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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........ ........ ;7�� ..........
.......... . ..
has permission to perform .......... (ge';�'n .... ..............................
wiring in the building oi:--.—/-/ . .......................................
at ....... i�.? ..... r—V-S S ....... Ph ................................ . North Andover, Mass.
F 0 - z' 0— q 2. 14 -; -), -, It
ee . ............. Lic. No. :�� ......... ......... ze.z.� .......
Ea�CMCAL INSPEcr6R
Check # 2-3 �3
8528
Cl.-Iea& &/ Vamac"& Official Use Only
Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) ileave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORI
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 C&[R 12.00
(PLEASE PPJNTIN INK OR YYPE ALL INFORMA T101V) Date: -n -7 -_ n 0
Town of-. .-W 9
,dz:n e!> k�2f k To the Inspector of Wires' - 7
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) -)-7 ?--,
Owner or Tenant Telephone No.
::5'*
Owner's Address
Is this permit in conjunction with a building permit? Yes
Purpose of Building
N o, L)l (Check Appropriate Box)
Utility Authorization No.
Existing Service Amps vo-ITP Overhead El Undgrd El No. of Meters
New Service Amps Volts Overhead n Undgrd El No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
OTHER: 1AICAIL
-4"O'�* '70�litiolloldetailifdesired. or as requiredbr the hispector of Wi
Estimated Value ofElectrical Work: (When required by municipal policy.)
Work to Start: ) _�2 — / A - )0 a 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 ofelectrical work may issue unli
the licensee provides proof of liability insurance including "Completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cov�pge is in force, and has exhibited proofofsame to the permit issuing office.
ov
CHECK ONE:-. INSURANCE 1.11 BONDE] OTHER 0 (Specify:)
] cerdA tinder thepains a penaldes &fpfrrjuM that the infbrmat1'an7,!!5 this aPPlicadon is trite and complere.
FIRM NAME: 7),' �–, _;_ _/ -,--> --7,.X _-_ '0
I—
Licensee: -ZDt.��
6Y -applicable. enter , "exempt -
Address: .01
'*Per M.G.L. c. 14 , s. 57-61, s'ecurity v
OWNER'S INSURANCE WAIVER:
Signature
9 _C7
LIC. NO.: 052,
__'�Z�' �� _7
LIC. NO.:
Bus. Tel.
Alt. Tel. No.:
I ; XT
0.
am aware that the Licensee dh,-_,z)7ni Wfm,. th�
'Jule mcW Oe W011'ea t�v the Inspector of P.
N o f R e
No. of Recessed Luminaires
e s
No. of Ceil.-Susp. (Paddle) Fans
F ns
a
1 0. of
T]r
Transformers k'Vlk
'o f L i
No- of Luminaire Outlets
No. of Hot Tubs
Generators k`VA1
No
Im
0 0 f L u r
No. of Luminaires
n
11,
Swimming Pool Above Ei In-
n
m
o. ergen cy Ig
9 ng
grnd. rnd.
r nd.
Battoe
Battery Units
Un its
cc
eu
0 f R e
No. of Receptacle Outlets
p
No. of Oil Burners
FIRE ALARMS
No. oi
No. of Zones
0 0 S_
No. of S -witches
f te h
rofDishwashers
No. of Gas Burners
0_ of retection an
o- of Detection an
In tiat _
1, Devices
Devices
No. of Ranges,
ota
No. of Air Cond. Tons
No. of Alerting Devices
i
No of Wa t
No. of Waste Disposers
at Pump Number —
He ons IKW
-, 1 . ... ....
'!�!: 1% ... . .. . ... ....
i4 i 111 til 1� 11111!!!
Totals: n��Detection/Alerti�g
Devices
-No. 2
Space/Area Heating KW
LocaIE] Municipal El Other
Connection
No.of Dryers
Heating Appliances KW
Secur e s-*
ity SEt
r Equivalent
No. of Water
Heaters KW
of of
"
e --or
Data Wiring:
I
s ts
Signs BaHasts
No. of Devices or Rquiv lent
No. Hydromassage Bathtubs
No. ofMotors Total HP
I elecommunications Wiri
N_ M'n—A.— -- M_1_21_�A_
OTHER: 1AICAIL
-4"O'�* '70�litiolloldetailifdesired. or as requiredbr the hispector of Wi
Estimated Value ofElectrical Work: (When required by municipal policy.)
Work to Start: ) _�2 — / A - )0 a 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 ofelectrical work may issue unli
the licensee provides proof of liability insurance including "Completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cov�pge is in force, and has exhibited proofofsame to the permit issuing office.
ov
CHECK ONE:-. INSURANCE 1.11 BONDE] OTHER 0 (Specify:)
] cerdA tinder thepains a penaldes &fpfrrjuM that the infbrmat1'an7,!!5 this aPPlicadon is trite and complere.
FIRM NAME: 7),' �–, _;_ _/ -,--> --7,.X _-_ '0
I—
Licensee: -ZDt.��
6Y -applicable. enter , "exempt -
Address: .01
'*Per M.G.L. c. 14 , s. 57-61, s'ecurity v
OWNER'S INSURANCE WAIVER:
Signature
9 _C7
LIC. NO.: 052,
__'�Z�' �� _7
LIC. NO.:
Bus. Tel.
Alt. Tel. No.:
I ; XT
0.
am aware that the Licensee dh,-_,z)7ni Wfm,. th�
Dat�e .......
TOWN OF NORTH ANDOVER
PERMIT FOR, GAS INSTALLATION
This 'Certifies that ... � t .............
has permission for gas installation . z ...............
in the buildings of ....... ...................
...............
at
........ . ........................... I North Andover, Mass.
Fee ..... Lic. No.�—�,7.. . ..........
e' -'-!-GAS -INS-�6w;R
Check # 115�5-117
6658
mAssAcHusEmuNIFORmAPP"cA�roNFORPERA/ffrToDoGAsFmNG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
Building Loqations Fass ,5�
Owner's Name
N ewo Renovation. Replacement
�U B-BASEM ENT
7ASEM ENT
-S T.
F L 0 3 R
� D -
'FL 0 0 R
R D -
'FL 0 0 R
TH -
'FL 0 0 R
4 H -
0 0 R
I ti
�FL
F L 0 0 R
F L 0 0 R
T H
F L 0 0 R
0 U
z
z
Z
I j
Lj
Z
�U B-BASEM ENT
7ASEM ENT
-S T.
