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HomeMy WebLinkAboutMiscellaneous - 25 CASTLEMERE PLACE 4/30/2018e i 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, §, 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed' on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166, § 32, an electrical permit shall be issued to the person, furl or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shallbe limited as to the time of ongoing constructionactivity, and maybe.deemed_bythe.Inspector_of_W.ires abandoned.and_inxalid-i£he_ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the, permit application. ❑ The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 23 8 of the Acts of 2012. The purpose of this act is to promote job;growth and Iong-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain-permits and licenses concerning the use or development ofreal property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008_and extendingthrough August 15, 2012. ule 8—Permit/Date Closed: ,Dote: Reapply for new permit ❑ Permit Extension Act —Permit/Date Closed: � Date ....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41V(Aot.�, 4 ,#1 ao This certifies that ............................... has permission to perform ...................... ...... ........ ...............�.... .. wiring in the build' of 0 at......................................................................... North Andover, Mass. Fee ..I. .......... Lic. No.24011 .......... .. ... 9 ELECTRICAL INSPECTOR'/ Check# 10683 I Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Officia l Use Only Permit No. _ f t�- 6 ?3 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(ME ), 527 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:Y//,o City or Town of: NORTH ANDOVER To the Ins ctoi' o ^ireZ By this application the undersigned gds notice of his or her intention to perform the electrical work described below. Location (Street & Number) i� � rIQ STAG rn ,p,® Owner or Tenant Telephone No. Owner's Address _ —*) R /22 to Is this permit in conjunction with a building permit? Yes �, No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters N r snnta}:n ni'IU.. 4-77-4 — •..L7. . L _ _ _ � 7 _ _ No. of Recessed Luminaires --w"t No. of Ceil: Susp. (Paddle) Fans tuule In"Y ae walvea by the ins ector o mires. No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. ernd. Ao. of Emergency ig mg Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. of Gas Burners No. ofDe testiting Dead vices 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. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers No. of Waters KW HeaterSigns Heating Appliances KW No. of No. of Ballasts Security Systems.* - No. of Devices or E uivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent 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 ;K BOND ❑ OTHER ❑ (Specify: I certify, under the 'ns and penalties of erjary, that the informal' . i this appli do is true andcomplete. FIRM NAME: LIC. NO.: Licensee: Signature. LIC. NO.: % (If applicable, r "exem " in the licens n b line.) Bus. Tel. No.• Address: d / y Alt. Tel. No.: Z6 3 *Per M.G.L c. 147, s. -61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ • ..v t . FLECTR.1.('k].i.t .lC-E.[tiYJ_C l..M. !t1► [ JuCJ+ R�VJ Y 1CeJUJC � J : , ELECTRICAL INSPECTOR . ROU'G.XNPCTION; Passed— - Salled--[ ] fie -inspection regteized($50.00) ~ [ 3uspectoxs' commwats: - ir. r y •s•, e. • (Xnspe oxs'i atuxe �xto �rxfials) Date ]Passed- [ J Failed--[ ] Pe-5nspection.xequixed($50.00)-•[ Inv ectors, comments: (i)1spectors' Signature -no initials) Date I Y MAR GROUND INSPECTION.. passed- [] T+ailed—[) Re-iuspectiou.required ($50.00)- [ Ins _tors comments: (Inspectors" Signature •- no Hfiais) Pate 9 INSPECTION -• OTTTER: Passed—[ I Failed- j )- 'ate -inspection xegwred ($50.00) •- [ 7 Inspectoxs' conzxuea.ts: �Lxspectoxs'ignatuxe xto initials) Date ID 0OBv TAGS ARE TO BE FILLED OUT AND LEFT ONSITE IF THE APXA. TO BE INSPECT UD 19 NOT .ACCESSIBLE AND A. RE USPECTION OF X50.0018 TO BE CMGED. t The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaffily Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ 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. t Homeowners who submit this affidavit indicating they aie 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 Nat r" Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sip -nature: Date: Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants ` Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or 'f town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-8777AMSSA.FE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia Date .1�l.Z�l.1 ! ........... _ NpRTN TOWN OF NORTH ANDOVER O � 9 • - " PERMIT FOR GAS INSTALLATION This certifies that.P 111CA2'1- :-1.... ....... . has permission for gas installation .. l� ?�h, ..o :.!