) Pt rn k 111, New ri Renovation IT Replacement Plans Submitted Yes D No El FIXTURES wcn a a a W F* W E� W d I-% F a a x x a W W d W A ", 0 E" d d W cf) z wLr E� F rA rn Q Q 0 d Lti d d E� SLRER C &��1VIIVT 2PD FLOOR 3M FLOOR 4M HfM 5MMOM 61H ROOK 71H HOOK 91H FLOOR (Print or type) Check one: Certificate Installing Company Name y tj M6 re, LCorp. Address 404 '(je ��. � Partner. Business Telephone q44jFirm/Co. Name of Licensed Plumber. �� �1• l�b�1�C:6 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [a Other type of indemnity 11 Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance 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 Massachus S Plumbing Cod Ch ter 142 of the General Laws. Y Type of Plumbing License Title ' City/Town icense Mumoer Master E� Journeyman ❑ APPROVED(OFFICE USE ONLY Location c' 341 .�t.PAJ�cuood No. Date 1,-/2-0y M0RTN TOWN OF NORTH ANDOVER , p : : Certificate of Occupancy $ �,S1ACMU5Et� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a ,7 u' Check # ( c 1r 4 /Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: ® DATE ISSUED: ® � e SIGNATURE: Building ConimissioneEinseector of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �y Map Number Parcel Number V 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage & 1.6 BUILDING SETBACKS ft Front Yard 150` Side Yard 3 16 Rear Yard //S Required Provide Required Provided R aired Provided 1.7 Water SupplyM.G.L.C.40.§54) 1.5. Flood Zane Information: 1.8 SewcWc Disposal System: Public Pmate 0 Zone Outside Flood Zone Municipal On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.11 Owner of Record ` (� I p ✓1 / 1. 066 XL�-&4� J G�I w(�2te 7— � 4wuo0 GI?A,2 , I� • I-I uwJ(� Name(Print),j A rdd ess for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: z Signature Tele hone ,,1 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ 202N C_ QEC�/_E2 Licensed Const tion Supervisor: d 5 o ,I I �: �I�S N� I� � �t 5,` License Number Address I env l �(�� Y 6�Z O Expiration Date Signature Telephone r. 3.2 Registered Home Improvement Contractor Not Applicable ❑ �_sAAAC. 6tk&z.(�4 Ih LTJ �rn in any N �— 3 f-- (( 1= irn `� Registration Number AN s N£wbl, y (,�n 0ASS G l`t5 ( Address I ;�r. 11, C 10V I.zfo� � I�s �� , ;�� r�A Expiration Date Si nature Telephone Y SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Si ned affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Work check all appReable New Construction ❑ Existing Building K I Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify RVX-a 9-e,2 IFN'.)E3 a .-K,4e rkw Brief Description of Proposed Work: Gx � h4 �Na K1�c�tr>y SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFTICIAL USE ONLY Completed by permit applicant 1. Buildinga Building Permit Fee (S'G-D Multi lier 2 Electrical (b) Estimated Total Cost of 9 n Construction 3 Plumbing rb Building Permit fee(e)x(b) 4 Mechanical HVAC a2 (/Ol 5 Fire Protection 6 Total 1+2+3+4+5 3 6iTD Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize 10..12yi C- FG k e'�— to act on My behalf,in all matters relativV to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �A 2�] l�. s 0 C k E2 as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief n /Z- Print ✓.�-C.. Qin- Sigalftale of O er/A ent Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TMERS 1 2 3PD SPAN DINIENSIONS OF SILLS DMIENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andover ti tAORTH O qti tt4eo lbs O Building Department 0 27 Charles Street * _ North Andover, Massachusetts 01845 �` s (978) 688-9545 Fax(978) 688-9542 9SSACHUS�� 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 cl 1, s150a. The debris will be disposed of in/at: n hV3 Facility location n / Signatur f Applicant 5 1-2-5 ON;, Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: City Phone F7 am a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: �:TV Address 1 Aes 1��1 City: N w to U2 S b t ci 5 l Phone# q 7 6 a a l o? Insurance Co. r_.A%4-E2w urAPolicy Company name: Address City- Phone#: Insurance Co Polioy# 