F L 0 3 R
� D -
'FL 0 0 R
R D -
'FL 0 0 R
TH -
'FL 0 0 R
4 H -
0 0 R
I ti
�FL
F L 0 0 R
F L 0 0 R
T H
F L 0 0 R
(Print or type)
Name—
Fi�
Name ot'Licensed Plumber'or Gas Fitter 14 fA , i. —, - -
Check one: Certificate Installing Company
0 Corp.
Partner.
INSURANCE COVERAGE
I have a current liability Insurance, policy or it's substantial equivalent Check one:
if h v hj YeSEI Norl
If you have checked yes. please indicate the type coverage by checking the appropriate box.
r
Liability insurance policy Other type of indemnity
0 ow er , s rE C3 Bond
wrier's Insurance Waiver: I am aware that the licensee does not ha the Insurance coverage required by Chapter 142 of the
M ss. e 1 2=
Maus. General Laws, and that my signature on this permit PI -i ives this
Check one: requirement.
Signature of Owner or Owner's Agent Owner 13 Agent
i hereby certify that all of the d=ls and information I have submitted (or entered) in above 13
application are true and accurate to the
best of rny 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 S
Code
�pn Chapter 142 of the General Laws.
By:
Title
City/Towm
APPRbY ED �OFFJCE USE ONLY)
13 . Signature of Licensed Plumber Or Gas Fitter
--plumber
E:3 Gas Fitter
Er Master Licen.-
1:3 Journeyman
T 30 elo,
Permit #
H
Amount 0
Plans Submitted
U
0 U
z
z
Z
I j
Lj
Name ot'Licensed Plumber'or Gas Fitter 14 fA , i. —, - -
Check one: Certificate Installing Company
0 Corp.
Partner.
INSURANCE COVERAGE
I have a current liability Insurance, policy or it's substantial equivalent Check one:
if h v hj YeSEI Norl
If you have checked yes. please indicate the type coverage by checking the appropriate box.
r
Liability insurance policy Other type of indemnity
0 ow er , s rE C3 Bond
wrier's Insurance Waiver: I am aware that the licensee does not ha the Insurance coverage required by Chapter 142 of the
M ss. e 1 2=
Maus. General Laws, and that my signature on this permit PI -i ives this
Check one: requirement.
Signature of Owner or Owner's Agent Owner 13 Agent
i hereby certify that all of the d=ls and information I have submitted (or entered) in above 13
application are true and accurate to the
best of rny 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 S
Code
�pn Chapter 142 of the General Laws.
By:
Title
City/Towm
APPRbY ED �OFFJCE USE ONLY)
13 . Signature of Licensed Plumber Or Gas Fitter
--plumber
E:3 Gas Fitter
Er Master Licen.-
1:3 Journeyman
T 30 elo,
Date
of
TOWN OF NORTHANDOVER
PERMIT FOR PLUMBING
This certifies that
.........................................
has permission to perform ..........
/-"Z ' ........ ...............
plumbing inth buildings of ...................
,e
at ................. North Andover, Mass.
..............
Fee-�P ....... Lie. No.��-
14
Iff/ PLUM KG INSPECTOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLLMOING
(Type or print)
NORTH ANDOvER, MASSACHUS=S
Building
)wners Name 14,a 014�0 Date
Permit #—�4� "C
of Occupancy e-9, Amount - '35F"5z,
New 0 Ren I ovation Replacement Plans Submitted Yes No
El 13
Installing company Name 41011 F-IL0 Check one: Certificate
Address AL( a,113, , "�", 15,4 F1 Corp.
ma Partner.
-business Telepbone -
ZX - &171- Wo Firm/Co.
Name Of Licensed Plumber: A-11YA J-�--e-e"
Insurance Coverage: Inwcate the type of insurance coverage
b��eckina
Liab.flity insurance policy y I lecking the appropriate box:
Er Other type of indenillity Bond
In M
SME�Pce Waiver I, the undersigned, have been made aware that the licensee of this applicatio'
three insurance n does not have any one of the, above
Signaturr Owner Agent
I hereby certify that all of the details and inforniation I have submitted (or e ritered) 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 th . e Massach �tte P15*ing Code and Chapter 342 of the General Laws.
By: 613,11M 77
Urn tT
Title Type, of Plumbing License
CityTown 1 2W?
APPROVED (OFFICE USE ONLY 1,1UCnSt INUMDer - Master Journeyman
El
COMMonwealth of Massachusetts Official Use Only
FNRK�—^ Permit No.
DePartinent of Fire Services
Occupancy and Fee Checked //6
BOARD OF FIRE PREVENTION REGULATIONS l[Rev.11/991 (leaveblank)
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 PRflVT flV INK OR TYPE ALL AVFORMA Date: 9 12- 6 J_ 0 tS
City or T6wn of-. ' n &,,� MmgL-, To the Inspjc�or of Wire_':
By this application the undersigned gives notice of his or her the electrical work described below.
Location (Street & Number) Z;X116rM
Owner or Tenant 1A Telephone No.
Owner's Address 2, Rpime-& 'TA
Is this permit in conjunction with a building permit? Yes No (CQc�Ap'p-roli"A'itle Box)
Purpose of Building SIS Utility AuthoAmtion No.
Existing Service 200 Amps I ZqLVolts OverheadEl Undgrd g No., of Meters
New Service Amps . Volts OverheadEl Undgrd 0 No. of Meters
Number of Feedenand Ampacity
Location and Nature of Proposed Electrical Work -
3
K 644a W-Q�0&�L
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
Na. -o -f ow
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting FWures 40
A]Wye r- � In-
Swimming Pbol gm& 11 grod.
f4o. ot Emergency Lipting
E!Hm units
No. of Receptacle Outlets r)
No. of Oil Bunkers
FIRE ALARMS
JNo. of Zones
No. of Switches
No. of Gas Bunkers
f Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
HeatP
Y=131umfier
ITons
iKW
Seff-Co
No of ntained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
M "'
Local 0 cm El Other
No. of Dryers
Heating Appliances KW
Security Systems:
No� ofDevices or Enuivalent
No. of Water
Heaters KW
No. of' -N-o.-oT-
Signs Ballasts
Data Wi i
No. rf 9vices or Equivalent
No. Hydrommsage Bathtubs
No. of Motors Total HP ..'�nknkunicafions
Wirinr,
No. of Devim or Equivalent
IOTHER: t()o AVq1? Sc,6 Rb-��r-i
Attach additional detail ifdestred, or as required by theInspector offires.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the perforrnance 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.