� ...... �1rrvwrl in the buildings of/11 .. � ..... rr�. .......................... . at . , da 14-?af7e ............. /North Andove , /Muss. Fee "A*.4v . Lic. No..A?AT� 1.. . fli��i ?i ! A ... GAS INSPECTOR Check # 386 S/ 7913 MASSACHUSETTS UNIFORMAPPLICATON FORPERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations ,255 0,45rz.6MCA5 'ALAC6 Al, AA1Oo ✓e4_ Date Owner's Name (2Aher5 61?06,/,V New Renovation 13— Replacement Plans Submitted Permit # Amount $ 3t) -- (Print or type) Check one: Certificate Installing Company Name /MA4i9L � 14 e& j5 12�2 B—Corp. 02 71 (ri C Address a 1 S M' ODL 6 s6X 7V ep✓ P, �t,�5 Partner. ' 13r/Rc,' 1V6 WAI AIA I6ZL.3 Business Telephone -78 _ ® /too Firm/Co. Name of Licensed Plumber or Gas Fitter fid/ d LN'�i INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®� No If you have checked _es, please indicate the type coverage by checking the appropriate box. Liability insurance policy ©�_ Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:1 Agent 13 1 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 St Code and Chap 2 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signatur&A Plumber Gas Fitter �1Claster Journeyman icensed Plumber Or Gas Fitter P /Oa3C/ ]cense Number � a w � o a w x z U x H x cw7 °m Q ° a a w z o z z F w x C7 w d ZG o a o a > w C> w H � z � H Q x x w a w w � p w H w w E. H U x x z d 0 d m o x a a a° a> o° H o SUB-BASEM ENT B A S E M E N T t 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6 T H. F L O O R 7TH. FLOOR 8TH. FLOOR (Print or type) Check one: Certificate Installing Company Name /MA4i9L � 14 e& j5 12�2 B—Corp. 02 71 (ri C Address a 1 S M' ODL 6 s6X 7V ep✓ P, �t,�5 Partner. ' 13r/Rc,' 1V6 WAI AIA I6ZL.3 Business Telephone -78 _ ® /too Firm/Co. Name of Licensed Plumber or Gas Fitter fid/ d LN'�i INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ®� No If you have checked _es, please indicate the type coverage by checking the appropriate box. Liability insurance policy ©�_ Other type of indemnity 13 Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner 1:1 Agent 13 1 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 St Code and Chap 2 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signatur&A Plumber Gas Fitter �1Claster Journeyman icensed Plumber Or Gas Fitter P /Oa3C/ ]cense Number I # �'N .....T.C-OMMONWEALTH OF MASSACHUSE17S. 17 -.�..:,Aimfwi^NWEALTH OF M AX� LICENSE TO )9SUESM. -6�L.�,ARY J -0's, 19 - 11 F,,RE T ST A B URY 08/28/13 23-21 777777-7-� 215 Middlesex Turnpike 9 Burlington, Massachusetts 01803 •781-272-0100 * Fax 781-272-9001 4. VA - 7821 Date .IO. /•�! •�� ........ �` 6 TOWN OF NORTH ANDOVER • i s PERMIT FOR GAS INSTALLATION I This certifies that .,p e � . e 11a //, sk r , has permission for gas installation ..Gly....! -/,C-? , in the buildings of .�' tt �? ! .'&va I ................... . . at .:2,1— ............. . , North ndover, Mass. Fee.,�q%C?o Lic. No -,y GAS INSPECTO Check 4 / y Q IN /(00 65&6ao /I/, MASSACHUSETTS UNIFORMAPPLICATON FORPERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations c-2 S C2A,51-6 ' 6 Owner's Name New 1:1 Renovation Er Replacement Date Permit # Amount $ 0 /WIC 7V A/fF�L 8 e,!)W A,/ Plans Submitted (Print or type) Check one: Certificate Installing Company Name 1i4A4FL I If °AC45 1251t P4V A,1,5 AJ6 Corp. Address o2/s �%���/ ��� 7UQN,101k6 Partner. &iRLI�VC—IDA/ Af4 Business I e ep one --74 / , a7 _67 /00 Firm/Co. Name of Licensed Plumber or Gas Fitter �J-Dse y d!2 INSURANCE COVERAGE Checkoyne: � I have a current liability Insurance policy or it's substantial equivalent. Yes LI � Non If you have checked ,yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity 1:1 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 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 eta ee Gad Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signatit.eof Licensed Plumber Or Gas Fitter Plumber /-1 /0oZ3 f Gas Fitter r Icense um e ©-Master E] Journeyman 40` w a w x O v O x v w w c7 w QQz Q x x a a z w w F w > F w x 1C Z Q v WZ O Z w x x W O vFi o x w 3 A a z> A a H o SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND, FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Check one: Certificate Installing Company Name 1i4A4FL I If °AC45 1251t P4V A,1,5 AJ6 Corp. Address o2/s �%���/ ��� 7UQN,101k6 Partner. &iRLI�VC—IDA/ Af4 Business I e ep one --74 / , a7 _67 /00 Firm/Co. Name of Licensed Plumber or Gas Fitter �J-Dse y d!2 INSURANCE COVERAGE Checkoyne: � I have a current liability Insurance policy or it's substantial equivalent. Yes LI � Non If you have checked ,yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity 1:1 Bond 13 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent 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 eta ee Gad Code and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signatit.eof Licensed Plumber Or Gas Fitter Plumber /-1 /0oZ3 f Gas Fitter r Icense um e ©-Master E] Journeyman 40` 9203 Date. NORTq TOWN OF NORTH ANDOVER fe PERMIT FOR PLUMBING SSA U This certifies that .................. 