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HomeMy WebLinkAboutMiscellaneous - 24 TYLER ROAD 4/30/2018§ ( 2 w�} ��I / /} gym\ \�\ Pel o : � � Date ... �Ae.! .� ...... . TOWN OF NORTH ANDOVER s PERMIT FOR GAS INSTALLATION This certifies that ...0 ��rl-S..d,� ... • • • • • • has permission for gas installation in the buildings of/ . tfam.. / l `� lG �I U ............... . at .....`�. 7.. �` "� . �G!"... ......%' /North�j� oven Mass. Fee,(v. a Cao 7Z . Lic. No. 4."/ Cd�gr� 1. . . / q GAS INSPECTOR Check # D Ca Z / G TYPE OR PRINT CLEARLY APPLIANCES 7 BOILER BOOSTER MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 1 MA DATE PERMIT # JOBSITE ADDRESS Z, OWNER'S NAME r OWNER ADDRESS LS -- __.__ _,_.. TEL-- FAX T� OCCUPANCY TYPE COMMERCIAL ( EDUCATIONAL RESIDENTIAL NEW:�I_�. RENOVATION: E] REPLACEMENT: / PLANS SUBMITTED: YES El NOF FLOORS- BSM I 1 1 2 1 3 1 4 1 5 1 6 7 1 8 E 9 1 10 1 11 1 1213 14 CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES _ NO Ej 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ©( BOND I_( 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 E—JI AGENT Q SIGNATURE OF OWNER OR AGENT 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 142 of the Genera Laws. PLUMBER-GASFITTER NAME/, _ _ ( LICENSE # , __ SIGNATURE MPJMGF�JP 01 JGF LPGI F CO ORATION 0# �j PARTNERSHIP 0#= LLC [j# COMPANY NAME:��- n '�---�.-- :�.--�__----`-�,�----- -ADDRESS CITY FAX ELL EMAIL z 0 F U W A4 V❑ O y❑ W } H W EO IL Z w w M: � 3 ~ W O w a W w w N a o a w a J a a Q �a � w x w VO W H °z 0 H U W a - CQ7 a L`1� The Commonwealth of Massachusetts - Department ofIndustrial Accidents Office ofInvestigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �� (/ ✓J r Address: Z t,) FoNe.'5 J— -!5r �. City/State/Zip: lei 1 M-n M �-017 SZPhone #: L! Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Ll employees (full and/or part-time).* have hired the sub -contractors 2.VQ I qm a sole proprietor or partner- listed on the attached sheet. T sip and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.]r employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. F1 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F1 Electrical repairs or additions 11. [J Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ? Homeowners who submit this affidavit indicating they tie 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date; Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certto under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -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 Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston, MA 02111 Tel, # 617-72.7-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax # 617-727-7749 www.inass.goV1dia 11 Date.... TOWN OF NORTH ANDOVER Vow r -I PERMIT FOR GAS INSTALLATIO This certifies that......... 5t - V - f has permission for gas installation ............ in the buildings of .............................. at .......... North Andover, Mass. Fe&2,.... .... Lic. No.,:-� . 1.'�- . .......... GAS INIE=W Check # /-?� 4 4 iski— MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) ,Mass. Date Q 03 Permit # Building Location .2q TYLER, R D Owner's Name G t N k A K ii A Q O MOP -1H ANDOVEiZ N1A Type of Occupancy Sl O�iJ 1 l A U New ❑ Renovation ❑ Replacement I* Plans Submitted: Yes❑ No ❑ Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone -68,7—'1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # )CJ Corporation 1862 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes .If you have checked yes, please Indicate the type coverage by checking the appropriate box. liability insurance policy K 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 El I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu gte to the best of my knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U i T of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 3, 45 Glty/Town Journeyman APPROMEU O FIC SE ONLY ■���■tom■�� �H tmom NEI ■■���o,�������mom INS no] NMNNMENM mono 0 NMI ME 0 NEI .. ... ■�t���������tt���t���t��� mom Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE, MA 01840 Business Telephone -68,7—'1105 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # )CJ Corporation 1862 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: I have a current liability insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes .If you have checked yes, please Indicate the type coverage by checking the appropriate box. liability insurance policy K 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 El I hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and accu gte to the best of my knowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U i T of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 3, 45 Glty/Town Journeyman APPROMEU O FIC SE ONLY n z- H LL N J () 2 O . O w, 1_- U � LL ¢ n LL O w O 0. , z a a ¢ .Qi z hw- tt. LL ~ b J LL Z O O LL a J O m n