CBECK ONE: INSURANCE 0 BOND El OTBER El (Specify:) blait-oue-d t' -,r -----e
Estimated Value of Electrical Work: (When required by municipal policy.) # (Ex
Worktostart: 1128105 Inspections to be requested in accordance with NIEC Rule 10, and upon completion.
I cerdfy, under the-pains-andpenafties ofperju;y, that the informadon on this appficadon is tme and conrkte.
FIRM NAME: co- �Mff�lckart-ll C- LIC. NO.: /4
Licensee: -T"bA., P UP�r-kMl= Signature
(If applicable, enter t 11 M the ficense number7ine.)
Address: / V I-- P-4-1AJ1EA,1 M11.)
w Tv -r- a nla-u-N-F, -Fu v r -m 1 am aware tnat the Licensee does
required by law- By my signature below, I hereby waive this requirement.
Owner/Agent
Signature Telephone No.
jJ=J&JM,,-1 LIC. NO.:
%.-� r — 6
Bu& Tel. No.:
Aft. Tel. No.: R16 --Co
not have the liTb-i-liiy insurance coverage
I am the (check one) [] owner El owner's agent.
EE.- S
Re) C/9 41
�7t,�
ok�-
4
Date ....... //, � , � /—,vX&
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This celifies that ..... ...... ............................
11
has pennission to perform ...... AX ......... ..........................
wiring in the building of ... ...............................
ver
........ North Ando -M
at ....
Fee..
...... Lic. No!M��Q� .............
z ELECTI=�, Z
Check # Ao/
5165
TBECOAMOATHEALMOF
DEPARTMEATOFPUBLICS4MY
BOAROOFFIREPP,EVEMON
APPLICATION FOR PERAIRT TO PERFO.
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 1 4
Town of North Andover
The undersigned applies for a permit to perform the electrical work
Location (Street & Number) �1 '? Jr -0 -5 1� �(
OwnerorTenant
Owner's Address AV4E-
lEITS 12.VO Permit No. Office Use on ly
am Occupancy & Fees Checked
vjj
ELECTRICAL WORK
ICAL CODE, 527 CMR 12:00
Date 1-9
la
To the Inspector of Wires:
Is this permit in conjunction with a building permit: Yes M No E]� (Check Appropriate Box)
Purpose of Building I Utility Authorization No.
Existing Service Amps 'Volts Overhead M Underground No. of Meters
New Service Amps Volts Overhead Underground No. of Meters
Number of Feeders and Ampacity
k
Location apd Nature of Proposed Electrical Work "A- ArT_
No. of Lig�ting Outlets
No. of Hot Tubs
1
No. of Transformers
Total
4
1
KVA
No. of Lighting Fixtures
Swimming Pool Ab
I
Bel
Generators
KVA
groonvde
R r o uOrwd M
4
No. of Receptacle Outlets
No.ofOilBu ers
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. ofDetection and
No. of Zones
No. of Ranges No. of Air Cond. Total
71- Tons
No. of Disposals No. of Heat Total Total
Pumps Tons
KW
Initiating Devices
Ng...,of Sounding Devices
No. ofDishw shell� Space Area Heating KW
I
,
N�'..btSelf Contained
Det9ction./Sounding Devices
Local Municip al
Other
No. of Dryers Heating Devices KW
1
0 Connections
I I
No. of Water Heaters KW No. of No. of
Signs Bailasis
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER-
haxanoeGDWrag-- RmarittDtlrmWmnentsofNb%wbisettsGm)edLaAN [��O M
Ihavtao-mulLmbihtylawmmPbkyiwkdngConipk!eO agoorrisalslantalepvalent YES
e�qWCDvar
lbaveahnadvandpfoofof&grmtotheoffim YES -71 r-9) IfyuuluwdrdedYESpleawit�tbetyWofcovwdgeby
. box, F
d=ldng the TRT—a8-- 0 1- -
NSURANCE [Z BOND 01HR Flease Specify)
Work to Start
rAPJrdL"1i-7,W
Esffnatcd Value of Ebc" Wojk $
Rwgh FHA
SignedunderM es of peoxy.
FIRMNANM A- - AA A -C
A L LmBeNo ZAJ
Domsee �-�Sgnature J ucmT No 7-
Busness Tel No. A 0
ZJ A, VJ - 3?
- Alt. Tei No - 2 2 k 7--
OWMJZ'S INSUIZANCEWAIVER, lam &,arethat flielimwdoesnothave ll-rainsurancecovff�orjts atstanhal equwalentas wgiodbyMassachusNts General Laws
and thatmy@gnaftmon thispennitapplicalion waves ft requiruncrit.
(Please check one) Owner F-1 Agent F� Telephone No. PERMIT FEE
Nignalure ot Own -777-777 77,7=77 V
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation insurance Aff1davit
Marne Please Print
Name.:
Location:
Ci!Y 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.
Company name:
Cily: Phone #:
Insurance Co. Policv #
Company name:
Address
Cily: Phone #: 9
insurance Co. Policv #
Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties af.a fine up to $1,500.00
and/or one years' imprisonment -as -well-as-civil.,penafties in. -the form -cfa..STOP.W-ORK.-ORDER..an.d..a.fine -of .(.$1D0..00.) -a �dayagainst-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 peijury that the information provided above is true and correct.
Signature.
