The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 3 CHAPIN ROAD 4/30/2018BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �Q CCE P n, PROPERTY OWNER (Oint MAP, NO: (2� -0- PARCEL: ZONING DISTRICT: Histodc'Distfict Machine Shop Village . yes no 'yes no TYPE OF IMPROVEMENT 4 0 'AM-deos �, CO. Ilk Residential yes no 'yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration --------- No. of units: Commercial Repair1;TepIacement__`-- Assessory Bldg Others: Demolition Other, W !Se ic; ell Floodplain.' "Wetlands Watershed�Distdct WaftedSewer DESPRIPTION OF WORK TO BE PREFORMED: � C', Please Type, qr Print Clearly) OWNER: Name: Aririrp.q_cz- ARCH ITECT/ENG I NEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. GH Total Project Cost: $ FEE: $ Check No.: Receipt No.: 1A1/6(; NOTE: Persons contracting with unregistered contractors do not have access to th� guarantyfund x Si nature of contractor nature crlkdent/Ownbr� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT COMMENTS DATEAPPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osaood Street fIRE'DEPARTMENT .. Temp:Dumpster�on §ite' yes �,no -L-ocated�at 124'main street F: re epartment S- lignature/date -COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes —No MGL Chapter 166 Section 21 A —F and G min.$100-$l 000 fine NOTES and DATA L3 Notified for pickup - Date Doc.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing,. Siding, Interior Rehabilitation Permits Li Building Permit Application • Workers Comp Affidavit • Photo Copy Of H.I.C. And/Or C.S.L. Licenses • Copy of Contract Li Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Ei Building Permit Application u Certified Surveyed Plot Plan Ei Workers Comp Affidavit Ei Photo Copy of H.I.C. And C.S.L. Licenses ii Copy Of Contract • Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) • Mass check Energy Compliance Report (if Applicable) Ei Engineering Affidavits for Engineered products NOTE: All dump.ster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) • Building Permit Application • Certified Proposed Plot Plan • Photo of H.I.C. And C.S.L. Licenses Lj Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) • Copy of Contract • Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: INSPECTIONAL SERVICES DEPARTNIENT:11PITORM07 Revised 2.2008 Location rlv-,�&I�J No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # _�j -1 / '2 6 Buil&g' Inspector or — Nov 04 2008 11:58PM MIKE SIDMAN 6039345514 P.1 V91 Window Agreement -Page 1012 404 Me ft, MAhboro"k MA 011632 (08) 911MOD - Par. (608) 919-01)(113 CulswmerService (800) 573-7606 ProclitictManager: ^-�f fjyA.�,4 J&L Windows, Inc., d1bla 11%=-newal byAnderser-L WIN&OW Rr.F%.AQXMENT A,,JQ: Window AgreeMent NA Home Impirovemint4Contractor Limnse #140601 (Expir" 11MG20110) FWarallraxM98344042011 . indly. License& John Esler (CS 974251), Kathleen Blanchard (#149601) Contract oata: Homeowner ("Owner")'s Name(s)� -rfOA AVA( "0 StmetAddress: 40cA cityrrawn: A., surts! zip: P/i yx7 Hpmp Phone; 92r 97k — 9— 20- 7: X$ -C7: Work Phone: Job Site Address (if different): E-mail Address: Y'a VA Q (cA,±, lkaa4ar6le M hd% rwo%virlM nnrl wnrk tn ha nArfnrinnati hv Re-narmal hv Affidarsen r-contractor,ii: Contractor will furnish and install Renewal by Andarsen-approved materials to the following specificaflonsi 1. Date on which Work Is Scheduled to Begin: S.