w ~ w LL m U O O0 I- z tr O w O a w Q z w Q O_-1 U- Z J 0. J Z O H U w z The ' Commonwealth of o:ttc4 Use o.tr `rtincnt o ••r•te so. ' Dcpc .:.,. jPublic Sojcry ' BOARD OF FIRE PREVE=OH REGULATIONS 527 CMR 1200 3/90 occur -7 & fee 0%dcud APPLICATION �FOR PERae HwAchuscas a) MJT.TOPERFORMELECTRICAL WORK All "tk Code. 527 CMR 1200 (PLEASE nnix Iii nm OR; Date `� City o+ • . - -- r Tots of � •�%•�Q': To the Inspee r of S7ires: ' 7ba undersigned applies toc saer��peroiC to perform tha electrical, work described below. Location (Street & fiber) OF�/e, R�(, Owner or Tenant I l L SLR4 N-n4x► "Aa 't1) 'Owner's Address 80LY oi'�1 •° V�D.c 04 Is this permit in conjunction v itlt a building permit: Yes ❑ No ❑ (Check Appropriate Box) 1!urposc of Buil-ding 51 016 ( Utility Authorization N0. Existing Service Raps /J Volts Overhead ❑ Undgrd ❑ No. of Meters , ❑ Uodgrd �'" Service erv-ice A°Ps / Volts Overhead ❑ NO. of iieters H=ber of Feeders and Ampacity Location •and •Mature of Proposed Electrical Stork No. of Lighting Outlets No. of Not tubs No. of Lighting Fixtures Swing Pool No. of Recepticle Outlets No. of Switch Outicts No. of Ranges No. of Disposals No. of Dishwashers No. of Oil Burners No. of Cas Burners Air Cond. Ho: 'of Neat Tot, Pueos Toi Space/Area Heating e ❑ in- ❑ Md. tons an No. of Dryers Heating Devices' )3J No. of Water Heaters Im No sfflo. of Ballasts No. Hydro Hassage Tubs No. of Motors Total HP O=.- _ No. of Transformers Iota RVA Cenerators XVA No. of Emcrgency Lighting Battery Units FIRE ALUM • No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Sel Contained Detection/Sounding Devices- LOCI evices• LOC*1�'Itlunicipal l.1 �nneetlon0 Other Low Yoltage INSURANCE. wo:;,tCE: ' Pursuant to the requirements of Y3ssachusetts Central laws I have a current Li ilii Insurance Policyincluding Completed ,equivalent . (� g p Operations Coverage or its substantial Iyou have ch eked M, Please indieabtetthe typeed dofrcoveragef of ab cheto cking his othecap ME] bo g appropriate box. INSURANCE BOND [] OnMt 0 (please Specify) FstL=ted Value of Electrical Work ,S ' piration ace) Work to Star A"/1 4 9'. . "ection Data Requested: Roca h 8 `� Co, j .Signed under thenalttes o ! perjury=. rim &Qat sign LIC. No. -A 1a of Licensee k 'P. Ives Signature__ y l% ,,u )lddress _ A. 0. 801( 1' o d • i� /�) LIC. H0. �y1�J-NQS.. Q',jl�� Bus. rel. No. - teal.?,•.. � Ou`:ER'S INSU'UItiCE•NAI': =Alt. Tel. No am . aware that the,Licensee does not have the.insurance coverage or 'its suo- stantial equiiAleat as required by Massachusetts Centralvs, an4 tRat.tsr signature on this permit application waives this requirCMPRto Owner Agent (please check one) Telephone N.o. ?T": L'"er ; C T � Date ..... .-- Ms TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... 5.,....la,,/'C.S.fea..... lkoS......... :....... has permission to perform.....12.�v. Jk�1....... t �.0?Q.� ...................... wiring in the building of ...... +m q.../.. ..................................................... at ............. d.. ...... T.y./ffl......... ! .................... , North Andover, Mass. Fee ..1�— �. vv Lic. No.14/20./............................................................... ELECTRICAL INSPECTOR GV " 027/97 11:59 50.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer i v Location �/ a MO.Date NORTH TOWN OF NORTH ANDOVER f � � • OL Certificate of Occupancy $ sACMUs t� Building/Frame Permit Fee $ �`• Foundation Permit Fee $ Other Permit Fee $ TOTAL $ -� Check # /1-5 eVV ..i �Building Inspecid TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: C Building Commissioner/In for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Ages : 1.2 Assessors Map and Parcel Number: h Map Number Parcel Number 1.3 Zoning Information: ZoningThstrid Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Rapfired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Infomration: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record (C r . 1f-(- RLD, Name (Print) L�L Address for Service Signature Telephone ^.2 Owner of Record: 1 Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable Company Name Registration Number Address Expiration Date Signature Telephone O Z M 90 O Mn r M r r s z G) SECTION 4 - WORKERS COMPENSATION (AG.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building fY Repair(s) 0- Alterations(s) Ui - Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: irlric (VyA Qddthr appfvx - (P` x20 (mio exls-hnc do -c(-, IJ SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by pen -nit applicant OMCIAL USE ONLY 1. Building (a) Building Permit Fee Multiplier 2 Electrical �— (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR MTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relaf t ork a thorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief C/Ah- Print Name .11 Signature of Owner/A Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR T11VIBERS 1' 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE IZ-, IV FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT in Ps ke&g oQ PHONE fl —s 1 ASSESSORS MAP NUMBER �� LOT NUMBER SUBDIVISION LOT NUMBER STREET ) �V ( VD. STREET NUMBER C)i 1 �........... .....................