Date
Print name Phone.#
Official use only do not write in this area to be completed by city or town official'
City or Town Permit/Licensing
E] Building Dept
F-lCheck if immediate response is required E] Licensing Board
F-1 Selectman's Office
Contact person: Phone Health Department
Other
I
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee
TOTAL
Check #
P 18221 - I Building Inspector
11
.1
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
"PLICATION TO CONSTRUCr RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
116 sedift Aw offind-
BUELDING PERNUT NUMBER: DATE ISSUED-
c6�
SIGN A/A/ I
Building Commissioner/las ectof'of Buildings Date
SECTION I -SITE INFORMATION
1. 1 Property Address:
2--7 FoSS 0
1.2 Assessors Map and Parcel Number
4
Map Number Parcel Number
1.3 Zoning Information:
District Proposed Use
1.4 Property Dimensions:
Lot Area (sf) Frontage (ft)
—Zonm'p-
1.6 BUILDING SETBACKS (ft)
Front Yard Side Yard Rear Yard
Reqp�r,A) Provide Required Provided ReqLlired Provided
+
1
3 0 / `�— 3 -z>
1�
-- 1.5. Flood Zone Information: 1.9 Sewersp Disposal System
I.Mater Supply NI-G.L.C.4WO.. 54) zone Outside Flood Zone 0 1 0 On Site Disposal System 0
Public 0 Private 0 muai-t
SECTION 2 - PROPERTY OWNERSE"JAUTHORIZED AGENT FiKDt.L.;!"C U77(ic-l-, 77-3
2.1 Owner of Record 27 FoaS
ejCAM�e—S +- . C-- k M � e- n � e rS
NameftPrint) Address for Service
=ignaW e Telephone
.er of Record:
%Name Print Address for Service:
Si. ature Telep o
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Constructiolsupervis r:
Licensed Construction Supervisor:
-f
q _1 0
AA --1,/7
64 _a,3 : el --
13 51 k,
Signature Telephone
Not . Applicab . le 0
License Number
z h z- mo,6
Expiration Date'
7 3 2 Re 'stered Home Improvement Contractor
T ocoj co t�tr
Not Applicable 0
�,—Ompany Name
Registration Number
12ko 7
Ad e
2 3
_,4
SiAnature ne
�x ptraton
SECTION 4 -WORXERS CONWENSATION(KG.L C 152 1 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 Description o ?nposed Work (check appUcab1t)
New Construction 0 Existing Building R" Repair(s) 0 Alterations(s) 0 Addition I!r
Accessory Bldg. 0 Demolition 0 Other 0 Specify
Brief Description of Proposed Work: � )
q '5 Q— —Z d' )<
1) M AO nj�oli)g J CV/ A) �3
0 A -V
Cb1--V\J , 95,6,0,t", FO�>-�F aNA 11z- &�A
I emirTION A - Rr.TTMATW-n Vn?VQQ7W1[TrT1rn?J d-d'%Clrc I
item
Estimated Cost (Dollar) to be
Completed by permit applicant
OMCIAL USE ONLY
I . Building
oac), 00
�aj Building Permit Fee
Multiplier
2 Electrical
M0, 60
3"
(b) Estimated Total Cost of
Construction
(D
3 Plumbing
26-04."
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
0 0 1
Check Number
� A A�Am r a �Vv Llm� �M A xxxojmx� JLJL%JIN JL U J3M %-Un1rLM JLJ&V WnEfM
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUI]LDING PERAHT
0!�,22 f -S. acupepo-') as Owner/Authorized Agent of subject property
Hereby authorize to act on
My a , in all ma�jrs relative to work authorized by this building permit application.
fZ
'Si "iatur ot-Ov�ner' Date
SIECTfON7h OWNERJAUTHORIZED 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
Sig -nature of Owner/
NO. OF STORIES SIZE
BASENIENT OR SLAB
SIZE OF FLOOR MvIBERS 1 2 ND 3 KU
SPAN
DINIENSIONS OF SILLS
DIMENSIONS OF POSTS
DINENSIONS OF GIRDERS
HEIGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CHDANEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATUIZAL GAS LINE
., 10
5' 1- X 4V
Joe
'r *eWCdY 727 r*.- ;-17,-e 1A,SVWOC AW -0
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The Commonwealth of Massachusetts
Department of Industial Accidents
Ofte of 1nve0gWkns
Boston, Mass. 02111 -
Wbrkers' Coapensetim lnsimwice Affdmt
PISM Print
cft Al, A nao v c, � ft" *
F� I am a hwmww Worning;9I wat rnyseff.
F-1 I arn a sole pqxIetor and have no one woriting In arri capacity
I am an ernplo�w PnN IV WT7 scornpfflsation for ffry ployess worldrig on this job.
. A r. 4. 1
IV A SOO
OaO3�
02 4Z7 61.3
NO
I nasaws Co. Pokv a
Fdkveto semnewGrOW w mpAred wds Secdon 26Aor MGL 152 con low todukqmwan daind, p@ngaftd.efln@upta$1,5W.W
anderoneymWIMPrbov, WORKORDERAWA fkw d ($1WAM-Sift figN1W MIL I
urKMrstaid that a copy of this stdwrwt may be fbnmcW to On Office of lnvosdgsftm of ow M for covargp vWi1ksdW. .
I do hereby Jbaftowandr��UWNWWGFFY dMAV~fibUW18ftRa"dcW1
Sion . aturs7ln- 02M
Print
ISM
OfficW use only do not wrRe In this am to be cwpk&W by c1ty or town dr1cW
#6 ('134
CRY or
Bu#&V Do#
[]Check I Immediate response As requkW Ltenaft Board
0 Selectmen's Ofte
Contact Phone
[j HMO Deparftwnt
[3 Other
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 Permi . t
Number is that the debris resulting from this work shall be GL
dispose of in a properly licensed solid waste disposal faci . lity as defined by M
c 11, S 150 A.
The debris will be disposed of in:
(Location f F Hity)
aci i
Signature of Permit Applicant
Date
NOTE: Demolition permit from the Town of North Andover m I ust be obtained for
this project through the office of the Building Inspector
J
6 4�_,2 � -ff--
bc,�_Mp -00 t Aor- Kd-66dA
FORM U - LOT RELEASE FORM 5 1- Y_,O�S_
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__)�+L I k kji�_ WO,( SO_)�J
PHONE6os 437 6
LOCATION: Assesscw's Map Number PARCEL
SUBDIVISION LOT (S)
.STREET 2-7 Foas ST. NUMBER Z7
0*******************OFFICIAL USE ON ------
MC,0MM1rN6ATJ64 OF TO ENTS:
TOR DATE APPROVED
I DATE REJECTED
TOWN PLANNER UATE APPROVED
DATE REJECTED
COMMENTS
FOOD INSPECTOR -HEALTH DATE;V �PROVED������
DATE REJECTED
SEPTIC INSPECTOR -HEALTH DATE APPROVED
DATE REJECTED
COMMENTS
PUBLIC WORKS - SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR E
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Date.
