HomeMy WebLinkAboutMiscellaneous - 245 GREAT POND ROAD 4/30/2018N
i2
537
0
-+47
S US
Date ... ?a..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that., .....
has permission to perform ..... ....................................
wiring in the building
North Andover, .............................
-Mass.
Fee.5O.. ...... Lic. No. ..............................................................
ELECTRICAL INSPECTOR
-7
ii/r:9ffit". I CIR: BMW Dept. PINK: Treasurer
f Office Use Only
01he Lfommonwralih of tto nl~huoei#o Permit No. -5
13epartment of Iluhlic *Ufetq Occupancy & Fee Checked—
� � BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 X90 peave blank) ) -��
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 ,16 7—s-941
(X* or Town of NORTH ANDOVER To the Inspector of Wires:
The udersicned aoolies for a permit to perform the electrical work described below.
Location (Street 3
Owner or Tenant
Owner's Address
Is -!i:s permit in conjunction with a buildina permit:
Purocse of SuiiCing
Existing service Amos _J `:pits
New Service Amps Voits
Numcer of Feeders ano Ampacity
Lccaticr, and Nature of Proposed Electr!cai 'Nerx
Yes _ No (Check Apprcooriate Ecxx)1','K �-�
Utility_ Authorization No. (�t� 6 (?
-7 r-
Cvernead _ Unogrnd _ No. of Meters
Overread Undcrnd _. No. of Meters
Total
No. of Ligntinc Cutlets No. of Hct tics No. of Transtormers K:A
No. of Lighting Fixtures Swimming Pool Atcve— 'n -
No. grrc. _ ;rnc. _ Generators KVA
OTHER:
INSURANCE CCVERAGE: Pursuant to the recuiremen:s ct Massacncsens ;ereral Laws
I have a current Liaeiiity Insurance Policy inc:ucinc Comc:etec Cceravcrs Coverage or ;is suostantiai ecuivaient. YES NO = I
nave suomitted valid proof of same to the Ctfice. YES I -J NC = if •sou nave cnecKea YES. piease inaicate ;he type of coverage cy
checking the ac C opriate pox.
INSURANCE SONO. = OTHER = ;Please Scec:f-:)
(Expiration Date)
Estimated Value of Eiectncal WorK s
Worx to Stan to -73.. 96 Insoec;:cn Date Recues;ec: Rcugn Finai
Signec uncer :h Penaities of perjury: n
FiRlt NAME
(Q Co , Ljc. tic.
Licensee Signature L!C. NO.
Bus. Tei. No.
Address All. Tei. No.
C.VNER'S ;NSURANCZ RIVER: I am aware that the t-:censee cces not nave the insurance coverage or its suostanaat aurvaient as re-
cuirea ov Massachusetts General Laws. anc ;hat my s:gnature on :nis :ermrt aopiicauar. waives this requirement. 0 r A4ent
:P!ease cnecx ore) `t�J\J
'eiecrone No.
PERMIT FEE C/!)
(Signature of Owner or Agents i gc_g
i
No. of Emergency Lignang
No.
of=,eceotacie Cutlets
' Ne. of Cil Surners
Sattery Units
No. ...t
S.vitcn Outsets
No. of Gas Surners I
FIRE ALARMS No. of =ones
No. is Detection arc
r,
Initiating Devices
-otai
No. of Ranges No. cf Air C; nc.
9 rcns
Heat o;ai -- -
No. Disposals Nc.�t
of
Pumps Tons C.V1
No, of Sounding Devices
No. of Seif Container
No.
of Dishwasners
ScacerArea Heatinc C.V
oetectioniSouncinc Devices
I — Municioai77
! Local Connec';en _Other
No. of Orvers seating Devices C:J
No. of Nc. ^t
11tl Low Voitage
No
of Water Heaters KW
S;crs Ba:ias:s
Wiring
II
No.'