-Jat Expected Date of Substantial Completion, 2. Contractor will Install a total of a windows in Owner's h6me, using the following individual quantities: 7r, — Double Hung (DS) 0 Equal sash 0 Cottage sash (113 top, 2r3 bottom) D Odel sash (213 top, 113 bottom) Casement (CW) 0 Hinge right 0 Hinge left (as viewed from extehor)� OStandard handle OMetro handle Double Casement (CDW) OStandard handle []Metro handle Casement I Picture / Casement (CPW) 0 1:11 or 0 11:21 OStandard handle Z]Matro handle 2 Lite Gliding Window (GW) Glider I PkAure / Glider (GPM 0 1:11:11 or 13 121 Awning Window (AW) Picture Window (PW) Bay or Bow Window: 3. VVes []No #Windo �ustbm FI(Replacement-_L& 4. 0 Yes gNo # of sills to be replacoid by Contractor 5. P_Yas 10 No # Windows to be New Construction Full frame (includes now Interior & exterior casings), ZZ Exterior casings: 0 Pine [3 Maintenartco-frw material 0 Factory applied DD8 Fibrox brickmold 6. Glazing to be: 15LHigh Performance 11 Other If other, pleasLh specify: 7. Exterior color to be: VWhita 0 Sand 0 Canvas C1 Terratone 8. Interior color to be: PLWhite 0 Sand 0 Canvas 0 Torratone 3 Wood Not@: Interior color can only be white. wood or same color as exterior. Wood interiors need to be finished by Owner. 9. Hardware: PMhite 0 Stone [J Canvas 0 Brass Double Hung: Install lifts? NkYets []No 10. 13 Yes dLNo Contractor will remove metal f rames or grilles. # of Units: _ 11. 0 Yes WLNu Contractor will install new paint -ready or stain -ready casings. Inside or outside stops # of openings: Interior casing # of openings: _ Exterior casings # of openin s: 0 Pine 0 Maintenance free material '—Owner Is aware that Contractor does not do any painting!�- ..IK-dw—nerinitals 12. 0 Yes "o Contractor will wrap exterior casings _wIth-alu—mi-nim coill stock of color. Note. Re a a crew holes in casing. . . quired with storm window remcva; removal of storm windows will Is v il 13. Now windows to have: 0 Half or DILZud screens Screens to be: 4%Eiberglass 0 Aluminum 0 TruScene 14. Windows to have grilles: 13 Yes ANo If Yes: 0 Grille Between Glass (GBG) 0 Removable Interior Wood (INTW) 0 Full Divided Light (FDL) Gfille pattems: #:_ #:— #:— fp— D P 17 M DH OH DH DH CWIPIcture Glider CPW or GPW *use additional sheet If needed Owner approved (inifial6): _ 15, Yes 0 No Contractor will Insulate, caulk and seal* windows with 3 -point system to prevent water and air Infiltration. 16. Yes Q No A limited warranty shall issue to Owner upon completion of the job and payment In full (see reverse aide). 17, Yes C3 No 11tilildling. Permit - Contractor will secure any and all necessary permits. The fee for the parmiks) Is not kncluded In the Contract Prixndw7snarale c ec is uired he time of sale for hi s 18. Additional job details: A e -M Fi S4 0&7� ?o A&n 1D. ElYes 13No Ownerhasrovi ed the Acl d Itinna I Terms ana Con ditionstovern Ir g this Contract oin the rei 2D. Total Contract Price; 7 O.L.- Regular Retail Price: $ All avallable dl,vounts r1iied, Wes 0 No 21. Deposit (1 t3): $ paid by 0 Cash RFinance (Account #: 11/4-6 -9 Second (113) $/1 a-22 to be paid by Cash at start of job on J- y -0, r- (Estimated start date), Final (113) $ ' - Z f7-- to be paid by Cash at completion of job on J- 7-70 Y' . (Estimated completion date). 22. KYes D No owndr agrees to be present on the final day of installation for final Inspedbirt and to dalive(final payment. No rinai Dsvment shalil be demanded unffl this contract Is completed fo the sailsfactbr; of a# parties. NOTICE: All home Improvement contractors and subcontractom must be registered. Any Inquiries about a contractor or suboontractDr.r6latng to a registration should be dirnted to: Registration Olvielan, Program Coordinator, One Ashburton Place, RooM INI 1,00oltgin, MA 02108, Tol: (61T) 727-3200, ext. 26239. The parties hereby mutually agree In advance that should a 4disputs arise regarding this contraof, Contractor