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 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I f understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I I do herby certify under the pains and penalties of penury that the information provided above is true and correct. Signature Date 's Print name - CE-o)4�- C- ►J C C k-�C2 Phone#-r+ Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑Check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: phone#.. ❑ Health Department ❑ Other FORM WORKMAN'S COMPENSATION s. 1251 West Linda Vista Blvd. 234 Brentwood Circle Oro Valley,Arizona 85737 North Andover,MA 01845 phone 520-498-5242 I f I .. Ali 'T •'"" �t ..� ti's' . � tier!:. �f 1251 West Linda Vista Blvd. 254$rentwood Circle Oto Valley,Arizona 85737 North Andover,MA 01845 phone 520-498-5242 00 4e u �'� 1~'""s' �t�,tet-; �_C'ii,1[i HCl✓rte-:z t ev � I {y 121-4 ( l�J , l �r�;��: : .�, , � e.��°mac� ,,k"'�,��r�,`�G'��'�r`,�,,,�"�,� •� ���s 1251 West Linda Vista;Blvd; 234 Brentwood Circle Oro Valley,Arizona 85737 North Andover, MA 01845 phone 520-499-524.2 o u�t -- fj —L rfPa � yT� • ' r t i _ { (DIC a® 1251 West Linda Vis+ASIV41 234 Brentwood Circle Oro V411ty,Arizona 85737 NorEh Andover,MA 01845 �l 'f4l ill l at rZ v (DI /I v e-2 44 NO LdA 4t H-7 1 -t-, .1h 17, I po I Ij VT r ...._._........_...,__._....,-._.-._..._........_.. 1. j. o a n✓ N�2 „?,f ?,res al' ^y�..__. rN an In an R .._ F, NORTH Town of 0 No. Z 70 T 0 CA E o dover, Mass., COCHICHEWICK AD RATED PPa��S S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT... . �..... ...... .. toA Z Ra S.�..�................... ..................... ....... ............... Foundation .. .. . ...... .............................. I �6W00 I �I I-kC4'has permission to erect.....�!f.6101.0f building on.!q4 ..$�'�.................................................. Rough 0 to be occupied as........... .... .... ....... .r�........................................................................... 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. rn 1P41 to j' a 4d vap aw I PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough (.. Service .00 BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE smoke Det. NORTH TOWN OF NORTH ANDOVER r 0 PERMIT FOR PLUMBING SSACMIS� This certifies .. . . . . . . . . . . . has permission to perform . . . . . k-! . . . . . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .P/-? ... . . . . . . . . . . . . . . . . at. . ..).`j.I. . . . North Andover, Mass. Fee. 32. .Lic. No. 7�. . . . . . . . . a-�.-� . . . . . /PLUMBING INSPECTOR Check # U 5465 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) r G Ve4^ , Mass. Date ZIX,A" .26!q 2 Permit# YY 63 Building Location %6"^1eA CG'+�JAJC��r's Name Aft Q E A/A Type of Occupancy—",2t--51 -DE1'1 tI A(� New ❑ Renovation ❑ Replacement R"" Plans Submitted: Yes'❑ No ❑ FIXTURES z z m a Hz Y F- N J 0 C01 z •• W W W Y .J 0 Q N O a ¢ O Z W F- W ¢ ,S ¢ y Z W N V Y Q W d r (� ¢ C7 N y ¢ } Q f N 2 S C7 Q Q X = O 7 ¢ d W ¢ < W c Q 0 = .Cr a ¢ OJ u. W S l- f. W O G ' 3r -1 N ¢ i- Q Y C C W ¢ Q S z = Y 0. p d W U Y W Q F } H O N v61 O N Z O O N Z z W 1' O V Y r 3 Y aim talc p J 3 Y 0 u. O p d S ¢ 'm O sus—BSMT. BASEMENT IST FLOOR 2NOFLOOR r 3RD FLOOR 4TH FLOOR et STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing.Company Name ""AOr3Ee'7 aQ SAnim 4TAeQ Check one: Certificate Address A(n Ct:ACW man) ❑ Corporation /r E%N i!i5-A) Al A ❑ Partnership Business Telephone ("4 Z-5177 A 2 tm/Co. . Name of Licensed Plumber "&d F e T ! SA ry m04 re -0c`% INSURANCE COVERAGE: I have ayes currentflability ins ra rance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. a NoIf you have checked Les, please indicate the type coverage by checking the appropriate box. A liability insurance policy Ad Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives,this requirement. Check one: Signature of Owner 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 the permit issu for this application will be in compliance with all pertinent provisions of the