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HomeMy WebLinkAboutMiscellaneous - 240 OLD CART WAY 4/30/2018 (2)Date... .................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .............. Q-4 ... .................................................... ... ..... .... ha rmission to perfoperforml wiring in the building of .... �=I. .................................................................. at.240 01 ACOC7�� ..... I n�over,�Mlass. ............................. Zp Z ...... ................................****'** ......... .................... Fee ....... Lic. No. . ...................... ELECTRICAL INSPECTOR Check # r Commonwealth of Massachusetts tt Offiicial Use Only _ r' Permit No. 1 Z � ZZ — Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 127 C 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of. NORTH ANDOVER To the Inspector of Wkes: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 0 6910 Owner or Tenant NAAL, /-4&p Owner's Address 544 Telephone No. Is this permit in conjunct' n with Ibuildin permit? Ys .M No [I (Check Appropriate Box) Purpose of Building �'SX� Utility Authorization No. - Existing Service 700 Amps 1 ZY0 Volts Overhead,© Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires dZl' No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets f` Z No. of Hot Tubs / Generators KVA No. of Luminaires /,Z Swimming Poo Above ❑ n . rnd. No. of Emergency ig ting Battery Units No. of Receptacle Outlets 30 No. of Oil Buses— FIRE ALARMS I No. of Zones No. of Switches 141 �— No. of Gas Bur, No. of Detection and Initiatin Devices No, of Ranges No. of Air Cond. TotTona No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: Number " ' KW No. of Self -Contained Detection/AlertingD ices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances � KW SecNo. urito Devils s or E uK No. of Water Heaters0 KW No. of No. of Signs Ballasts Data Wiring: No. of Devics or E ��al No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications No. of Devices or E u valent OTHER: Attach additional detail if desired, or as regidred by the Inspector of Wires. Estimated Value of Elec ical W rk: 6 (When required by municipal policy.) Work to Start: /�j'- Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE V RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM N LIC. NO.: Licenseea4/L.13 a.607'Signature LIC. NO.: (If applicable, enter "ex pt" in the tic nse number line.) Bus. Tel. No.: Address: 97 +.t7L�.st �01r- 6V o S gc-) Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the r permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an L electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the i notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8—Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH 1NSP ION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature. Date: FINAL INSPE TION: Pass M V Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: dv C Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com -6, • The Commonwealth of Massachusetts M.Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA. 02114-2017 www massgov/dia ` aM Svw� Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/1'lumbers. TO BE FILED WITH THE PERMITUNG AUTHORITY. Name (Business/Organization/Individual): �7 e nug, 40E Address: ilvA-icF��ru� Phone City/State/Zip: n.,•: ... -you an employer? Check the appropriate box: Type of project (required); -Are to ees fiill and/or part-time).'` 1 m a employer with .0 em P y %. [INeW'dbnstrubtion 2. Q 1 am a sole proprietor or partnership and have no employees Working for me in insurance required.] 8. E] Remo delirig 9, ❑ Demolition any capacity. [No workers' comp. 3.❑ I am a homeowner doing all work myself [No workers' comp. insurance required] t 10 ❑ition 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will insurance or are sole 1.0 Electrical repairs ora r `Io ensure that all contractors either have workers' compensation with no employees. um lrl re airs or additions �� i'== g p proprietors 5. ❑I am a general contractor. and I have hired the sub -contractors listed on the attached sheet. These -contractors h6ve employees and have workers' comp. insurauce.t 13•. Roof repairs 14.n Other sub 6.FJ We are a corporation and its, officers have exercised their right of exemption per MGL c. 152 § 1(4) and we have no eMpldydes. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those. entities, have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. compensation insurance for my employees. Below is the policy a X am an employer that is providing workers'nd job site information. Insurance CompanyNam e: 145!5 JS Policy # or Self ins. Lic. #: �O Expiration Date: /v zl /,, Job Site Address: ��U 69-0-T GJ %ti City/State/Zip: 1/1 )oLV 14 Da !,ems Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). er MGL c. 25A is a olation punish Failure to secure coverage as teas well asc civil penalties?in the form ofS criminal ORDER and fine of up to $250.0 0 a and/or one-year imprisonment, be forwarded to the Office of Investigations of the DIA for insurance day against the violator. A copy of this statement may coverage verification. X do hereby certify r tliepains andpenalties ofperjury that the information provided above is true and correct. Phone #: V 0 Official use only. Do not write in this area, to be completed by city or town official City or Town: PermiMeense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone Contact Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for theiremployees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of Wk 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 receivef'ot 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('1) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub'contractor(s) name(s), address(es) and phone number(s) along with their certificates) 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. De 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 IndustrialAccidents. 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia 0 i _ Commonwealth of Division of Profess Board of State Exa Y 21916-A . . License No. RICHARN 97 BUT L n+ a WAKEFIE A Master Elec 07/31/2016 Expiration Date 009614 Serial No. Date .R-12..-51.5 . ..... TOWN OF NORTH ANDOVER This certifies that .... I ....... t ..'.CI.0 has permission to perform .... M.i plumbing in the buildings of—, at ....2 ....(:).4...0 etyO Fee, -2. .Q..` ....... Lic. No. ANIA... Check # PERMIT FOR PLUMBING soe-Ace 0 ............... . .. .......... .................... I......................................................... !^-��..A ......... North Andover, Mass. ................................................................................. PLUMBING INSPECTOR I %d,D M 1t1,4 `Y'y'3a ,:;&v hl �d 1��?_fl \,A J � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I_ CITY MA DATE C^'`�" PERMIT # IZ JOBSITE ADDRESS Q OLD 7 (�OWNER'S NAME E}Ll L—jift Q' P OWNER ADDRESS TELE FAX TYPE OR OCCUPANCY TYPE COMMS ZIAL © EDUCATIONAL ❑ RESIDENTIAL ©� PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO[—] FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK _ TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER BACKFLOW NOTE: BOILER NEEDS A BACKFLOW 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 CHECKED YES, PLEASE INDICATE THE E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true aF4accugfe to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in co e w Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S AME M. " " Sam 1 LICENSE # SIGNATURE MPJP❑ CORPORATION❑#PARTNERSHIP❑# LLC❑#r 0 COMPANY NAME�O�(✓1n ADDRESS WJttj— —_- —�/� CITY Ve " l! STATEI ZIP 1 CII TEL / 7 FAX a' -t'4 :Z /' CELL_ EMAIL �? (.. -14 - ,:;&v hl �d 1��?_fl \,A J � The Commonwealth ofMassachusetls Department of Industrial Accidents Office of Investigations 600 Washington Streef Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Blectricians/Plumbers Applicant Information Please Print Legibly Name (Business/organizatiorAndividual): Address: City/gtate/Zip; Phone M Are -you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a enVloyer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part time).* 2. ❑ I -am a sole proprietor or partner- have hired the sub -contractors listed'on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g. Demolition working for me in any capacity. employees and have workers' insurance.t 9. Building addition [No workers' comp. insurance required.] comp. 5.0 We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Phtmbit g repairs or additions myself~ [NdVokkerg' comp. right of exemption per MGL c.152, § 1�4), and we have no 12.❑ Roof repairs insurance ftgU1red] t employees. [No workers' 13.❑ Other coin. insurance Iecmired.l *Any applicant that checks box M must also ED out the section below showing their workers' compensation popey information. t Nomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContmctors that check this box must attached an additional sheet showing the nam of rho sub-conttactbrs and state whether or not those entities have - employam If the sub -contractors have employees, they must provide their.• workers' comp. policy number. I am an employer that isproviding workers' compensation insurance for my employees. Below is thepolley and f ob 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 sbcure 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 ane -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: -- — Phone #: use City or Town: area, to or town offrcial 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 #: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Streei Boston, MA 02111 www massgov/dia Insurance Affidavit: Builders/Contractors/Electricians/Plumbers NaMe (Business/OrganizatiorL4ndividual): Address: a 3 j' W cam.\ rw'; S f . U O( Phone #: "7 Fl" A,ree,-yoouu an employer? Check appropriate box: 1. Ly I am a employer with 0_ 4• ❑ I am a general contractor and I Type of project (required): etnploxees (full and/or part time). * have hired the sub -contractors 6. ❑ New construction 2. ❑ I -am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees Thesesub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workeis' comp. insurance? g. Bufidin addition E]g [No workers' comp. insurance iequired.] 5. ❑ We are a corporation and its 10. F-1 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their . 1 l.bi�mbing repairs or additions m secf'' co [NvtroYkersl£ Y �• right of exemption per MGL e.152, § le4), and we have no = 12.0 Roof repairs insurance t:eVred.] t employees, [No workers' 13.0 Oilier comp. insurance renuired.l 'Any applicant that checks box #I trust also fill out the section below showing their workers' compensation policy inrormdtion. t Homeowners who submit this andwit 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-contractbrs and state whether or not those entities have - employees. If the sub -contractors have employees, they must provide their.• workers' compi policy number. I am an employer that Is providing workers' compensation insurance for my employees'. Below is the policy and job site information. Insurance Compauy Name• �� ��� �l-e v2 ,<� , �•, Policy # or Self -ins. Lic. #: , U \� 13 ' L' �.� _ �S� Expiration Date: Job Site Address:_, iLlb 01 b C&,Z- tt-4- e City/State/Zip: /J/ 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 ole -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 I do hereby cern �u der'fhe p penalties of perjury that the information provided above is true and correc4 Signature: !'-7 Date: '%moi use only. Do not write fn runts area, to be completed by city or town offu:iaL City or Town: PermitlLicense # 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 #` JI / • PIRATION DP a rl 4-2(L- l j .ems, �0! 1- l-o(o I -111' 2o\0 Old On -'-Pk tUc,r North Andover MIMAP April 1, 2015 _. ...._. ....- ::_:.:'Ju :::_:=' •_•. •'.::_:.: • 107- -0024 262 BOSTON• ::::: :::::dr .,i,_: a3U� -: ' ST4? •:.'.::="Jtr :':.. klri • _::. _ .. _:: • .. .,alit.. �:.::" �Ltc .. �I • ,y3 •. ••.::...:,vt�: ..'. ••`.-•'••...�' Iti ::.':. -. �,UG `_.. .. .._• ger. ':-��•- •<•:.._: •-:..._:. .: •....;..._ --• _. _ .:::.. :_:__ .:_:.? 24.05 107.B-01079:B-0079 : i;•,v:�`-�107.B-0108 '.y `' 10780111 187 OLD CART WAY I, •:::.:_;-::::. 107.8-0110 .. _:.. I, •.. 225 OLD CART WAY 199 OLD CART WAY 235 OLD CART WAY 150' 215 OLD CART WAY 107.B-0112 ,bli tz 146' ��y6 296'BOSTON ST 2' 178 OLD CART WAY 107.B-0155 245 OLD CART WAY / 115' SAT 107.8-0119 n 208 OLD CART WAY 107.B-0117 107.B-0118 R2 107.B-0113 240 OLD CART WAY 107.B-0030 255 OLD CART WAY 314 BOSTON -ST jos � 107.8-0120 138 OLD CART WAY 107.D-0025 274 OLD CART WAY 107.8-0114 107.B-0116,Sq 267 OLD CART WAY �6J Aja 145 OLD CART WAY 107.8-0103 109.8-0085 ,5A 42 OLD CART WAY Z3ti 100 OLD CART WAY 121 OLD CART WAY 107.B-0115 107.B-0086 107.B-0101' 107.D-0002 30 OLD CART WAY' 107.B-0087 107.B-0027 54 OLD CART WAY — Rail Line 'w Wetlands Zoning Interstates 0 Exempt Lands Busine s 1 District G Bu me s 2 District Horizontal Datum: MA Slateplane Coordinate System, Datum NAD83, _ I — SR Roads f. r Easements Busine s 3 District ■ Busine s 4 District 0 Gene Business District 0 Plan— Commercial Dev E7 Corrido Development Dist NQRTq Of a q� '�� �� e� 00 3 Meters Data Sources: The data for this map was produced by Merrimack Valley Planning Commission (MVPC) using data provided by the Town of North Andover. Additional data provided by the Executive Office of Environmental Affairs/MassGIS. The information depicted on this map is for It be for legal boundary 0 MVPC Boundary 0 Municipal Boundary 0 Conddo Development Dist C Corrido Development Dist Industri 1 District L O —• ' ' in - planning purposes only. may not adequate definition or regulatory interpretation. THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, CONCERNING Zoning Overlay B Adult Entertainment It,IndZd 2 District = n * THE ACCURACY, COMPLETENESS, RELIABILITY, OR SUITABILITY OF THESE DATA. THE TOWN OF NORTH ANDOVER DOES NOT Downtown Overlay District 0 Industri 13 District ,� o� M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF Historic District 0 Industri I S District Reside ce 1 District ^"^'� �7 °��I.o � THIS INFORMATION ®Water Protection Reside ce 2 District 7S `SACMUS 0 Parcels to Reade ce 3 District C: Hydrographic Features 1" = 139 ft de ce 4 District �.de ceSDistrict -- Streams de e6 District „age esidential District '- — -� 3 'K ,+ : x "t3cY.r.'f � t rte• . `5."r : t"`ib'"'�^ y is � . � n - ",�, : Ly. ,�,'� � .. �vr� 'Ti rJ' �,�,'� ;f, �. '�� ��'� q^• '7 t-�-F�� i, .�C �_ rs �.. tf . 4 '' "j' a'}'' `� Y1` '''s s "Kiri .0 � x � � u� � r•� } � s,t, � `t �' ��� � t �tY � �x ;� _. s3;;., �G >-;� ,� it �� .�� ,•af �� rte. .� f: 2' ,k ..` ' f•� t ��:"� Ar �^ rAr .17 fit `-�,` � �as�'�'�y�„�� � r �.� �." a. �l�'�� ='�% � +i�'."�,4•'+�jj�#j TriP��,,'�,'' ���� �s�' `'�' -y�t `'�� ,�. � '„P��`3 ' V �•^'` 'moi- ' �"+sem :�',� �� y �:t ,f ./' ,�,. ,. t i? "•r rri 40 C r � H r t fi•� £ 5 �� �,�� � �: � \ . . ���" � :fes ry '\ k �. .. .• ,.,�-* ti. -�t` ...tom„! '+ � • g � 2 � af: ice`, ` � „'�Fh" � � � %� • a�y'�4�"� � '`� b... r... _ -�. ..! ` ►. i. �.��s�, 41' . ":f•: , � � diT.3zy 4'����3��:..rw t .\ tit ". 0 Harty Porch 8. Renovation 240 Old Cart Way, N: Andover, Me 01845 D3 -// -2015 1/8-1'0° or noted , Schematic Pian SK- z Mark Wagner - Architect 5 Malcolm Road Cambridge, MA 02138 617-661.7175 markwagnerarchitect@gmail.com Harty Porch & Renovation 240 Old Cart Way, N. Andover, Me 01845 3 -fl -2015 114"=1'0" or noted N Schematic Plan SK- 2 Mark Wagner - Architect 5 Malcolm Road Cambridge, MA 02138 617.661-7175 markwagnerarchitect@gmail.com v O Z 0 LE Harty Porch & Renovation 240 Old Cart Way, N. Andover, Me 01845 3 -11 -2015 1/4"=1'0" or noted Schematic Plan SK- 2 Mark Wagner - Architect 5 Malcolm Road Cambridge, MA 02138 617-661-7175 markwagnerarchitect@gmail.com TE I I l -AE 1 O v O Z 0 LE Harty Porch & Renovation 240 Old Cart Way, N. Andover, Me 01845 3 -11 -2015 1/4"=1'0" or noted Schematic Plan SK- 2 Mark Wagner - Architect 5 Malcolm Road Cambridge, MA 02138 617-661-7175 markwagnerarchitect@gmail.com Location ci 0-/" �(: � /, ")a t No. Date , f , , NORTq , TOWN OF NORTH ANDOVER Oi�.•e :•ti0 Certificate of Occupancy $ J•►CNus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # VI -4 18862 - /IL ," uBuilding Inspector TON" OF NORTH ANDOVER BUILDING DEPARTMENT TION TO CONSTRUCT ;0VAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING . J'26 WON 7- B I URDING PERMU NUMBER:- �DATE ISSUED: SIGNATURE: Building C( 7 'It �u Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors NIV and Parcel Number: zl--� - il - 0 % \ -1 - Q -�� Map Number Parcel Number 1.3 Zoning"Information: 1.4 Property Dimensions: 2 im—ifig District U. Lot Arm (sf) Frontage (R) 1.6 BUIELDING SETBXCKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Rewired Provided 1.7 Water Supply M.Gl-C.40. 1.5. Flood Zone Information: Public 0 116vate 4�� zone ide Flood Zone 0 1.9 Sewerage Disposal System Municipal 0 On Site Disposal System SECTION 2 - PROPERTY OWNERS1BP/XUTH0RIZED AGENT Historic District: Yes No 2.1 Owner of Record IR nc'��-A i6 C'., "raNh C>' r -V S!N �DL�A Name (Print� I-) 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 Not Applicable 0 Licensed Constiveti)m Supervisor -4 ss License Number q - vo- Expiration Date V \1 Telephone 3.2 Registered Home Improvement Contractor Not Applicable 13 -:S �- - C,' --VN Company Name S Z�' 4-% za Registrati(m NumiTer Address 9 411 Expiration Daft k'Si,Mtu&1Q Teleplione T M X z 0 i::16. 90 0 z M 90 0 M rM G) SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 Workers Compensation Insurance affidavit must be completed and subs in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work (check an aoolicabl New Construction ❑ 1 Existing Building 'q I Repair(s Accessory Bldg. ❑ I Demolition ❑ I Other Brief Description of Proposed—Work: 1 ic(6) with this application. Failure to provide this affidavit will result ❑ Alterations(s) 'J4 ❑ Specify Addition X I SECTION 6 - ESTIMATED CONSTRUCTION COCTC I Item Estimated Cost (Dollar) to be :.. ' . OF" Completed by permit applicant _ 1. Building (a) Building Permit Fee / Multiplier 2 Electrical (b) Estimated Total Cost of / / c f o Construction 3 Plumbing Building Permit fee (a) X (b) soy? 4 Mechanical HVAC 5 Fire Protection / 6 Total 1+2+3+4+5 — Check Number �y / SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN 1 �� OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Own /Authorized Agent of ubject property V Hereby autho a to act on My behalf, in all matters relative to work authorized by this building permit application. ` Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,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/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS Isl2 ND 3 RD SPAN DINIENSIONS OF SILLS DIMENSIONS OF POSTS DWIENSIONS 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 O z WD W Cd n L SIM ,c oj*4W c ` CL CL N C yr O V V •OorO �o J co �a C=2 y �o m CD ". CD c O y y ?Nk -q;ZQ y . m o a� C, O O m 'ave m •:a=CM Cm M C act 'o i m Or m �m H Z opO o S CL. c .o = m aw o N H o y mm s N 2L O C Z ccO "r c .y O V •O p � C d O CD C E-. CO 16, s CL m > O � n z 0 U C/) goil O 4-1 Qr CO) h O CL O CLC O a� Cos O O V .EL CO) C O O C _O �. (A ,moo LLI 0 U) W W 1% W U) 94 0 a A v u +' E U A -r ca z U w W o w W C� w�' w O F to —co w --i co o cn cn L SIM ,c oj*4W c ` CL CL N C yr O V V •OorO �o J co �a C=2 y �o m CD ". CD c O y y ?Nk -q;ZQ y . m o a� C, O O m 'ave m •:a=CM Cm M C act 'o i m Or m �m H Z opO o S CL. c .o = m aw o N H o y mm s N 2L O C Z ccO "r c .y O V •O p � C d O CD C E-. CO 16, s CL m > O � n z 0 U C/) goil O 4-1 Qr CO) h O CL O CLC O a� Cos O O V .EL CO) C O O C _O �. (A ,moo LLI 0 U) W W 1% W U) rUKm U - LU 1 KGLGA,c rvRm INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from 4 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 1 �-* ' C r1`�� - PHONE q�? - aI �� 5 LOCATION: Assessors Map Number -129- C PARCEL 111- SUBDIVISION LOT (S) STREET --,1� c,\% C,&,—,C; ' ST. NUMBER OFFICIAL USE ONL RE TI S OF N AGE CONSE ATION ADMIN RA R DATE APPROVED DATE REJECTED COMMENTS) `�1 �& R r �i1�,,�1P & �J TOWN PLANNER DATE APPROVED � ��;" DATE REJECTED COMMENTS DATE APPROVED DATE REJECTED / � � ' S PTIC INSPE R- T DATE APPROVED G- �-5 / r%ATC r% a-- iL`/%Tl'f1 moi. • /Y� /i // �.� ✓Cid -' � jT��J7r c.- �!�_ PUBLIC WORKS - SEWER/WATER CONNECTIONS '- ;)-a,- DRIVEWAY )- ,-DRIVEWAY PERMIT 12 1—CIO 0 FIRE DEPARTMENT 'ECEIVED BY BUILDING INSPECTOR /1/0 ,)'J/y�-�-I DATE Revised 9197 Jm HONE CALL ( J 141 C L A.M. FOR DATE T E P.M. M PHONED OF PHONE AREA CODE NUMBER EXTENSIORLEAS.E GALL MESSAGE WILL CALL ( 1G�/1� (/LL1i'// F . AGAIN SEE YOU 1JANTS TO SEE YOU SIGNED c Q r s V r / / / / / EXISTING HOUSE nr 1240 y 41 •� / LA .o' -.j / ti W o,:p / 25.50 �E c� Lo. I PROPOSED ADDITION SCALE: 1 " = 40' DEED BOOK 9832 PAGE 190 P. AREA . 47,142 SQ. FT, f mom PLAN E� ASSESSOR MAP BLOCK LOT 18 CERTIFIED PLOT PLAN OF LAND AT #240 OLD CART WAY NO. ANDOVER, MA OCT. 2005 AS DRAWN FOR: PAUL & SARAH HARTY 9240 OLD CART WAY NO. ANDOVER, MA 01930 Michael McGuire Building Inspector Town of North Andover BUILDING DEPARTMENT & INSPECTIONAL SERV] Community Development and Services Di 400 OSGOOD STREET North Andover, Massachusetts 01845 h!W://www.townotnorttianctover.com P (978) 688-9545 or 9534 F (978) 688-9542 INFORMATION REQUEST Building Department Please use this form if the Building Inspector is unavailable to provide immediate assistance. Please fill out this form in its entirety to ensure an accurate and prompt response. All requests for information will be handled as soon as possible. CONTACT INFORMATION Date: O�/�,� Phone number:1 Fax number: Address: INQUIRY - Property in question: (Please include as much information as possible) Subject: Inquiry: ( /� WSX/It" A�—v . C-�p 91 14,11- V, �/ S/�o '/-/J Z v Thank you for your interest and inquiry. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 It NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: 210 is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 117 S 150 A. . Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: 5 ; � � C.cJ•� i v� Fire Department Sign off: Dumpster Permit (Location -o& aci I ity) Signature of Permit. Applicant j Date �', \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (13usiness/Organization/Individual): r L. Address: City/State/Zip: ( rL c. rl A ��A . Phone #: 'n (? - Qa,\- Z):-1 -!�T D�, Are you an employer? Check the appropriate box: CK I am a employer with 4. ❑ 1 atm a general contractor and 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. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 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.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. [N Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electriclal repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I must also till out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. / am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. (1\ Insurance Company Policy # or Self -ins. Lic. #: 1r G Ck Z4:� 1�; 13 Expiration Date: :) - a9" -�) �Q_ Job Site Address: P- 14. Q 1)1 � LUrV 7Z • City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. 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): I. 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confinnation 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 till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/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 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia OCT -25-1005 04:16PM FROM -Phil Richard Ins 9787741318 T-739 P.002/002 F-555 ACORD, CERTIFICATE OF LIABILRY INSURANCE 10/25/0 " PRODUCM TMS CERTIFICATE IS ISSLEDABA MATTER OFINR7RMATIDN Phil Richard & Associates ONLY AND CONFERS NO RIGHTS UDONTHECERrFICATE 491 Maple Street HOLDBZTHMCERTIRCATEDOESNOT AMENT�EXTENDOR Suite 102 ALTER THE COVM&GE AFFORDED BY THE POLI CIES BELOW. Danvers, MA 01923 INSUMRS AFFORDING COVERAGE MAIC # IN9URw INSURER AIG J.L. Ward Construction Inc. INSURIR 11- 50 50 Glidden St _..—.—....._.__......_._._..._......... . • INSURER C: Beverly, MA 01915' D16URER D: rTi'Tl m'T.rei y THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NEh D' TYPFOFINSURANCF POLICYNUMBER POUCYEFFBCDVE POUCY EIIPIRJOON LIN"T9 NOTICETD THE CERTIRCATE"OLDER NAMED TOTHE LuT,BUT FAILURE TODIDSOSHALL 240 OW CART RD. GENEtALLIABlJTY NORTH ANDOVER, NA 01845 REPNESENTRfIrMy, AUTNORPAD REPRESENT �, EACH OCCURRENCE i PREAI13E3 EAww m 7 COMMERCIAL GENERALLIAOUTY Mm EXP OM CLAMS MADE I I OCCUR 3 PERSONAL&ADVINJURY S GENERALAGGREGATE i PRODUCTS-COMPIOPAGG GEI•LAGGREGATE LIMIT APPLES PER: 6 POLICY I I jEMOT- LOC AUTOMOBILE UAbiM ANYAUTO COMBINED SINGLE UMI T (Emaidne) i HOMLY INJURY (p- P -S" ALLOWNED AUTOS SCHEDULED AUTOS X��RY = HIREDAUTOS NON -OWNED AUTOS PROPERTY DAMAGE !r'w eMgNlq s GARAGEUTABLJTY AUTO ONLY - EAACCIDEPIT x OTHERTHAN EAACC i.. . ANYAUTO AUTO ONLY. AGG i EXOESINUADBRELLALWDR.I Y EACH OCCURRENCE _ OCCUR CLAIM6 MADF AGGREGATE 6 DEDUCTIBLE i RETENTION S 1! YORKERSCOMPENSffIONAND TORYLIMR FR A EMPLOYER9'LVIaLRY ANY PROPRETORIPMTNER/B(ECUTM WC9305734 7/28/05 7/28/06 E.LEACHACCDENT _....----••- — i 100,0_00 i 100.000 E.LDISEASE- FAEMPLOYEF IfOmCERAYEMBEREXCLUDED? isPbe [aALPRo=wcNsCdDN EL. DISEA66- POLICY IIMIT S 500,000 Ot11ER 0 ®CRIPTKD N OF ODERATION81 LOCATIONS / VIM ELM l MML USIONS ADDED BY END ORSAAENT I SPECIAL PROVISIONS CF RTIFIC ATE HIDLDB2 CANCELLATION ACORD 25 (2001108) ® ACOW "114MMATION, I 95 SHOULD ANYOF THEABOVE DESCRIBED POLICIFSBE CANC6.LLD BEFORETHE EXPIRATION DATE TNHLBDF, THE ISSUiiC NISUREA WILL ENDTAVOR TO MAIL _j5_ DAYL W RrrTW PAUL & SARAN HARTY NOTICETD THE CERTIRCATE"OLDER NAMED TOTHE LuT,BUT FAILURE TODIDSOSHALL 240 OW CART RD. IWWENOOBLXMTIDN KIND PON TN RSAOENT80R NORTH ANDOVER, NA 01845 REPNESENTRfIrMy, AUTNORPAD REPRESENT �, ACORD 25 (2001108) ® ACOW "114MMATION, I 95 ACQJ�v CERTIFICATE OF LIABILITY INSURANCE 10/25/2005 Circle Business Insurance Agency Inc 247 Newbury St. Danvers, NA 01923 THIS CERTWICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. �� EXPIRATION 978-777-7030 INSURERS AFFORDING COVERAGE NAICR Na>RR) J.L. Ward Construction Inc Roja Rk SCOTTSDALE INSURANCE CO. 50 Glidden St Beverly, NA 01915 978-921-2752 RISURER B: DIS RER C wsuRER D: INSURER E: 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 LTCI POES.AGGRFQATFLIYITASW WMuevuauroraorn-ay.....,........ Paul & Sarah Harty 240 Old Cart Road No. Andover MA 01845 /25/05 MD25(280U88) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CM02EUM BEFORE THE EMRATION DATE TEEREW. THE ISSUING INWRETR VALL ENDEAVOR TO NAAE 10 DAYS VWWWN tgTICE TO THE CERTIFICATE HOLDER NIWED TD THE LEFT. BUT FAILURE TO 00 SO SKALL I.POSE NO OBLIGATION OR LIABILITY OF ANY KM IKON THE IIJS t ITS AGEIgS OR REPRESEiTATIVES. OACORO CORPORATION 1988 TYPE OF f'6tRAN(E ---M POLICY NUMBER EFFECTIVE �� EXPIRATION LMtiTS A GENERAL LLA TTY C�RCRAL GENERAL LIABILITY IA CMtISMADE aOCCUR 1131559 06/18/05 06/18/06 EACH OCCURRENCE s 1,000,000 PRF�SES (Ea eoarence) $ 50,000 IDEXP(Aryeaepersen) s 5,000 PEmNALaAovnjRY i 1,000,000 GENERAL AGGREGATE s 2,000,000 GENA AGGREGATE LWO APPLES PER: POLICY CT LOC PROOUCTS- COhPAJP AGG $ 1,000,000 AUTOMOBILELIABRm ANYAUID ALL ONREDAUTOS SCHEDIJ EDAUTOS HREDAUfOS NOPFOWREDAJTOS CXIMB9ED SHINGLE LRAT (Es��) S BODILYIJ,fIRY s (Per Person) BOOILYIWLRY (PeraccKWO i PROPERTY DAMAGE S (Perexksull) GARAGE LIABILITY AWAUfO AlTOONLY-EAACCIDENf j OTHER TH41 EAACC S AHTOONLY: AW : EXCESSANIB EMALIABILITY OCCUR a CRAYNSMADE DEDUCTIBLE RETENTION FJ%CH OCCURRENCE i AGGREGATE : i s W ORKERSOOAPENS'11T IONAND EMPLOYERTUABAITY A0/RROTETORFMI RVE OFfICF3UNSWER EMIUOLD7 Ityas.elasvlbeundu SPECIAL PROVISIONS Wow TORYl1ANT5 ER E.L. EACH ACCIDENT j El. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LMIT S OTHER 3CRIFF 0NOFOPERATIONS/LOCATIONS/VEHICLES/EXCWSWNSA00W BY ENDORSEMEW/ SPECIAL PROVISKWS Paul & Sarah Harty 240 Old Cart Road No. Andover MA 01845 /25/05 MD25(280U88) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CM02EUM BEFORE THE EMRATION DATE TEEREW. THE ISSUING INWRETR VALL ENDEAVOR TO NAAE 10 DAYS VWWWN tgTICE TO THE CERTIFICATE HOLDER NIWED TD THE LEFT. BUT FAILURE TO 00 SO SKALL I.POSE NO OBLIGATION OR LIABILITY OF ANY KM IKON THE IIJS t ITS AGEIgS OR REPRESEiTATIVES. OACORO CORPORATION 1988 T �iie "(oar»mro�uuea� ���uraP.lia _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 139222 Expiration: 6/24/2007 Type: Private Corporation J.L. WARD CONSTRUCTION, INC. JEFFREY WARD 50 GILDDEN ST. BEVERLY, MA 01915 Administrator License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston, Ma. 02108 at ali without signature ✓�ie -Va»r�no�uuect�e o�✓�iaoaac�iu4eG� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR i Numbec.. CS 063821 BiW 0911611959 Expires: 09/16/2006 Tr. no: 2712.0 Restricted;"_00 r JEFFREY L WARD 50 GLIDDEN STREET. BEVERLY, MA 01915. Commiss sioner 4 00 - 35,000 d enclosed space (MGL CA 12 S.60L) E 1A - Masonry only 1G -1 & 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. i DIG SAFE CALL CENTER: (888) 344-7233 Page 4 TOTAL COSTS FOR ALL ITEMS LISTED ABOVE $154,440.00. Cly `G3� PAYMENT SCHEDULE: �Gv�•( WITH ACCEPTANCE OF CONSTRUCTION AGREEMENT $ 23 Grp PRIOR TO COMMENCEMENT OF EXCAVATION 30,888.00 PRIOR TO COMMENCEMENT OF FRAMING $ 30,888.00 PRIOR TO COMMENCEMENT OF PLASTERING $ 30,888.00 PRIOR TO COMMENCEMENT OF INTERIOR TRIM $ 30,888.00 AT COMPLETION OF CHECK -LIST $ 7,722.00 ACCEPTANCE OF PROPOSAL: The enclosed prices, specifications and conditions are satisfactory and hereby accepted. J.L. Ward and Company are authorized to do the work as specified. Payment will be made as outlined above. This proposal is valid for 15 days from the date specified. Signed and Signed and SealedDate: `o�\��� Signed and Date: 10 -1(I -oz - •*All material is guaranteed to be as specified. All work to be completed in accordance to Mass State Building Code. Any alteration or deviation from submitted specifications, involving extra cost will be executed only upon written orders; and will become an extra charge over and above this estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheck So$ware Version 3.6 Release 2 Data filename: CAProgram Files\Check\REScheck\Harty.rck PROJECT TITLE: Family room/Playroom addition CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) WINDOW / WALL RATIO: 0.15 DATE: 10/25/05 DATE OF PLANS: 10/24/05 PROJECT DESCRIPTION: Playroom addition over existing garage, mudroom remodel between garage and kitchen DESIGNER/CONTRACTOR: J.L. Ward Construction 50 Glidden St Beverly, MA 01915 COMPLIANCE: Passes Maximum UA = 241 Your Home UA = 141 41.5% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter -V ue R -Value U --Factor Jam, Ceiling 1: Cathedral Ceiling (no attic) 53 30.0 0.0 2 Ceiling 2: Cathedral Ceiling (no attic) 87 30.0 0.0 3 Ceiling 3: Cathedral Ceiling (no attic) 21 30.0 0.0 1 Ceiling 4: Cathedral Ceiling (no attic) 852 30.0 0.0 29 Ceiling 5: Cathedral Ceiling (no attic) 34 30.0 0.0 1 Wall 1: Wood Frame, 16" o.c. 71 13.0 0.0 6 Wall 2: Wood Frame, 16" o.c. 18 13.0 0.0 1 Wall 3: Wood Frame, 16" o.c. 39 13.0 0.0 3 Wall 4: Wood Frame, 16" o.c. 102 13.0 0.0 8 Wall 5: Wood Frame, 16" o.c. 39 13.0 0.0 3 Wall 6: Wood Frame, 16" o.c. 71 13.0 0.0 6 Wall 7: Wood Frame, 16" o.c. 18 13.0 0.0 1 Wall 8: Wood Frame, 16" o.c. 219 13.0 0.0 18 Wall 9: Wood Frame, 16" o.c. 280 13.0 0.0 23 Wall 10: Wood Frame, 16" o.c. 219 13.0 0.0 0 Window: 2832: Wood Frame, Double Pane with Low -E 8 0.030 0 Window: 2850: Wood Frame, Double Pane with Low -E 27 0.030 1 Window: 2445: Wood Frame, Double Pane with Low -E 21 0.030 1 Window: 2840: Wood Frame, Double Pane with Low -E 21 0.030 1 Window: 2451: Wood Frame, Double Pane with Low -E 24 0.030 1 Window: 2340: Wood Frame, Double Pane with Low -E 36 0.030 1 Window: 1437: Wood Frame, Double Pane with Low -E 10 0.030 0 Window: 4041: Wood Frame, Double Pane with Low -E 16 0.030 0 Door: 2668: Solid 17 0.035 1 Door: 5468: Solid 36 0.035 1 Floor 1: All -Wood Joist/Truss, Over Unconditioned Space 852 30.0 0.0 28 Floor 2: All -Wood Joist/Tiuss, Over Outside Air 34 30.0 0.0 1 Furnace 1: Forced Hot Air, 92 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in REScheck Version 3.6 Release 2 (formerly MECcheck) and to comply with the mandatory requirements listed in the RES check Inspection Checklist. The heating load f)r this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% ofthe design load as specified in Sections 78OCMR 1310 and J4.4. Builder/Designer Date (J Ons RFScheck Inspection Checklist Massachusetts Fnergy Code REScheck So$ware Version 3.6 Release 2 DATE: 10/25/05 PROJECT TITLE: Family room/Playroom addition Bldg. Dept. Use I Ceilings: 1. Ceiling 1: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: Rear Hall cath. ceiling 2. Ceiling 2: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: Mudroom/Hall cath. ceil. 3. Ceiling 3: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: Laundry cath. ceil. 4. Ceiling 4: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: Playroom cath. ceil. 5. Ceiling 5: Cathedral Ceiling (no attic), R-30.0 cavity insulation Comments: cantilever cath. ceil. Above -Grade Walls: 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 2. Wall 2: Wood Frame, 16" o.c_, R-13.0 cavity insulation Comments: 3. Wall 3: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 4. Wall 4: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 5. Wall 5: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 6. Wall 6: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 7. Wall 7: Wood Frame, 16" o. c., R-13.0 cavity insulation Comments: 8. Wall 8: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 9. Wall 9: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: 10. Wall 10: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: Windows: 1. Window: 2832: Wood Frame, Double Pane with Low -E, U -factor: 0.030 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: 2. Window: 2850: Wood Frame, Double Pane with Low -E, U -factor. 0.030 For windows without labeled U -f ctors, describe features: # Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments: 3. Window: 2445: Wood Frame, Double Pane with Low -E, U -factor. 0.030 For windows without labeled U -factor;, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: 4. Window: 2840: Wood Frame, Double Pane with Low -E, U -tactor 0.030 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: 5. Window: 2451: Wood Frame, Double Pane with Low -E, U -factor. 0.030 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: 6. Window: 2340: Wood Frame, Double Pane with Low -E, U -factor: 0.030 For windows without labeled U-Ictors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: 7. Window: 1437: Wood Frame, Double Pane with Low -E, U -tactor: 0.030 For windows without labeled U -tactors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: 8. Window: 4041: Wood Frame, Double Pane with Low -E, U -factor. 0.030 For windows without labeled U -tactor;, describe features: # Panes_ Frame Type Thermal Break? [ ] Yes [ ] No Comments: Doors: 1. Door: 2668: Solid, U -factor: 0.035 Comments: 2. Door: 5468: Solid, U -factor: 0.035 Comments: Floors: 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R-30.0 cavity insulation Comments: 2. Floor 2: All -Wood Joist/Truss, Over Outside Air, R-30.0 cavity insulation Comments: Heating and Cooling Equipment: 1. Furnace 1: Forced Hot Air, 92 AFUE or higher Make and Model Number Air Leakage: Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfin (0.944 Us) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/$2 pressure ditrerence and shall be labeled. Vapor Retarder: Required on the wars -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R -values, glazing U -factors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct insulation: Ducts shall be insulated per Table MAT 1. Duct Construction: [ ] I All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut of the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Siang: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. I Swimming Pools: [ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20% ofthe heating energy is from non-depletable sources. Pool pumps require a time clock. I Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 OF or chilled lluids below 55 °F must be insulated to the levels in Table 2. Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Sizes Pining System Types h3sulation Thickness in Inches by Pipe Sizes • Heated Water Non -Circulating Runouts Circulating_ Mains and Runouts Temperature ( F) Up to 1" Un to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 ` 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. NOTES TO FIELD (Building Department Use Only) Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pining System Types Ranee (F) 2" Runouts V and Less 1.25" to 2" 2,511 to 4„ Beating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) r`1 ? • a .r vi �� ��� ,�—� 4 �• � � � � a �N � � �� �� T � � . �� � a' �✓ � � � J, � �� � � � � 2 J �� � �n G I� ��p('� ,� �.. �: � S p� Date .. oL TOWN OF NORTH ANDOVER O � A PERMIT FOR GAS INSTALLATION This certifies that .........-./...71..� 1_. has permission for gas insta lata : . ..tea in the buildings of ............ .................... at SR y�...17-r'-*�� . , North Andover, Mass. Fee: -Z'.. !.! .. Lic. No �,O ?�..... � -fie.......... . GAS INSPE&OR Check # 1.3 1%5 C w 5628 G MASSACHUSETTS UNIFORM APPLICATION FOR PERI. - ` '.SF!TTING (Print or Type) r' /l+ ��etlzx , Mass. Date JV - /4� 20 Building Location .2Xb 4LO41,4Y Owner's Nal Telephone 9%� t'v9%- 'TA/rs Type of Occ New ca Renovation Replacement E] Plans ©( Permit #� ne .SSM,411 Hq�P?y upancy /7/6 qS e, Submitted: Yes IS NoO Installing Company Name EnergyUSA Propane, Inc. Check one: Certificate Address 100 Myles Standish Blvd., Suite 101 X❑ Corporation 132 C Taunton, MA 02780 El Partnership Business Telephone (800) 822-1300 Manager -Bob Olander X8055 Firm/Co. Name of Licensed Plumber or Gasfitter William Kent Corson (800) 822-1300 X8051 Cell (508) 294-6660 INSURANCE COVERAGE: EnergyUSA Propane,,, -Inc.- has a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch. 142. Yes X❑ No If you have checked ves, please indicate the type of coverage by checking the appropriate box. A liability insurance policy X❑ 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: Owner ri Agent 0 of Owner or Owner's Agent I hereby certify that all of the details and information 1 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 issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Code and Chapter 142 of the General Laws. .-Type of License: By .Plumber Title Q Gasfitter City/Town X Master APPROVED (OFFICE USE ONLY) Miourn,eyman Signature of Licensed Plumber or Gasfitter License Number 3707 J z O w co I w U LL LL O w O LL O J w m z O H U w a U) z_ U) w w 0 O w a N w 2 U F - w Y z O H U LU CL U) z Q Z LL LU LU LL p 0 z 0 J_ m LL O w a 06 w Q z O z J D m LL O z O Q U O J 0 N 4 _ 1-800-822-1300 * EnergyUSA® Propane DATE PAGE NO. A NiS ource C om pany s/" 1411 / /.gf nL BY �.:e ni-n7®l�f✓i eafth of IVOa�ssa�Q;h�ii.`%�eu, ()Iiicial llsc Only u1= _ UL'pdrtraent of dire Services Permit No. _ loses BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fec Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: �-3 . Cc City or Town of: �p,e A(w" To the Inspector of Wires: By this application the undersigned gives notice of ltis or her intention to perform the electrical work described below. Location (Street & Npumber) Owner or Tenant /- Telephone No. Owner's Address ayo p f G'4i� Is this permit in conjunction with a building permit? Yes �Y No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service a00 Amps 'fid 940 Volts Overhead ❑ Undgrd © No. of Meters l New Service ` Amps °" / — Volts Overhead ❑ Undgrd ® No. of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (;ree.� G !;; "'J IG-*, W 1, �A �-e,,14I� Completion o the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Sus . addle Fans p ) a No. of Total Transformers KVA No. of Lighting Outlets 21 No. of Hot Tubs Generators KVA No. of Lighting Fixtures a' - Swimming Pool rnd. bove ❑ Inrnd. ❑ o. o Emergency Lighting Battery Units ^ No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches Iq No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges — No. of Air Cond. Total Tons No. of Alerting Devices �-- No. of Waste Disposers Heat Pump Totals: Number Tons T— KW - No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW .. p g Local ❑ Municipal ❑ Other , Connection No. of Dryers .. Heating Appliances % gay �- ecurrty Systems: No. of Devices or Equivalent o. o Water Heaters KW .. o. o No. o Signs Ballasts Data Wiring: c No. of Devices or Equivalent No. H Hydromassage a Bathtubs y g No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent 'L OTHER: ... Attach additional detail if desired, or as required by the Inspector of Wires. 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 proofame to the permit issuing office. CHECK ONE: INSURANCE �' ] BOND [:1 OTHER OTHER ❑ (Specify:) i�at (xpi Estimated Value of Electrical Work (When required by municipal policy.) Work to Start: l{.• - © le Inspections to be requested in accordance with NEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Cf;. LIC. NO.:-Alc,,�a Licensee; Q /1.,,`� Signature LIC. NO.: (Tf applicable, enter "exempt" in the license number line.) Bus. Tel. No.: .. Address: Alt. Tel. No.: $ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normal y required by law. By my signature below, I hereby waive this requirement. I ain the (clieck one) ❑ owner ❑ owner's agent. Owner/Agent C:rtn1tnrc Tr.lnnhnnr Na PERMIT FEE: $ Date .. "? - /(-)T� ...... . • TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that' -".....: .''" `` ' .... . has permission for gas installation in the buildings of . t.t :r - .......................... at 7N .. '�?l'. �- � - •!l .... , North Andover, Mass. Fee,. .. Lic. No'/Gaul! .. ' A•.•�:,:,........... GAS INSPECTOR Check # 5484 �IASSACHLSE rS UNIFORM APPUCATON FOR PERM TO DO GAS FITTING (Type or print) Date 't"�" l /o/ 2006 NORTH ANDOVER, 'MASSACHUSETTS 2 yo of Ceti Building Locations — Permit. # Amount $ Owner's Mame y New ❑ Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) 0 Name Address !� usiness SKOPkvI-SA , -P+H— 'Z. o a I 4 -jv,ek-S, ILA4 O tg Z - C one: Certificate Installing Company Corp. ❑ Partner. Firm/Co. Name of Licensed Plumber or Gas Fitter 6' INSURANCE COVERAGE• Check one: I have a current liability Insurance pol' or it's substantial equivalent. Yes ❑ No❑ . If you have checked rtes, please i 'cite 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 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 1 nave suomtttea (or enterea) in anove application are true ana accurate to the best of my knowledge and that :ill plumbing ,%ork andj'A&t#llations performed under Permit Issued f r this application will be in ,:cmpliance with all pertinent provisions of the Ivla achus tts State Gf ode�nd Ch$pfe 142 of General Laws. (� � ri ( i tle ity/Town IAPPROVED,OFFICE USE CNLY) gnature of Licensed Plumber Or Gas Fitter umber / e6 <a� fitteriLense Number er Journeyman BASEMENT FLOOR �e������������������■ (Print or type) 0 Name Address !� usiness SKOPkvI-SA , -P+H— 'Z. o a I 4 -jv,ek-S, ILA4 O tg Z - C one: Certificate Installing Company Corp. ❑ Partner. Firm/Co. Name of Licensed Plumber or Gas Fitter 6' INSURANCE COVERAGE• Check one: I have a current liability Insurance pol' or it's substantial equivalent. Yes ❑ No❑ . If you have checked rtes, please i 'cite the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information 1 nave suomtttea (or enterea) in anove application are true ana accurate to the best of my knowledge and that :ill plumbing ,%ork andj'A&t#llations performed under Permit Issued f r this application will be in ,:cmpliance with all pertinent provisions of the Ivla achus tts State Gf ode�nd Ch$pfe 142 of General Laws. (� � ri ( i tle ity/Town IAPPROVED,OFFICE USE CNLY) gnature of Licensed Plumber Or Gas Fitter umber / e6 <a� fitteriLense Number er Journeyman Date . 2—/,.,,7 Ob s ORT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i This certifies that ................................ . has permission to perform-- ..... ....... ..` . .'mow..:. . plumbing in the buildings of ......... . . ....... , North Andover, Mass. .f Fee`s 7...... Lic. No. X07�.. ... . . 11.-=; Vis ..:................ PLU BING INSPECTOR Check # , 6875 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Zu Date WYGi� /C) � o d Building Location 2 y0 t)t-a < iAi T- a Owners Name >�� 94 k-4 % Permit y Amount Type of Occupancy New 0 Renovation L.J Replacement1:1 Plans Submitted Yes No ❑ (Print or type) Installing Company Name 'S Ko M Q Address r ` 0 - /3 ,Z 2©, Q/7 /K4 is z3 Check one: Certificate ❑ Corp. Partner 'inn/Co. Name of Licensed Plumber: � - k A - S K3;';1 urs �l'- Insurance Coverage: Indicate the e of i surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity E Bond W Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent I hereby certify that all of the details and information best of my knowledge and that all plumbing work compliance with all pertinent provisions of the Ma sa By: i= gnat Title 5 City/Town kens APPROVED (OFFICE USE ONLY ave submitted (or entered) in above applic ion are true and accurate to the allations er rme rider Per t Issued or this application will be in etts Statep)�b odg, n Chapter of the General Laws. of Plumbing License umDer Master Journeyman ❑ 1' • J .J -----...��©-�.----------- 1 ' ---------------------0--- ..1 --------------MM--MM- MMM ' I • �.' ------------------------- ' .M.---...-W-------------- i 1 �' ----------------------MM- 1 t -o' ------------------------- W.Ii:loroe-,RMMMMNNNMMMNMMMMNMMMmmmmmm (Print or type) Installing Company Name 'S Ko M Q Address r ` 0 - /3 ,Z 2©, Q/7 /K4 is z3 Check one: Certificate ❑ Corp. Partner 'inn/Co. Name of Licensed Plumber: � - k A - S K3;';1 urs �l'- Insurance Coverage: Indicate the e of i surance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity E Bond W Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner Agent I hereby certify that all of the details and information best of my knowledge and that all plumbing work compliance with all pertinent provisions of the Ma sa By: i= gnat Title 5 City/Town kens APPROVED (OFFICE USE ONLY ave submitted (or entered) in above applic ion are true and accurate to the allations er rme rider Per t Issued or this application will be in etts Statep)�b odg, n Chapter of the General Laws. of Plumbing License umDer Master Journeyman ❑ Date.... :. .... TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ............ P ....... !Q Q� ../............................................ has permission to perform ...fir �A' �''�.../ ��tiE L ............... ............... ........................ wiring in the building of ' ` N.�T Y .................................................................................. /� PL ��!'�..g .. ,North Andover, Mass. at....�.....Y........................ `%................. A ,per Fee.................. Lic. No.............. ...................:...... ........ ELECTRICAL INSPECTOR Check # O 6.� r O5 r Y t;r:rtirnonwealth of Massachusetts Deprrrt'raent of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Petntit No. Occupancy and Fee Checked [Rev. 11/991 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -3 Cly City or Town of: IVCR `j 4h To the Inspector of Wires: By this application the undersigned gives not c of 11is or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant P Owner's Address aro 40 Is this permit in conjunction with a building permit? Purpose of Building Existing Service �00 Amps Jacl 93P Volts New Service Amps — / — Volts Number of Feeders and Ampacity Telephone No. Yes ,N No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd Overhead ❑ Undgrd [M No. of Meters I No. of Meters t Location and Nature of Proposed Electrical Work: G� G C �A f �'� I A /t-44,14 Attach additional aetau y aestrea, orus ieyuireu „y utc j—yc w. J "•' 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 me to the permit issuing office. CHECK ONE: INSURANCE K] BOND ❑ OTHER ❑ (Specify:) ' �alel p Estimated Value of Electrical Work (When required by municipal policy.) Work to Start: 0 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: &A i`C )r� cwr&..,,,_ LIC. N0402n Z� Licensee* Veplg',j F e-G,�. SiguaturcV-&,4„4 y" LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 'r Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normal y required by law. By my signature below, I hereby waive this requirement. I aln the (check one) [] owner ❑ owner's agent. Owner/AgentPERMIT TSE: Signature Telephone No. ,. b N2i S 3 Date f%.— ��....'�..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING r f ) e This certifies that ....!�� �Y �-.:......... ................................... .......................... has permission to perform ..................... �-�.Q -•-�`f.. :......................................................... wiring in the building of .:............................. ./............................................... at-............................................................... .............. . North Andover, Mass. Fee.`: ... ....... Lic. No C"(3 ,-/ .......�. ;� �..................................... I— ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Or1cr U" 0�1�1' _V �`` The Commonwealth of Massachusetts No. /i7r occuoa�F 4 Fw Check.e ,.A Department of Public Safety 3/90 (tee v bta�,k) 00 BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12 E APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, S27 CMR 12:00 (PLEASE PRINT IN INK OR (TYjPE ALL INFORHATION) Date /1k9/9 q City or Town of I J • ond()/e — To the Inspector of Wires: REG CPY The undersigned applies for a permit to perform the electrical work described below. RCT ACT Location (Street & Number) qD Omer or Tenant �6 l�or' Owner's Address Is this permit in conjunction with a building permit: Yes ❑ No N (Check Appropriate Box) Purpose of Builcing (� G� Tf1 Utility Authorization N0, %xisting Service Amps / Volts Overhead ❑ Undgrd ❑ No. o? Yzters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Yete-s N=ber of Feeders and Ampacity Lucacion and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Hot Tubs No. of Transfor:sers iota'_ kv,; No. of Lighting Fixtures Swimming Pool Above ❑ In- E]grnd, grnd. Generators KVA No. of Receptacle Outlets No. of Oil Burners JNo. lBattery of Emergency Lighting Units No. of Switch Outlets No. of Cas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No, of Sounding Devices No. ,of Self Contained Detection/Sounding Devices _ Local ❑ Municipal ❑ Other Connection No. of RangesNo, of .:ir Cond. Total tons No. of Disposals No. of pUMos Tons KW !seat Total Total No. of Dishwashers Space/Area Heating KW No. of Dryers (Heating Devices KW No. of Water Heaters KW No, of No. os Sizns Ballasts Low Voltage WiringI`11f�/ No. Hydro Massage Tubs INo. of Motors Total HP OT'HEA INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES (-] NO F1 I have submitted valid proof of same to this office. YES ❑ NO If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE S1 BOND ❑ OTHER J (Please Specify) (Expiration Dace Estimated Value of Electrical Work S Work to Start Inspection Date Requested: Rough Final Signed under the penalties of perjury: FIRM NA License Address OWNER'S stancial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) CIsI4 Telephone No. PERMIT FEE S ` Signature of Owner or Agent Location r 1 No. ` Date prt�.o ,tip TOWN OF NORTH ANDOVER Fp Certificate of Occupancy $ io •#`r - j,y Building/Frame Permit Fee $ 5 ,ssACMUSE� o v' Foundation Permit Fee ' Other Permit Fee $_ Sewer Connection Fee $ f -2 Water Connection Fee $ P, TOTAL wilding Inspector /,,,*--A(,b 4AID W 7746 Div. Public Works ►- Wx A Location 43-Z- f �! No. Date Of N� oT",,ti TOWN OF NORTH ANDOVER C& „ -Certificate of Occupancy $ S • i Building/Frame Permit Fee $ sAGMUS t� Foundation Permit Fee $ y Other Permit Fee $ M Sewer Connection Fee $ Water Connection Fee $ (5 i* .Sol TOTAL $ 1 (D Building Inspector 7539 Div. Public Works Location¢ No. t Date 9'-Z 9� NpRT� t TOWN OF NORTH ANDOVER p _ pt�«io �,tip � lt7 p Certificate of Occupancy $41 Q a • ^per r Building/Frame Permit Fee $ ~ �,' ^• s t`' -� �tMu Foundation Permit Fee $ Other Permit Fee $ M g Sewer Connection Fee $ 14/0 38Z - Water Connection Fee $ TOTAL i ild' g Inscto TO f 8404 i u c Works Location No.- Date i Z. r 9104 ,t TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ V Other Permit Fee $ Sewer Connection Fee $ r� Water Connection Fee $' �7 TOTAL A; :3 Building Inspector. Div. Public Works PER31IT NO. 49Z-__ APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP iqo. ��� g I LUT NO. 111 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE ZONE SUB DIV. LOT NO. — LOCATION PURPOSE OF BUI N �L-QTIC0(_0L^,�.�lg_ �t,_rj w[ z cee. (aAa. 4w OWNER'S NAME Ty`I . NO. OF STORIES SIZE OWNER'S ADDRESS I I D P �S�v�� ��„ BASEMENT OR SLAB G�� ARCHITECT'S NAME ARCHITECT'S NAME T „ ,Bv) �� SIZE OF FLOOR TIMBERS 1ST .2:&C go 2ND��3RD BUILDER'S NAMEt�Vu-7— SPAN ' L4 •A�x I-'�^ DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS --- "POSTS DISTANCE FROM STREET G O —? DISTANCE FROM LOT LINES - SIDES "Z) REAR �� "" '" GIRDERS Z_,e_t 7— AREA OF LOT A e FRONTAGE ', HEIGHT OF FOUNDATION -7r Off/ THICKNESS /"�C�c_ IS BUILDING NEW SIZE OF FOOTING I /ti X IS BUILDING ADDITION? MATERIAL OF CHIMNEY k)BDOV ATy�,0 IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND Sot Ix�p WILL BUILDING CONFORM TO REQUIREMENTS OF CODE \/ate -G 7 IS BUILDING CONNECTED TO TOWN WATER -le-5 BOARD OF APPEALS ACTION. IF ANY )�G N IS BUILDING CONNECTED TO TOWN SEWER ND IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS PERMIT FOR FOUNDATION ONLY 3 PROPERTY INFORMATION LAN SEE BOTH SIDES REGULATED BY PARA 1142.1 @,O, EST. B � 3 S EST. BLDG. COST PAGE 1 FILL OUT SECTIONS 1 - 3 EBT. BLDG. COST PER SQ. FT. SZ• PAGE 2 FILL OUT SECTIONS 1 - 12 DATE C Q PAID 7v e EBT. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILE 4 SI RE OFjdWNER OVAUTHORIZED AGENT 4 F E E ZS " PERMIT FOR FRAMUBUILDING "$ sa' G to p . rrb ri FIL.-Flutr PERMIT GRANTED ©ATE: FEE PAID:.._...^ 1 �[! GJ� oc> s ; BLM FMMT Fm $ SEP 2 7 W4 LES M FE 1cx5 DUE FRANJE PENN $ -1 5= . »I OWNER TEL. # CONTR. TEL. #� ID - 3 37 7 CONTR. LIC. # 0 H.I.C. # BUILDING RECORD 1 OCCUPANCY 12 + SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA - APARTMENTS • RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. 1 r - J. 5 L rr , "., ' j+ v, , 1a is pt. � J .1 1st I .,-+ ..M4 _TE'M49 . A �l *311'" CONSTRUCTION 2 FOUNDATION CONCRETE mww 4_ CONCRETE Bl'k 'PINE BRICK OR STONE PIERS 8 INTERIOR -3 HARDW D PLASTER DRY VJAII UNFIN. FINISH I 2 13 _ 3 BASEMENT AREA FULL '/. '/t '/. FIN. B M AREA _ FIN. ATTIC AREA N_O B M T HEAD ROOM re FIRE PLACES _ _ MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH B 1 ��_ 2 3 _ j DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING _ HARDVV D COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. & FLOOR _ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIORPOOR _ ADEQUATE I NONE rj ROOF GABLE HIP GAMBREL MANSARD 10 PLUMBING BATH (3 FIX.) TOILET RM. 12 FIX.) _ L FLAT SHED WATER CLOSET ASPHALT SHINGLES LAVATORY L —1I WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. OT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'i 2nd _ 3.d NO HEATING 1 r - J. 5 L rr , "., ' j+ v, , 1a is pt. � J .1 1st I .,-+ ..M4 _TE'M49 . A �l *311'" C•) O z cn m D O Z CO) CD .O.1 Z CD O CL r � o o � a� v CD CL � rG CD o .- Q O CD O CA 'a n� c 0 c CO) ET Cl) CD O 0 CD CD a 'CO) CD O O co O G CD v cnm ^ z —•inoc d O :5CD rr°n co »�� w C n rD o H 0 a� a m. Z �'p H . No' I o� = = C 0 G a ? CD a c os O N b (D y CD --IO O ? CD :� "M = m a 13 v c_ ?�=CDC S.CO) r� V C2. cc o =r =r CD •.� co �� CD C- -off c ECDL n n� '1 W O cnm ^ z —•inoc d O :5CD N .a co »�� w C n rD o H 0 a� a m. Z �'p H . No' I o� = = C = G a ? CD a c os O N b (D y CD --IO O ? CD :� p OC* = = mo o ;- CD 13 ?�=CDC S.CO) C2. cc o =r =r CD •.� co CD C- -off c ECDL d CD CJ N CD N O ycr N a C � c O•c c CL CO) c Cp CCD CO) CA CO) CD CCD w NCD , CO � _ CD o N CD ? V� O CCDCD :V T D �� !7 m CD CO) CDW CD . o = TO odiA C C=2 D Z o � o 2 a A Z CO CDW cn O cnm ^ z ?7 w P ° Z M w C n rD 7c x r H w x z w n C :7- G a r b (D o :)rl tz x M �',•��t£.l iii+nd�titiWYlhlii'nas:1.4;'lti,a; ,r•'.•,: .. „ _.., r i. ;., ', ti., , a: •? DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuober: Expires: Birthdate: CS 046067 01/18/1997 01/28/1959 Restricted To: 1G DAVID K JOHNSON 13 SOUTHERN BLVD NEYBURY, NA 01951 S�� SEP27 i I t t NEW HAMPSHIRE DRIVER LICENSE DAVID'K JOHNSON QGT�ON LANE 03842.. t pp��RR qq�TT ((��"{"� OrCII.IIBTllg ER LICENSE EXPIRES 01 _ZN)2.V 1 018 RQQ�AT� RESTRICTIONS NT. 9GS � - 25EX T? ' -I c_1n gin M FORM U -..LOT RELEASE FORM ; INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: a�„� /r ^ /yJ� j L-rZ&-"49 Phone 79 -��_7 LOCATION: Assessor's Map Number Z07 6 Parcel Z/ % Subdivision �l%a�oyt ��f®e�=C.�c Lot (s) /S' Street Z C�� ��� St. Number Zap ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: ( � Conservation Administrator Comments Town Planner Comments Food Inspector -Health SepticInspect--or-Health Comments Date Approved�`1 Date Rejected Date Approved 2 Q Date Rejected Date Approved Date Rejected Date Approved a Date Rejected Public Works - sewer/water connections -7-211) 9- Z driveway permit,�rltJ -�-03-?¢ Fire D''`e`partmen/t� d,aG� (�/� ri&d s� !� � t�,,x,A �'a p"C�i zrt�i�lG ys 1Y�( &-7�dr Received by Building Inspector na.7 Date SI Po r N W �l Z i SI Po r Z 1c I' SI Po r E -U W , 7N I� Y Q c 1 '' `: ti.' _ _•,�J:,n:S.�'awtlwA,ir•,.�'.ca= ^.'Q�s`'xC:.'] '.._i. �•�?'n};:1"i��•3�'e�. `` +�.nw4w�S�.:is\.. __.:i�.Y�._—.moi-u-- •: w� V -0n v �; v _ T � z z \ z v In C12 15 rn T rm a C O C G C a _ Q.o�m m C m ti C! -a co C y n d n T cp O Q c 1 '' `: ti.' _ _•,�J:,n:S.�'awtlwA,ir•,.�'.ca= ^.'Q�s`'xC:.'] '.._i. �•�?'n};:1"i��•3�'e�. `` +�.nw4w�S�.:is\.. __.:i�.Y�._—.moi-u-- •: w� V m H 0 v �; v _ A r� v� O v In C12 rn • O rm a O C G C a _ Q.o�m m C m ti C! v C y n d n T. O Z?'� ;-Qo H CD ��- m = CO N TI � m � �� co co O CD � m ti o o C/! ism: C.7 C Hca :A Cl). :J : 7 ca m m m C7 m 3 CO2 t _ ,.:. _ C Cl) co /�� C-- lz�AA r tQ CD CA czl CD w N co co J C m O it co — o N� a co �m rn m o_ CA CD C: t co mpg dm co rz: - �� aM 0 m ac CD C z rrs o Be o co j a c o Z m Z w m H 0 cn W =o =�a�1. � �; v _ A r� v� O v In cn W =o =�a�1. � �; ��a A CA 14 n v In C12 rn • O ra a y p.. 0 C ny Ima xx ox C" m d lit r rt z C14 d Q y � syn ww OO o d z >x y y � v m C d t� Aowl O 01 d r� 0 m 00 � rn ft Z O C 3m ngo C. 0 O o44 cD 0 Z 0 a Office Use Only I _T1 t� 01 4t &1MMUU1Ur #� � 4 ia1J5ar U5rft5 Permit No. ! / / }�¢}tEtThItEltf IIf Unlit 6afrttj Occupancy & Fee Checked - BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3�so (leave blank) �C '-a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3TC) q S OOK or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 24() Ot-U CARZ wA/ Owner or Tenant Pw) mal Eaus Owner's Address Is this permit in conjunction with a building permit: Yes C No ❑ (Check Appropriate Box) Purpose of Building Py -51 �, W ,e-- Utility Authorization No. Existing Service Amps Volts Overhead �J UndgrndC No. of Meters New Service Amps Volts Overhead L_ Undgrnd C No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No. of Lighting Outlets I No. of Hot Tubs No. of Transformers KVA No. of Lighting Fixtures Swimming Pool Above^ grnd. L— In- grnd. Generators KVA No. of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners I Battery Units No. of Switch Outlets I No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. Disposals I No.of Heat Total Total No. Sounding Devices of Pumps Tons KW of No. Self Contained No. of Dishwashers Space/Area Heating KW ction/Sounding Devices Detection/Sounding No. of Dryers Heating Devices KW Municipal Local ❑ Connecctiio��nyn_it�O�tyh�ar Nig of of �t/� Low Voltage ALf�t'^' S No. of Water Heaters KW all I Signs Ballasts 1 Wiring !� t ` " ` No. Hydro Massage Tubs I No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws ^ I have a current Liability Insurance Policy including^moieted Operations Coverace or its substantial equivalent. YES = NO _ I have suomitted valid proof of same to the Office/. ES = NO = If you have checked YES. please indicate the type of coverage by cing the ppropriate box. NSURANCEBOND — OTHER = (Please Specify) - — !. (Expiration Datel mated Value of Elec/tp�caI Work S 105OD Work to Start 0�p415c� Inspection Date Requested: Rough Final Signed under the Penalties of perjury: FIRM NAME rtYYO�£ 2L t C. LIC. NO PJrl(�G(� �K1 — LicenseeT_Ila �� 0 Signature / LIC. NO Q-7 P /��� �Y {� Bus. Tel. No. `� �a Address -7 go Li QA9 `�^���N N ` ©k59 Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantiae equivalent as re- quired by Massachusetts General Laws. and that my signature on this permit application waives this requirement. Owner Agent (Please check one) 5�ua d6 Telephone No. PERMIT FEE 3 (Signature of Owner or Agent) x•5505 )I A 7 Date .............. TOWN OF NORTH ANDOVER MEN& S' PERMIT FOR WIRING ,SSAAT.0 c U Hus ra This certifies that...l.f..'! .... k CL ................ . ................................. has permission to perform ........f ..:.. . ................. I ......... ............................ wiring in the building of ........I........`......................................................... at .......... ............ ................ T ....... .............. . North Andover, Mass. Fee ............... ....... Lic. No.--.... , .. ............................................................... ELECTRICAL INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File