2; &'rzaw / 'e�04111 " 47 . . . . . . . . . . . . . . . . . . . . . . has permission to perform .4,44 'Jr plumbing in the buildings of .................kj ................. at ... /Z� " 4 ......... ...... .... .,Porth Andover, Mass. Fee. Lic. No. A ,........ PLUMBING INSPECTOR Check #, JW t ��, v9 S t S 63�-- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 0S 045Tl�519LRE Owners Name iC41kM5 Dk'0W A/ I of Occupancy Qe.S/Q! �—.le-C-- Date Permit # Amount New [3 Renovation � Replacement 1:1 Plans Submitted Yes 1:1 No FTXTT TR F C (Print or type) Check one: Certificate Installing Company Name f iM,.-- j— 4 M `A4,4S/rt-- 13--orp. -P'J/4pG- Address `X15- 14' 006E5e2c N El Partner. alaj- As7yil A44 Business Telephone -7B1 _ d 7a - O /Ob El Firm/Co. Name of Licensed Plumber: 0,56PW OC6-Q-t% Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 ---Other type of indemnity 0 Bond X7 Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent M 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 Massachusetttate Plu bin Code a ter 142 of the General Laws. By: igna ureo icen er Type of Plumb' icense Title 1� dPwn icense um er u APRMaster L. —" Journeyman APPROVED (OFFICE USE ONLY • ..MMMMMMMMMMMMMMMMMMMMMMMMM MMMMMMM.MMMMMMMMMMMMMMMMM MMMMMMMMMMMMMMMMMMMMMMMMM 1 ' ------------------------- .,1 •e' -.-..--m-----m------.---- 1 ' .........................N 1 ' ---------------------M---N W,1 •I' ...---..-M-.------..-M---N ------------------M---.--N ' .........................E (Print or type) Check one: Certificate Installing Company Name f iM,.-- j— 4 M `A4,4S/rt-- 13--orp. -P'J/4pG- Address `X15- 14' 006E5e2c N El Partner. alaj- As7yil A44 Business Telephone -7B1 _ d 7a - O /Ob El Firm/Co. Name of Licensed Plumber: 0,56PW OC6-Q-t% Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy 0 ---Other type of indemnity 0 Bond X7 Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent M 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 Massachusetttate Plu bin Code a ter 142 of the General Laws. By: igna ureo icen er Type of Plumb' icense Title 1� dPwn icense um er u APRMaster L. —" Journeyman APPROVED (OFFICE USE ONLY 9256 Date. �/4!... . :: TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING " A�`�' , This certifies that .. ........ . sfir has permission to perform ..• �% �?15 .................... . plumbing in the b ildings of ...��r.�-s r 1 at...Z.S Cis �P 7e�2 'wZ North, Ar, Mass. Fee. Oo .. Lic. No.. /o PLUMBING INSPECTOR Check # 6��"'� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS / Date Building Location x,7,5 CAs��ajF, Owners Name C� <1� 5 fjeOW A/ Permit # Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No ri FIXTURES (Print or type) Installing Company Name %40q1,j4gL ,6 ,GI eA'Uc5T6L Address o7�s "/001–•�� �i'0110'k6 P/- �27.�- Check one: a -Corp. MPartner Firm/Co. Name of Licensed Plumber: 165641 D� , Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Certificate r2 7/G Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent M 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 State Plu nd Chap of the General Laws. By: Signature o icense u er Title Type of Plumbing License ' ".7r5✓�{ QG�i9 City/Town APROVED (OFFICE USE ONLY icense um er Master 0— Journeyman PPR .J • ------------------------- (Print or type) Installing Company Name %40q1,j4gL ,6 ,GI eA'Uc5T6L Address o7�s "/001–•�� �i'0110'k6 P/- �27.�- Check one: a -Corp. MPartner Firm/Co. Name of Licensed Plumber: 165641 D� , Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Certificate r2 7/G Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 11 Agent M 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 State Plu nd Chap of the General Laws. By: Signature o icense u er Title Type of Plumbing License ' ".7r5✓�{ QG�i9 City/Town APROVED (OFFICE USE ONLY icense um er Master 0— Journeyman PPR •....W7MT70nWLUL11r. UJ 1C�Xllu (d CiY�G'�ZZS ' Department of .Industrial Accidents Office of Investig1�'ations a_ �... 600 . Z .... s ashangton Street •.}� Boston, MA 02111 ;; It www.mass.gov/dia - Workers' Compensation InsuraataceAifdavitr Buil`hers/Con�rae�ors/ElectricianslPlumbers -Applicant Information PleasePrint Lel=ibiy Name (Business/Organization/Individual): Hamel,'& McAlister, Inc. w M Address: 21.5 Middlesex Turnpike Burlington, MA 01803 . City/State/Zip: Burlington, MA 01803 Phone #: 781 272-0100 Are you an: employer? Check the appropriate box: 1. [ lam a employerwith 50 4, .❑'I am a general contractor and]. employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- lusted on the attached sheet..$ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We area corporation and its required.]