HvCro Massac@ Tubs
No. of Motors Tptai ;�'P
OTHER:
INSURANCE CCVERAGE: Pursuant to the recuiremen:s ct Massacncsens ;ereral Laws
I have a current Liaeiiity Insurance Policy inc:ucinc Comc:etec Cceravcrs Coverage or ;is suostantiai ecuivaient. YES NO = I
nave suomitted valid proof of same to the Ctfice. YES I -J NC = if •sou nave cnecKea YES. piease inaicate ;he type of coverage cy
checking the ac C opriate pox.
INSURANCE SONO. = OTHER = ;Please Scec:f-:)
(Expiration Date)
Estimated Value of Eiectncal WorK s
Worx to Stan to -73.. 96 Insoec;:cn Date Recues;ec: Rcugn Finai
Signec uncer :h Penaities of perjury: n
FiRlt NAME
(Q Co , Ljc. tic.
Licensee Signature L!C. NO.
Bus. Tei. No.
Address All. Tei. No.
C.VNER'S ;NSURANCZ RIVER: I am aware that the t-:censee cces not nave the insurance coverage or its suostanaat aurvaient as re-
cuirea ov Massachusetts General Laws. anc ;hat my s:gnature on :nis :ermrt aopiicauar. waives this requirement. 0 r A4ent
:P!ease cnecx ore) `t�J\J
'eiecrone No.
PERMIT FEE C/!)
(Signature of Owner or Agents i gc_g
r
Location eS
No. Date
{
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ EE
Foundation Permit Fee $ $
Other Permit Fee $
11'_59 Sewer Connection Fee $ /DCO. M
644
9148
Water Connection Fee $
TOTAL $ 'n
_Buildi g Ins or'
�a �
Div. publ' Works
Location D
No. - Date Z 9
oT ;;'�o
TOWN OF NORTH ANDOVER
�� ♦ 0
p
Certificate of Occupancy
$
Building/Frame Permit Fee
$
�,SSACMUS t�
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee $
Water Connection Fee $
TOTAL
3 . - A � U 116:08
150.00 PAID
Building Inspector
Div. Public Works
PERMIT NO. 1
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGE 1
MAP 4-40.
I LOT NO.
2 RECORD OF OWNERSHIP :DATE
BOOK :PAGE
ZONE
SUB DIV. LOT NO. 1-57—
1
—
LOCATION S - O YVOL /C UG !) Q„ J
�}
!
PURPOSE OF BUILDING
A
` /w a,—",
L
OWNER'S NAME
NO. OF STORIES
/✓ SIZE
�" !� �.
J J
OWNER'S ADDRESS lo'ke7—
BASEMENT OR SLAB
tiT
ARCHITECT'S NAME O1
SIZE OF FLOOR TIMBERS
/r�e
IST J�/gl 2ND Q. x �� 3RD
y 4` y
BUILDER'S NAME I
SPAN /Ty � t
DIMENSIONS OFSILLS
DISTANCE TO NEAR ST BUILDING / 3Z
DISTANCE FROM STREET
POSTS
`/.-a
DISTANCE FROM LOT LINES - SIDES -470 REAR
% O
(�v/
GIRDERS
AREA OF LOT S� FRONTAGE
3! 1
b J
HEIGHT OF FOUNDATION
C� / THICKNESS
IS BUILDING NEW yes
SIZE OF FOOTING
�J�st �T X
V_)s
-2 9
/'v
IS BUILDING ADDITION l 0
'V
MATERIAL OF CHIMNEY
r
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
�dA
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE {y
/
es
IS BUILDING CONNECTED TO TOWN WATER
yI-S
BOARD OF APPEALS ACTION. IF ANY PIA
/V
IS BUILDING CONNECTED TO TOWN SEWER
ve S
Y
IS BUILDING CONNECTED TO NATURAL GAS LINE
es
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 - 3
PAGE 2`FILL OUT SECTIONS I - 12
'ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND /pAPPRROVED BY BUILDING INSPECTOR
DATE FILED g //,? l ! v
3?17 /
PERMIT GRANTED Q- p
19� era
3 PROPERTY INFORMATION
LAND COST id's 71 orb
EST. BLDG. COST C/ fW
EST. BLDG. COST PER SQ. FT. d%-6
EST. BLDG. COST PER ROOM Az ovz)
SEPTIC PERMIT NO.