TOWN OF NORTH ANDOV
PERMIT FOR
This certifies that ...................
has permission for gas installation /r� �r ..........
in the buildings of ?-,A
......................
at ............. North Andover,. Mass.
Fee. 9?.�. Lic. No...V ... .... .
s jr���
P�
c�
Check# d I,
5985
a
RF
9, M I
TM
TM F R
Installing Company Name A71 co, Check one: Certfficate
Address IL10 Sou-rH InPIN ST C) Corporation
iDDI,670-r,� MR- 0 1 t914 C3 Partnership
'Business Telephone 7 /,SO )(Fiffn/Co.
Name of Ucensed Plumber or bas Fitter
NSURANCE COVERAGE:
have a current RabMy Wourance policy or ft substantial equivalent which masts the rwivirements of MGL Ch. 142.
yes\pK No 0
If you have ffiecked M. please Indicate the type coverage by c"nq the appropriate box
A liabiffty Insurance policy Other type of W40MRY a Bond .13
OWNER'S INSURANCE WAIVEFL, I am aware that the flom donnalhmftansu, Coverage required by Chapter 142 of dw
mass. General Laws, and 1hat my signature on this permft appkation walvas Oft roquirement.
Chad ona:
Signature of Owner or Owners Agent
Owner r a Agent 0
I hereby oerfify that all of the detalls and Information I have submitted (Of entanKU In above application am . and accurate to the beat of nvy
krowledge and that an plumbing work and ftwftflatlons, performed under the permit Issued for this will !P =2 an
�,ertinerft provisions of the Massachusetts State Gas Code and Chapter 142 of the 77 -
Type of Ucense!
-Ptumber Sign re of Ucensed PlurribdaMairFItter
Tirtie -0safliter
-Master Uoensa Number q00 I
CftyfTown -Journeyman
APPROVED (OFFICE USE ONLY)
S
6W
DivislorioPPIZOFESSIOtIALLICENSU;IE
11 YfERS
IN
P L w K-09. E
L I C FN SE.D'-
Uou :IGASFITT
vo
MN
'MICHAEL B :"t
1.6 KICROL
'LYNN. 2-37 S.
Till
7'14: HUSETTS
Commo0if ts,
DIVISION OF I'll OF ESSIONAL. LICE NSURE J
IN PLUMBO'S `Akd. 6�S'!�ITTER!5'
LICENSED A. A --GAS INSTALL
TO
.14ICHAEL A ii�Sd' .`iR
L6 NICHOLS'"Av; "'a" ,
LYNN 2-3718
259162
933
. . . . . . . . . . . . . . . .
r'Y
,7ET.TSj
TO
--- ---- --- ---- - 6kY ANDCONFERS NO RIGKTS UPON THE CERTIFICATE
A"Ieby's, Wyman himuramce Agency Inc. HOLDER, THIS Cr -KI It- CATE DOES NOT AMEND, EMD Ok
.w -
is . z C"At St. ALtER;fHk:COVERAGE AFFORDED BY THE PMMES B&O W.
Beverly, NA 01915
susan'2mbin INSURERS - -AFFORDING COVERAGE NAIC#�'
Kichmal A. Bryown ITT!!p- Fati;;;! Gran
ge Lummuce Co. 147381
BRA: c/o TTS, Inc. 1 16~111:
IGURERQ:
140 S. Na" St.
Viddlton, MA 01949 POIRERD:
THE POLICIES OF INSURANCELISTEDBELOW HAVE SEEN ISSUEDTOTHEINIUMNAMEDABM FOR THE POLICY PERIOD INDICATED.
ANY REOUIREMENT, TERM OR CONDITION OFANYCONTRACr OR arrIER DOCUMENT WITM RESPECTTOWHICM THIS CERTIFICATE MAYBE ISSUED
MAY PERTAIN, THE INSURANCE AFFORDED 13Y THE POLICIEs DESCRIBED HUM 18 BUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
PMtCIES. AGGREGATE LNITS SHOWN MAY HAVE BEEN REDUCED By PAZ CLAW& - -
MSR
rf" OF MSURANC*
POUCT MMER
mxmm
umrrm
–UL=—
GENERAL UAS&M
TID
11/01/2006
�
11/01/2007
EACHOOCURREWX $
DAMAGE TO RGNTFD S Selo"
x COmmERMLGENERALU*ALnY
CLAM MAIDE -1 OCCUR
MEDEXP.VM=npmm) S fS.994
PERSONAL A ADV KPJRY S 10000#
A
GENERAL AGGREGATE 8 2,000,
g2
GEWL AGGIREGATE LIMIT APR" I
PRODUCTS - COMPKIP AM S
PRO-
.mCr
AL0710mom"
ILLA1118j"
OOM INED 80KILE LIMIT
ANY AUTO
(to sod""
DOOLY "JURY
ALL OWNED AUTOS
SCMED ULED AUTOS
(P -P—)
DODLY HJURY
HfRED AUTOS
NOKLOWNEDAUTOS
(P-Sadde"
PROPtRrf DAMAGE
LAASAJTY
AU70 ONLY - EA ACCIDENT S
OTHER THAN EAACC I
A.1 AUTO
AUTO ONLY.' AGO 8
EXCE S&AJM BRELLA LIABRJrY
EACH OCCURRENCE I
AGGREGATE
7 Oi:CUR F CLAIMS MADE
S
DEDUCTMILE
RETENTION
WORKERS COUMNSATM AND
WC STATU, TH-
10
ot
9mpLOyffRrLfiA0LnT
E.L. EACH ACCIDENT S
ART PROPRPETOWARTREPJFXECUTIVE
LL DISEASE - EA EMPL 8
OFFr-ERIMFMBFR EXCLUDED?
deberbe to do
Off
LL DISEASE - POLICY L'Off S
.PIECKL PROVISIONS'
OTHER
DIE SCRPT100M OF OPERATPONS I LOCATMS I G;;ts I EXCUJS*M ADDED BY INDORWRIlEff I SPEOft PRoymon
For Information only
CANCELLATION
INC= ANY OF THE ASM 11 ED POLICIES 01 CANC== BEIM THIR
6011RATION DATE TNIF". THR MIUM NWJRRR WILL ENWAVOR TO MAL
DAYS VVRII * NNOI TO THE CRATIRCATI11 NOLM RAIIIIIIIn TOTHE LEFT.