Massachusetts State Plum " g Abde andapter of the eral Laws. By, vL'1i Title re of Licensed Plumber • Type of License: Master�/ Journeyman❑ City/Town - APPROVED OFFICE USE ONLY) License Number 3 5 BELOW FOR OFFICE USE ONLY FINAL INSPECTIONS SKETCHES 1 PROGRESS INSPECTIONS FEE NO. APPLICATION FOR PERMIT TO DO PLUMBING NAME do TYPE OF BUILDING LOCATION OF BUILDING PLUMBER PERMIT GRANTED DATE 19 PLUMBING INSPECTOR FORM L DEPARTMENTAL REFERRAL FORM T0: ,.Building InspectorT Conservation Administrator Director of Community Development Director, Public Works Fire Chief Health Agent Police Chief FROM: Town Planner and/or Clerk, Planning Office RE: Preliminary Plan Definitive Subdivision Special Permit Site Plan Review ' Date: A Public Hearing has bee scheduled for 3c� p.m. on (� hi( ncy 1 �a bee discuss the plans checked above. (Preliminary plans do not require public hearings . ) The Technical Review Committee Meeting is scheduled for: Thank You. rl s r Location 9 '34 0 Rl° tw X)A CtL No. 3 Date ✓� NpRTN TOWN OF NORTH ANDOVER s ?o�t...o ,•otic Certificate of Occupancy $41 _ BuiT '6, rame Permit Fee $ j L CHU t� Foundation ON Fee $ ether Permit Fee $ See, nnection Fee $ Water Co n Fee $ 4t. + TOTAL $12305 Building Inspector C i COP,, Div. Public Works Locationt �Y3fik �` - 1 ,No. r Date '' pORTTOWN N OF NORTH ANDOVER Of tae , ,h Off ° • oma p CertlfiL� of Occupancy $ — a ,r 00 a Building/Fra ermit Fee $ ✓` ' fl� ndation Perm $ s�cwusa Oth' . mit Fee $ Sewer C tion Fee $ Water Conned Fee $ , TOTAL s . /$ r z^ ti Building Inspector Ilio P„hlir Wnrim Location"r �- No. �`'d Date /9 NORTM TOWN OF NORTH ANDOVER G Certificate of Occupancy $ + Building/Frame Permit Fee $ �Ss^CM � Foundation Permit Fee $ Other Permit Fee $ ;,3 Sewer Connection Fee $ Water Connection Fee $ TOTAL $ GBuilding Ins e�cttbr �s. aatn 12 8 3 0 to/oe«e 14:25 oo Div. Public Works r7R%ITT NO. APPLICATION FOR PERMIT TO BUILD — NORTH' ANDOVER, MASS. FF PAGE 1 Y' MAP h40. I LOT NO. �2 2 RECORD OF OWNERSHIP iDATEBOOK !PAGE F—_ — ZONE SUB DIV. LOT NO. — X1308 1 202 LCICATION PURPOSE OF BUILDING 34 Brentwood CirriA OWNER'S NAME NO. OF STORIES& Sara �f1ltiarf E OWNER'S ADDRESS 234 Brentwood C'1 r('1 p BASEMENT OR SLAB Basement ARCHITECT'S NAME Libby & Parkpr SIZE OF FLOOR TIMBERS IST 2X10 2ND 2X12 3RD BUILDER'S NAMEHenry C Becker Custom Bldg T_.td SPAN Varies: Sewage A3 of plan DISTANCE TO NEAREST BUILDING 9n DIMENSIONS OF SILLq)Ouble 2X6 pressure treated DISTANCE FROM STREET 220, + - "3 1/.2 POSTS Lally DISTANCE FROM LOT LINES-SIDES REAR 2 .X GIRDERS AREA OF LOT 49,500 sq ft + - FRONTAGE 150, 501 HEIGHT OF FOUNDATION 7 1 _611 THICKNESS 101, IS BUILDING NEW no SIZE OF FOOTING X IS BUILDING ADDITION yes MATERIAL OF CHIMNEY masonry y IS BUILDING ALTERATION yeS IS BUILDING ON SOLID OR FILLED LAND solid WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER yes BOARD OF APPEALS ACTION, IF ANY IS BUILDING CONNECTED TO TOWN SEWER yes IS BUILDING CONNECTED TO NATURAL GAS LINE es INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST 90,000.00 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 ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED 4/9/98 BOARD OF HEALTH j SIGNATURE O OWNE AUTHORIZED AGENT FEE PLANNING BOARD p PERMIT GRANTED OWNER TEL.# H CONTR.TEL N-Y �l ? l5 16 —�— CONTR.LIC.#-.Qdo S� 7 7 BOARD OF SELECTMEN a - BUILDING INSPECTOR t v - BUILDING RECORD R 1 OCCUPANCY 12 SINGLE FAMILY _ S'ORIES 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 2 13 CONCRETE BL'K. PINE _ BRICK OR STONE H PIERS — PLASTER — — DRY—WALL UNF1N. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ 1/. 1/1 l/. FIN. ATTIC AREA _ N_O B MT FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE �_ WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'D _ ASBESTOS SIDING _ COMMON VERT. SIDING ASPH.TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS.8 FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR ADEONE QUATE N 5 ROOF 10 PLUMBING GABLE IF, 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 J# TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS.6 COLS. STEAM STEEL BMS. 6 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 II NO HEATING i c►O R Tti Town of _ - over No. op rn * s .0001 dover, Mass., �J 19 �09 coch HEMICK S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic.System c f THIS CERTIFIES THAT.......R.A.