4 APPROVED BY
A4
NUILDING INSPKCTOR
OWNER TEL. N 664-34 / L/
CONTR. TEL. # 36
CONTR. LIC. # 6 IF U
H.I.C. #
BUILDING RECORD
1 OCCUPANCY.
12 '
SINGLE FAMILY
OFFICESMUL
THIS SECTION MUST SHOW EXACT -DIMENSIONS OF LOT AND DISTANCE FROM
MENTO ti.
-
OFFICES
LOT LINES AND EXACT DIMENSIONS OF. BUILDINGS.. WITH PORCHES. GA -
APARTMENT$
APART
RAGES. ETC. SUPERIMPOSED. THIS -REPLACES PLOT'PLAN. ` -
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
,
CONCRETE
d
1
2 13
v '
CONCRETE BL K.
—{
PINE
BRICK OR STONE
I
HARDW D
PIERS—jj
PLASTER
}
DRY WALL
_
UNFIN
_
3 BASEMENT
I
, r
AREA FULL
. FIN. B'M'T AREA
-
'/,
FIN. ATTIC AREA
NO BMT
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
I
9 FLOORS
v'
CLAPBOARDS
B
1
2 3
DROP SIDING
CONCRETE
�_
WOOD SHINGLES
EARTH
ASPHALT SIDING
HARDW D
—
_
ASBESTOS SIDING
_
COMMGN
VERT. SIDING
ASPH. TILE
_
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON MASONRY
ATTIC STRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER BLK.
STONE ON.MASONRY
WIRING
STONE ON FRAME
_
SUPERIOR POOR _
I
ADEQUATE NONE
,
5 ROOF
10 PLUMBING
GABLE
HIP
BATH Q FIX.)
GAMBREL
MANSARD
TOILET RM. (2 FIX.)
FLAT
SHED
WATER CLOSET
_
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
_
TAR & GRAVEL
STALL SHOWER
_
ROLL ROOFING
MODERN FIXTURES
_
TILE FLOOR
TILE DADO
6 FRAMING
I 11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
_
HOT W'T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H•T'G
t-�+�t--•:'—'�
e
UNIT HEATERS
GAS
r�/'`�i
o+w N
i NO. OF ROOMS
OIL
B'M'T 2nd
ELECTRIC
1st 13rd
NO HEATING
ON
P
x
w
0
Q
o
u
N
T
C/)
O
z
0
z
d
o0
C13
ro
r
toc
v
c
O
�
z
0
z
a
°°
al
O
W
�
z
a
¢
W
P4
v
ncw
c
w
a
0
W
a
z
0-4
o°�
cG
—M
ii
W
�
w
a
w
z
y
cin
v
o
o
cn
40 0
uml
-z
Q
Q:
a
H V
Q CD
Z
t— o
y C
_W O
LL N
� N
°C E
W
C3 m
C1
= f0
� o
CD o
c �
o c
C H
�% O
V C.3
d =
Cu CQ
d C
� O
CZ
O d
N
E Q
c C
CD c.
� N
C
O m
C:5
V
cj CM
WE
:ate
N CO
m �
i
m 3
� C6
m J
N C
cv
:gym
co CD
QV i
N m m
C O Q
Q, C L
Cm •o
Cal N
'� ZO
C � O
O C1
N m C
dY C
Q= R C
_ � m•N
U V C�
ow—
0O2 m - C_
O .N
$ CL- Co
E
CL
_N
i
N
s
N
C
cm
m
C2
Ca
C
C
m
O
CT
C
.0
O
N
m
O
Z
CD*
N
•
U
CD
0
co
L
0
C C.3
Z
CD
C.