INIT FAILURE TO MAL IIIUCH NOTICE IIIHALL WPM NO OBLIGATION OR LAANLnT
OPANYMOUPMTHIMURMffgA(MKMORR04MKIICrATMM
AUTMORIM RIP`R2fflWA7M
Nare S10111117/8"um
ACORD 25 (2001M)
GACORD CORPORATM IM
1,DF created with pdfFactory Pro trial version www.p0actomeo
The Commonwealth of Massachusetts
Department of Indtistrial Accidents
Office of Investigations
.600 Washington Street
Bostoi; MA 02111
UV wwV,.massgov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu'mb
Avylicant Information Please Print
Name (Business/Organization/Individual): Q14 Li
Address:—/YO qou7H
M&'N
City/Statelip: 4F71o,,)
Phone 9 7& T? q R 7�6
Are you an employer? Check tb "ppropriate box: Type of project (requiredD:
1. 2��Iarn a employer with
4. [3 1 am a general contractor and 1 6. 0 New construction,
., employees (full and/or part-time).*
2. 1 am a sole proprietor or partner-
have hired the sub-contractDrs
fisted on the attached sheet t 7. 21emodeling
ship and have no employees
These sub -contractors have 8. E]Demolition
working for me in any capacity.
[No workers' comp. insurance
workers' comp. insurance. 9. E] Building addition'
5. We are a corporation and its
requirrA]
10-0 Electrical repairs or additions
officers have exercised their
3. 1 am a homeowner doing all work
right -6f exemption per MGL 11-0 Plumbing repafts or additions!,
myself. [No workers' comp.
c., i5l, -§1(4), andi�e have no 12.[:] Roofrepaus
1'. .:-
insurance required.] t
I , ". . -. - , i.. .,� .
13.0 Oiliel:
employees. [No.wolkers - , ' I
r
comp.. isumnce required.]
-J
Any applicant that checks box #1 must also fill out the section below'' shov&g their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are do6g sh�woik andthen him outside c�n� must submit a new affidavit indicat�g
lContractors that check this box must attached an additional sheet sh6,wing the isme4the sub -contractors and their workers' comp. policy infbin;diom;
I am an enTleyer that isprovidfing workersO compens�fion'mlsiu'ranceform
Y vnployee& Below is thepolicy andjob site
information.
Insurance CompanyName: AM,-, 6V
4-, Wyl)MA)
Policy # or Self -ins. Lic. #: 1AJ C
Expiration Date
Job Site Address- i .
City/State/Zip:
Attach a copy of the workers' compensation oft' declaration page (showing the policy number and expiration date).
P y
Failure to secure coverage as required under, Section' 2�A of MGL. c. 152 can lead to the imposition of criminal penalties of a
fille up to $1,500.00 and/or one-year imprisonmeMa's1well. as civil penalties' in the form'of a STOP WORK ORbEk and a fine
of up to $250.00 a day against the violator. Be advis6d.that a copy of this statement may be forwarded to the Offlod of
Investigations of the DIA for insurance coverage verific�tion.'
I do hereby cerd
.fy under thepains andpenaldes qfperJw)4at the informadonprovided above is true and corre�t
I W1
ne 7f, V
Offidal use only. Do not write.in this area, to he conipleted by city or town orkiat
City or Town: Permit/Ucense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Persow" Phone#:
5954
Date...
.......... .........
TOWN OF NORTH ANDOVER
0
PERMIT FOR WIRING
.. ........................ ...
This certifies that ... ..........................................................
has permission to perform .......... ......... ..............................
.............
wiring in the building of A�—� .........................................
/ .....................
at. North Andover, Mass.
................................................. e� ) ........
Fee,/,k5-. Lic. No /) .. 6
..................... ............ ............................ .. ..................
ELEcrRICAL NSP R
Check# c;2141-1 2�
Commonwealth of Massachusetts Official Use Only
Permit No.
Department of Fire Services //
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS l[Rev.11/991 (leaveblank)
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 PRRVT IN INK OR TYPE ALL AWORMA Date: 912-61.0td
City or Town of- n GhOk, Mm�o To the InspiAor of Wires:
By this application the undersigned gives notice of his or her rform the electrical work described below.
Location (Street & Number) 2 q
Telephone No. (o
Owner or Tenant
Owner's Addmss--zr7 r--o-6Z Rzt�-X
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building 5S F `k� - Utillity Authorization No.
Existing Service WC) Amps 12,0 Zq(317olts Overhead [:1 Undgrd DF� No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity A
Location and Nature of Proposed Electrical Work: K-LtbLkAn \&A-^
Comoletion of the followme table mav be wanvd bv the Inspector of Wires
No. of Recessed FUtures
No. of Ccil.-Susp. (Paddle) Fans
NO. Of -To-tal
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators K -VA
No. of Lighting FUtures
Above Ei In- r-1
Swimming Pool gmd. gmd. L -J
No. olFLmergency Liptinag
Agt�te Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
JNo. of Zones
No. of Switches
No. of Gas Burners
f Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat
Totals:
er
I
KW
I
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
SpacelArea Heating KW
Local 0 Municipal Other
Connection
No. of Dryers
Heating Appliances KW
Security Svste�as:
No. ofDevices or Equivalent
No. of Water KW
No. of No. of
I
Data Wi i
rf
lo
Heaters
Signs Ballasts
My t
No. ices or Evivalen
No. Hydromassage Bathtubs
No. of Motors Total HP
I
Te-Fec—ommunications Wiring:
No. of Devices or Equivakrit
OTHER: t o C) A VA V> 5 L>.k-Z1 Pa 0 e I I
A ttach additional detail zfdesir.ed, or as required by the Inspector of Wi . res.
INSURANCE COVERAGE: Unless Azived 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 [S BOND n OTHER E] (Specify:) C-Toapne 2/06
t (Expiration Ddte)
Estimated Value of Electrical Work: (When required by municipal policy.)
WorktoStart: qJ28105 Inspections to be requested in accordance with NEC Rule 10, and upon completion.
I ce7fify, under the*pains-andpenafties ofpe? Fur
. j y, that the information on this appfication is tme and conWkie.
FIRM NAME: i�lleLf 16'c� LIC. NO.: /911 (o 2- 8
Licensee: --76 %"Vs, t-,' L_�J-Nt-Lme>1' Signature�/-�
(If applicable enter "exWpt " in the license number 7ine.)