�ALA A .....t... R.Rq...........t��nk..W.ct.R. ..................................... BUILDING INSPECTOR Foundation .4.. .... .!!S...... buildings on .......... �',�Re.h. . dc?. C.t��e�..-1.... has permission to erect-A-c�. g a� .. ,........ '�W . .... . . ' Rough to be occupied as , �N 1..� ..... .. ...(.....!!<.. ..Y1/!.d Chimney ,ky.l�e.. �. .. .:. . . . . provided that the person accepting this peri 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION TELECTRICAL INSPECTORARTS Rough .. ..ea), ......... Service BG INSPECTOR F . 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. 2 u' Burner R C(.,�� I�► Street No. G` tll� .` Smoke Det. FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verity that all necessary approvals/ rmi Boards and n, artments having jurisdicts does not g ion have been obtained. Thiel ove ^ ' the applicant and/or landowner from compliance with any applicable or requirements, r APPLICANT FILLS OUT THIS SECTION APPUCANY PHONE 2,93� ! LOCATION: Assessors Map Numberq l� PARCEL g1-Z$o G4SY? I SUBDIVISION LOTS S 2 i STREET t, (,e4 �vaa) Cc v- l ) 'F } ST.NUMBER 2� y `"OFFICIAL USE ONLY r RE NDA N OAF TOWN AGENTS: • _ r tONtFAVATION ADMINIS RATOR DATE APPROVED i' DATE REJECTED COMMENTS --� S y11 urepo OWN PLANNER DATE APPROVED ` DATE REJECTED i ? COMMENTS a, FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED TI PECTOR-HEALTH DATE APPROVED l + DATE REJECTED i COMMENTS f i. 7i PUBLIC WORKS-SEWER/WATER CONNECTIONS 1 i DRIVEWAY PERMIT 1 FIRE DEPARTMENT i 1 RECEIVED BY BUILDING INSPECTOR DATE 1 14 r CK 14W T,;s is to car*that twenty(201,,drys p aua elapsed from date of decision Sed Ft F �'i. :a Jtaut filing ofrHn� " R ; ' JOYCE B RAP-` ; iw Date r ,.,' TOWIN t'L :k d t �� Y Joyce A.Bmdshm 'sSSti`�y -NORTH ANDOYER Town Clerk 7A1PlN dF NORTH ANDOVER �rEA: If12 s � . ��ja7IIa4l� ' i v. : _ - MASSA01L Si`:'i 5 tea - _ AaoC)*muV ;LSzuv BOARD OF APPEALS l� Any appeal shall be filed within(20)days after the date of filing of this notice in the office of the Town Clerk. NOTICE OF DECISION PROPERTY: 234 Brentwood Circle, North Andover, MA NAME: Robert& Sara Schwartz DATE: 2/11/98 ADDRESS: 234 Brentwood Circle PETITION: 002-98 North Andover, MA 01845 HEARING: 2/10/98 The Board of Appeals held a regular meeting on Tuesday evening, February 10, 1998 upon the application of Robert& Sara Schwartz, requesting a Special Permit under Section 4.136, paragraph (3)-(c); & (iii)=(3); (1996) (non-Disturbance Buffer Zone) for construction of an addition, of Table 2, of the Zoning Bylaws which is in R-1 Zoning District. The following members were present: Walter F. Soule, Robert Ford, John Pallone, Scott Karpinski, Ellen McIntyre. The hearing was advertised in the Lawrence Tribune on 1/27/98 &2/3/98, and all abutters were notified by regular mail. Upon a motion made by Robert Ford and seconded by John Pallone, the Board of Appeals unanimously voted to GRANT a Special Permit pursuant to use requirements of Section 4.136, paragraph (3)-(c); & (iii)-(3); (1996) to construct a proposed addition of 6 sq. ft. and 18 0 0 sq. ft. and to come within 100 sq. ft. of a non-Disturbance Buffer Zone, finding that the , - - coristruction is less tha- 2 roto floor area of the existing structure:Rcefer to the-Topographic • Plan of Land dated 1/12/98 and revised 1/14/98 by Merrimack Engineering Services. Voting in favor. Walter F. Soule, Robert Ford, John Pallone, Scott Karpinski, Ellen McIntyre. The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local,state and federal and building codes and regulations, prior to the issuance.of a building permit as requested by the Building Commission. � BOARD OF APPEALS r . _ Waiter F. Soule; �tlr " ,hail