. officers have exercised their 3• ❑ 1. am a homeowner doing all work right.of exemption per MCL myself. [No workers' comp. c, 152, § 1(4), and we have no insurance required.] t ern.ployees. [No workers.' comp, insurance. required.] Type of, project (required):, 6. ❑ New construction 7• ❑ Remodeling 8, ❑ Demolition 9• ❑ Building addition 10.7 Electrical repairs or additions I LEITlumbing repairs or additions 12. ❑Roof repairs 13. ❑ Other - f- rr.�....... •--•� .,.......,.. �� ==ua. �� u�, ��� �,�� c�;Uun oeiow snowing their workers' compensation policy information.'. t homeowners who submit this affidavit indicating they are. doing all work and then hirentitside contractors must submit anew affidavit. indicating such. YContractors that chock this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp..policy information, I •am an employer tlzaj is providing workers' compensation insurance for my employees. Below is the policy and job, site r ilt forrnation: Insurance Gompany.lgame:: HVAC . Compensat"ion Corp. Policy # or Self -ins. Lica#: 12-49.010-10 Expiration.Date; 1/ 1/ 4012 ob Site Address: oZ S C4SrZt5t E E City/State/Zip: compensation poiicyclec aro on page (shoW57-1-!Tme policy num Failure to secure coverage as required under Section 25A of MCL c. 152 can lead to the imposition of criminal penalties of a _ fine up to $1.,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of'the DIA for insurance coverage verification I do herehy ceefji under the pains and penalties of per, jury that the info:rna ion providl d ahove is trae and correct Phone #: 781 2�4-0100 x218 Official U -re, only. Do not write in this area, to be completed by city or town officio[' Cid' TC)ru: _ lae:->9nit/E.icense # Issuing AtUthorhy (c' 1. Board ufHealth 2. Building Department . C4/To-wi3 Cleric 6. Bihar f 4. Electrical Inspector 5.'P'lu'mbing InslrectoIr Contact Person: Phone # ''COMMONWEALTH OF MASSACHUSETTS COMMONWEALTH OF MASsACHUSE 215 Middlesex Turnpike • Burlington, Massachusetts 01803 •781-272-0100 • Fax 781-272-9001 Location c> A No. !_ Date Ham,. TOWN OF NORTH ANDOVER 1L 31'/ �i 3 1205127/99 11:29 Certificate of Occupancy $ -- Building/Frame Permit Fee $ — Foundation Permit Fee $ _ Other Permit Fee Te N+ $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ a Building Inspector 25.00 PAID Div. Public Works .I i ` T r I� 0 z (�0 4 O W N i �o E JC �r A F� X w ZZ v 3U O O a o z A Q� v� I MM O a ,V) 3 C7 C7 x E m w V) x x o 0 0 z o ri a z m q q q T � a o z � C H o z v a � � a UJ ¢ � I i, CO I o J \ (� w 'vUn ¢ ¢ w F z �- a o z 0 0 [.� o °¢ z a z z o o 3 wz Q ¢ a ¢ O -W • � z � z � � v � o w ¢ va w a w ¢ o c7 z o S c7 z Q o W a Z O c= m 5 m S m .I c i ` T r I� 0 4 1 CC) i �o �r w ZZ v 3U O O c 44 �Ul Ul ILt uno 44ME& Ont 194 �1 Rp V wW cn1. w LLJ ^ z = a LL w �Q wm > h -Q � 'M m _ LL � dl w n? 0o N Z� ¢~ z U O TO � LL d i W Z V �W Q Z w0m r LUN H a m •-1 w a Z R+ M< d 'D cam d ' L L 0 'i 0 w U O LL PQ �a EH OF ZZ9 z H Qi ® COUic a to v zc ~ L rw ©_ a d .a w v — � � w Cl) E� w d � O L d c ca O LL � cc (� � N `� _/ M. O 0 0 ai LL arc M ® W Q >' a d ui O U .m o Q 4) N 'E .y w w .0. d U 16 t LL V •.+ '� o L) � M �' Z H _ — �0� c X A CL w ai O cc A 0 cc i x y A 0 V O c rx U N a> U a lo .GN=� OC 3 ea 0 0 T) C = A V C4 i O w L t1J vi.yev'C i C a) t U 'i u _w O LL PQ EH OF ZZ9 z H Qi ® COUic a to v zc A4 ©_ a z w — � � w Cl) Of L U LL � (� � N `� _/ M. O O a; (JLO LL M ® W c d � � E N(aLL A C v O w L o w U 16 o L) p d �' Z H 0 — �1 a F 1w .Y m 7 N �Q �w O O N O .d r to p 00 N M O rn 00 ci Z pz W criw W n Z LL W �a wm } !—Q Cl) Ow w yp � Ow orcn Z J > cn > ►- p �z ao 0> LL 0. =w x� 2 U �ui Q Z m OW .tyam N �a:) U- Waz a d �o .L- > a. O O m mLU c� U o era_ LL L �+ cc: � V W V H Z 3 EEw w i �•OZr �Q d cc „ N Z m= V O J Q m � C J ami 000 Z Q > m m n. b. M CL A m W 3 U f— Z p ~ Q d m O a d N d Q w I{ .0 .Q L LCL 44 y t vz O m Lr) V N d Vl y p O �C c� 0 Q NO M O K Z � LnE _ C 0 � � �- cc� O � d•• as dL V OJ v E- R ea a— Eo "' Er E 0 a W �ocr = Z o t _A lC a.:� i s uW d 'cU L N t O V N O +' V a.� rn ; 00 MCD aEi .. H C'D"0 :C8 N= *+w O � '00 O O M d u i V V cc O v a E J a d S z U 0"— MO z L w O N U= ^N � W o 0 4- Ei N L Q G� N U. L Z O cc in U) O J O N U) U C-6 Ir w d w E J J mO in Z 2 "' ) a F- U) fie t�o�rr�rrwacusea��i a��%���acfi��,� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 060219 Birthdate: 04/27/1954 Expires: 04/27/2001 Tr. no: 8508 Restricted To: 00 MARK TRAINA 6 RYANS PL BEVERLY, MA 01915 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston, Mays. 02111 K Workers' Compensation Insurance Affidavit �Qnttcanr�tniormnrton -,��= --- rtense�e-ttrn��tee�oty - ».