O cn
f CO
1 �
cnCD
� 'O
W3 CL*j •�
•E `= m
CD 0 co
co
L
CD O
cc o Q
CL =a
y
c Cquc
Cc
C.3.3 J -0
.Q 0 CR
C CD
.0 C
cc
c/!
0
a
FORM U - VERIFICATION FORM
INSTRUCTIONS: This form is used to verify that all necessary
Approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
*.***************Applicant fills out this section*****************
APPLICANT: _ 1�cT/ �C (hJ,J I ea ITS/ Phone
LOCATION: Assessor's Map Number Parcel
Subdivision o Lot(s) S
Street r ---P a7r n St. Number L�.S—
************************Official Use Only************************
RECO DA ONS OFOWN AGENTS:
Conservation Aaministrator
Comments
Cil 1_4j'o
Town Planner
'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
driveway permit
Fire Department V_L11*.
�.�e
� ,Received by Building Inspector
Date
Growth Management Bylaw Exemption Statement
Town of North Andover Building Department
This form shall be used to assist the Building Department in their determination of exemptions under section 8.7.6 of the
Town of North Andover Growth Management Bylaw. The building applicant shall provide all of the necessary information
as requested below.
Name of Applicant on Building Permit (below) Address of Property for Permit (below)
< d'J e W -4 y -- a ITY a,,, G/ /t
Mapand/Parcel : Purpose of Application (check below)
Phone Number of Applicant: Single Family _ Two Family
56("t(e !:� b 7 y
I the undersigned applicant for the above property attest that the attached building permit for which this
form is completed does comply with the EXEMPTION section 8.7.6 of the North Andover Growth
Management Bylaw. I also understand providing this form does not absolve me or any party to this permit
from the requirements of obtaining other permits required prior to the issuance of the Building Permit.
Further I understand that my interpretation of the EXEMPTION status is subject to review by the Building
Department and is only officially accepted when the Building Permit is issued.
Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the
above lot, in the building permit application and associated attachments, complies with one or more of the
following sections as indicated by a check mark.
This is an application for a building permit for the enlargement, restoration, or reconstruction of a dwelling in
existence as of the effective date of this by-law, provided that no additional residential unit is created.
�( The lot(s) were/was created prior to May 6, 1996 are exempt from the provisions of this Section 8.7 of the Zoning
I
This application is for dwelling units for low and/or moderate income families or individuals, where all of the
conditions of 8.7.6.c are met and/or represents Dwelling units for senior residents, where occupancy of the units is
restricted to senior persons through a properly executed and recorded deed restriction running with the land. For
purposes of this Section "senior' shall mean persons over the age of 55.
This application is a part of a development project which voluntarily agreed to a minimum 40% permanent
reduction in density, (buildable lots), below the density, (buildable lots), permitted under zoning and feasible given the
environmental conditions of the tract, with the surplus land equal to at least ten buildable acres and permanently
designated as open space and/or farmland. The land to be preserved shall be protected from development by an
Agricultural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar mechanism
approved by the Planning Board that will ensure its protection.
This application represents a tract of land existing and not held by a Developer in common ownership with an
adjacent parcel on the effective date of this Section 8.7 shall receive a one-time exemption from the Planned Growth
Rate and Development Scheduling provisions for the purpose of constructing one single family dwelling unit on the
parcel.
This application represents a lot which is ready for building permits,(i.e. all other permits from all other boards and
commissions have been received and the project is in compliance with those permits), and the Development Schedule
does not accommodate issuing a building permit in that Year, one building permit will be issued per Year per
Development until such time as the Development Schedule accommodates issuing building permits. Applicant must
supply approved form U with this EXEMPTION.
Please provide any and all information that would assist the Building Department in making a determination
that your application is allowed one or more of the above EXEMPTIONS.