r1_-. /decoct8 i ESSEX NQRTI4- REW LA \1�R r— A TRUR C()PY, ATTEST, a "310 CMR 10 a9 Fann Z ' ❑EP Re No. Ue o?ovided py OEP) q�ry,r«v� North Andover�,�,:_ ConstIanwealth ^� + ! of Massachusetts Robert & Sara Schwartz -• OaieAeauevF;fed 1/20/98 234 Brentwood Circle NEGATIVE Determination of Applicability Massachusetts Wetlands Protection Act, C.L. c. 131 , §40 From NORTH ANDOVER CONSERVATION COMMISSION Issuing Authority To Robert & Sara Schwartz Same (Name of person making request) (Name of prcperry owner) 234 -Brentwood Circle Address Address This determination is issued and delivered as follows: by hand delivery to person making request on (date) February 5, 1998 by certified mail,return receipt requested an (date) 1 Pursuant to the authority of CLL c. 131 ,.6.40, the North Andover Conservation Camm2ssion has considered your request for a Determination of Aeolicability and its sucocrting docurgentatfan,"and has made the following determination(checK whichever is applicable): 234 Brentwood Circle Location: Street Address Lot Number: 1.. The area described below, which includes all/part of the area described in your recuest, is an " 'area Subject Id Protection Under the Act.Therefore, any removing, fiiling,:dr_edaing Cr altering of that area requires the filing of a Notice of Intent. �• The work described below, which includes all;part of the work deschbed in your request, is within an Area Subject to Protection Under the Act and will remove, fill, dredge or alter that area. There- fore,said work reawres the filing of a Notice of Intent. ct �. � . d Cc. ATTEST- ! A True Cgry Effective 11110/89 Town Clerk r: 21 f e - P. l�i" �r v 3•. l ne•work described below, which includes all:part of the work described In your reu�ast, Is within Me Suffer Zone as defined in the regulations, ar,d will alter zin Are2 Subject to Protetticn Under the Act.Therefore, said work requires the Mind of a Nolte of Intent This Determination is negative: 1. ❑ The area described in your request is not an Area Subject to Protection Under the Act. Z. p The work described in your request is within an Area Subject to Protection'Jnder the Act. but will not remove, fill, dredge, or alter that area.Theretcre, said work does not recuire the filing of a Notice of Intent. 3. Id] The work described in your recuest is within the Buffer Zone.as defined in the regulations. but will not alter an Area Subject to Protection Under the Act.Therefore, said work does not reauire the filing of a Notice of Intent. Applicant to schedule a pre—construction meeting t4. inspect erosion control. 4. C The area described in your reauest is Subject to Protection Under the Act, but since the work described therein meets the requirements for the following exempticn.as specified in the Act and the regulations, c No a of Intent is regwrez" Issued by A ORTH ANDOVER Conservation Commission , Signature(s) This Determination must be sioned by a majority of the Cdnser�aticn Commission. On this 4th day of February 1 98 beicre me personally apoeared Joseph W. Lynch, Jr. , Chairman to me known to be the person described in.and who executed. the tere_oine instrument, arc acknowledged that he:she executed the same as his/her trge act and deed. Notary Public My corrmisslcn`excires This Determination noes not relieve ine aoolicant from comotying with ait other a_bntacle ledera!,state or locat stawtes.orcinances.' by-iaw3 or regulations.This Determination shall oe valid for three years form the aale of issuance - r r•ti' gofn; ity,pperson aggrieved t .this�eie.^•nination,any owner of land aburtina Ire fano upon wnic.'1 the oroposed work IThB 8r'h iC ft,if a zo be eong.'or eny len iesioeri6 of Ina city or town in wnlcn sucn land is locates.are nerecy nctif tec of ineir riont to ieouest the Deoanm ini cif Envimnmenu it Protection to issue a Suo-arsecino Determination of Aooiicaoiiny,providing the reeuesi!s mace ov cenfliec mail or nano r "Imeryto the Decarinien;,witn the amcroonate filing lee and Pee Transminal Farm as provjced to 7,i0 C1.1Pi ic.o3(—,)within ten pays from r'- the Gate of tasuance of this Determination.A Copy of the request snali at ine same time be sent by cenitiec mail or rang delivery to the n Ca'r.V_arvauon lzmm ssion and ine applicant. r 2.2 ' �SRf3��4eass�Mr4�11M*.•`r�S,`�, f, Tom. J/��anv�narz�u�o�'✓��aeaacluJet�a DEPARTMENT OF PUBLIC SAFETY s f CONSTRUCtION SUPERVISOR LICENSE Numt�i Er,pi-es; Birthdaue: CS ' 100511:,.0 112/2000 03/12/1953 Restrr•'etl Te:f 00 • HENRY C ,BFC�ER -f or"*,1 [ITTLE",S:1N NENBORY, MA 61951 ���� � �a'Poomsno�uaea�/�+o�✓�iiaeadb�iaekl — = KNIE IMPROVEMENT CONTRACTOR Registration 104931 Type - PRIVATE CORPORATION 1 Expiration 01!15/98 HENRY C. BECKER CUSTOM BUILDI Hern•y C. Becker tle's Lane ; ADMINISTRATOR Newbury MA 01951 . i i I , r r MAScheck COMPLIANCE REPORT Mazzachuzettz Enengy Code ; Penm.it # ; • MAScheck So4twa4e Venz-ion 2. 0 ; r , Checked by/Date ; • CITY: Have4h.itt STATE: Mazzachuzettz HDD: 6027 CONSTRUCTION TYPE: 1 04 2 4am.i-ty, detached HEATING SYSTEM TYPE: O-the4 (Non-E-tec-t4.i.c Reziztante) DATE: 4-7-1998 • DATE OF PLANS: 10/97 • TITLE: Schwa)ttz Residence PROJECT INFORMATION: SchwaAtz Rezi.dence • COMPANY INFORMATION: • Secke4 Con,6tAuct ion • COMPLIANCE: PASSES • Requ.i4ed UA = 171 You4 Home = 171 A4ea o4 Insu-t Sheath G-taz.ing/Doon Pe4.imete4 R-Va-tue R-Va-tue U-Va-tue UA • ------------------------------------------------------------------------------- CEILINGS 700 30. 0 0. 0 25 WALLS: Wood F4ame, 16" O. C. 720 21 . 0 0. 0 41 GLAZING: W.indow.6 04 Doo,%z 177 0. 310 55 • DOORS 54 0. 330 18 FLOORS: Oven Unconditioned Space 680 19 . 0 32 ------------------------------------------------------------------------------- • COMPLIANCE STATEMENT: The p4opozed bu.itd.ing de,3.ign 4ep4e�sen-ted .in theze document.a .ins con,t.i.�sten.t with the bu.i.-td.ing p-tan.a, 6pec.i4 icat ion,6, and othe4 ca.2cu-ta-t.ionz zubm.itted with .the pe,%m.i t app-t.icat ion. The p4opoded bu.i.-td.ing ha-6 been dez i.gned to meed. the 4e.qu.i4ementz o{ the Mazzachuzettz Enengy Code. The heating -toad 4o,% -th-iz bu.i-td.ing, and the cooting -toad .i4 app4op,%i.ate ha.a been dete4m.ined urtng the appttcab-te Standa4d Dez.ign Condit tons {pound .in the Code. The HVAC equipment ase-tected to heat o4 coot the bu.i-td.ing • Asha-t-t be no 94ea.te4 than 125% o4 .the dez.ign -toad ass zpec.i4 ied .in Msectionz 780CMR 1310 and J4. 4 . • Eu.i-tde4/Deztgne4_,4.,,,iDate �/f p� • MAScheck INSPECTION CHECKLIST Mazzachuze.ttz Ene4gy Code MAScheck So4twa4e Ve4zion 2. 0 Schwa4tz Rezidence DATE: 4-7-1998 Bldg. , Dept. , Use ' r r CEILINGS: C ] 1 . R-30 Commentz l L ocat ion r r WALLS: • ( ) ; 1 . Wood Fname, 16" O. C. , R-21 ' Commentzl Location r WINDOWS AND GLASS DOORS: ( ) 1 . U-value: 0. 31 Fon w.indowz without Qabeked U-vatuez, dezc4.ibe 4eatu4ez: # Panes Fname Type The4ma2 B4eak? C 1 Yez ( ] No Comment s/Locat ion DOORS: C 1 1 . U-value: 0. 33 ' Commentzl Locat ion r r r FLOORS: C 1 1 . Oven Unconditioned Space, R-19 Commen.tzl Locat ion r AIR LEAKAGE: . ( ) Jo.intz, penetAat ionz, and ak.2 othe4 such open.ingA .in the bu.itd.ing envelope .that ane zou4cez o4 a.i4 .leakage must be zeated. Recezzed - Q.ightz murt be .type IC dated and .inzta.Cked with no penet4ationz � on .i.nztatted .inztde an app4op4.iate ai4-tight azzemb.ty with a 0. 5" ctea4ance 44om comburttbte mate4.iatz and 3" ctea4ance 44om .inzutat.i.on. VAPOR RETARDER: ( ] Requ.i4ed on the wa4m-.in-w.inte4 zide o4 att non-vented 44amed ce-i.2.ingz, wattz, and 4.too4z. r r MATERIALS IDENTIFICATION: C ) ; Mat.e4.iat,6 and equipment mutt be .ident.i4.ied iso that compt lance can be dete4m.ined. Manu4actu4e4 manuals 4o4 att tnztatted heating and cootiag equipment and ze4v.ice wate4 heating equipment must be p4ovtded. Inzutat-i.on R-vatuez and 9taz.ing U-vakuez must be cteaAty ma4ke.d on the bu.ikd.ing ptanz on Apec.i4.icattonz. DUCT INSULATION: • ( ] ; Ductz in unconditioned zpacez must be .inzutated to R-5. Duces outz.ide the bu,itd-ing must be .inzutated to R-8. 