�.,_ ;��-��+:_°::�:�-•�•u� name: location: city phone # ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity 'I am an employer providing workers' compensation for my employees working on this job. I am a sole proprietor, general contractor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polices: comoanv name: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a Copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ! do hereby certify under the pains and penalties of perjury that the information provided above is true a�ae- Print ct and corre Signature Date!YJ name &64A) + ____Phone # / i D l I `6& official use only do not write in this area to be completed by city or town official city or town: permit/license # r'1Building Department oLicensing Board check if immediate response is required CjSelectmen's Once C31-1ealth Department contact person: phone #;-10ther (revised 7/95 P1A1 m m m m 0 m _v, N! d C � CO) Cl) CD Z w 0 0 � CL _ ? O 0. _• y o p CD CD CLQ CD Er CD O CD tm C y. CD CD Q tD O_ y I to CD I O7� 0 cn C ? O d = hd N m NCDy w d < d m mCL 0 m Cr1 phi Pd G r _ � phi n = 5.0 51. N o T rn ?a -+ = m y -1�mN o f CD m a O ��=pro Com! Zed .m a y = •� . V 0 m N O Cis IC Cl - CD m ': N C y 2L:4k C �C : N A y _ . CD � CD co �O CD OOl 1 : c CD ow 0 i:� o m o C: s a� 0 0; n1 O ~' _ CD rj y 0 9 Z' O z Opr~ Z CJ7 ~ hd r7 w G w G Cr1 phi Pd G r _ � phi n � G x In C LJ cn Gl. 7C 0 t_ . Location' No. `%S ` �% Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check # 60AI "'18 3'13 (� -Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 7 ft 0 W- BLUDING PERMIT NUMBER: DATE ISSUED: 1-7 SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: ,Qs 04SI-Irom1w 1.2 Assessors Map and Parcel Number. C2 7. Q0 4 -,00- Map Num Parcel Number Al xh? a-/0 vel- 0/ 1.3 Zoning Information: Zoning District Use 1.4 Property Dimensions: Lot Area (sf) Frontage (fk) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide ReqWred Provided ReqWred Pmi&d 1.7 Water Supply AGI.C.40. § 54) 13. Flood Zone Information: 1.8 SeviaW Disposal System Public 0 fti/sw a zone Outside Flood Zone 0 Municipal 0 OnSite Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1-11 -'";-(AIC; U i 3t(!( -,t: 2.1 Owner of Record P-,rl5e,4 Fla. Address for Service e Telephone 2.2 Owner of Record: Name Print Address for Service: signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: ALicensed Construction Supervisor: Address Signature Telephone Not Applicable 0 License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable o Company Name Registration Number Address Expiration Data Signature Telephone i SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 f 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No ....... 0 SECTION 5 Description of Proposed Work check as a bk New Construction ❑ Existing Building 0 . Repair(s) ❑ Alterations(s) Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify _ Brief Description of Proposed Work: I RF.f'TinN 6 - iiCTTMATTTI 1rn111CTDTTl-mTnni Failure to provide this Addition ❑ will result Item Estimated Cost (Dollar) to be OFFICIAL, USE ONLY Completed by permit applicant .: 1. Building 171 610L /)' 06 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x tbl 4 Mechanical HVAC 5 Fire Protection _-- 6 Total 1+2+3+4+5) 1 Check Number 4ZVVT1[nN i. nWNVQ ATIVUd11017 A TT/Au �. Va LL' a L' L V7 EX i" 1, OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILniNr- PF19MTT '' , 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. •Si nature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT_ DECLARATION 1'� property as Owner/Authorized 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 NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR T vIBERS SPAN DIMENSIONS OF SELLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR TO NA' SIZE 101 2, 3 X 0.3.,-25,-2005 14:40 FAX 181 410 5006 S C 4 23 3 SS5 I FEWLES )MnG-.QE MORTGAGEE PLOT PLAN MORTGAGE' : Pectlic'; MOOKW CB"P- MORT(YACORt C11 list "Phe r 6 I*Gwn Duie; Aktgw;i 14, 2003 Location 1S CASTLEMERE ROAD, NORTI-1 ANDOVER, MA, Rcre—lees o -J Boolz! 47F7 & PrIga: Ra 9791 -I' Lot 0 ZA Roorded nt 010 F -MME County North District Rugialtvy of Doeds. offidsore lip, ra b, crud I& r-71.7b1fdo Frquel(v 1; ral [if:, /Am, i-mr ooUmd:rc.r Ge'•hdpelcei wid I rolp if ;,';e iinL f MICHEL No. 37GI6 lie +,o'lrirr rho Fivod H-1 Aoe, f."r afelflivu!N1 on "Picn"C'" file 1'01;",': k m 49d POU ( for Xor,,l Ybxir,or. MA.) bv the III Duu,.1u.qf77vp'. re de i c, I hni, -uncr Jj;?i--, 2. 11993 T'k iIIJIJ 71 Fff.k-! e# -,A) i;JL?77,' U/ 61FEAT POND POAD etc; U `7 x ',C 'fv41 LX28 iZ3.;i 01 9 Z:o 4 41 11 7'�� bey & 7 k' v 4 41 11 7'�� 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 SECTIO APPLICANT - C dV l. c a V WA,/ LOCATION: Assessors Map Number SUBDIVISION STREET CASA-" V- TOM ADMINISTRATOR OFFICIAL USE ON - DATE APPROVED DATE REJECTED Otg13 PHONE_�L� 6 -Sp 3 PARCEL_ LOT (S) ST. NUMBER DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_______ RevbW 07 jm aJ M, a I 0 QN- I 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: S� 107S x. Halo ( ocation of F /Y)A Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector t NORTq 0 4,.