Address: A0, x146 me-Male&l M9-01�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does
required by law. By my signature below, I hereby waive this requirement.
Owner/Agent
Signature Telephone No.
jj=JL�=� LIC. NO.:
Bus. TeL No.: A F329 -0,
Alt. Tel. No.: 8/6--b'/jaT
not have the liability insurance coverage normally
I am the (check one) E] owner E] owner's agent.
FP0?MIT FEE. $
';�- 6 - C, �) -
Date .............
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING.
This certifies that r e . ..........
has permission to perform .... 4'V
..................
plumbing in the buildings of . ..............
F ... ........ North Andover, Mass.
at. r:c
Fee. Lic. No.lcl,.015- .3 ...... k .
j -:� ----------
PLUMBING INSPECTOR
Check ff C
6523
fflAQQA4,nUbl=t IS UNIFUHM APPUCATION FOR PERMIT I U UU tLUMtIMU
(Plint or Type)
NORTH ANDOVER, , Mae@. t)ats
Building Permit J- )-y3
Location
Owner's,
Name
New 0 Renovation Replacement 0 Plans Submitted: Yesff- �No 0
FIXTURE9
Installing Company Name &L9W.
Check one:
(3 Corp.
Address �;VPO J , 11 Partnership
0- / PC5:,7 2-rlrmlco.
Business Telephone F "? CY
Name of Ucensed Plumber 4ki�91—\l
INSURANCE COVERAGE: Check one
I have a current liability Insurance policy or Re substantial equlvalerc Yes 0 No 0
It you have checked y". please Indicate the type coverage by checking the appropriate box.'
A liability Insurance policy D Other type of Indemnity [3 Bond 11
1.
cedincate
OWNER'S INSURANCE WArVER: I am aware that the licenses does not have the Insurance coverage required by
Chapter 142 of the Mass. General I.Aws, and that my signature on thils pern-A application waives this requirement.,
Check one:
Signatuts of Owner or Owner a Aqent Owner 0 Agent 0
I = cwtify that all of the detafis and InImmailon I have submittted lor entered) in above application we We and &wA&te to the best of my
It and that :N MbIng wock and Installations ptrformod urxIar the Permit Issued fac tW pkation will be in compffancs with d
Winen?Perovi Wons I Massachusetts Slat* Pkimbing Code anx! Chapter 11412of dw
Its@ of I Wd Pkirnbef
--444ria ftuis
License Number
Type of Pkimbing License. Mastei C1
Joutneyman
A!"U'VED (OFFICE USE ONLY)
Fill
11-711MINAINEEMEN
NONE
IN
MEN
NOINNIONNIONNININ
Installing Company Name &L9W.
Check one:
(3 Corp.
Address �;VPO J , 11 Partnership
0- / PC5:,7 2-rlrmlco.
Business Telephone F "? CY
Name of Ucensed Plumber 4ki�91—\l
INSURANCE COVERAGE: Check one
I have a current liability Insurance policy or Re substantial equlvalerc Yes 0 No 0
It you have checked y". please Indicate the type coverage by checking the appropriate box.'
A liability Insurance policy D Other type of Indemnity [3 Bond 11
1.
cedincate
OWNER'S INSURANCE WArVER: I am aware that the licenses does not have the Insurance coverage required by
Chapter 142 of the Mass. General I.Aws, and that my signature on thils pern-A application waives this requirement.,
Check one:
Signatuts of Owner or Owner a Aqent Owner 0 Agent 0
I = cwtify that all of the detafis and InImmailon I have submittted lor entered) in above application we We and &wA&te to the best of my
It and that :N MbIng wock and Installations ptrformod urxIar the Permit Issued fac tW pkation will be in compffancs with d
Winen?Perovi Wons I Massachusetts Slat* Pkimbing Code anx! Chapter 11412of dw
Its@ of I Wd Pkirnbef
--444ria ftuis
License Number
Type of Pkimbing License. Mastei C1
Joutneyman
A!"U'VED (OFFICE USE ONLY)
Date.2 . ............
04. TOWN OF NORTH ANDOVER
4
PERMIT FOR GAS INSTALLATION
y SACHUS
This certifies that .1441 ... 4.
has permission for gas installation .... P. "o. k,. ...........
in the buildings of . .9. e f ..........................
at .............. N of ass.
Fee. Lic. No.,/ e7.., .... ...
A I
Check# / 3
5170
N
�0
MAS!�ACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
NORTH ANDOVER Mass. Date
kuilding Location p'P7 <5 Q20
Permit #
Owners Name
Replacement Plans Submitted
New Renovation
El XT I I R �:S
(Print or Type) Check one: Certificate
Installing Company Name Corp.
Address OL-) ?c-- Partner.
=-f---F'irm/Co.
Business Telephone:
M0106-7 P,
Name of Licensed Plumber or Gas Fitter
Insurance Coveraq Indicate the type of in S urance coverage by checking the
appropriate box:
Liability insurance policy F --j Other type of indemnityF--1 Bond ED
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 coverages.
Signature of owner/agent of property . Owner I--] Agent El
i hereby certiry that all of the details and information I have submitted (or entered) in above application age true and accurate to the best of rnY
knowledge and that zU p(umbing work and inseAgations perfornie�d under'Pe(mit issLed for this appLication will -be in compliance with ad Pcttiucnt
provisions of the Jassachusetts State Cas Cude and Chapter 142 of Cho General Laws.
TYPE LICENSE
By lumber
Title Gasf itter- Signature of Licensed
City/Town: Master Plumber or Gasfitter
--aourneyrnan
APPROVED (OFFICE USE ONLY) Vicense Number
M
OEM
a
MIMERIMMIMMEMEMIME
r"WREEMEMEMN
MEMENIMEMEMIMMENNUME
MEMENAMMUMMERIMEMMEM
MAREEM
SEE
opt
(Print or Type) Check one: Certificate
Installing Company Name Corp.
Address OL-) ?c-- Partner.
=-f---F'irm/Co.
Business Telephone:
M0106-7 P,
Name of Licensed Plumber or Gas Fitter
Insurance Coveraq Indicate the type of in S urance coverage by checking the
appropriate box:
Liability insurance policy F --j Other type of indemnityF--1 Bond ED
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 coverages.
Signature of owner/agent of property . Owner I--] Agent El
i hereby certiry that all of the details and information I have submitted (or entered) in above application age true and accurate to the best of rnY
knowledge and that zU p(umbing work and inseAgations perfornie�d under'Pe(mit issLed for this appLication will -be in compliance with ad Pcttiucnt
provisions of the Jassachusetts State Cas Cude and Chapter 142 of Cho General Laws.
TYPE LICENSE
By lumber
Title Gasf itter- Signature of Licensed
City/Town: Master Plumber or Gasfitter
--aourneyrnan
APPROVED (OFFICE USE ONLY) Vicense Number
'40 T
0
'�SACHUS
Date .....
.... ....... ...
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...... d 2 c*..y ............
has permission to perform ....... t. Ir
............ .... ........
wiring in the builpg of .... Q/4?z�-� ................... j.
,q7 ... Skl ...... ............... . North Andover, Mass.
U
Fee ..... —7. L,ic. N *f W . ............. 4
CU
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File
Q
S q
The Commonwealth of Massachus'em ..-7:1...,
,�C.tt
Department of Riblic Safcry
Occwpa�y 4 r.a Chck.�
qJ BOARD OF FIRE PREVENITON REGULAnONS S27 CMR 12:00 3/90
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL -W----'ORK
AII woork to 6e Per.iormed In accordance with the M&L"ch"Cru FJcctfkxl Code. S27 CMR 12:00
(PLEASE PRINT IN INK OR TYPE I 'FOR ATION) Dat e
CitY or Town of
A e -t
To the Inspector of Wires:
The ur%4:�-rsigncd applies for a p-ermit to perfor= the electric I rk describ-ed b, -low.
Loc�ation (Street & Number)- 27
LIC.
Owner or Tenant— r ;--7
Owner's Address
1-2
OWNER'S INSURANCE WAIVER: I am aware that the Licensee
Is this permit in conjunction with
a building permit:
Yes [�o (Check Appropriate Box)
Purpose of BuildLnk.
coverage or its sub -
Utility Authorization NO.
F-Xisring Ser -.ice ZvIll, Amps
Volts
Olverhe-ad �Undg-rd L No. of -,ets�ts--
He- ServIce, Amps
Volts
Overbead Undgrd No. of Meters
Number of Feeders and Ampaci
Location and Nature of Proposed Electrical Work
No. of LigIttigg Outlets
lio. of Lighting Fixtures
No. of Hot Tubs
Swimming Pool Ab
gg Vde
No. of Transformers ToFa—1
KVA
�dll Generators KVA
No. of Receptacle Outlets
No. of.Oil Burn ers
No. of—Emergency Ci`gh-tli-�g
Battery Units
No'. �of Switch Outlets
No. of Gas Burners
FIRE AIARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Local [:] Hunicipal
nnection130ther
No. of Ranges
No. of Air Cond Total
tons
Nr of Disposal.,;
No. of Heat Total Total
Pu=ps Tons KW
-qo. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices 1W
No. of Water ';eaters KW
No, of No. of
Signs Ballasts
LOW V01t2ge
No. Hydrop Massage Tubs
No. of Motors Total
HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Rassachusetts General Laws
I have a current Li bili insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES 1 have submitted valid proof of same to this offic YES
If you have che ke 9 ---NO 0
-��YES; please indicate the type of coverage by checking the appropriate box.
INSURANCE [5--BONDE] OTHER (] (Please Specify) 4 - 5� S —
Estimated Value of Electrical Work S
Work to Start
Inspection Date Requested:
Signed under the penalties of perjury:
(Expiration-Ta--t-eT
Rough // (fo41&-X- Final
FIRM 111,111,11 1
IC.. NO.
Licensee,&;&�-
n�y_ Signatur
LIC.
Address
Bus. Tel. N .
0
1-2
OWNER'S INSURANCE WAIVER: I am aware that the Licensee
It-- TPI N -
does not have the insurance
stantial equivalent
at required by Massachusetts Ce
-neral Laws, and that my signature
coverage or its sub -
application waives
this requirement. Owner Agent
(Please check one)
on this permit
Telephone No. PERMIT FEE S
—0w—nero`rA-8en-tT—
Location
No. Date
A ThOWT4 -1
TOWN OF NORTH ANDOVERS
6
.6 0 -
Certificate of Occupancy $
Building/Frame Permit Fee $
SS U Foundation P; ee $
e
Other Permit e s 34
Sewer Connect�'djh Feet
Water Connection Fee $
TOTAL $
8345
Div. Public Works
PERMIT NO.
IS
LIM
L",
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
PAGE I
MAP +40.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK :PAGE
Z?PE
SUB)DIV. LOT NO.
f-OCATION
PURPOSE OF BUILDING
OWNfER'S NAME
NO. OF STORIES SIZE T3
OWNER'S ADDRESS
0-
BASEMENT OR SLAB
A NAME
.,�CHITECT'S
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME vo —
SPAN
DISTANCE TO NEAREST BUILDING 13' 6A(L,41
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES is" REAR 416 1 7 1/
GIRDERS
AREA OF LOT sz� FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
1�11-1- BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
-90ARD OF APPEALS ACTION. IF ANY k
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES fk rc:
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
"I'
PERMIT GRANTED It
3 PROPERTY INFORMATION
LAND COST
--EST. BLDG. COST 3
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
OWNER TEL. #
CONTR. TEL. #
CONTR. LIC. #
H.I.C. #
,A —AAS oll—cgt
e'5 -ft" lr�cto
OCCUPANCY I ..� 1 12
MULTI. FAMILY OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
CONCRETE
PINE
3
1
CONCRETE BL*K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
13
DRY WALL
UNFIN.
3 BASEMENT
AREA FULL
FIN. B M T AREA
1/1, 1/2 1/1
FIN. ATTIC AREA
NLO 8 M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS 9 FLOORS
CLAPBOARDS
B
1
3
DROP SIDING
WOOD SHINGLFS-
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
CONCIZETE
_�_APTH
�ARDVI D
COMMON
ASPH. TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK ON M.ASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONC. OR CINDER BILK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR P R
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
I HIP
BATH (3 FIX.)
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
�LAT
SHED
_�H
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER BMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W T'R OR VAPOR
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS
I As
OIL
i ELECT� C
'M'T I I 2�d
3,d
I iZ �E�ATIIG
BUILDING RECORD
THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
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