may submit such dispute to a private arbitration service that has been approved by the Office of the Consumer Affairs & 6tuallness Jqelgulalli and -Owner shall be required to submit to such arbitration ". provided In MOL e. 142A. Contractor Signature-, Owner SlI --- I—, NOTICE- The signatures bf the pirtles. above apply on to ftIr agrZ;n'��`o' alterne dIsp6te resolution Inklated by Contractor, Owner may initiate alternate dispute resolution even where this section Is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES J&L Windows, Inc. d/bia Renewal by Anderson By: Z&O01-y. ProductMonager Owner Sigrw!A- . - . - . M, � _P .. SM14 C I - - Product Manager (Print Name) Owner Signature While -Renswal by Andersen Yellow- Installation Pink - Homeowner I .17 1\ Nov 05 2008 12:00AM MIKE SIDMRN 6039345514 . ......... ........... ......... ............. p. 6 J -e L"Ien Owner of the subject prop MtY hp-xby authorize &Ren�ew�alb Anders n (d.b,a. – J@L Vindows) to act On my behalz in all wO.rk authOHZed by this building perrait application fol matters relative to address c)fjob atuxe of Owner / *1 —Zo I 9 1 �- �,M A A WE Y --O Date as Owner/_Authoriz ft-u--i� �� sta4tements 'and infc)- 'APZUereby declare kation,'o e"fore� ation that, the oing application for: Signed under t�e pains and-penalti-ea of pe��. Pritant Mane . I D4 Otis stmet 240TthbCW04h. MA. 01532 Pbone (508) 919-0900 FRX (508) 91.9-0903 Date; The Commonwealth of Massachusetts . Department Of Industrial Accidents Office of Investigations 600 Washington Street .9oston, M� 02111 www.mass.govIdia Workers' Compensation Insurance Afridavit: guilders/Contractors/Electricians/Plumbers 0 Applicant Information lease I Print Legibl y Na'Me (.Business/O'Wizador&di,,idual): A.- i n Address: I A jJ AU - �Vji 'City/$tate/Zip' I 1� 1� Phone#. (!, ph, ?157,d�PA, Are you an employer? Check the appropriate box: I al am a employer with 4. D 1 am a general contractor and I 2.[employees (fiffl and/o.rpart-time).* ] 1 am a sole proprietor have hired the sub -cont . ractors or partner- ship and have no employees listed on the attached sheet These sub -contractors have working for me in any capacity. [.NO Workers' cOMP. insurance workers' comp. 'Misurance. 5- We are a corporation and its requiredj 3, 1 am a homeowner doing all work Officers have exercised their - right'of exemp4on per MGL myself [No Workers'comp. c. 152, § 1 (4), and we have no Insurance required.] t. einployees. [No workers, A 7=7=7 cOMP. insurance required.) tAnY aPPlicant that checks box #1 must also 0 out the section below showing — T40meD— L theirworkers'co -.44 Type of pr Ject (required): oj 6. []New construction .7. Remodeling 8. Demolition 9. Building addition 10. Electrical repairs or additions I I -[I Plumbing repairs or additions 12.0 Roof repairs 13. [1 Other _t, — Pum;Y nuormauolL Os rmt m's affidavit indicating they are doing an work and then hire.outside contractors must submit anew affidavit indicating such. ontractors that check this box must attachedan additional sheet showing the name of the sub -contractors and their workers' comp. policy information, am an employer t)iat isproviding workers 2 coNlpensadOn insurancefor . my information. employees. Below is the polic Y* andjoh site Insurance Company Name: ce— - Policy # or Self -ins. Lic. M Expiration Date Job Site Address: City/State/Zip: Attach a copy of the workers, compensation Policy declaration page (showing the policy number and'expiration &te). -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 imprisonmen� as well as civil penalties in the form of a STOP WQRK ORDER and a fine of up to $250-00 a day