■0 �'ho F ! • i 11 TOWN OF NORTH ANDOVER *'�;; _'�� r BUILDING DEPARTMENT 400 OSGOOD STREET NORTH ANDOVER MA 01845 978-688-9545 978-688-9542 Fax HOMEOWNER LICENSE EXEMPTION . Please print DATE_����d� JOB LOCATION Number Street Address Map/Lot HOMEOWNER Name Phone PRESENT MAILING ADDRESS o2 �G4SL11�i2C�1P �. own State Work Phone 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 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, one or two family dwelling, attached or detached structures attached or detached structures accessory 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 North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements HOMEWOWNER'S SIGNA APROVAL OF BUILDING OFFICIAL Fr- Z w O O F=4 W �o A` o ` o o c is o i, Y'd y �► E Q 44 Wo Qu W V � ' r C E c o� �300 z e C .m Ce C C W o NZ r: =:S g c z: :moiCOO w�Z o eo � ri :0 d o C ` • Cjt Go1C coo 40 W C WZ Z • w a w c Z O V a o�� C O F--1 ti > 3 CL = W m EMS o F- z aasom Zoo a Z O U O �! L G3 Z p„ O y Q c I cm COD y Q .0 O 'E m m Z s �� �3 m O Q L ML o a cmQ 0 ccC CL O C Z0 CL � V y � C C — y 0 U) U) C9 W W cz W U) o a a � a v � W �o A` o ` o o c is o i, Y'd y �► E Q 44 Wo Qu W V � ' r C E c o� �300 z e C .m Ce C C W o NZ r: =:S g c z: :moiCOO w�Z o eo � ri :0 d o C ` • Cjt Go1C coo 40 W C WZ Z • w a w c Z O V a o�� C O F--1 ti > 3 CL = W m EMS o F- z aasom Zoo a Z O U O �! 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Y 8 0 k a a � �� z i ' } m i W 1� z I:� 1 = O ML 0 L � �1 t. 1 s z m O m z 0 0 , 11 Y r M M I 2 0 0 III I M J J I Z h x O CUA n W y1 u D m L L J D N W W N t a 1 m ; < J a It N z Z M L = I J OF 1 f Z a 0 0 0 D D 3 O W a m 0 W D U FD U g 0 z m h D h Z J W W W Z D m J 0 0 M z 0 S m 0 z 0 x z z 0 ] W m m 0 ] z u 0 u u u r 0 8 a �` h 0 t7 2 2 i=— 0 r 2 O u h IJ► 0 O Z a p0 = 0 w J J J J Y!0 0 Z W ] ] ] ] W W Z C a M t I W N i < z a a w a p N L Z O a p D x c W a � < h �° s It 0 u _ ✓ 0 O 060 f 0 W � C 40 t W O O < Z O z q w IL ' ° o Z ryA, O t Z < W Z h 0 OIL J yZj < O M Z 0 00 0 p< Z z< F h O J Z z Z J O M a U W a oc W u W u W u D D OJ ] 0 0 m o x J Z�0<1 Z Z J ►- 1- h to W m m m < z N 0 O i o i a e a 3 0 J 0 0 A I z 0 0 k � �� z i ' } m Ir 1� z I:� 1 = O ML 0 L � �1 t. 1 s m O m z 0 0 , �. 0 k u i ' H 1� z I:� 1 't�y�. .{i•.i nl� � �1 t. 1 1 ; z 0 0 , 11 r. r M M I 0 0 0 III I M J J I Z O CUA n m y1 u m L L k ' I:� 11,E 't�y�. .{i•.i nl� � �1 t. 11 r. 13 CUA k M M O z W tv w q Oa ao u 0 w V)) w z z w w° 04 , cu u X. w a a :J ° c� co c u. a a U w w u: V � w a C�7 ' c��4 m w w w E w d z cn v) E CA N .0 O i N C O cm CD cc C1 m o` cm 'c N m Z O z 0 g I CD O E G v z CL O y D � O Om i O O yCLm m CD CD CLI � � L CL C Q o env v CD C ID C.3 y O C C CO2 O c c CD C 0 0 C N O ' C A O V V CL C A A +.' c O � y :CD Ea m :D :.• v o n „' N O N �D cm 0. m c �. a::. CA ca m m 3 N O A N A co m m O nvL N O TD Coa a�z V y O zo c � o a � ym� :moo _ H � j y � W w vi 'ant 1° c uj 'E =- v .0 v N CD �o o c CO) o� O� N N E CA N .0 O i N C O cm CD cc C1 m o` cm 'c N m Z O z 0 g I CD O E G v z CL O y D � O Om i O O yCLm m CD CD CLI � � L CL C Q o env v CD C ID C.3 y O C C CO2 O ,4 — M G v, MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI ) , (Print or Type) No. Andover t 'Mass. Date NoV m 7 19� Building Location 25 Castl emere P1 ace Permit # ,,Fd 2, Owner's Name ferry Moses New 11 Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name Andover P19 & Htg. CO. Inc. Address 573 So. Union Street l awencp , fd a 01843 Business Telephone 685-8383 Name of Licensed Plumber I Check one: Certificate ❑ Corp. 1031 ❑ Partnership ❑ Firm/Co. INSURANCE COVERAGE: Check One I have a current liability insurance policy or its substantial equivalent. Yes C✓J No ❑ If you have checked yes, pleases indicate the type coverage by checking the appropriate box. A liability insurance policy 7 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage reguired by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner El Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliar a with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 1420� e General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) T;p of License: - eA, , PI umber Signature of Licensed Plumber Vµ ❑ Gasfitter License Number 6739 ❑ Master ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI I j (Print or Type) ` No. AndoverMass. Date A 19 q1- I: is /.` Building Location 25 C a s t l e rn e r e Place Permit # 4fO 2 -- Owner's Name ferry [1oses New ff] Ftenovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No ❑ Installing Company Name Andover P1 g & H t g. Co. Inc. Address 573 So. Union Street I= a' IAl 6; q . orf �n 1�4 3 Business Telephone 685-8383 Name of Licensed Plumber INSURANCE COVERAGE: Check one: ❑ Corp. ❑ Partnership ❑ Firm/Co. Check One I have a current liability insurance policy or its substantial equivalent. Yes 0 No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. e policy �/ A liability insurancOther type of indemnity ❑ Bond ❑ Certificate 1031 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check One: Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 oft the General Laws. By Title City/Town APPROVED (OFFICE USE ONLY) Type of License: AA I — G3 Plumber Signature of Licensed Plumber ❑ Gasfitter License Number 6739 ❑ Master ❑ Journeyman Date.