■...... 2...0.......02.0...0...■ a ■......■ ........................... OFFICIAL USE�ONLY......... RECOMMENDATIONS OF TOWN AGENTS I..�.(.�v-...�.^g: S ................ DATE APPROVED .S{ �10d ....... CO``N�LL,S//,,ERVATION ADMINISTRATOR DATE REJECTED TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED FOOD INSPECTOR - HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR - HEALTH DATE REJECTED CONOAENTS PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED CONUV(ENTS RECEIVED BY BUILDING INSPECTOR MART8A1E IMBPECT10N PLAII City/Tornr ------------------------ 14NOave:-- 8latel Mfa ----------- ---------- Delco_ ►.np rx...'.1_ t g 9#... kslcl...�_.:. -0 Drnerl A 1,r.�w+b 6uyerl ....... A--�-c°.Z__. ------- Deed Rct._1 4C.?G..�. ?s ._ Plan No. °> 4 __.-- Drawn per City/Tows of _._Ja/p--- _ Tax Assessors flap, E E Tor -------------------------------- --- D G- __� ----- J . -- -- ___ 1 hereby certify that the above Mortgage insptclion-Plot was propar for ase in�cmKtioa with a ser Nort9age and is not inbtnded or rtpremted to be a property line or land surrey. It cannot be used for tstabli0ing fester hldgt r Valls or building lines. No rtspaniibility is extended herein to the land owner or occ aat. The locatio+r ot, the original bailding(s) as shore Wein was in coa9ltance with the local applicable zoning bylaws s tffect when constrrlcte4, VitM respect to horizontal di.ensional rt4virestnta, to lot lines or is exespt fros violation enforce t action nadir RA L. Titit Vllr Chap. 40A, Etc. ), unless othtrwite shown herein. Subject buildino(s) lies in a flood zoacksigna4d 20411__.. and shorn on FIRM sap Cossunity-Panel 1_20_(d_;,�cr�latedr;�___ Job Pb.i�lio'JT JCD, 11IMPORATEO, LAND USE i IEKLOPMEUT COM TANT9 4 AU7QM LANE, NETNUENr Pill 41944 906.683-9933 k g-osSwu- �p j x '1y X CCS c " -A PXrsh"IS O -Y7 Ce,-X-Cc,6 HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Q `t �� (� r VI Number Street Address Map / lot "HOMEOWNER Gn" R YA o 6g,- I-% S, I�- Name Home Phone Work Phone PRESENT MAILING City Town State Zip Code The current exemption for "homeowners" was extended to include owneroccupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that helshe will comply with said procedures and requirements. n HOMEOWNER'S APPROVAL OF BUILDING OFFICIAL Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 - ,`(978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Q `t �� (� r VI Number Street Address Map / lot "HOMEOWNER Gn" R YA o 6g,- I-% S, I�- Name Home Phone Work Phone PRESENT MAILING City Town State Zip Code The current exemption for "homeowners" was extended to include owneroccupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that helshe will comply with said procedures and requirements. n HOMEOWNER'S APPROVAL OF BUILDING OFFICIAL Town of North Andover o� �a to qti Building Department o 27 Charles Street * _ North Andover, Massachusetts 01845 ?, e� �► (978) 688-9545 Fax ((978 688-9542 l l �!a p°RAtreo 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 c11, sl 50a. The debris will be disposed of in /at: I 514yya"' + - V-�' ilukch 6,zP)k'15 ap"k Facility location Sign ture 6 Applicant E2-23-00 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. M 71 M M 0 M CO2 10 CD � Z CD O a. r C n� Mq .p O o p a� Q CD 0 Feen W. co) 10 CD O 7 Cop) d 03 O N! .p O y O CD 0 CD a ra . CD CO! 0 O CD 0 CCD CO c?� O m 2 O -� CA Q N ao R m Cl) = m n m C9 'ac2no m � N z O.�► ,d.0 m N—O T CL n CD -1 G CD N O N O 3E O O: n O cl m _ o 03 O0 z:5 • O c O N n _ rA�,. i4wArAb 2 m m N m ' o m'A `f \ / C O. e'+ O = O N N;� Q (nCD CD C — `aCA CD CD 00 O m o � �G o =CD m cn w = CD m W N m IM Cl)dC* CA =gib fiy w Cn d Cn rB o to 110 g, 00 C) y ^11 w ci� � M ,ted � Ix w , "t7 p �c7 w (� �1 w 'r1 C O C/)31 �a f^�^�'D' a x n rD O t7l 9 I y 0 0 c Location// / / / No. /19- Date .5 -3 60 TOWN OF NORTH ANDOVER Certificate of Occupancy $ °'•jBuildin /Frame Permit Fee $ �s9 r, Foundation Permit Fee Other Permit Fee TOTAL Check # C� -, - $ Lf ,l/'6 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING -1 t BUILDING PERMIT NUMBER: / DATE ISSUED: 6-3 _ a SIGNATURE: VIAC Building Commissioner/In§L=tor of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning hiformation: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area s Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record J/4 A-11 %_ Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ,a CC e -C lc'K Licensed Construction Supervisor. t4 /—y A LIFF A Vi dilr� ess Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor r L^/C2 C o ri oO/�cj• Not Applicable ❑ lG CS-� Company Name Y Al�),4Crs Address &a,.r,t 6?6 -20,�� V Registration Number Expiration Date nature Telephone OU M a Z O �I W O z M 90 0 Mn ic M� r Z G) N 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 an in the denial of the issuance of the building . rmit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Descri tion of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Ao— Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �S9'4CC ,00�/� CJiy�TS l k' zj)�/ 5'T`- o plg&1 5- I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant = ,I)MCIALPSE ONLY 1. Building /)/j Q v (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building pennit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, &XI as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 ND3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE COMMERCIAL LINES POLICY COMMON POLICY DECLARATIONS Policy Number: CPP 0120 53 68 59 Named Insured and Mailing Address (No., Street, Town or City, County, State, Zip Code) WILLIAM R CLARK JR CLARK REMODELING 16 LYNDALE AVENUE METHUEN MA 01844 RENEWAL BUSINESS DIRECT BILL Replacement or Renewal Number of CPP 0110536859 Policy Period: From 06/16/1999 to 06/16/2000 12:01 A.M. standard time at the mailing address of the named insured as stated herein. IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part Commercial General Liability Coverage Part Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Owners & Contractors Protective Liability Coverage Part Commercial Auto Coverage Part Countersigned: 04/20/1999 By 20.08100 DAVID J DEANGELIS INS AGCY INC 283 MERRIMACK STREET METHUEN MA 01844 (978)682-3397 $ PREFERRED $ MUTUAL INSURANCE $ COMPANY COMMERCIAL LINES POLICY COMMON POLICY DECLARATIONS Policy Number: CPP 0120 53 68 59 Named Insured and Mailing Address (No., Street, Town or City, County, State, Zip Code) WILLIAM R CLARK JR CLARK REMODELING 16 LYNDALE AVENUE METHUEN MA 01844 RENEWAL BUSINESS DIRECT BILL Replacement or Renewal Number of CPP 0110536859 Policy Period: From 06/16/1999 to 06/16/2000 12:01 A.M. standard time at the mailing address of the named insured as stated herein. IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part Commercial General Liability Coverage Part Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Owners & Contractors Protective Liability Coverage Part Commercial Auto Coverage Part Countersigned: 04/20/1999 By 20.08100 DAVID J DEANGELIS INS AGCY INC 283 MERRIMACK STREET METHUEN MA 01844 (978)682-3397 $ 100.00 $ 569.00 $ 4.00 TOTAL $ 673.00 THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS, COVERPGE PART COVEP- AGE FORMS(S) AND FORMS7ANDENbORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY. CD -1 (07-97) Includes copyrighted material of Insurance Services Office, Inc., with permission. Copyright, Insurance Services Office, Inc., 1983, 1984. INSURED COPY LIBERTY MUTUAL. Workers Compensation and Employers Liability . Policy . ACCOUNT NO SUB ACCT NO: Liberty Mutual Insurance Group/Boston 1-309921 0000 LIBERTY MUTUAL FRE INSURANCE CO. 16586 POLICY NO. - TD/CD1 SALES OFFICE CODE ES REPRESENTATIVE COD /R ST YEAR WC2-31S-309921-010 XXX STWOOD -- 101 ASSIGNED. 3000 2 1998 Item 1. Name of WILLIAM CLARK JR Insured DBA CLARK REMODELING FEIN 02-1424407 Address 16 LYNDALE AVE - RISK ID 242274Y. METHUEN, MA 01844 Status 01 INDIVIDUAL n Other workplaces not shown above: SEE ITEM 4 Mo. Day Year Mo. Day Year Item 2. Policy Period: From 02-19-00 to 02-19-01 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed .here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03.06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verificationand change by audit. Minimum Premium $ 500 ( MA) Total Estimated Annual Premium $ 516 Interim adjustment of premium shall be made: ANNUAL This policy, including all endorsements issued therewith, is hereby countersigned by SEE ATTACHED FORM 1710 Authorized Representative Date 02-28-00 Loc. Code I Term. Oper. Audit Basis Periodic Payment Rating Basis Pol. H.G. I Home State I Dividend KENE W AL UN 02-28-00 NRMA WC2-31S-309921-019 GPO 4030 R1 Copyright 1987 National Council on Compensation Insurance INSURED COPY WC00 0001 A n Premium Basis Rates LINE 110 Estimated Per$100 Estimated Code Total Annual of Re- Annual Classifications No. Remuneration muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 ( MA) Total Estimated Annual Premium $ 516 Interim adjustment of premium shall be made: ANNUAL This policy, including all endorsements issued therewith, is hereby countersigned by SEE ATTACHED FORM 1710 Authorized Representative Date 02-28-00 Loc. Code I Term. Oper. Audit Basis Periodic Payment Rating Basis Pol. H.G. I Home State I Dividend KENE W AL UN 02-28-00 NRMA WC2-31S-309921-019 GPO 4030 R1 Copyright 1987 National Council on Compensation Insurance INSURED COPY WC00 0001 A n #JOIN:` ,conrRaCTW r ' R� "LQla5b3 ti . Type 1 CLARK REMt>mlk Nil'Iia>t R. Clark, Jr. �.., � �.Yo�ele �A,ve�url. . • . ,aor�xsiw"uri . , ilstMtat� •>?!A �I84�i J ¢� 4� /cP �anvrno�,uuea/.