0. DUCT CONSTRUCTION: ( ] Att duces must be zeated with mazt.ic and 4.ib4ouz backing tape. Pnezzu4e-zenzit.ive tape may be used 4o4 4tbnouz ducts. The HVAC zyzte.m muat p4ovtde a means 4o4 bakanc.ing a.in and wate.4 zyztemz. , TEMPERATURE CONTROLS: ( ) ; The4mortatz ane 4equ.i4ed 4o4 each zepa4ate HVAC zyztem. A manual on automatic means to pa4ttatty 4ezt4tct oa shut o44 the heating I ; and/o4 coo.ttng .input to each zone on 4too4 zhatt be p4ov.ided. r ( ] ; Rated output capacity o4 the heat.i.ng/coot ing zyztem .ins not gneaten than 125% of the dez.ign .load ass zpec.i6ted .in zect.ionz 780CMR 1310 and J4. 4. MISC REQUIREMENTS: C 1 Re4e4 to 780 CMR, Appendix J 4on %equ.i4ementz netat.ing to zw.imm.ing ` pootz, HVAC piping conveying 6tu.idz above 120 F on ch.itted ¢tutdz betow 55 F, and c.incutattng hot water 4yztemz. ----NOTES TO FIELD (Bu.itd.ing Department Use Onty)------------------------- TO DATE TIM FROM 7 AREA CODE EXT: COMPANY A /l NUMBER PAGER MOBILE -sem' FAX !t MESSAGE 61O U `J SI NED RETURNED MILL CAL! p� ❑ PHONED ❑GALL BACK ]RETURNED Q AGAIN WAS IN ❑U PEN-TAB INDUSTRIES.INC. i i Bk 4917 PG 3011 JOYCE l3P.ALL iAW ••;1Ry+� i; TOWN CLEF) ti NORTH ANDOVER hrq abpeol sail tie filed ,,��:61 7 �wr04in 1201 days after the TOWN of NORTH ANDOV[rDCT 23 9 15 r91 dATe:Cf filial of this Notice In,the Office Ot the Town MASSACHUSETtS ATYLS'1` Clark. ATMA Copy BOARD OF APPEALS 'g.ae••a•0�` dipwd eu�aftd fled Tom Tlfls rwadyar dela Tom Clerk hm ar arrwa 1 NOTICE OF DECISION xe.+a~rs 234 Brentwood Circle W I NAME: Robert i Sara Schwartz DATE: 10/20197 t!t ADDRESS: 234 Brentwood Circle PETITION: 034-97 did» North Andover,AAA 01845 HEARING: 10/14/97 The Board of Appeals half a regular meeting on Tuesday evening,October 14,1997 upon he on applicatiof Robert t Sara Sehwartr.req8t ueaa Variance from Section 7.pwagreP for rolef of aside setback in Table 2. Said premises island and building located on theleC 16'97 AN9:45 + st side of 234 Brentwood Circle, which is In the R-1 Zoning District eset. The follamng members were pr : William J.Sullivan,WaNer F.Soule,Raymond Vrverizik� John Pak",Filen McIntyre. The hearing was advertised in the Lawrence Tribune on 9130197 and 1 OMM7,and all abutters iwere notfW by rsgulsr mail. O— Upon a nation made by Raymond Vivenzfo and seconded by Walter Soule,the Board of d Appeals unanimously voted to GRANT relief of a side setback of 5.4 fest for the new addition to the house,and Ow ardsting peeps side aathadc ectal to be 4.2 feat from garage werteng to the South side lot fine on the condition that a new and corterled Plan be submitted by Mr. lllvan,Walter Schwartz with respect to the C$ft garage. Voting in favor. Wiliam J.Su a F. Souk,Raymond VNenrio,John Palone,Fien McIntyre. The peftorw has satisfied the provision of Sedon 10,paragraph 10.4 of the Zoning Bylaw end that the granting of these variances will not adverselyaffect the neighborhood or derogates from the Intent and purpose of the Zoning Bylaw. {� Note: The prorrGng of the VaAance creditor Special Perm*as requested by ties applicant must abide } does not necessarty ensure the granting of a Sul"permit PPN� by al appNoable local,•tela and fedw I and butt"codas and regulations,prior to the Issuance of a buNdiep permit as requested by the Building Commission. BOARD OF APPEALS William J.Sullivan,Chairman may,•a- '� A. olYr+'� x i gOA71y BK 4K y r ,'-s Is tO 09*that W"(20)dsy8 0� '`'• O. 1:s elapsed tram date of dedston filed :,;Ihoutfllingofan�p�, = JOYCE BPD/" 14# ' Date n�i -dc. 6- l c Y • . ... :..:... Tfl'/V14 CLF( .loyceasradstgtw 'sSA(:M S. NORTH AHDOYER � Totm Clerk .. TOWN OF NORTH ANDOVER '\ 31I010 tSA101 MASSACHL.ISr3;"TS 6aoo mut d +LSZUV BOARD OF APPEALS Any appeal shall be filed within(20)days after the date of filing of this notice in the office of the Town clerk. NOTICE OF DECISION PROPERTY: 234 Brentwood Circle, North Andover, MA , NAME: Robert & Sara Schwartz DATE: 2/11/98 ADDRESS: 234 Brentwood Circle PETITION: 002-98 North Andover, MA 01845 HEARING: 2/10/98 The Board of Appeals held a regular meeting on Tuesday evening, February 10, 1998 upon the application of Robert& Sara Schwartz, requesting a Special Permit under Section 4.136, paragraph (3)-(c); & (iii)-(3); (1996) (non-Disturbance Buffer Zone) for construction of an addition, of Table 2, of the Zoning Bylaws which is in R-1 Zoning District. The following members were present: Walter F. Soule, Robert Ford, John Pallone, Scott Karpinski, Ellen McIntyre. The hearing was advertised in the Lawrence Tribune on 1/27/98 & 2/3/98, and all abutters were notified by regular mail. M Upon a motion made by Robert Ford and seconded by John Pallone, the Board of Appeals I unanimously voted to GRANT a Special Permit pursuant to use requirements of Section x 4.136, paragraph (3)-(c); & (iii)-(3); (1996) to construct a proposed addition of 6 sq. ft. and 18 0 M sq. ft, and to come within 100 sq. ft. of a non-Disturbance Buffer Zone, finding that the , construction is less than 25% floor area of the existing structure. Refer to the Topographic O `� Plan of Land dated 1/12/98 and revised 1/14/98 by Merrimack Engineering Services. Voting in o favor: Walter F. Soule, Robert Ford, John Pallone, Scott Karpinski, Ellen McIntyre. cn The petitioner has satisfied the provision of Section 10, paragraph 10.4 of the Zoning Bylaw and that the granting of these variances will not adversely affect the neighborhood or derogate from the intent and purpose of the Zoning Bylaw. Note: The granting of the Variance and/or Special Permit as requested by the applicant does not necessarily ensure the granting of a Building permit as the applicant must abide by all applicable local,state and federal and building codes and regulations, prior to the issuance of a building permit as requested by the Building Commission. BOARD OF APPEALS Walter F. Soule; e; /decoct8 %*V? -* Z3L1 '%3v4"+wvoA IJor-1-�. ^,ods--" �wr.� iJM ila IYtHVL64L4SEi2 P.02 Town of North Andover Cf No�r. 1 OkRCE OF c? . •.. tioo� COMMUNITY DEVELOPMENT AND SERVICES A � 146 Main Street . • North Andover,Massachusetts 01845 �-• ' WVIAM J.SCO'rt tip' ,.•",h Dler ss�COW MTMNRY AT)DT.Tr%xM'rr%y_AxD PERMIT DATE June 3 1998 PERMIT LOCATION 234 Brentwood Circle OWNER'S NAME Schwartz BUILDER'S NAME Becker Custom' Building LTD. MASON'S NAME L. Da.igneault & Sons Inc. , MASON'S ADDRESS 44 Church St. Kingston, NH -03848 MASON'S TELEPHONE (603) 642-5943 MATERIAL OF CHIMNEY Block & Brick INTERIOR CHIMNEY % EXTERIOR CHIMNEY NUMBER AND SIZE OF FLUES 2 - 121, x 12,- THICKNESS 2^THICKNESS OF HEARTH 611 Will chimney or fireplace conform to requirements of the code and have rules and regulations been received: Yes DATE June 3, 1998 SIGNATURE OF MASON CONTR. LIC. p66 S7 7 EST. CONSTRUCTION COST/CONTRACT PRICE + PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS • _ SOLID 8 CK EOUYRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARAOBAPPp,At5 688.9341 BLJUZU40 688-9341 CONSERVAnoN 699-9330 HEALTH 688-9340 I'LANNI(o 681.9333 F NORTH Town of t _ Andover. . No. /_3 J0 o _ m * - -T'- - * Z - - _ 19 9� s . dower, Mass., wJ• P-.7.9 9 0 L I K E /O- Y �I� '9 COC HICMEWICK 1` v S AATEO lk `G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. . .... ......................... . ... .... . . . . .... . ...................... ...................................... Foundation .. . . has permission to erect........................................ buildings on ��. Rough .. ............................ ... ...... ............ g to be occupied a '..... ......... Chimney .. ... . ... .. .. ....... ......................................................................... provided that the person cepting this perm' hall in every respect c orm 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this hermit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO S ELECTRICAL INSPECTOR ARTS Rough ........................ ........................... .. ... .. ... . ... .. . . ............. Service BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough P P Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det.