// 7 . `! !........ . WN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �j V 7 19 This certifies that .,r....... , t ...1 Mt' ..................... has permission for gals installation /!, f ..'.. !...: .:..... A.:.. . in the buildings of . .l e. ; ; �? . /.. ,r ......................... . at .2.)....: ............, North Andover, Mass. Fee. Lic. No.:.`._!" .... .......................... GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File L�hnyw_!/.0;2), y Issued to Ati- Address cira For Installation of: BTU Input _ Restrictions State Gas Company GAS INSTALLATION AUTHORIZATION PERMIT ISSUED BSG Representative Mil INSPECTOR This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment: ❑ Heating System (BTU Input ) ❑ Range ❑ Water Heater ❑ Clothes Dryer ❑ Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO. 721 LAWRENCE, MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 Location 625 Cit S4 IF No. Date `7-aq-D3 �ORTM TOWN OF NORTH ANDOVER O'.o y,ti0 Off•. O� `i Certificate of Occupancy $ CH U•Eta JACMS Building/Frame Permit Fee $ Foundation Permit Fee $ K Other Permit Fee $ TOTAL $ `(J Check # �657� Building Inspector ' TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING (isr BUILDING PERMIT NUMBER: ! DATE ISSUED: -2 SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: - 1.2 Assessors Map and Parcel Number: Pe,"Oe, YOe, � C� 7 %I vtiV / f/ 22 ,,//�� CJ�o Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RequiredProvided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone boformation: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No 2.10 r f Record ALJ a Name nt) Address for Service �G3 7 Signature lVaphord 2.2 Owner of Record: Name Print Address for Service: A Signature Telephone SECIfION 3 - CONSTRUCTION SERVICES 3.1 LPynped Construction Supervisor: Not Applicable ❑ 61 CAM 05-I 3 q 2— Licensed Construction Supervisor: License License Number Qi r� Address 71 � j 7-2_ 1_ D T Expiration Date Sign Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 1 Company Name Registration Number Address Expiration Date Signature Telephone MU M Z O 0 4 W 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 a Ucable New Construction ❑ Existing Building Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 41Jn+ We, rJCk "044.0-ri_ LtArljl V_'J&_V'M t -&L I SECTION 6 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollar) to he Completed by permit applicant OFITICIAL USE ONLY 1. Building f7 W (a) Building Permit Fee Multiplier 2 Electrical br o (b) Estimated Total Cost of Construction 3 Plumbing DOp Building Permit fee (a) X (b) 4 Mechanical HVAC 5 Fire Protection �- 6 Total I+2+3+4+5 -1 C1,0 017 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS NT O — R '�C''ONTRACTOR APPLIES FOR BUILDING PERMIT I, V t J l 'ctv as Owner/Authorized Agent of subject property Hereby authorize C�� 64V 69&4Jn to act on ` My behalf; ' 11 m rs relative o wor authorized by this building permit application. Signature ier Date I SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge r and U t • 1 k Print Name/ "/ ( / /// / of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIlvIBERS 191,2 ND 3 RD SPAN DIMENSIONS OF SILLS DINIENSIONS 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 (PaPVed) k w (slam a0u,$) l-4n11onGONd 31VG 31V4 —30 ivo, —ASCM403HO 95b8-6ZL (18L) :xeA AS 031vinoivo 006E-6ZL (TSL) :lal 06810 Sl13snH0VSSbW'831S3H0NIM ON 133HS ;aaa}S yaan4o £ eor ONI `S31VI30SSV'8 AI?JVIbOW NHOf BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ' Number: CS 051342 Birthdate: 07/21/1961 Expires: 07/21/2004 Tr. no: 3019 Restricted: QO CHRISTOPHER J BROWN 1264 SALEM ST r HANDOVER, MA 01845�� Administrator 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 properly licensed solid waste disposal facility as defined by MGL Chapter 111, S 150 A. The debris will be disposed of in: Wadc sc)u (Location of Facility) Signature of Permit Applicant -7-le-6 Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector A C/) =I m m 0 m y 'O a z CD O ar j d = CL =. Ooc p CL cW CD O O cc CD CO) 'O CD O Lrm!j CA d _ CO O CO) 'O n c O C COO Ma d 0 _ CD CDa y CD 0 co O CD O 0 i FA n O z cnC O z G C p m = O —• co O cr y dO cy Eco 10 o a c CO c2 ) 3 m CD Z �-o H --4 CA .. CD asdIM m CD G .O•. N p -� N o• m m = > >� C CCO, �. Odc O .•� 00 CD .7b 00 0 C• CO) CL to cl,c ^' rr S a CO y N CD to 0 CD 4%,Ik.� m x a O C C y cc, -•► m : v, ? o :3 CD C! 3 o m ON ell C:, n CD coo o CDCD CO)CD , C2 c=r m m a'o C-) C7 .n--►• O O = s O � � O . JU tw Cn O d C/) (D o G 7 M 7d w oCa C) N. x CL7 r" O dG '•� r5. O w O pGq x O CL cn (D ^ - 0 'p17, OO a. O � Immi 0 0 c IN.Pc.tt !