By signing below I attest to the accuracy of the information provided and that the attached building permit is
allowed an EXEMPTION as cited above. Further I understand that the submittal of misleading and or
inaccurate information, or the checking off of an above item which does not comply, whether done to my
knowledge or not, is grounds for refusal by the Building Department to issue a Building Permit.
ature of Owner or Authorized Agent who signed the Attached Building Permit Date
form must be attached to the Building Permit upon application for such permit.
CERTIFICATE OF USE &OCCUPANCY
• Town of North.Andover
Building Permit.Number 40 el Date
THIS CERTIFIES THAT
THE BUILDING LOCATED ON Z I S ( 25 R
MAY BE OCCUPIED AS / IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
,00 CERTIFICATE ISSUED TO ak opw�
ADDRESS •
s4CNUs� Pector
t
H
i
ON
W
rA
as
• Q
a
O�
o
O
¢�
z
0
w
O
O N
C
z
g a c
w cn
CU
w° c
U w
c c
W �,
° v c
° c
c
Lw
0 cn cn
• Q
ui
o
O
�p z
a�
O
E
c L
O
O v
Z
co
CL
O CO)
p C
O
I 0 C
ca p .o
•E cc m
co 0 CD
CL
r 4�
O
O p O
R O Off.
CL cmQ
Cl ccCIO�
c
v J10
�C. O .co
c Z s
C..7 y
O O
—
C—
�— C
c
-
p
o
�o
0
O
O N
C
;
m O
V V
d C
ea �
Q
f •�
p i
N
CIO
�tY
E a
0
�
O
O
�
U
�
•
I A
CL
N
C
•
M+� V O
V J
/\
I��
cm
O
m C
E
: N A
co
m
..
�
4
m
O
y C
O
C
CA
O
mo
c
CLU
m
O
cm
c
N
p,Ct
m O �
'
mc
:ono
Q
m
:cmc
o
=
m
m G
N
m
h
W
C
ev t m
-=o
O
��
r-
E
mN
O
W
V
m
C.3
O C
VD
C'
m ' O
a o y
O
_
H
z
$ CL. CIO
a�
O
E
c L
O
O v
Z
co
CL
O CO)
p C
O
I 0 C
ca p .o
•E cc m
co 0 CD
CL
r 4�
O
O p O
R O Off.
CL cmQ
Cl ccCIO�
c
v J10
�C. O .co
c Z s
C..7 y
O O
—
C—
�— C
c
-
p
0
W
a
Q
CIO
0
�
O
O
�
U
�
V J
I��
O
a�
O
E
c L
O
O v
Z
co
CL
O CO)
p C
O
I 0 C
ca p .o
•E cc m
co 0 CD
CL
r 4�
O
O p O
R O Off.
CL cmQ
Cl ccCIO�
c
v J10
�C. O .co
c Z s
C..7 y
O O
—
C—
�— C
c
-
p
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
�- 1''_ Mass. Date �_Pl i -_`I _7_ 19 Permit # -�3 2- -7
Building Location aLtS
6W, [-VgtA (1,0 o
New-/ Renovation ❑ Replacement 0
Owner's Name i l� C 0 1j'a t S
Type of Occupancy --SINGLE FAMILY
FIXTURES
Plans Submitted: Yes O No O
Installing Company Name GALINSKY PLUMBING & 11EATING INC.
Address P.O.BOX 1701
HAVER14ILL, MA 01831
Business .Telephone 508-374-1743
Name of Licensed Plumber STEPHEN C. GALINSKY
Check one: Certificate
L3 Corporation 1906
O Partnership
O
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes>P No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy)"t Other type of indemnity O Bond 0
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.
Signature of Owner or Owner's Agent
I herchv certify that all of the details and information I have submitted for entered) in the
and inslallalionc tx rfnrmr!d under the permit issued for this application will be in Cpmplia
General Lawc _-��/� /L/I
Ay _ Signature of Licensed P
title _ Type of license: Master Journeyman ❑
('"down license Number .-l-0348--- -
APPROVI'D 10FHCE USE ONLY)
Check one!
Owner ❑ Agent O
application are true and accurate to the best of my knowledge and that all plumbing work
1 47peninent p,mnjions of thp0AWachuWs Stato0humbing Code and Chapter 142 of rhe
■
■■
■■■■■■■■■■■■■■■■■■',
■■
■■■■■n■■■■■■■■■n■■■■■'
...
ern
■■v
■e■■■■■�I■■■■■■■■■■
3rd ..
NOON■■■
■■■■■■■■■
NOON■■■
..
■■
■ ■■■
■■■■■■■■■■■■■■■■■
■■■—NOON
81111h rLOOR
■■■■■■■■■■■■■■NN■■
Installing Company Name GALINSKY PLUMBING & 11EATING INC.
Address P.O.BOX 1701
HAVER14ILL, MA 01831
Business .Telephone 508-374-1743
Name of Licensed Plumber STEPHEN C. GALINSKY
Check one: Certificate
L3 Corporation 1906
O Partnership
O
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes>P No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy)"t Other type of indemnity O Bond 0
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.
Signature of Owner or Owner's Agent
I herchv certify that all of the details and information I have submitted for entered) in the
and inslallalionc tx rfnrmr!d under the permit issued for this application will be in Cpmplia
General Lawc _-��/� /L/I
Ay _ Signature of Licensed P
title _ Type of license: Master Journeyman ❑
('"down license Number .-l-0348--- -
APPROVI'D 10FHCE USE ONLY)
Check one!
Owner ❑ Agent O
application are true and accurate to the best of my knowledge and that all plumbing work
1 47peninent p,mnjions of thp0AWachuWs Stato0humbing Code and Chapter 142 of rhe
Date...
3273
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ..ef l�.P.t. ..f •••.••..••••.•.
has permission to perform ......... • ....
plumbing in the buildings oof�... < L.�'•��• .... • • • • • .
at 2. ` a ...,�,a.�! . (` �... , North Andover, Mass.
Fee376 . LG 1.ic. No.. L .1. Y. J' ..... :........................
PLUMBING INSPECTOR
03/13/97 13:30 370.00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
j4r'•..,,.Y��.+,.s�>').,a✓�,.�w-v ...-+."vC� ��.,r"�."'_ _-• �-. ... - .. r ,..-Gra. Y.y L..
h r
2494 Date.. :. I..... �' ... .
A
SRM
LL
of Ho RT e1ti TOWN OF NORTH ANDOVER $
' PERMIT FOR GAS INSTALLATIOIR
!l.
This certifies that . .. .. .. .. �` . ...... �
has permission for gas installation ..... ..!i,�'?�t �..�.
in the buildings of -^y//.'... . .................
at �. . 1..(!�-:�, a�. No
�rth Andover, Mass.
Fee. 10.'... Lic. No........... ..........................
3gw �p GAS INSPECTOR
WHITE: Applicant . C.ANJ : Building Dept. PINK: Treasurer GOLD: File
1. ..s..r.., rt• i 1 .1 . f - wmv, µril.%4
' MASSACIIUSETTS UNIFORM APPLICATION. FOR PERMIT TO UO G SFITIING
(Print or Typr)
• 1 -MA? Mass. Date A It 191 :1 Permit N JV
-114 Building Location -%LAOwner's Name
()(Ai ��
L!'L�A �� V ��� "-�61 + Type of Occupancy SINGLE 1,AP1.[LY
New [ Renovation U Replacement O Plans Submitted: Yes IJ No IJ
FIXTURES
Installing Company Name GALINSKY I'LUrIBING & HEATING ING
Adds ess P • 0. BOX 1701
HAVERHILL, NA 01831
Business Telephone 508-374-1743
Narne of Licensed Plumber or Gas Fitter STEPHEN G. GALINSKY
Check one:
KI Corporation
❑ Partnership
d Firm/Co.
Cettifitate
INSURANCE COVERAGE:
I have a curr,ernt liability Insurance policy or Its substantial equivalent which meets the requirements or MGL Ch. 142.
Yes lv No U
II gnu have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy Other type or indemnity U Bond U
OWNER'S INSURANCE WAIVER! I am aware that the licensee does not have the insurance coverage required by Chapter 1142 o1 the Mass.
(;nrnr,al Laws, and 11,,11 my 51prlature on this Hermit annlication waives this requirement.
check one:
Owner O Agent. C
Cip,nahne nl Ocaner or 0%%nvt's Appnt
I I, t,,11 trrliIs II,ai all of the (if lAil r and Inlo—aIinn I haat whrrhIrd for emir,rd, in d,r abn•e spplitMinn art I, or and at to, At, to thr I•e51 of my kmn-lydte and Ike all plumhinr —A
amt ;-0,m int r—to'n 4 un.lrr the permit i.•ur.d In, ibis arptit al;nn will tr in tompl,Amtr with at! proinrnt prosisions of the Massachusetts Slate Gas Code and Chapter 111 of tine Gent, at Is
Isar of lit emit %
I..r. r.fit,
Tot, `faun S frnatv,r of llcn�sed plumb, m Gas tittrt V
t Inurnrl man
_--
■D■■
■■■■■■■■■■■
Ist
�■■
.
■e■..a.....INN
..
■■
..e.e.e..
i■�■e■i■
.,
■■
■a■■■■■■■i■■■■■■■■■
■
..
■
■■■■e■■■■■■■■■■■
■■■■
I■
■■■
■■■■e■e■■■e■ei■■■■
..
■■■■■■i
NOON
■■■■■■
■■■■■
Malmo
■■
..■...........a.....__
,o
■■ie■�ee■■■■■e■■.■■e�■■��
Installing Company Name GALINSKY I'LUrIBING & HEATING ING
Adds ess P • 0. BOX 1701
HAVERHILL, NA 01831
Business Telephone 508-374-1743
Narne of Licensed Plumber or Gas Fitter STEPHEN G. GALINSKY
Check one:
KI Corporation
❑ Partnership
d Firm/Co.
Cettifitate
INSURANCE COVERAGE:
I have a curr,ernt liability Insurance policy or Its substantial equivalent which meets the requirements or MGL Ch. 142.
Yes lv No U
II gnu have checked yes, please indicate the type coverage by checking the appropriate box.
A liability Insurance policy Other type or indemnity U Bond U
OWNER'S INSURANCE WAIVER! I am aware that the licensee does not have the insurance coverage required by Chapter 1142 o1 the Mass.
(;nrnr,al Laws, and 11,,11 my 51prlature on this Hermit annlication waives this requirement.
check one:
Owner O Agent. C
Cip,nahne nl Ocaner or 0%%nvt's Appnt
I I, t,,11 trrliIs II,ai all of the (if lAil r and Inlo—aIinn I haat whrrhIrd for emir,rd, in d,r abn•e spplitMinn art I, or and at to, At, to thr I•e51 of my kmn-lydte and Ike all plumhinr —A
amt ;-0,m int r—to'n 4 un.lrr the permit i.•ur.d In, ibis arptit al;nn will tr in tompl,Amtr with at! proinrnt prosisions of the Massachusetts Slate Gas Code and Chapter 111 of tine Gent, at Is
Isar of lit emit %
I..r. r.fit,
Tot, `faun S frnatv,r of llcn�sed plumb, m Gas tittrt V
t Inurnrl man
_--
T Date......." �. %......7...
�.� 871
NORTH
TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
i off°
�,SSACHUS� N
This certifies that,, •/ ( ... ...........(�........................... g
has permission to perform- ..../lr-.....y ............
wiring in the b 'ld;ng of ..... .. all ��� .
at .�............P'h.(!......../(J.Y.................... . North Andover, Mass.
Fee .3-9.3.�. Lic. No.. -. In%.�/'�<.............................................................
ELECTRICAL INSPECTOR
%b% 3
WHITE: Applicant CANARY: Building Dept. PINKi�urer �
.�\ Office Use Only Q /
01he Tommonurenlfh of fttsoothu rtts Permit No. Q�7� �/�
Btparnntat of Public *afetq Occupancy A Fee Checked •✓ �7 J
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3190 peave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cade, 527 CM/R, 12:00 Q
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7" —1 K- r
QOK/ 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 8
Owner or Tenant
Cwner's Address
77
!s :his permit in conjunction with a building permit: Yes No I (Check Apprc.c lr ate Sex)
� / ✓J�< <i
Purpose of Buiidin, � Q(A.1Q1� Utility Authorization No.
71��--%.3 U
Existir
"cit --ver.^.e3d _ Una rnd ri No. of Meters
g Ser✓ice Ames 9
New Service yUU Amps /w! o27C� `/pits Cvernead Undgrnd - No. of Meters
Numcer of Feeders anc Ampacity
,! j
'NcrK X Qa
Location and Nature of Procosed Eiecmca!
/
No. of Ugntinr Outlets
No. of Ho: uCs
Tctai
No. of Transformers K'.A
No. of L gnt:ng Fixtures
Above—
Swimming ?oci
yrrc. —
'n- —
crcc. —
Generators KVA
No. of Emergency L:gnting
No. of Recectac!e Cut,ets
No. of Cil Burners
Battery Units
:,t Sumo.^, Cut!ets
Jo. of Gas Burners
--
FIRE ALARMS No. of Zones
o`ai
!
No. of --election arc I
No. of Ranges
No. cf Air Cone. ons
Initiating --evices
Heat –riot
Nc
--:-,
No. of Discosa!s
of
?umcs Tons
Cv !
No. of Sounding Devices
No. of Self Container
No. of Dishwashers
ScaceiArea Heanr.c
K:✓ I
DetecttcnrSouncing Devices
No. of Dryers
r.eating Devices
<�%
I
Munic:cai
Lcc31 Conner :on _, Other
No_ of NC. r.
! Low voltage
No. of Water Heaters
S;cns Ba:as:s
Wiring
No. Hvrro Massage Tubs
I No. of Motors otai ^ P
CT HER:
INSURANCE CC`✓ERAGE: Pursuant to the recuirements of %1assacna:setts genera! Laws
! have a current Liae:iity Insurance Policy inc:ucir.c Comc:etec Cceraucns Coverage or Its suostantial ectuvaient. YES NO = i
11
nave sucmitted valid oreof of same to the Office. YES t NO = it you nave cnecKeci YES. piease inoicate the type o coverage cy
cnecxing the aocroonate Cox.
INSURANCE l BOND = OTHER = ;Please Stec:`:;
(Expiration Date)
st!mated value of E!ectrtcal WorK S
W01'K :o Start y`�� G! % Inscec:cn Date Reccestec: Rcugn �/LJt (� eG Final
Signec uncer the Penalties of perjury: //--
F!R!.1 NAMEj ( IC. NC.
Licensee / �� Lal-,J/-7PA )ra . Signature NO.
Rus. Tei, No.
ArdreSs 42 Alt. tai. No.
a
CWNER'S INSURANCE iA ER: I am aware that the t.:censee roes not have the insurance coverage or its suostantial eeuivaient as re-
curred Cv 1.1assacnusetts General Laws. ane that my s:gnature cn :^is _ermit aopticat:ri'. waives :his reeuirement. Owner Agent
(P!ease checx crei
e;ecnone No. PERMIT FEE S
,signature at Owner cr Agent)
Y-65_65
. . ........
j I,' T/Ql/
NI
32 \ ..
900
f �
IC
I \
i ... \
' ST
O
O
tV
W
. M _
n
.. q
iv a
.tH OF
AEY
13 HOFMIANN
MER MACK MMMNG SERVICES. INC. :
RAWRS by
oaorc cNc.�[tas • uvo s�x+�►vrrs • fib,
w s,a fit . Mmt•. r.�wousm ana • ,n ceon•n abe, �n sm . r,x rvri�.» +.w
r
1