�i a�✓j/iaasac%ucelta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 049212 Birthdate: 01/31/1952 r` , .'• Al' Expires: 01/31/2002 Tr. no: 15448 Restricted To: 1G WILLIAM R CLARK JR _ 16 LYNDALE AVEC, METHUEN, MA 01844 Administrator m M M m 0 m _v C � co) Cl) CD n Z co) CD O CL r- cl) = O CL =• CO) � � n CD o v CD o CL cr m CD CCD o ww C CD H• CD C:O y CO O CD tp y O 1 Z CD O oCD CD0 C C ? w 2 CD —•N O Cr W G O m -0y �; CO O. O CD C 7 C! G y p CL n T Z =r -O H Q, m o: CD No' T =r CD n so O CLy CD --140 m N p OCD m > > ® G n -� O O •-► ri O oZ y COf _ CL W � o D o co CD r CD O N ;� O cn O m ' rn o CD N -� 7 N R g V^J'���J d CQ C pp — CO o •c � � a h y mcn CA CD m d CD N A C* z �C: �mo cn O =a m CD cnCD bm C, cu . :fib: Oca QJ : c r: m d d to 0 -c a y ao C) W � e �o M H � m w o OCC p m��o w OGc o zi O � �• N a O �` o c ` Location No. l Date NaRTM TOWN OF NORTH ANDOVER Occupancy $ . ^ , Certificate of '�',S'^••� •'<�' s�CHusa Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�� „,' i Building Inspector W-WIM I Y > Y � Z - N Y r— V• `TTS u g - C' �/ N ih r- m —1 mom. r• T K x N X N is K Z N T • M. j m Y � C N, i J Z m F � = W-WIM I IX N u I /01 Y > Y - N Y r— V• `TTS C' ih r- m —1 mom. r• T K x N X N is M. j I Y � C N, o IX N u I /01 i C' ih r- m —1 mom. r• T K x N N — I Y � C Y N m F m = IX N u I /01 acolla �j "Ongfk ;'A 1: t 1; t 64 !�!: ,• 0 PRODUCER FW( 846-SIOS 6 17 8 4'6 5 1 0' 0 0 4; ^mr%11e`Ku TMIZ .rn i irt%.j% i r. ea kwouzu Au IRRIOCKU 1r4rv"1jK^PIvr4 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE '.1liot. Whittier, Hardy Roy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED fly THE. POLICIES BELOW, $7 Putnam Street COMPANIES AFFMING efiVEM! Winthrop, MA 02152 COMPANY T tiz'� Aft, oaneell S--arrozza Ext.- 2.2 5 A ............ .. .................. ............. - ..... ...... .. ... ... CCMPANY Transportation Ins. Co. Family Poc", & PatioCo., Inc. 92 South Broadway . ........ .. . ..... ... .... ....... ....... Lawrence, MA 01643 COMPANY ..................... COMPANY F9..i:PA'T�.tI'r-POLICIES OFINSURANCE LISTE6 BELOW HAVE BEEN INDICATED, NOTWITHSTANDING ANY AEO Ul REMPENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .......... .......... r . ....... ........ ............. ...... ...................... ..... ..... ..... COPOLICY TYPE OF INSURtNcs POUCV NUMOGR ErFE071VE POLICY EXPIRATION LIMITS LTR OATS (MM/DD1YYI DATE(MMIODA-Y) G9 KCIRAL LIABILITY GENERALAOGREGATe S100000D COMMERCIAL GENERAL LIABILITY PRODUCT4 - COMPIOP AGO 1 1000000 CLAIMS MADE X :OCCUR .... ............................ ........ .............. . P ERSONAL& ADV INJURY I 50000 A DI OWNERS & CONTRACTOR'S PROT 1AC1,1 OCCURRRN05 500000 ............................................ ........................... FIRE DAMA426 (Any one fire) S S0000 ............... MED 6XP (Any omp parson) S 5000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 9 ANY AVlrO .......... . ...... ........ 000 000 ALL OMEDAUT05 BODILY INJURY X SCHEDULED AUTO. A ....... 13038607 12/31/1999 12/31/2000 .. . ..... 14IRM AUTOS BODILY INJURY X NON-OWNEO AUTOS (Par poodeni} PROPERTY DAMAGE S GARAGE LIABILITY AUTO ONLY -SAACCIDSNT •ANY AUTO .......... 0 THE R THAN AUTO ONLY: EACH AOCIDENT: AGG1RGGAT6: 4 CXCESS LIABILITY EACH OCCURRENCE 2 ,IM@RFA1.,A FORM ............ . . AGOREOATZ OTHER THAN UMBRELLA FORM ........... W0149ENS COMPIENBATION AND X 1W GRIPLCYRAW LIAMLITY ELEACH ACCIDENT 8 THE PAOPMETORI ^L V)CCIS5942897 12/31/1999 12/n/2080 100000 PART,14ER2i9XECUTiVr INC EL DISEASE - POLICY LIMIT $ S00000 — ' --1 '111.1.11 4 .......... ....... OFFICERS ARC; EXCL SLOISEASE-EAEMPLOYEE 9 100000 OTHER -5�Wrf N�01 FNIRA-nONSILOCATION3(VLIHICLl!3l3Pl!CIAL ITEMS ............. 21 '1 " ijl;jijblk? M 4 ANY OP THE A 820 PCUCIII ELLED BEFORE THE XPIRArION DATE THEREOF, IN PANY WILL EN VCR TO MAIL W ITIT ECER AMED TO TWN LUFT, %UT PA1LUR M C" 5 1 OSE LIGATION DIR LIASIUTY 0 ON V IN A 10 T OF%R b0 VE Insured's Copy Paul Roy Nk. ",qw L^� 7 HOME IMPROVEMENT CONTRACTOR Registration 118204 Type ' PRIVATE CORPORATION Expiration 02/12/01 FAMILY POOLS & PATIOS INC GLENN WIGGIN BROADWAY �` 4M �o OR tA4VRENCE NA 01843 ADW41STRA 6QAM OF 6WLDMIG FiEW"Tw" Liter. mow SUPERVISOR %mb r_ CS 0=30 Bim%d r: 07/MSW Exairs: ti7/19i MI Tf. no: 448 d Ta W lAI Avmc POULOS 92 S ORDAVARV . a., iJ11MFENCE, IIAA Of$q A+Osw+lslradnr 'all &W�u HOME.IMPROVEMENT CONTRACTOR Registration 118204 Type - PRIVATE CORPORATION Expiration 02/12/01 FAMILY POOLS & PATIOS INC WILLIAM C. GIANOPOVLAS BROADWAY ADMINISTRATOR LAWRENCE MA 01843. N _.... D �3 �dr�3:rg � �kpa �• �3•alaW o, Q g w� p� 33383 • C C 3 $ o N D • v Q=_ o wfA . 7iIQ�oY. g-h�j- 09,333 aM M.O 9Q .a iii Q C WZ N O w� 3 $ % G N m fp 60. SMR r 3g s ° baa wg� oa i�•N�� 1 s v � ,q M • 1 _ Icy o E �o a� 2 = w1 i N w g 3 NN _� � u ; v u m c n Q p u a�. D A a at I at C. T X 1 FORM U - LOT RELEASE FORM INS T RUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION APPLICANT 614)14' + A k tT2P►'t" PHONE q')S— '091— &"0'f S - LOCATION: Assessor's Mao Number SUBDIVISION STREET 2Q Ty I>°i►4 K,r+ " PARCEL OP - LOT (S) 00? -S S T . NUMBER 04 OFFICIAL USE ONLY ----------- RECOMMENDATIONS OF TOWN AGENTS: i COINSERVATICN ADMINISTRATOR COMMENTS Q TOWN PLANNER r 1� COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED ((�% DATE -REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED � PUBLIC WORKS - SEWER/WATER CONNECTIONS 4 �. UU 11 APR 5 2000 DFJVE'NAY PERMIT FIRE DEPARTMENT 13UILDING DEPART HENT RECEIVED EY EUILDING INSPECTO DAT MORTGAGE INSPECTION PLOT PLAN a NORTHERN. ASSOCIATES, INC. 630 TURNPIKE STREET NORTH ANDOVER MA (508)975-7117 f. 4 MORTGAGOR.' MICHAEL 6 GINA ARMANO DEED REF. 1406 / 348 L OCA TION: 24 T YL ER ROAD PLAN REF. PL OR334 CITY. STATE: NORTH ANDOVER MA SCALE: 1- 40' DA TE.' 3 / 29 / 93 JOB is 93/ 01029 T 22 _� M -f � . ��� • ' i ci 2 . c� moi. 14 r _ ►-� Z of eQe GGIFjT/al.Cl Q j,.�oop t O r I 4 1 I 3►o t !� Cf) M m Cl) 0 m CO) C CU CA Cl) CD n Z y CD O 'C CL r 0� ? O CZ _• CO) nC 0 CD CD O .7 CL �c CD CCD O CCD G CD V; CD CZ O CA cc CD O I y O m Z CDCD O o 0 CD I O N Q N h � CA g On. 0 m mAa0 m ♦ Z Nm.- ?" N '� O .dr m N T m H G CA ` --1N ohm: m n 7 O N m to0 ow G M O N O O O C"'CL a �,ra •� QJ A.. to c?� CD tu V^I C7= l J c ao C m ca CDCA crn V/ � N� :o O mC (� CD H :O JU O z N �m CD C3 IOU m "z Qig. �c o a O C9 R O p - o� �7 Crl y w o G C) � � w z G rr rA Hro 7i w G z r f1 m phi n - QC/)7C C C r , d z C1 c U O n a7 o PTI � y 0 0 c -N° r2.. -- GO Date ..//--)/� ......... .' TOWN OF NORTH ANDOVER o PERMIT FOR WIRING This certifies that ........��.. �-� 1cc �� . c ►.. j ..— ..0 ,. ,.. c, ............................................................................... has permission to perform .......1.......�`��.......... 7—.�:... wiring in the building of i r ............. U ............................................... ................ at ...... —, � �. �. f t /l. , North Andover Mass. T. .... .......... ...................... . , �.�� Fee �.��..:.4�v..... Lic.No.�......... �.............��'r;:+../.•�`.................. S 7i] E RICAI. INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THE 60MM0NWE4L7H0FM4MCHUSE77s Office Use onI DEPARTMF.M OFPUBLICSAFM Permit No. BOARD OFMEPREVEMONRWM4770AS527CMR12 0 Occupancy & Fees Checked VAPPUCATIONFORPERAff TO PIWORMELECTRICAL WO ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, S27 CMR 12:00 l (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 6 Owner or Tenant Owner's Address Is this permit in conjunction with a building permit: Yes � No (Check Appropriate Box) Purpose of Building �+�s/�-P�G 10 Utility Authorization No. Existing Service Amps / Volts Overhead E3 Underground M No. of Meters New Service Amps Volts Overhead r --J Underground r --J No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA N6' of Lighting Fixtures Swimming Pool Above Below Generators KVA groundg1:1round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal f7 Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP htst.rwwCo� Ptnstpntbihece zemetsoflVwmdw9&Gataa(Laws Iha%eaaxotLiabitdyltsatoePblrymAxkgCarO* Cova,Wcritsmbstatialagivalalt YES NO Ilmewbmilbedvalidptoofof lothe0ffia-YES "NO r--J Ifycuha%cdmdWYFS,pleaserttclic*theNxOfMWdWbydakirgthe WpLp bcpL L.JJ INSURANCE BOND OTHER Wak1oSlatt WW ifa ll hipedimDWRapesied ftfflesy) EVirafimD* Estimated Vakxdt{F.leMxal Weds $ Rwoh �i -a // Final OWNWSRiSURANMWAMI?,,Iamaw=fttbeljmwdmsnt tleisswmx andthatrnysigtrakncnthispamit wai esdrism men eriL (Please check one) Owner Q Agent a Telephone No. �' ` LioatseNo .1J /K Btsu mTdNTa 47-33FY� A1tTVh 7— 4!*/qf3 oriksWVwrtWe*i%da>taste#WbyMassadnsM� Laws PERMIT F `� L P S„ M Location .i No. = nate --- — NORTh TOWN OF NORTH ANDOVER O��t.a° ,•,h Certificate of Occupancy $ t4L Building/Frame Permit Fee $ SACMUSt Foundation Permit Fee $ _ Other Permit Fee $ Sewer Connection Fee $_ ,�. c> Water Connection Fee $ m TOTAL $ a Building Inspector Div. Public Works r Location "No. Date u c TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ f, Foundation Permit Fee $ Other Permit Fee $,— Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works Cl N1 CA CM) d "0 C 0 Z co) d O �• C CL = CO) O C -J CD CD CL C7 CD CD O CD cc w CD CD O. l7 CO) �C I C2 CO) Ci 1 CD za C CD Cl dc CD A, cn V 1 \ J O C 9 O V J V J O z cn c z� a °f = C Co O Q N o.o�m -0 y m CLn m Cl) CC' Z y, m ,,. c a �o �-0 N � o w0Q O T IFacyC 0N N� o IEm m o > > CA m >24 .� O o Zt.a . m c ?O' N O. tC O =r O m N 7 C-) -0 CL CD CD O p1 co, N C ppINC — CL O N C .� m CA 1 �y CA O m O CD .�O 'J O O O CD =m C co): CD Cl CD O � CU M O 1 . O.,M C7 n CO) O 1 c O ' � m m � r �q p ,oCIQ Z �-� �' O Ogi ::r �--� GO 0 xPC* O x O :j rOil 07 0 � Sw H 0 0 c 0 4. i wull" J. SCOTT Director Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 146 Main Street North Andover, Massachusetts 01845 CHIMNEY APPLICATION AND PERMIT DATE2 ZI -7/:7g-" PERMIT # LOCATION �2� TZ4 ler D SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688.9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 OWNER'S NAME MI }(ate t 61 U 3 BUILDER'S NAME Jo C )': MASON'S NAME E C C e v U MASON'S ADDRESS cS-f -• r'Yl �1 1�0? 1 MASON'S TELEPHONE_ MATERIAL OF CHIMNEY INTERIOR CHIMNEY EXTERIOR CHIMNEY rl C n 4J NUMBER AND SIZE OF FLUES_ t 2 THICKNESS OF HEARTH j_j 1/ + �►e S4MQ •� Will chimney or fireplace conform to re quirements of have the code and , rules and regulations been received: cnI + DATE maon ncrS C6,J)4 C)�- rev • �_ SIGNATURE OF MASON CONTR. LIC. #IZ__fin j n EST. CONSTRUCTION COST/CONTRACT PRICE a0 l PERMIT GRANTED FEE ROBERT NICETTA, BUILDING INSPECTOR INSPECTED REMARKS SOLID BRICK REQUIRED THIS PERMIT MUST BE DISPLAYED ON THE PREMISES BOARD OF APPEALS 688.9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 s e 1dC r1`^E �. h Z G) Z N 0 0 PA • � w �i « • w -4 � z M w Q P w � A w • o: s C > z G z • a (1 0 0 pati -4 - M w n A n A n A s A ^ r M 1 O i -4 A O A L1 O 0 0 w w r O> Z 0 cz► z n °s i n Y CM r IA A A O £ 1 A /0 V il A � 70 o C � i 0 z •1 r•i M 1 C O 0 A = O Z Z z '� • . a • � w �i « • w -4 � z M 0 « ��sxxs ^ { o o: s C > z G z A (1 pati r O r O r O w n A n A n A s A ^ r M 1 O > O A L1 O .Oi s! O M z r O> Z cz► o n °s i n r n 0 A A O £ r 0 /0 V il A Q 'OS"I i « « • « • ,�, A 0 « 0 « 0 « ^ { o o: s C C > z Z z A (1 0 r O r O r O w n A n A n A s A ^ r M 1 O > O A L1 O .Oi s! 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Z O T% • o ' • • • a Mpi _ r _ ON�i 0 kk\ a = � \ � \7\ « c== E §/§ e /§/ § � a � � � ' g CO G§ u §/ // b $\ §/ §k { DEPARTMENT OF PUBLIC SAFETY } CONSTRUCTION SUPERVISOR LICENSE Huber: Expires: Birthdate; CS 005385 08/16/1991 08116/1943 Restricted To: 00 PHILLIP A SILVERIO 520 S NAIN ST ANDOVER, NA 01810 ` asnaatj stq� ;o 110110ow Io; asneo st apoO 6utp1 jin8 MIS s`llasnquMN aqg ;o uompa Zuaizno a ssassod 01 M171 Galion Ahmed Z V t - 51 htuo humor - Vt auoN - 00 00 101 palati`lsay TOWN of NORTH ANDOVER AFFIDAVIT Limp- Catractor I.EW SxgIffomt to Pemrit AqAicaticn- tig- c_ 142 A rats that the ' rtiaa, alb za0;12m, rePadr, mai, cmnlitiai, Cr calstnrtirr of as aYiffi t -in to ate' Pte- eas-tsg az30:­='p' ai b dld-- irxg c cnt z g at list ar b.nt Mt =r?- t�m far $ I TTi - _ -Cr to SU rt, rix 4dch are adjac a-1 to slil reS3cr bzldajellm da -p- by r CC tnaci Oath cert= , alug TL.th other Type of Work: g6tCrI 'ti 00 Address of Work `-fi� (?caner Name: /�� !'pC�i �. i `� Date of Permit Application: I hereby certify that: Registration is not required for the following reasor(s): Work excluded by law Job under $1,000 Building not owner-oc Aipied Owner pulling own permit Other (specify) Est. Costo, 001/ G ✓t 6 office Use Qtly Femit No_ Rate Notice is hereby given that: OWMM PUiLiNG THEIR C4iN PERMIT OR DEALING WTIH UNREGISTERED CONTRACMRS_ FOR APPLICABLE BCME DTROVE = WRK DO NOT HAVE ACCTS TO TIE ARBITRA- TION PROGRAM OR GUARANIS FUND UNDER MM c_ 142A_ - Signed trd­_ pa--lties of perjury: I hereby apply for a permit as the a4it ot�eio err Date - tL ctor�t'ame Registration No. V OR: Notwithstanding. the above notice he eby apply t a permit as the owner of the above property: Date 0fer ame a'4Po ao4oadsui buTPTTnH Aq padtaoag 4uam4ledaa a.ITa 4TuLlad APManT.Ip - suoT4oauuoo .I94PM/aa.Mas - SX1014 oTTgnd. s4uaututo� Pa,.oa Cag 9:4eo panoaddy agea p9409Cag 94ea panoaddv 94Pa g4TP9H-10409dsul oTgdaS u4TP9H-.Io439dsul pool sluammon r pa�oaCag a�eo pano.Iddy 94Pa .IauueTa uMoy '. ----------------- S S swammoo pa�oaCag a�Po panoaadv 94Pa aO4ea4stututp� uoT�en.IasuoO S9K M��Nym Sa ********ATup asn TPTOTJJO**** .Iaq�unH • qS _ (S)40,1 uoTsTdTpgnS Tao�Pd aaqutnH dew s,.Iossass K = NOIyViJO'I S auogd 1 C�U� �U,9 uoT.�Sas sTu-4 -4no s TTT3 Weo.Tddv**************** •s4u9a9aTnbaa so susoT4eTnbai`met agegs 20 TROOT atqeoTTdde due tRTA aoudTTdWoo aomJO/pule qeoitdde atm adaTTal qou atMoptdT SOOP qpcTdggo ua uoTgoTpsT.Tnl buT"q squaacgzddaa PUP s .zd aR addle �C.zessaaau p � �0=3 sgiat�ad/sTedo�ddd tTd getn AJTiad og pasn ST atzo3 sTgy : SNOIWaa,ZSNI mHoa asvnaa JAY1 - a HHoa v CA d C - -oCD 0 n Z y CLO =• _ ? 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RA11lM�1tIT IST FLOOR !ND FLOOR SAO FLOOR 4TH FLOOR STH FLOOR aTH FLOOR 7TH FLOOR aTH FLOOR Installing Company Name A-- c�-� Address �-2 '.�{,q� 'p , Business Telephone -- Z Name of Licensed Plumber or Gas Fitter Check one: Q Corp. d4rertnership O Firm/Co. INSURANCE COVERAGE: I have a current liability Insurance policy or its aubstantlal equivalent. Yes ck o It you have checked yea, please Indicate theNo O type coverage by checking the appropriate box. A liability Insurance policy O Other type of kldemnity n CertNicate OWNER'S INSURANCE WAIVER: I am aware that the licenseedoes 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: nature of owner or Owner's Agent Owner O Agent ❑ I hereby certify that an of the details and Information I have submitted (or entered) M above n kowledge and that all Plumbing work and Installatlons performed under the permN Iss pertinent provisions of the Massachusetts State ties Uod of eY Title Cfty/Town /1F"10VED (OFFICE USE ONLY) e and Chapter 142 Tronsa- bernaursor License Number Q Joumeyman e and accurate to the best of my will be In compliance with all or w tM7 X b91 ,w d = H M> = z O ~ j 1C tl n � O z e�� S V Ib a X_ _ J w ►• IL me O a a: M .= a .of p o `; J z O 0 5 N s H 0 a R !~ O O a:30 Y C / O ae p ati ee r 01tl i Installing Company Name A-- c�-� Address �-2 '.�{,q� 'p , Business Telephone -- Z Name of Licensed Plumber or Gas Fitter Check one: Q Corp. d4rertnership O Firm/Co. INSURANCE COVERAGE: I have a current liability Insurance policy or its aubstantlal equivalent. Yes ck o It you have checked yea, please Indicate theNo O type coverage by checking the appropriate box. A liability Insurance policy O Other type of kldemnity n CertNicate OWNER'S INSURANCE WAIVER: I am aware that the licenseedoes 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: nature of owner or Owner's Agent Owner O Agent ❑ I hereby certify that an of the details and Information I have submitted (or entered) M above n kowledge and that all Plumbing work and Installatlons performed under the permN Iss pertinent provisions of the Massachusetts State ties Uod of eY Title Cfty/Town /1F"10VED (OFFICE USE ONLY) e and Chapter 142 Tronsa- bernaursor License Number Q Joumeyman e and accurate to the best of my will be In compliance with all or �. Date. .............. NORTH TOWN OF NORTH ANDOVER pf '. A 0 '� � � pp PERMIT FOR GAS INSTALLATION SACHUSEtS O CU This certifies that.',.... f ....... �..:r .. `.�...... has permission for gas installatio ...... ... ... u? . - n, in the buildings of ....................... ��........ �, at ... ............................. . North Andover, MUS. Fee::` . .... Lic. No./ / -7!" -/ . ....................... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer • ' MASSACHUSETTS UNIFORM APPLICATION:FOR.PERMiT-TO.DO:PL.UM6lNG (Type or Print) NORTH ANDOVER ,Massa, : Dater',: �... � building Location Permit Owners Name _�-4le , Act, bkmo . v " New D Renovation Replacement [] Plans Submitted (Print or Type) Check one: Certificate Installing Company Name d -Corp. . Address artner. 'A"wF�-U6!�� ng) (n - Cj Firm/Co. Business Telephone L-k-Jh ^ 7>LA2`"i Name of Licensed Plumber: k;LA, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1-1 Bond 0 Insurance Waiver: 1, the undersigned, have been made aware that the licensee of ;;.. this application does not have any one of the above three insurpnce coverages. Signature of owner/agent of property Owner Agent', I hereby certify that all of the details and infoinalion i have subtniticd (or entered) in above application sic true an'eurate to Uhe best of my —• - knowledge and that all plumbing work and installations lrcrfnrmcd under rcrohit icsucd for thsapplicalt win be in eorthptiance with an perlinept pto•. wisions of the Massachusetts State Plumbing Code and chapter I4I of lite By Title . City/Town: APPROVED `OFFICE USE ONLY) Signature of Licen d Plumber I� ype of Plumbing License a9 - License Number Master Q Journeyman ' ■®N NEMENE® ENEMIN■ ENEENNE mono mono EM ARM so K-11HES MONK MINK (Print or Type) Check one: Certificate Installing Company Name d -Corp. . Address artner. 'A"wF�-U6!�� ng) (n - Cj Firm/Co. Business Telephone L-k-Jh ^ 7>LA2`"i Name of Licensed Plumber: k;LA, Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1-1 Bond 0 Insurance Waiver: 1, the undersigned, have been made aware that the licensee of ;;.. this application does not have any one of the above three insurpnce coverages. Signature of owner/agent of property Owner Agent', I hereby certify that all of the details and infoinalion i have subtniticd (or entered) in above application sic true an'eurate to Uhe best of my —• - knowledge and that all plumbing work and installations lrcrfnrmcd under rcrohit icsucd for thsapplicalt win be in eorthptiance with an perlinept pto•. wisions of the Massachusetts State Plumbing Code and chapter I4I of lite By Title . City/Town: APPROVED `OFFICE USE ONLY) Signature of Licen d Plumber I� ype of Plumbing License a9 - License Number Master Q Journeyman ' 3496 4 f HGRTM ?°•<��•.�;•,',"oo TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING r This certifies that .... ............... . N has permission to perforrn,......... = ... plumbing in the buildings .of : .... ............ . at . �-!4�... ..... �-?!I , North Andover, Mass' F................... . PLUMBING INSPECTOR WHITE: Applicant CANARY: Building Dept. 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