�),eCIC 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 SECTIO 7 APPLICANT Pjkj5Cd-PHONE 4—Z- C( LOCATION: Assessors Map Number Q x PARCEL —_—. SUBDIVISION LOT (S) STREET o? S- Cct5 iteM e(e- P1 ST. NUMBER c� S OFFICIAL USE ONL CONSERVA -ON ADMI STRATOR DATE APPROVED l� DATE REJECTED COMMENTS I TOWN PLANNER'DATE APPROVED DATE REJECTED FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE__ Revlgd WJm 05r'25f2005 14:40 FAX T81 416 5006 __ X7001 asr25l.00S u8'17 F:L1 3C°2$OSs51 f'EOPl:ES MOf1TGr,CE 1VfORTCTAGEE PLOT PLAN 11011TC.kCF:E : Pecole's %10rl9AK-00rP. M ORT G' AC OIL : Ch rise>p he r e raven it:<0Y*4 Yia ....YS**4ao*M1fi1+w'��Lw4Arr..nJ.;Ly.4ve4��44MAfr*iiL..M1 ww'R,:,<�i. �} StirIC: 1" = 50 l•l. Lime; Augur 14, 2003 Location : 2S CASTLEMME ROTI?, rORni ANDOVER., VfA. RJnwc�" Dcod Dook; 47M7 A Pogc:3U i Pbin Nc. 9792 f LUL I; .A ) Rocorded m tl,e Essex COUhIy Nortlit Miirict Rcsissly of DGedS. {•{,";:'::Ati.Yirl:t`.1 p, r(J,A:::�"1 v'A v:iA %**... A T.--bra*4, kl,'{-✓i•4J+h#*file•,, AJ: tA-•-'4LF,T rVnrrs : - TYds plrf plmr jot 91Qr9yrt; td Ilse o dy. uffdC(S QfP IIP" fo b0.0=1 IL A71"70-111 F—Wp V lr+r�+'• I hz,-ah),cdr / j, r�u1 IHe inairfln�!a;; :rlwr: nn ori., plan Gdar'e.,if.r;c'ld fpprmillaroly !n 'i;u„ rl 41n6' Crriirciy' 1, fdl`+r 1(rr GUllrll!!711Q,r Gf 1i1C pG'L'ej r++14 that is (Or L'OL of "lie linrc !:/ rODdn'u_ilu17,1 in co with Ihc=unnr�! ( urCNEL rg}uirrl(nn!rfl..rn_t:'infiou'ncJNurrhAndlive, „ t�.-,aSMKrtR� ! ! «!3u rx::"rtjp Y*cn ,1r iacnnr+ru(111c hrri(J,rrg,'sl on r1,c nl ol�r! ,noper'(;: No- 37666 J•, a'ad. rn.t III! ,VLhin r(9e flvOd M-1 AreC :..f dlhr/a J!ce(611 uphiriforMe �+ . p•su b rnmrrr!,iry f'rtac; N 2,.0 O9d 0006 (7. (Jor North Aorornm MAJ 0,11,; +� red^r«I DepArtn;rrt/ cf 0-hur, Dewtunmenl, Fedeirl la w,uncr '"• :1dRiNd4lydrlcn dalod: Jinn. 2. i999. !tSh •'r'r C.n.71110)i Jrnuh 711,+C�A'i 975-aa71 JAS Proj1Y Sifter. Atenu:e°, AN f,1:44 Fast !jib)4%5.77+9 61?EQ r A, : JVd%°l7 P01VD EOA 40 P- \05/25/2005 WED 15:26 FAX 2002/002 4 Til TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT !EtRENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMiT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioneffl or of Buildings Date SECTION 1- SITE INFORMATION 1. 1 Property Address: s (fasflmer e_ Plt:- e.. 1.2 Assessors Map and Parcel 3q IA Map Number Number. Parcel Number N. /1! /Q(`m/ �'yf �- 62) $ L S 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fr 8 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required I Provide Required Provided Required Provided 1.7 Wow Supply M.G.L.C.40. 34) Public ❑ Private ❑ Zane 13. Flood Zone Info®sties: 1.1 Outside Flood Zone ❑ Municipal Sewanee Disposal System ❑ On Site Dispowl System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT L' I �'TNCT; Yr? Mo 2.1 Owner of Record 7 Pri5eth- C- �vwn �� Gices t/� ��_ /�'.. N Aydovee- N�(Plr-) Address for Service: Signature Telephone 2.2 Owner'of Record: Name Print Address for Service: SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature 3.2 Registered E Company Name Address Telephone Contractor Not Aanlicable ❑ Registration Number Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 J 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 ....... ❑ SECTION 5 Descri tion of Proposed Work check an a bli New Construction ❑ 1 Existing Building ❑ I Repair(s) ❑ Alterations(s) ❑ 1 Addition ❑ Accessory Bldg. ❑ I Demolition ❑ I Other ❑ Specify Brief Description of Proposed Work: V Af) D -r-0 /_)( /* "4 /tz 77CCAi I rwrTinN 6 - RSTIMATF.D CnNSTRiTrTinN rnCTC I Item Estimated Cost (Dollar) to be Com leted by permit applicant OFFICIAL USE ONLY :. 1. Building/ ` `��©� ' �0 (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number szu ilutr is uwrjLx Au inumic,A i iur i u Bz uuBwL9'i'ED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Owner uthorized Agent of subject property Hereby authorize to act on My behalf a matters re ve to authorized by this building permit application. Si tore 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 Si ture of Owner/Agent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 b7. 2' 3 SPAN DIMENSIONS OF SILLS DIlvIENSIONS OF POSTS DIMENSIONS OF GIRDERS 1lEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMINEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ,4-z� ---� ,, NOBTh TOWN OF NORTH ANDOVER OFFICE OF A BUILDING DEPARTMENT 400 Osgood Street �'•o"'"" �-` �. North Andover, Massachusetts 01845 D. Robert Nicetta, Telephone (978) 688-95454 Building Commissioner Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: _ldsh JOB LOCATION: a S �C05Hernere. P�oc-p - Number Street Address Map/Lot HOMEOWNER�---- Name Home Phone Work Phone PRESENT MAILING ADDRESS aS 6'_'0_ are. PICtCe- 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. r, HOMEOWNERS SIGNATURE 14.11GC C' APPROVAL OF BUILDING OFFICIAL 130.ARD OF MITAL,S GR8-9541 CONSI:RVA•I•ION 688-9530 IIF.V;L116kX_9540 PLANNING 09-9535 c Q�- -. C -lb a........... 0 -7 k H I I i/ FA 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: 1190 - (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector