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Home My WebLink AboutMiscellaneous - 247 MAIN STREET 4/30/2018 (2)9317 Date . Q4,, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACNUSE� This certifies that . ......fr. 101-S. ... .......... .... . has permission to perform ..7&4/A/ ... . 444C/ n .... . plumbing in the buildings of ..f�qr! !'e.r ..................... at ............` .... S' ............./ . , North Andovet, Mass. Fee Z�fU Lic. No. A?/eP . 6 s /„��r ...... _ PLUMBING INSPECTOR Check # l�S 3 P SUB BSMT. I" PLOOR —f""'—FLOOR 3"d FLOOR 4� LOO 5 OF[ 0R ' b6i 7 FT F OR 8 F OOR MASSACHUSETTS UNIFORM APPLICA FOR PERMIT TO DO PLUMBING . City/Town: An G`!�,� MA. Date: I Ito— I� Building Location: 5XA_1 M R', r` S't' Owners Name: . Permit# Ihcy R.jrr%tGr Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential K k - New: ❑ Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES I 3 W O 4 w CO us 0 LO UQ I— _W Z I� rn � 0 C7 Cra CO U) jL UJ W Uj V b LL o c10 Z 9 O 0 0 z z W� ImLu Installing Company Name:Check One Only Certificate # Address: ❑ Corporation City/Town: L.Awrc�C.t State; ("11� ❑ Partnership Business Tel: 911 CQ3 3--n 1 Fax: El Firm/Company Name of Licensed Plumber: /V eJ)0lei 3 De.Jre+tt it UR'ANCE CO`JERAGE: have a current liability insurance policy orits substantlal equivalent which meets the requirements of MGL..Ch. 142 Yes ❑ No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE IAIV,R: I am aware that the licensee does not havA Thp in- LSji=.qn@ Ci?gE'- rcge.ei(cd t_-1 rin8p`B( lil Oi itic assgo s General Laws, andthat my signature on this permit appiication waives this requirement• AA� Check One Only ner or Owner's Agent Ot`''her ❑ Agent 1 hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142,of the General Laws. t By Title City/Town APPP.OVED (OFFICC USE ONLY Type of License: //� _.�+ s / ❑ Plumber SI nature Of Vicensed Plumber Master Journeyman License Number: 30113 i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0211.7 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El nniiectricians/Plumbers ran* T.,f.....,..�:..._ Name (Business/Organization/Individual): H5ffi7CIN, ce Address: wet � City/State/Zip: 014y2 Phone#: kre/you an employer? Check the appropriate boa: I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* ❑ I am a sole proprietor or have hired the sub -contractors listed partner- 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.] ❑ I am a homeowner doing all work officers have exercised their 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. D New construction 7. ❑ Remodeling 8..[] Demolition 9. [] Building addition 10.❑ Electrical repairs or additions 11 -0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other es,y applicant that the -:Ls box r1 must also fill out the section below a_o.viY_ :heir worre s' c,W s iioa1 L'^� inforr etion. 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 941g1et,, � W c:] � i r, R} o, L�, 0 -011) C -C, f �o I- Policy # or Self -ins. Lic. #. CIM 0I S f �-7 (j Expiration Date: Ia Job Site Address: c`y'% M9 i`n r4 /1 City/State/Zip: A), IV", (r. /'itQ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00. and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certhe pains and penalties of perjure that the information provided above is true and correct 77 97g- e64 -, y 77 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): L Board of Health 2. Building Department 3. City/Town Clerk 6. Other Contact Person: _1(0_1 _1(0_r 4. Electrical Inspector 5. Plumbing Inspector Phone #: A L CNIC SM CLAIMS DEPT. September 07, 2011 Commerce Insurance - The Commerce Insurance CcmpanysM Citation Insurance CcmpanysM Members of The Commerce Group, Inc.`" 11 Gore Road, Webster, Massachusetts 01570 (508) 949-1500 www.Commerceinsurance.com BUILDING COMMISSIONER or INSPECTOR OF BUILDINGS TOWN/CITY HALL N ANDOVER MA 01845 RE: Our Insured: MARTHEA FOURNIER Property Address: 247 MAIN STREET Policyk VL3635 Date of Loss: 02/15/2011 Filek XTT374-VNNC62 Board of Health or Board of Selectmen Town/City Hall Claim has been made involving loss, damage, or destruction of the above captioned property which may exceed $1,000, or cause Massachusetts General Laws, Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to my attention. Please reference the above captioned insured, location, policy number, date of loss, and file number on any correspondence. ESTHER O'NEILL Claim Specialist, Casualty Telephone: (508)949-1500 Ext: 11425 Toll Free: 1-800-221-1605, Ext: 11425 On this date, I cause copies of this notice to be sent to the persons indicated above, at the address above, by first class mail. September 07, 2011 Co11 mCuc COropanies .... COME GROW WITH S CIC 254 (Rev. 4/95) MAIL I33 Date.... °f,"`°:'. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......%. ..'� ...................... �.................................... % has permission to perform .....� % °'' n ' ` �— wiring in the building of ......... .......................................... at ..... Z y.7........./..".7f!r. iz........... 5�- ............ . Nortt�h An el, 1V ass Fee ... Z.v......... Lic. No, /*,,- .................:j ln.... ..10 ....... /lu.ECTMRICAL INSP CTOR' Check 'Y /t y�71�t3 %� 10595 _ / �RnuJcalutrAa[L�t. o��f%%ad�acicJ.r3Rlf� 0fliciol Use Only oURFQPtJI[AJt!• O�.JIPA �RlU1GRj - Per nrtNo. �' '• Occupancy and Fee Checked BOARD OF FIRE PREVEN- lON REGULATI NS Q [Rev.1/07] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORN All work- to he performed in accordance Nvith the Ninssnehusetts EiecLdcnl Code (NIC), 527 CMR 12-00 1-N (PLEASE FREVT -DV MW ORTI-PEAa NFOAK4—TIOM Date: SA K\ . 1(p -2-012 NOPO. City or Town of: -A N DmI-E R /'VIA To the Inspector of IT -71 -es: By this application the undersigned gives notice ofhis orher iatention to perform the electrical work described below. �^ Locatign (Street el- Number] _ Z47 Mk -IN e:;T Owner or Tenant 'Fcaa m i e -1p, 'Telephone No - V%8"—" Owner's Address S, — A is this permit in conjunction With a building permit? Yes ❑ No ❑ (ChedcAppropriatr-Box) Purpose of Building UtilityA_uthorizntion No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service, Amps / Volts Overhend ❑ Undgrd ❑ No. of Meters Number of Ir ceders and Ampacity. Location and Nature of Proposed Electrical Work, 1 � i Tr�r� ocS ome- Coninlalion afthe InllntoinR tnhle mn.o bo Nunrund l.n rt.� No. ofRetessed Luminaires No. of Ceil.-Susp. (Paddle) Finns No. of Tota9 Trnnsformers 1CVA No. of-LuminnireOutletsNo. of Hot Tubs Generntors ICVA No. of Luminaires SWimraing Pool Above . ElIn- Elo. rnd, rad. o mergency Lig eng Bntte Units No. of Receptacle Outlets No. of Oil Burners �N FIRE; ALARMS rq0- of Zones No. of Switches No, of Gas Burners o. o Detection an Initiating Devices No. ofRnnges No. of Air Cond. Total Tons No. of Devices 1; No. of'wasteDisposers HrntPump Totals: Number Tons 11M No.of elf -Contained Detection/MartinDevices No. oi`Dishivashers SpaedAren .stenting JGV Lural ❑ Municipal ❑ Other Connections No. of Dryers No, o£ Water lav (seaters Heating Appliances lCW No. of Na. a£ Signs Ballasts Security Systems-.-, No. of Devices or 'Ek uivnlent Data Wiring: No. o['Devices or I; ui'vn[ent No. Hydromassage l3ntbtubs No. oflllators Total HPTelecormmnnications i%'Viringg: No. oflievicns or Equivalent OTHER: T Attach addillonal detail ldarb-a4 or as required by rbeInspector of wj Estimated Value of Electrical WorL- (When required by municipal policy.) Work to Start: J — j p — i2 Inspections to be requested in accordance with MEC Rule 10, and upon completion_ 1fNSt142ANCG=CO.V1iRAG>r;=Unless'tivnived-iiy-th�ativner rio:penirit=for rise=pe'rfoiziiuhce afelectc`til worse-Ynay-issue aril the Iicensee provides proof of liabll* insurance including "completed operation" coverage or its substantial-' equivalent Thr undersigned certifies thatsuch coverage is kfare% and has exhibited proof ofsame to the permit issuing office_ CHECK ONE: fNSURANCE ❑ BOND ❑ OTHER ❑ (Specify-.) I' ceFlifiJ IfIItPL't'•tlrL'-DQItrS-ttllll ri�ltai>'[L?c-otrrtrjsiitrJ=flint-�li� isi�iirnrrrtsnn-nio-rf3e-:.:,n�;.,,,rt:,.;=:.�i.�:.._:.:`;►• :y:�"'=�.�; _:.. FERM NA.I1M,: LTC- N®.: Licensee: -M Ll iJNF Signature ..t/Yv�, W Ll C. P4 0-31 G (Ifapplicable, enter "mm t " in ilia &-ansa number line) Bus. Tel. No.' Address r o % FipAflLty�'� rip I -I INA Ci 32 Ait. Tel. Ndn.: *Per M.O.L, c, 147,5.57-61, security work requires Department ofPublic Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not bare the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ otivner*Sage Oivner/Agent Signature Telephone No. PERWT -FUE S Nalne(Businessl0rganization/indMdaaI): •■■ r , �r • ► i� Ali -� Ol Phone #: Are you a -A employer? check the approprinte box 1 _ F -I I am a employer with 4• [] I am a general contractor and I employees (full andlor part time) * . have hired the sub -contractors 2 am a sole proprietor or partner- listed on the attached sheet sbip. and have no employees These sub -contractors have working for mein. any capacity_ - employees and have workers' [No workers' comp. insurance sance comp. �m' . 5. [] We are a corporation and its required—) 3. ❑ I am a homeowner doing all work officers have exercised their myself- [No workers' comp_ right of exemption per MGL insmance required] t c. 152, §1(4), and we have no employees. [No workers' COMP. mstr a ce required.] G2 Type of project (required): 6. ❑ New constriction 7. ❑ Remodeling 8. Demolition 9_ ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other Amy npplicnnt that ebeds box ml mist also {M out the section below showing their workers' compensation policy it annation. .Eomeowners who submittb.is affidavit indicating they are doing all work and -then hire outside contractors mast submit a aew affidavit indicating such_ •� =Contractors that check this box must attached an additioad sheet sbowingthe name of the sub-conhuctors and stutewbether ornot those entities have :mplayecs_ I€the sub-caatmctnr have employaes,they must p Ovide their workers' comp. policy number. l a7iz laid errl�7loyer t/lat iS providlltg'DYOrNers' colrTerisaZYort irlstirapice for•lliy el?Tloyees Below Is tleepolicy widjob site Ir formadon- insurance CompanyName; Policy # or Self-ids.Lic. ff: Expiration Date:. Job Site Address: 2-47 Main ST Q&T-14 AMIDWeRcity/state/Zip: }_ ©L Attach.a copy of the workers' compelnsation policy declaration page (show' M- g the policy number and expiration date). Failure, to secure coverage as required under Section 25A ofM(3L c. 152 can lead to the imposition of criminal penalties of a fine tip to $1'500-00 and/or one-year imprisonment, as well as civil penalties in the form -of a STOP WORD ORDER and a fine of up to $250.00 a day againsttheviolator. Be advised thata. copy of this statementmaybe forwarded -to the Offiae of Investigations of the DIA four insarance coverage verification l da Icel eby cer7a))y under Elle ¢iris arld enalties of iary that the itlforwiatfoti provided above is trite and correct r d.�_ ffzcial use only. D_ o nqI urfte in this area., to be corjrpleted by city or tows officiat City' -.or Town: " Permit/License# Issning 16th osity (circle olae): 1. Boar((- bfEle-21th 2. B.>rn.ildingYDepartinent 3. City/'Ibwu Clerk 4. 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TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......14 ........................................ has permission to perform ..!)`.Q. ............................................ .................. .... If wiring in the building of �.. CA. at ........ .... � .......... ................. ..North Andover, Mass. Fee .l7-'!C'P--- Lic. No. ! A rff / ELECTRICAL INSPECTOR i Check # / Y U ThFCOIN 0JNWEALTHOF1YI1MCRUSE77S Office Use only DEPAR77UE7VT0FPUBLICS4FE7Y Permit No. BOARD OFFIREPREVEMONRWULl770NSS27CViR 12.00 Occupancy &Fees Checked L APPUCAHON FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 7 Z f '-0,rt, Town of North Andover To the Inspector of Wire: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) -2 Owner or Tenant `;VeR �� Owner's Address .t. Is this permit in conjunction with a building permit: Yes[El No M (Check Appropriate Box) Purpose of Buildingel i , 411 -OA -f r ,t , Utility Authorization No. Existing Service tog-� Amps l�aVolts Overhead Underground Q No. of Meters New Service . Amps / Volts -� Overhead Underground CM No. of Meters Number of Feeders and Am parity Location and Nature of Proposed Electrical Work No. of Lighting Outlets U No. of Hot Tubs No. of Transformers ! Total No. of Lighting Fixtures r Swimming Pool Above Below Generators J and ground K VA No. of Receptacle Outlets t7 No. of Oil Burners. r No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of AirCond. Toon' �vati FIRE ALARMS No. of Zones No. of Disposals ' No. of Heat 12 Total Total No. of Detection and No. of Dishwashers Pumps Space Area Heating Tons KW KW Initiating Devices No. of Sounding Devices No. of Self Contained .�.�. No. of Dryers / Healing Devices KW Detection/Sounding Devices Local Municipal Connections Other No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP � hmrntioeCo�a� Pld5t81ttOtltere(]lffit3i>B'�S1Bett5�19aIL34VS Iha�eaa>tlartLiabtldy>gC�rrple� C'o►a�a dssrl�tatalt�avalai YES Iha�esubmitbadvatidpioof VIXOSM YES U NO r7 If}whmedmd dYEB Pkmem&*dtetAxcf by dniangttc INSCIRANCE BOND 01I-JER a (ppm ,) 8#D Estur>*dValwdE1mpimlWade $ WakioSw h>ra:d n*RgxsWd Rc* Falai Signed unda'ie Pettaltis ofpajtay Fi12MNAME LixnseNa A JZ / Lianw (.GY`! Y/''► Sig[>i*mne I>SeNo =l`; i / l3us�el TNa 612, Adldresc e/A f.eo��e AkTeLNa OWNER'S INSURANCENVAIVER;lam awacet=drLic wd[0Mhayetheirnlaa<remymWoritss (4Miergasby?v C �d$>atrtrysrgrr�aernitaspanritapp�tt��sihisleRlmt�iiart, (Please check one) Owner a Agent M ' Telephone No. PERMIT FEE i Date .......:....° TOWN OF NORTH ANDOVER PERMIT FOR WIRING - ILI This certifies that ........................................................... I .............................. has permission to perform wiring in the building Of ......... ...... ... ......................... ... .... ........ ........... . North Andover, Mass. Fee..< ........... Lic.No. ! ( �V,4 .................................................... ELECTRICAL INSPECTOR Check # 7 8 5 4._ Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 2yls Occupancy and Fee Checked [Rev. 1/071 (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: r/? City or Town of: NORTH ANDOVER To the Inspe for 'of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 2 y7 4g&,, Owner or Tenant —1 -AA --4 r=te pr Telephone No. Owner's Address e Is this permit in conjunction with a building permit? Yes E] No (Check Appropriate Box) P� Purpose of Building PJ,vt es'I-/.y4 i Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead [1 Undgrd ❑ No. of Meters Number of Feeders and Ampacity f ✓ v t . .S', kA Ot No. of Gas Burners Location and Nature of Proposed Electrical Work: Add st, I '"-f-O 2:�:9r*7 1,/r/ pr Cf--QL6 PTa enr k L, s def elf 1 Completion of the following table may be waived by the Inspector ofWire.c No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above n- rnd. 1:1rnd. E]Batter o. o Emergency Lighting Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No, of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump umber .. Tons No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kit Security Systems: No. of Devices or Equivalent No. of Water K�'�' o. o No. o Data Wiring: Heaters 'Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: l • -e Pv t o rl iG a t IF Attach additional detail if de d, or as required by the Inspector of Wires. Estimated Value of Electrical Work:/„jp 0 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) I certify, under tl:e pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: /'/jC�� ►eq J�rM Signature LIC. NO.: 3 (If applicable, enter�};empt" in the license number line.) n Bus. Tel. No.:� /7 �i 70f1�; Address: ,� f5/gC�� 8�er..,e eAbocC� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires rtment of Pu lic 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 �w Signature Telephone No. FPERMITFEF-- $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,e z //e!6 ��4►f lh �.. Address: S'" ,Q /a c lr ,n p— SL J City/State/Zip: %stab VC! l'�A OM6�6l Phone #: 7 ',1 % 01/V / Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I `m ployees (full and/or part-time).* I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. $ These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.[�Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. fi 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: I City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify u)oer the pains andpenaljl'e4 of perjury that the information provided above is true and correct. Phone #: (or 7 *?q 7 0 V4 ( Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: AIP Date...6.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... � ....... ....................... has permission to perform .......5 e wiring in the building of .............. ........................................... ....... at ... ..,7 ............................ . North Andover, Mass. Fee.J!7.0.0.. Lic. No.,N....!.�5W ............. ELECTRICAL INSPECTOR Check # 6986 .A A Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official � �Usse Only Permit No. CJ Cf 46 Occupancy and Fee Checked [Rev. 9/051 (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: /p City or Town of: %%(/r/ii I x1o,-,-e/— To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) _*)i/-7 Owner or Tenant �l,/ip aLdr zw r _ Telephone No. Owner's Address JAA4 e - Is this permit in conjunction with a building permit? Purpose of Building Existing Service >,QM_ Amps /e'�o / deo Volts Yes ❑ No �?r (Check Appropriate Box) Utility Authorization No. 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: sub 106,n&�e �Ar rr I / .. OrA,0w0J i'.- e to) A n-f,oQ Completion of the following table may be waived by the Insnector of 17,7re.c No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- ❑ rnd. grnd. o. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number Tons KW No. oSelf-Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. o Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) / certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: le y A A LIC. NO.: Licensee: p� ,S �/,y,,i Signature LIC. NO.: 4JGS k / (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: / /7.29 ydc/�/ Address: S �i%Ipc/t30( _e 'SJ f-'P146ddy / Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ SignatureturaTelephone No. .&72 ( .. cl-9-'o J TOWN OF PERMIT Date/./O. X0 - R TH TH ANDOVER GAS INSTALLATION This certifies that.. has permission for gas installation ......... in the buildings of . . . . ,r- - r . %- . �. ........................ at 2. /-Ix 'A ..... ........ North Andover, Mass. Fee. Lic. No. 2. k A ............. 0 GAS INSPECTOR Check# 0"758 J► ■1 MASSACHUSETTS UNIFORM APPLICATON FOR PERMfr TO DO GAS FIT'nNG (Type or print) NORTH ANDOVER, MASSACHUSETTS AV ---- Building Locations �`�"�-�/�� Permit # Amount $ 3)r -- Owner's Name�� Newbl*, Renovation Replacement Plans Submitted (Print or type) Tom_ Chec one: Certifict sta 'ng Company Name l/�% i _L Corp Address "�-�� O Partner. Firm/Co. � — 11 Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance p licy or it's substantial equivalent. Yes D No 13 If you have checked es, please i icate the type coverage by checking the appropriate box. Liability insurance policy Other type of indemnity r Bond 0 Owner's Insurance W ' err: 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 i i hereby certify that all of the details and information i nave suottuttea (or enterea) to above appncanon are true ana accurate to the best of my knowledge and that all plumbing work and installatio rformed under Permit Issued r this application will be in compliance with all pertinent provisions of the M, achusetts at Gas Code and Chalpte>V42 th e 1 Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber C Gas Fitter 77 ourneyman Or Gas Fitter HORTh SACHUS Date./ ywy.A�- TOWN OF NORTH AN PERMIT FOR PLU NG 1.9 This certifies that J'A .................. ,94 has permission to perform plumbing in the buildings of ..P -G: .................. at. .7 .. . ......... North Andover, Mass. Fee. .. ...... NUMBING INSPE&OR Check # 7156 u 19 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Locatio445 7,VI0fy Owners Name Permit #�1 �^ Amount Tvoe of OCCUDanev New M Renovation M ReplacementA Plans Submitted Yes 0 No El FIXTURES (Print or type) Installing Company Name ''" ,Check one: Certificate Corp. Partner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indic a theApe of insurance coverage by checking the appropriate box: Liability insurance policy-" 1171T Other type of indemnity F1Bond❑ Insurance Waiver: I, the u drsigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature I Owner ❑ Agent 11 I hereby certify that all of the details and information I have su ed (or entered) in above best of my knowledge and that all plumbing wyk and instal;Xig§ performed under Perm compliance with all pertinent provisions -e n5sac u tate Plumbing C�rfr�►a�n,,�l// Title APPROVED (OFFICE USE ONLY Type of Plumbing License rcense um er Master ❑ true and accurate to the )plication will be in of the Journeyman 3 � Date. }/! . / lr. � ......,., NORTH / 3= �` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION h '=r,9SSAC�HUSEt.1 This certifies that .. . e h r 4.' .�- .......... . has permission for gas installation ....Cr�... ......... . in the buildings of .. Fc, jL' I: !'. c ........................... at . ! . 4. ..!.?� �. ............. North Andover, Mass. Fee. X .� . Lic. No. .. .....Q ...... GAS INSPECTOR Check # 1 Z' 5568 MASSACHUSEM UNDFORM APPLICATONFORPERMITTO DO GAS FITTING `r7' Date Q (Type or Print) NORTH ANDOVER, MASSACHUSETTS Building Locations `� / ►�i� .�-�.�� Permit # Amount $ Owner's Name Ne Renovation ❑ Replacement ❑ Plans Submitted ❑ Print ort p�) /j f / hec one: Certificate Install' g Company Name yl/��y)�7F�' --� • Corp. � Address,-- 4- - ❑Partner. usrness a ep one 777=70 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance ]icy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ye lease ' dicate the type coverage by checking the appropriate box. ❑ Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Wai er: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information i nave suorrutLeu wr C11LUICU) ,11 dUVVC at,f,,ILMIUH aic LJU� ai,u a.. ,..a�. . best of my knowledge and that all plumbing work and installati ns performed under Pe Issued for this application will be in compliance with ail pertinent provisions of the Mas9chusett to / er o ode and e General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of 1 ❑ Plumber ❑ Gas Fitter Master Journeyman IF WWI. Print ort p�) /j f / hec one: Certificate Install' g Company Name yl/��y)�7F�' --� • Corp. � Address,-- 4- - ❑Partner. usrness a ep one 777=70 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance ]icy or it's substantial equivalent. Yes ❑ No ❑ If you have checked ye lease ' dicate the type coverage by checking the appropriate box. ❑ Liability insurance policy Other type of indemnity ❑ Bond Owner's Insurance Wai er: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information i nave suorrutLeu wr C11LUICU) ,11 dUVVC at,f,,ILMIUH aic LJU� ai,u a.. ,..a�. . best of my knowledge and that all plumbing work and installati ns performed under Pe Issued for this application will be in compliance with ail pertinent provisions of the Mas9chusett to / er o ode and e General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) sed Plumber Or Gas Fitter License Signature of 1 ❑ Plumber ❑ Gas Fitter Master Journeyman sed Plumber Or Gas Fitter License Date .•..5/// x1r. . . " TOWN OF NORTH ANDOVER '• O ,+ 60 PERMIT FOR PLUMBING This certifies that (C.ct .. has permission to perform =-................ plumbing in the buildings of ... ................... at .. off. 4 ?...I!-.. h� �?A.�.... 1- ......... . , North Andover, Mass. u Fee .l ...... Lic. No. 2- . ........... PLUMBING INSPECTOR Check H �� 2 ?- 7 (Type or print) NORTH AND, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN Renovation 13 (Print or type) �-n e Installing Com]a/nynN�ame Name of Licensed Plumber: Insurance Coverage: Indiax Liability insurance policy Insurance Waiver: I, three insurance Replacement Date lame _ Permit # Amount 6 L nanrar Plans Submitted Yes C.he�ck,one: a Cee 'ficate Corp. FlPartner. , ElFIMV6. >e of insurance coverage by checking the appropriate box: Other type of indemnity 0 Bond have been made aware that the licensee of this application does not have any one of the above signature Owner 0 Agent M I hereby certify that all of the details and information I have submitted (or entered) in a ove application are true and accurate to the best of my knowledge and that all plumbing work and ins all tions performed and r rm_it for this application will be in compliance with all pertinent provisions of th c us s -tate Plumbin d r 142 of General Laws. By: re o icense u e .01 Type of Plumbing 11cense Title � City/Town icense um er Master Journeyman APPROVED (OFFICE USE ONLY Location =2[0 61A l f0 -�c- i" No: Date i t NORTH TOWN OF NORTH ANDOVER 0�,.•o _• 1h i? ' • OOL P. 00 s « Certificate of Occupancy $ �'ss�cMusE`Building/Frame Permit Fee $ 4250 Foundation Permit Fee $ d Other Permit Fee $ TOTAL $ �� S Check # '10656 V Building Inspector M Location �� f�lA fA1 No. Date - /5/,3/0 v,, - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $-� Check # .i'j`-:U Building Inspector + TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING ys. .. � *Av .. .. :, BUII,DING PERMIT MASER DATE ISSUED: / 013 A SIGNATURE:14 Building Commissioner/I r of Buildings Date SECTION 1- SITE INFORMATION 1.1 er//cy//Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number yin /A_ llnffoormation(�/ CN / t ! /� 1.3 Zoning Zoning Niiid Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 water Supply M.G.LC.40. 34) 1.5. Flood Zone Infotmation: Public ❑ Private ❑ Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ _ On Site Disposal System ❑ SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.1 Owner of Record q Name (Print) �j Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: A Signatupe Telephone SWTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: Address Signature Telephone Not Applicable License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone M X 3 74 Z O SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: L/ P 6A d D 6 6 b I fC fti Q/ + 8$s 6m gwT 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1 M Item Estimated Cost (Dollar) to be Completed by permit applicant � A Building (a) Building Permit Fee Multiplier Y SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ 1 Existing Building ❑ 1 Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ 1 Demolition ❑ 1 Other ❑ Specify Brief Description of Proposed Work: L/ P 6A d D 6 6 b I fC fti Q/ + 8$s 6m gwT 1 SECTION 6 - ESTIMATED CONSTRUCTION COSTS 1 M Item Estimated Cost (Dollar) to be Completed by permit applicant M""' OFFICIAL USE W4Ly I . Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (n) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number b SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, r/ [VUM- rl f, z A- 1,0- 0 A Ick,7 Z , as Owner/Authorized Agent of subject property Hereby authorize ✓`- ® h-r-�-t ` f "l G 5 to act on My be] al , in all in tt rs relative to k authorized by this building permit application. (� O �a7 iµ,[ �—, �/ -I l Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION i 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 of Owner/AQent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS isl2 ND 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE P. y 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 or requirements. r APPLICANT FILLS OUT THIS SECTION / APPLICANT Ae'TNEA dO2N164Z PHONE 1??6FK 7103 1 LOCATION: Assessor's Map Number 31 PARCEL 1 l SUBDIVISIOnN t r LOT (S) `l STREET a� 7 �� ST. NUMBER c4 OFFICIAL USE ON TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT -) IRE DEPARTMENT '144 - Cd dGJ Llt,, Ue _AtkQr)�f RECEIVED BY BUILDING INSPECTOR DATE Revised 9%7Im D. Robert Nicetta, Building Commissioner TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street North Andover, Massachusetts 01845 HOMEOWNER LICENSE EXEMPTION Telephone (978) 688-95454 Fax (978) 688-9542 Please print DATE: JOB LOCATION: 3 Num Street Address ap/Lot HOMEOWNER MhZ: h P_62_ r0(jX dV 1 !LC. _ Name Home Phone Work Phone 'i� 4 s ri PRESENT MAILING ADDRESS c N , "o 0\/L,� - MA 0 / K City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFFICIAL 114 ).ARD OF APPEALS 6R8-9541 CONSI.RVATTC)N 68X-9130 11Y Al,l'll 6Sk9540 PLANNIM; URS.05.35 NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordalice with the provis o of MGL c 40 S 54, a condition of Building Permit at* that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are -required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: 'Z —a -,z £ --- 'j L (Location of Facility) Signature of Permit Applicant Fire Department Sign off. r � ► Dumpster Permit Date m M m M B 2 y copi Cl) CD d 'fl O O Z y CD 0 ? O d= CO) n� c o CD CD O Q d CD CCD O CSD C O co) CL v y CD I C2 COD O CD Z CD a oCD C CD ems-' O 0 b n►�'s Off: W n 0 cn C z CIOH cn cc?�0 d Mc O - .woQw a So y CD CACh06� m / O Z . m M y 'i s C �m T rn w m �Omw 0 y o -."=: Z Eco CA m; OZy.n W0 CD I CL rr1 c. a ti = f, N M m o ?� 0 omy:� rCL C7� CC y : a V y n ff Q 'ccl S n y U o ff^^ S 3E mch H :� o V! .'O 7 0 00 . ♦ :� a N% ti CD zv' A go CD O o� w �c _ w so: n w =r C) '71 =o ;_� 071 G 0 � C) b ` 8 O d O O M w w n w C) '71 071 G 0 � C) b ` 8 O d O p 1 O C 1 W O �D z W N W • r.a A., IO O! OA O � A O O •E m m CD 0 CD CL _~ CD O� 3� O O G O a CL c a Co o � c cc v CL o co CO3C Z ts CD CL v y c C C cc— CO3 o o w : m C _O WCYA a w a a z� O:ov Cl CJ v •ac m C w a°4 w O L O d G w a4 p w' E rA cn O cn O �D z W N W • r.a A., IO O! OA O � A O O •E m m CD 0 CD CL _~ CD O� 3� O O G O a CL c a Co o � c cc v CL o co CO3C Z ts CD CL v y c C C cc— CO3 o : m C _O WCYA z� O:ov O �D z W N W • r.a A., IO O! OA O � A O O •E m m CD 0 CD CL _~ CD O� 3� O O G O a CL c a Co o � c cc v CL o co CO3C Z ts CD CL v y c C C cc— CO3 o : m C _O O:ov Cl CJ v •ac m C O L O 'low: c = is 30 N %.: �Ec L o �ca$% � CL-- ca mm 3 M M O, s 0.3 y : •O _Co ' yO O C y C `� � E h O a� S M: 3b y O Of cM.6 C O C � QC d h m C Z p� � m casN O z v 10 ca C � O Coo C C = m m 3 s �- d O .r y m"..~ C#* W C eo��= OIs Z w w w Cm ,. 'E ��c •fA Z o�c LU O C3 `m O• c S COD � O d 0'5.032 S cc d e = 's O �=.2a,.mNo O �D z W N W • r.a A., IO O! OA O � A O O •E m m CD 0 CD CL _~ CD O� 3� O O G O a CL c a Co o � c cc v CL o co CO3C Z ts CD CL v y c C C cc— CO3 ` Location`s No. Date aye NO*Tk TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ '� s•,^° • E<� Building/Frame Permit Fee $ 4C 14 Foundation Permit Fee $ Other Permit Fee $ TOTAL $� Check # 17592 Building Inspeciv TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING taiS "Alm.uoQfld BUILDING PERMIT NUMBER: I DATE ISSUED: Q7_ SIGNATURE: Building Commissioner/1 for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 2q� 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Properly Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT f 2. Owner of Record y 1-6--, It 4) q I 0 Na a rint) Addr ss for Service ea Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: A- v c ox- ( Licensed Construction Supervisor: 3'(� 0AWD . f ob v XA4- Address �Stgnature Telephone Not Applicable ❑ License Number Expirati Date 3.2 Registered Home Improvement Contractor U i M e., -�5f ✓m,),-1 Not Applicable 0 © \ 09 5-7 Company Name �!/�'O Jt.�'J 3 R 9D "W aL n y Registration Number � ,a4- Addres s �� g069 Expiration Date "Sign Telephone Ma rn X ic Z O v rn SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 25c(6) I' Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the bui!tng permit. Signed affidavit Attached Yes ....... Pf No ....... ❑ SECTION 5 Description of Proposed Work check au applicable) New Construction ❑ OFFICIAL USE ONLY Existing Building ❑ Repair(s) Fd Alterations(s) ❑ Addition 0 (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection's Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: TN\ C1 -x- :Roo - e?S�-D 1 S ! u-- ria CtAp T"S d rf D9 -I UFIV6� S� I SECTION 6 - FSTIMATF.D C0NCTR1TCTIn1V CncTc 1 Item Estimated Cost (Dollar) to be Com leted b permit applicant OFFICIAL USE ONLY 1. Building &00 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection's 6 Total 1+2+3+4+5� Check Number ar,t,iivt1NIavVV1\r.icAUIrivx]MA11V1r itVDEUUMJuhILID W11N:1N OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorizeC — i to act on My be�pj yin alj�natteri relative to work authorized by this building permit application. Signhture of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief —SA!1F NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2 ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE M $IV N 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant g1'2,'1 16 4— Date -Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM) 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION_ 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY,OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. @ 7�I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name:L Location: S Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �am an employer providing workers' compensation for my employees working on this job. Companynames Address City: ONV600 `F Phone #: 5r& Insurance Co. ' �� 1-�'�L� 1 C� SUIZ�AriC. Policy # LA -7 9271 A -150 Comoanv name: Address City: Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to $1,500.00 and/or one years' imprisonment -as _well_as_civil_penattieslnlheform nfa_STOP WORK -ORDER -and, .afiine.of.($100.00)-attayagainst_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify a er the airs and penalties of perjury that the information provided above is true and correct. Signatur 4 Date 2 4 Print name M Phone#379 6_35`50ra 9 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required licensing Board p Selectman's Office Contact person: Phone A Health Department Other Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 D. Robert Nicetta Building Commissioner (978) 688-9545 (978) 688-9542 Fax HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION Number Street Address Map / lot aImEel IT, IXePffj II:1Ci Name PRESENT MAILING ADDRESS City Town Horne Phone State Work Phone The current exemption for "homedwners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor: (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner' assumes responsibility for compliance with the State Building. Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner' certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATUR APPROVAL OF BUILDING OFFIC Zip Code z • W W tv c o O c O C � C3 V �CL'o C36 c 1 ev m c o 3 �p m J o _m m W = c Ea CF SO '00 ` CL :tea y m _ Z d! W $ cn a o w o o v X U G w a w a oo c�G w a a U W o rw U G w a � o w ir. pp�� A a cA o cn C o cn c o O c O C � C3 V �CL'o C36 c 1 ev m S H H W H IC W U y :. Cm c o 3 �p m J o _m m W = c Ea CF SO '00 ` CL :tea y m _ Z d! O � c fA Q o= Ci y O • C vl�c CL - Cos *O S H H W H IC W U y :. Cm o h S 3 �p m J _m W = c SO '00 ` y m _ Z O � c fA Q Ci y O • C3 2 C0 c o CL m ms 3 � CL +.+ O m r ~ O •� �_ m C ++ dt W c E Co C O 0 c ao ��M's a'.m E y t H N 0 ca c m 0 c C N CD m O Z 0 8 CD zip � c cm o•- CDCD o� y m m CD CD CD CD imp, CD CDL M: o a via y C y.r cc 23 •p CL 0 C Z O C.3 y O C — C . C c _A LLI U) W W W U) New Text Document Sign Permit work sheet Property Owner —71 +e z V rNr 4-- v -- Business name --Ae,,- jwr- C'N Property owner Address Sign Location Address 5 Zoning District Allowed area _ Proposed area 13 1_ Allowed height Proposed Height Allowed setback / Q MAa 3i (,�pfl rec. Proposed setback io s+ Co Sr 2 /DD Page 1 CP�ti,�� A z M 0 T O F= � M ro r m a r z 0 m cD7 0 m m 0 R hl O000:: -0m Q; z in C7j o m J 0 m A3 N A- O 0 c -0 o�oo� 0 Qw CD (D . p q 'fl "� � cD d y DLO Q ' `a n� 0 cn m �. 3 m C to � o � rn^ Cr ♦• J o cu cry o eD N N ca c m -o ' `° D w cu Q Q CL _CD cr n o � rn -"' r• J W C 3 rn \V cD a n� � � cn on n. m r W Z3 w ooz Tz rn 11 t i cn T-ol� (n I 0 .P r J Q; z in C7j o w C J a CD �2 t c -0 o�oo� ry Qw tD v n U' (D CD N _� O= 'fl "� � cD Cfl '� Cfl' 3 m n• ;.o w to crfl mac gin'= WID Cr c� 3 cn o cu cry o eD ca c m C1 i .0 w cu Q 0 ti _CD cr n J W C 3 rn \V cD a n� 0 .P r J ATTS `Y AJ` rn z C1 i T M- J W• 0 Z Q 0 C -- Cl - all r all V (L Ln z -0 m 3 T� V r n A z 0 71 z TO JN l D z 0 O m M 7 C 39t'd d3IK;JnU3~3Hi OTL9898ZE. TN:To GGGIT 10/60 t r' Date. 4-.4'� . ��v TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ��-!f..... "`'. f;j.......... ...... . has permission to perform ..> r \-:...<.,..,: '`�j.1...�•-. 1, ,-..-� .. . plumbing in the buildings of at ........... North Andover, Mass. Fet,-. ...... Lic. No.......... ......... 11 .............. PLUMBING INSPECTOR Check # 1 .6 j 6 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location2 ft5); Q at Owners Name F02 4n7 /f,'Z— Permit # T Amount Type of Occupancy �b W J YP P �7' New rl Renovation fn Replacement E] Plans Submitted Yes E] No FIXTURES (Print or type) Check one: Certificate Installing Company Name 1 (,&�1 L6 OTC, El Corp. Address El Partner. ff' L Business Telephone K—(, & Z- - ,�, 9 �irm/Co. Ar Name ofLicensed Plumber. 4 t-�' r� Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate bom Liability insurance policy � Other type of indemnity Bond F Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insuranCe Signature Owner El Agent I hereby certify that all ofthe details and information I have submitted (or entered) in above application ate true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massefts Sta Code and Chapter 142 of the General Laws. By: bignature 31 Mcensca Typpof Plumbing License Title q D City/Town ME= e IN um Mr Master ® Journeyman APPROVED (OFFICE USE ONLY fib' pLUS , , 217 MAIN sT�� 0 lis lC r 3�-�.zl (IRCLUOV6- A� TDP) Fo sr : 4 ° -K 4" po5 i 5 PAI N TFO ul m -W- 5 ' -tAL-L, CD�O�S - S((yN 6AGL��PJb=U1N�i� EDS � �t.P 1k`A-F FI,leuft A,"A IN C4CC,LF = PAST-r� Cb"C5/0)3360 Qut'LtNW LIJ SGV 0 VEC 15tiTE� S K rTC44 ----�> ,LA]l15 NIvW V - 7 ;-,? N2Date .................................. "0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that: ......................... : ............................. ; ..................................... has permission to perform................. ......................................... .. . .. ... ................................................. wiring in the building 0 ... ....... . / ..... '1.2 ...... I ... ............................ . North Andover, Mass. .. . ..... .. ... ,ee ..................... Lic. No.............. ........ ELECTRICAL INSPECTOR 07/09/99 13:01CANARY: AfAg DROP WHITE: Applicant PINK: Treasurer " TH0 A14—&S4CHV:S S Office Use only M DEPARTAIE?VTOFPUBLICS.iFETY Permit No. 0FFTREPREV=0NREGUL4T10NS527 IZ-00 -� Occupancy & fees Checked PAKEL d4 PERMT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACI{USSTS ELECTRICAL, CODE, 527 CMR 12:00 6J (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date % Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. FORWARD Location (Street & Number) Owner or Tenant Owner's Address SIP Ime, Is this permit in conjunction with a building permit: YesU�T No (Check Appropriate Box) Purpose of Building Re 6'm S /V G-&-+�c�z',_ Utility Authorization No. Existing Service Amps / Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work a No. of Lighting Outlets No. of Hot Tubs II No. of Transformers Total KVA No. No. 012ghnng Fixtures Swimming Pool Above Below Generators KVA and 0 wound No. oi�Receptacle Outlets No. of Oii Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of G Signs BaiIasis I' No. Hy ro Massage Tubs No. of Motors Total HP t OTHER - .. •.: -. i,. , .- �•/ i .� .i� .. • :.�- •...1• , • : � • :. • ..-.:lay :.: i � • • - • :.:. 0► • tea- � or:- •- r .• - • • a .• i - 0054 MR.; Lr-->see Z /2 %t% St h12 &Suess Tel. Na Ade§rn � 7 a S A� Tel Na OWNEZ'SNvSURANC' WAIVEF,IamawatethadrI]xiethe amr<ncecc �arts aislor i eqirval=asszedLyM tag SCff)ffalL ms and Amy WmL,mrnth s p=miX ' icn wanes ttz (Please check one) Owner � Agent !_J � obi Telephone No. PER"�fTT FEE Sp�f ' Location /"A IN S 7' No. 6 / Date /a % TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ a Foundation Permit Fee $ Other Permit Fee $ RE6 ECbR0WMFDP f e $ Water Connection Fee $ T��kL 01 1999 $ 02 6-, — NORTHANDOVER �7 �� EASURER-COLLECIU11 Building Inspector to 159 Div. Public Works we= N W : u ? r z z C o - 0 U U - U C_— Z W U C co w u - W � L o ? z = ^ p O L. C L � L F- z o w z -k � � - C n F- L w L = r "' o - o o Lr O O oU z Z Z ��l N _ % ✓) In � (n G ..i rn � �+M �1 O z O _U w \ % _ w w c � o � z �- �/ •) ��• W I'" w r C U u u LZ w (n V) .. n N W : u ? r z z C o - 0 U U - U C_— 00 W U C T_ w u - W � L o ? z = ^ p O � L F- z o w C F- L w W : u ? r z z C o - 0 U U - C_— 00 ZE U z W : u ? r z z C o - 0 U U - WILLIAM J. SCOTT Director (978)688-9531 Please print., DATE JOB LOCATION Town of North Andover OFFICE OF COMMUNITY DEVELOPMENT AND SERVICES 27 Charles Street North Andover, Massachusetts 01845 HO%fEOW\'ER LICENSE EX-ENIPTION f NORTN 1 41 SSACHUSE Fax(978)688-9542 Aj-A - /dumber J / Street address / l / Section of town "HOivfEOVVN�R" ( Y) C-)t� :\;o g—: (�f /0l 6 (r(—,71 2 Name Home phone Work phone PRESENT MAILING ADDRESS �s�' � o, 9—,-, Q_ CityiTown S tate Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family divelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-vear period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 m m m 0 m _v, .0 C � COP) Cl) CD 0 Z y CLO n� r c U) ? c CL _• y > CO O C CD CDCL O .�.� c� =r M CD CCD O CCD w E c O N)• CD CZ cv O CO) CcCD S- CO) O 10 CD Z CD o 0 CD 0 C w O _Z O CD i P� cn l J 0 cn C 0 _ m 0 CI a so to C C N C o N C/) ^ V) co, O z C/) ) C ?� O d =_ O cr N 0 & y _O.N = O �! CD cv CL Cl) m Ca COD co N ww � r.Z m 1i CD aid m y O CID y O O .► CD a 0 V' 00 0 T Z y C09 — aoCD 1 =r_ aom .T 4 CL w dc CD CD H CD O CD CLN n�:�Q d_ C CD_ C �O CD N N _ m CD • O CD .��►H _. D :\ C., �. 0 ^ 0 0 V' m o � co,N '0CD0 �: CD =m ;w co) CD CD =moo a� CD II fn Crt 07 o tz ' e7 )� w ?, T T w :Si G m ,z w C n � � o � r n CL tz M 0 y 0 O C a Date .. . ). -.. ? ....... / .... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... './. /!�. .5/111. ..... ") /.. / F.......... . has permission for gas installation . J?A; °. °' � ..�` ....::... �. � ... . in the buildings of F. ... ::.'.................... . at ... .` .Ftp % �' ... � .......... , North Andover, Mass. Fee. . (.k,. Lic. No.. .... ..l: : ti ........... /GAS INSPECTOR Check # / r i MA%ACHUSEITN UNUMM APPUCATON FOR PERNUr TO DO GAS FITTING (Type or print) Date 12-1171,11 NORTH ANDOVER, MASSACHUSETTS Building Locations �,) `17 P P7 41 k S7-9LZ�'7— Permit # / ^� ^, Amount $ /V ,D, 4 0mo u Ck+ aril �S- Owner's Name -r*/ f !'U U ilk t CA New a-� Renovation ❑ Replacement Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name 1l U1 b /9 L t-4.WfW19L � n Corp. Address -- --_3G /f Yrk- 171kft='Z� j Partner. ?ESV CW H'f')5r- Business Te ep one 574' 6 ,Y7 Y OTrm/Co. Name of Licensed Plumber or Gas Fitter yI yf 0 lj /% -3,-j INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 -- If you have checked yes, please indicate 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. of Owner or Owner's Check one: Owner I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts _�Iate Gas Cod,�_auc( Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber % �-o Sk% Gas Fitter License Number ElMaster LJourneyman x w a vl 1° z b e x w F a z z a o z w F z U w x o a o a o, w w �. M x x x w x ;w w H N x Z z w d a z o o �, W�w O V x w A OU a Wz x J a P A a F O SUB -BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. F L O O R' 4TH. FLOOR 5TH. F L O O R 6TH. FLOOR 7 T H. F L O O R _ 8 T H. F L O O R (Print or type) Check one: Certificate Installing Company Name 1l U1 b /9 L t-4.WfW19L � n Corp. Address -- --_3G /f Yrk- 171kft='Z� j Partner. ?ESV CW H'f')5r- Business Te ep one 574' 6 ,Y7 Y OTrm/Co. Name of Licensed Plumber or Gas Fitter yI yf 0 lj /% -3,-j INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 -- If you have checked yes, please indicate 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. of Owner or Owner's Check one: Owner I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts _�Iate Gas Cod,�_auc( Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber % �-o Sk% Gas Fitter License Number ElMaster LJourneyman I CERTIFIED PLOT PLAN 247 MAIN STREET, NORTH ANDOVER, MASSACHUSETTES MAP 31 LOT 4 THIS PLAN /S /N REFERENCE TO A DEED RECORDED A T THE ESSEX COUNTY REGISTRY OF DEEDS NORTH DIS TRIC T BOOK 5435 PAGE 231 ANAP 31 LO91 LOT 31 f0 A64P31 AMP 31 LOT 8 LOT 55 LOT 7 'P FD N31'36'5V FD \„ 199.33 MEAS. (199.701 DEED) w u o (D N SHEDS (TO BE MOVED) I 71.4. GARAGE w31 a I LOT LOT 5 r �$ w / EXISTING ►w} DWELLING y p — #247 w G _g4.5 _ I 1} cv o — Aw 3f LOT 4 0 I— — AREA - 42,427 s.fi ' I—I rn I ., I I � I I i _ Fo S29'34'210E Fo 211.49 MEAS. 211.59f DEED ------------ MAIN STREET MIN/MUM BUIL DING SETBACKS i aww y ro THE N. ,wooer am Dipr TNAT THE ZVS7M F011AVA710V ZONING.- (R-4) RESIDENCE 4 AS sr OWV DOES CaVFaW N7H IW rOWV FRONT - 30 FEET Or N. ANDOVER 2WNG RE6ULA770VIS REGARDI .SDE - 15 FEET smwi= FRou S7REET UN£S AND LOT LM/ES REAR - 30 FEET MEISNER BREM CORPORATION NAME.'Sf mmlr ".. amp LLC 151 MM SKET. SALEM. NN 03079 (603) 893.3301 SCALE.• 1 • = 40' 142 UTiLET011 RQI10. WM 16. KSw MA 01886 (978) 692-1313 DATE 9-20-05 PLAN IS /NIDAL/D YATHOUT RED SRS SEAL aF Mq�s�c RT kR a SIB NO. 2108 81012 ON 610/' so-lZ-6 316'0 art- M (W) 010 vR VWAM lot am v a mum Zit ass ,7lOi'£-"M (M) ROW HN IMM'LBO W14 191 , a w1 37VX 017 d lar- 3mv�v NOIlb80dd00 HhO d3NS13W AMMOMMS Z13 s 1334 Of' - d/6'3dl a� la n I N17 J07 aW S3N/7133d1LS AV" SJ/.?voLw 1.334Y0 d/ SAK!l167fV-V JAW/MOI d13�lOONV N X 1331 OF - 1M W s�yW ao AWOl 3W IUM AWJA?.O SAO MOW SV � 3�N30/S3Z/ (*-&)�9N/NOZ AK1lLAa76' Q3,Sba�d .?Mj .1 VM( 76'3S S,JO.43lcYnS 032/ ld-V WN AMOON6' N -?Hl 01 .(3/UGO / SWOV613S ONIMIng wnmlNiw J nOW /M O/7M NI S/ A(V7d 13MUS NIVN (0330 T-6s•uz) SUM 6b'l�Z / — — — — — — — FTS Z=Ir MY *; 1M M N �m ( ) y� I S1N3W3AOVdAl 107 Z a3SOdOVd tam 99107 01 107 If dYIY If dNY I I I I I to r ----I t:I I 1 Lb Z# ONIll3MO ONI1SIX3 T-OC66 t0 Ln 107 `F der 41 3�bad� c ISIX3 I Sa3HS aRV3016 a3Sodoad N M LO L 107 A? 107 I6 107 f dWY l£ OWN d17P XJ 3D Vd -9f *-9 � OOS 10/x/1 SIG Hl JON S0330 JO A X11 S193d .(1 Nn00 )(3SS3 31-11 1 V 03GcYO03by 0330 V Ol 30N3J333d N/ S/ NV 7d S/Hl % 107 If d do S.3113SnHOVSSVPV `d3AOONd HldON 13381S N/d!N L*Z NV 7d 107d U3SOdObld s Location No. -, e-,, Date // IS/'1")2— t►GRTM TOWN OF NORTH ANDOVER � n 41 Certificate of Occupancy $ ��S'•� • t<� s�cMus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspect .r� TOWN OF NORTH AND®VER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT.REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING s MY 3UILDING PERMIT NUMBER' � DATE ISSUED: � _a Q� C SIGNATURE: Building Commissioner/I ctor of B Idings Date DT /�TTAI►T t ciTV IT"nTAMATMN -_ Y _ 1.1 Property Address: 1.2 Map and Parcel Number: _ I Assessors Map Number Parcel Number 12 6) — - 1.4 Property Dimensions: ; 1.3 Zoning Information: tonin District Use Lot Area F'ronta' `e 00 L6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Reg1%ired Provide `rest Provided Recillired Provided 1.5. Flood Zone infofmation_ 1.7 Water Supply M.GLC.40. 54) Zone Outside IloodZone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System F1 ?ublic 0 Private 0 SECTION 2 - PROPERTY OWNERSIH'/AU1HORIZED AGENT 2.1 Owner of Record Na a Tint Q f''11,)Address for Seervice/ Vr`� $t � tcwyu�uc 2.2 Owner of Record: 0 Name Print Address for Service: M Signature Tele :hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable Q 0 Licensed Construction Supervisor: License Number .e . Address ic Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 g� d 0 � Company Name Registration Number roo rmm Address aes Expiration Date signature _ Telephone SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152J 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No.......0.. , SECTION 5 Descri p tion of Proposed Work check all. apph#ble: New Construction 0 Existing Building 0 1 Repair(s) 0 Alterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: SECTION 6 - ESTIKATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Cwpleted.by permit applicant _ 1. Building (a) Building Permtt Fee^ © c a I/N�Multi lier 2 Electrical -:(b) Estimated Total Cost of Construction�� 3 Plumb in Building Permit fee.(a) X (b) 4 Mechanical, HVAC C 5 Fire Protections 6 Total 1+2+3+4+5 _. Check: Nurti'be. SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date ECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1> v v v �s Owner/Adthorized Agent of subject Hereby declare that the statements and information on the foregoing application are true.and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TDABERS I sr 2 ND3Kv I IONS OF SILLS ONS OF POSTS ONS OF GIRDERS OF FOUNDATION THICKNESSOOTING }�L OF CHWINEY ING ON SOLID OR FILLED LAND ING CONNECTED TO NATURAL GAS LINE 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION *********************** APPLICANT%�'O (J �,AJI �/ PHONE .( -7/03 LOCATION: Assessor's Map Number-3—t—PARCEL�� SUBDIVISION_ &f LOT (S) STREETZ*7 UA -7;3 3- ST. NUMBER_4 *****************************************OFFICIAL USE ONLY*********************************** I/RECO}VI,MENDATION,5 OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED ( o DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm DATE D. Robert Nicetta Building Commissioner (978) 688-9545 ,'(978) 688-9542 Fax Town of North Andover Building Department 27 Charles Street North Andover, MA. 01845 HOMEOWNER LICENSE EXEMPTION Please print DATE O JOB LOCATION Number "HOMEOWNER Name PRESENT MAILING ADDRESS SAr N Street Address Map / lot Aisa#/ vvonc Hnone City Town State O Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual for hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 'HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL X21 C�Aj2 i�501� ,�-v�l�u� );ZoV) MAC)CO r--t 5 MAIN STREET mAzk t5y Sl�t.i 'I"0V;,� AT' 16 Mita irg:M DATE OF FIL 5T mr'C ��hC� 3_� �4r DATE OF PUB 1 INCH o 80 FEET HEARING 80 0 80 DATE OF APP W4h1r0lzm 5 -ro TliE: ZOf-,J t N CC 01.15TIZ IC --r TOWN OF NORTH ANDOVER ZONING BOARD OF APPEALS REQUIRED ----------------------- ,mow BOARD OF APPEALS PLAN ►oYSTEN TOWN OF NORTH ANDOVER,MASS STREET: 247 MAIN STREET ��'orarea� APPLICANT 6 OWNER: MARTHA FOURNIER ' uuA DATE: JUNE 19, 2000 SCALE: 1 "=80' REFERENCE .NG DEED BOOK 1315 PAGE 161 _C ASSESSOR'S MAP 31 LOT 4 NEA/ NYSTEN ENGINEERING ASSOCIATES,INC 126A PLEASANT VALLEY STREET,METHUEN 01844 )VAL TEL (978) 975-2575 FACSIMILE (978) 975-0135 U) m C m Cf) 0 m CO) CD az CD Q. m o ? CZ CDO o v 06 cr* %<_ CD o .. -_ CL O O co CD CO2 co O COO d CO CA0 n c 0 C. COO) Cl) CD 0 CD CDv CO) CD CO2 O CD O C CD C w 110, c?10 c m 2 O —•NOCD co dO m "0y � o o m n o C,* a� 3 m 2 =r.0vi 0 CD CD a S d = y m O m y p N O ? m m = O A 2>4 O m=lr �/ J _ N n `G IG O C!1 CD CD M CL7 \ / - CA o m O N cr Mcq Z, CCD N :V O f �VJ CO) N n �•dy�nn oto z Qj y (lbm CD c m Q/ I •T N cn _ m = o Cr1: o V : _ CD N 0 c o A o O p'_ x w x Cil Cb p'_ x r M w g, 0, °" � w a' � r �^ n 7C x N 0 c Date. a y - o y TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 41 4 This certifies that .............. . . has permission to perform . �0�g.. oc�S LUAF` 14` r plumbing in the buildings of.b `J r ~ 1 ................ at a .... ��..� ........... , North Andover, Mass. Fee.. 34 . Li c. No%(?e.`vZ I ('(. ...... G y D PLUMBING INSPECTOR Check #_ 55'5 .MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS Building SrT--Owners' N�� e Type of Occu an YP P cY_ New �_ Renovation Replacement -g 131 PRIORI CATION FOR PERMIT TO DO PLUMBING Date Fe 2 v F ami a Permit # /5 Amount Plans Submitted Yes [] No 12 (Print or type) Check one: Certificate Installing Company Name _1 )�Jl ��i l— I? U; 'i- 14TG 11 Corp. F1Partner. Q-firm/Co. Name ofLicensed Plumber: t k P bsurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy Other type of indemnity Bond Insurance Waiver: L the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance igaanue Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mass efts Sta Code and Chapter 142 of the General Laws. r By: WpaUlM o tens Type of Plumbing License `Title city/Town License i um er Master ® Journeyman r APPROVED (OFFICE USE ONLY 4P ,Locaton FNo. Date c MaRTM TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ ��s''•E<� Building/Frame Permit Fee $ s^CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # �G a rr �`Buildi g� r I C TOWN OF NORTH A INDIOVER UILDING• DEPART MEN'I' APPLICATION TO.CONSTRUCr REPAIR, REAiOVATE, . ,OR .DEMOLISH..A,ONE OR TW.O FAMILY. DWELLING 3UMDING PERMIT NUMBER' DATE ISSUED: 0?07 t� /o -IGNATURE: C Building CommissioneE/ or of. Buildings Date vJ&1Vj. JL 1"I'q I A Property Address: 1.2 Assessors Map and Parcel Number: Y ]. A Map Number Parcel Number 1.3 Zoning Information: v 1.4 ProP ert Y Ditnensioas:., . ming District ;< .Lot Area Fronta" e` $- 6 BUII.DING SETBACKS ft - Pront Yard Stde Yard Rear Yard Required Provide tui ec1 Provid Water S"ply MGI -C.40. 54) - --- Aic 0 Private 0 I Zone ;CTION 2 PROPERTY OWNERSE IP/Al TIIORIi Owner ofd ✓�R me nature %Telephone Owner of Record: 'ame Print CTION 3 - CONSTRUCTIOII Licensed Construction Supervisor: :nsed Construction Supervisor: Address for Service: Not Applicable ❑ License Number ress � ature,. tegistered Home Improvement Contractor pany Name ess i anre Telephone Expiration, Date I. Not Awlicable ❑ Registration Number E!z I � Expiration Date SECTION 4 - WORKERS C011'IPENSATICON (NLG.L C 152 § 25c(6j Workers Compensation Insurance atndavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildingpermit. Si ned affidavit Attached Yes ..... SECTION 5 DesCrl ttofi of Pfd died Work check au a :&1 _bl'), . New Construction ❑ •. xi ytilig Binding : Repairs) ❑ s Alferations(s) l (Addition ❑ Accessory Bldg., ❑ Demolition ❑ Other ❑ S, ify' Brief Description o Proposed Wor . ' T SECTION 6 - ESTIMATED CONSTRUCTION, COSTS Item Estimated Cost (Dollar) to be s Com leted b trait applicant 1. Buildit (a)Building Permrt Fee Ivluiti Tier 2 Electrical ~(b) Estimated Total Cost of . Construction 3 .. Plurnbn ,.. _ Building.. Permit fee (a) x (b) 4 ' Mechanical. HVAC 5 ..Fire Protection. 6 Total 1+2+3+4+5 ' 0,. �: -. .. Check'1`futllber - . . SECTION 7a OWNER AUTHORIZATIO TO BE COMPLETED WHEN +OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT rI, as Owner/Authorized Agent of subject property t Hereby authorize 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 1, - ,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true, and accurate, to the best of my knowledge and belief Print Name Signature of Owner/A ent Date XO. OF STORIES SIZE BA>JEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 NO IRP DIMENSIONS OF SILLS DIMENSIONS OF POSTS DUVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY FSB�I UILNGONSOLID ORFILLED LAS BUILNG CONNECTED TO NATURAL GAS LINE i Town of North Andover Building Department ' 27 Charles Street North Andover, MA. 01.845 D. Robert Nicetta sACHUSC Building Commissioner (978) 688-9545 ...•`(978) 688-9542 Fax Please print DATE JOB LOCATION Number "HOMEOWNER Name PRESENT MAILING ADDRESS HOMEOWNER UCENSE EXEMPTION Street Address Home SAI 6-7i a Map / lot Work Phone City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of two units or less and to allow such homeowners to engage an individual The hire who does. not possess a license, provided that the owner acts as supervisor. (State Building Code Section 108.3.5.1) DEFINITION OF HOMBNOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. • ' HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFIC 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 or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** APPLICANTI� II�,d„ �O �� PHONEI ? f( f(POR7/03 LOCATION: Assessor's Map Number PARCEL SUBDIVISIONT!!It :� LOT (S) STREETZ*7 U*y S ST. NUMBER *****************************************OFFICIAL USE ONLY*********************************** ECO ENDATION OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED ( G DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm ,TE Cl) m m m 0 CO) C O O � O d CO) Cl) Cl)10 0 CD Z y = C'). r MM o CZ =• CO) o n c v CD CD o Q CD cCDD o C CDCD y. CO CO) I CO CD � v CO) O 'v Z CD � oCD 0 C CD r �- 7,3 - O D t =w g �-- VI z c a o< m � y -4 o a o CO r, r�7 A c ca col, s �. z =-=H I ER Fn - T. bJ m h o m y o -1 Cly O o IEmm m n 0 � r- � a o ts� W = oO m ? :N c ff ^^ V/ m m N Cn 0 CD � ^^ c on m . . n CO O �,H C C M CO er . O y N � Q� Q � V J Fr"Vy7 io =L. W O .* m H CAQ CD cn �-{ CD � 7 CD N d H ca 0 0 C- CD 0 cn ... 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