against the Violator. Be advised -that a copy of this statement maybe forwarded to the Office of Investigations of the DLk for insurance coverage verificafion. I . do hereby cl�!Y under I pa and - penaldes o rjury that the information provided above is true and correct. M,FMX= Official use only. Do not write in this area, to be completed by city or town official City or Town: Issuing Authority (circle one): Permit/License 4 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Pluxnbi' 6. Other nor TrcnariFn� Contact Person: Phone M Massachuscits.- Department of Public Safetv .12111111. Board of Building Reg-ulations and Standards Constructi.on Supervisor License' License: CS 99255 Restricted to: 00 SCOTT PHILLIPPI 58 0 STREE7 WHITINSVILLE, MA01568 Expiration: 61-712011 Conini6sioaer Tr#: 99256 Restricted to: 00 00.. Unrestricted IG - 1 2 F=fly Homes' *tion of the Failare to possess a current ed -1 Massachasetts State Building Code is cause for revocation 61 this Ucense. Refer t4o: WWW.M2ss,.G-ov1JDPS QN B02rd of Buildi nj Regalations and Standards mum HOME INF.ROVIEMENT CONTRACTOR Registr�3�10'rx:, 149601 pplernent Card RENEWALBY 0 SCOTT PHILLIP 99 j�- 104 OTIS STREE '0 Adjulnistrator NORTHBOROUG T 32 AC -00. CERTIFICATE OF LIABILITY INSURANCE DATE (M=DlYYYY) PRODUCER .Joseph McKeone JP McKeone Insurance Agency, Inc. P.O. Box 333 Ann Arbor, MI 48106-0333 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 INSURERS AFFORDING COVERAGE ' 0 NAIC # INSURM Renewal by Anderson J&L Windows, Inc. 104 011s St Northbomugh, MA 01532 INSURERA: Hartford- lnsu�ancel Company INSURER a: Hermitage INSURER C: 1 INSURER D'. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR JJL ADOL INSR13 rifPEOFINSURANCT PbUCYNUMBER POLICY EFFECTIVE DATEIMMIDDFM POLICY EXPIRATION DATE (MMIDDrNi LIMITS B GENERAL ILIABLITY HCP 507 404 09/07/2008 09/07/2009 EACH OCCURRENCE s 1,000.000 UWA t 10 Rf NTgo PREMISES li oetwonw) 6 100,000 7X COMMERCIAL GENERAL LIABILITY CLAIMS MADE R OCCUR MED EXP (Any one person) s 5.000 PERSONAL& ADV INJURY IS 1,66050� GENERAL AGGREGATE s 2.000.000 GENL AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMPICIP AGO 5 2,000,000 -1 3 -1 LOO 7 POLICY F PERCOT A MOmOBILELIABILM 35 MCC XD 6390 10/01/2007 10/01.2008 COMBINED SINGLE LIMIT 1,000,000 4 AWAUTO (Es oodde 0 is BODILY INJURY X ALLOWNEDAUTi SCHEDULEDAUTOS (Par Person) s BODILY INJURY HIRED AUTOS NON-OVWMN D AUTOS (par Accidoni) PROPERTY DAMAGE (Par nimident) GARAGE LIABUJITY AUTO ONLY - EA ACCIDENT s OTHER THM F-AACC S ANYAUTO AUTO ONLY. AGO S EXCESSIUMBREI I A LIABILITY EACH OCCURRENCE 8 OCCUR CLAIMS MADE AGGREGATE S DEDUCTIBLE RETENTION s A wORKERSCOMPEIISATION AND 35 WEC PP 1444 02JI 712008 02/17/2009 10- ITO.C.S.T.A.Tui I FTP"-" EMIPLOYERSi'LIABILITY E.L. EACH ACCIDENT s 500,000 ANY PROPRIETORJPARTNERIEXECUTIVE El DISEAS9 - EA EMPLOYEE 8 500,000 OFFICERIMEIMER EXCLUDED? 111yea.desm" under I SPECIAL PRONASIONS below 61. DISEASE - POLICY LIMIT I S 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS INSURED COPY 29 12001/081 SHOULD ANY OF THE A13OVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KOM UPON TKE INSURER. ITS AGENTS OR AUTHORIZED REPRESENTATIVE 4*4 9) ACORD CORPORATION 1988 Te a.1 rRitc, A r trim WoodMpyl Cdmpositiftime OU41. ArM 'Low E Piclu re -ENEROY PERFORMANCE -RATINGS U4a*ctor (.U.S)/I:.p . in C e ictint Sblar Heat G� o ff' -'0-8-32' -0.:i 32 ADDITIONAL PERFORMANCE RATINGS - Visiblei Tran sm . !tta n-ce. - I" It, um V, 's PESIGN PFtESSOFW(PSF)--: 0 4-02, '0 0-, 6229 boJ u AmvA, 1*'w-i-lom.,W.,Ilqi...i.�."—&U.%,i.,io&.Wo..&,A,, - 401C jot I, 7-e- 400 FrenchwoodS Gliding AndersenO 400 Series Frenchwood@ Gliding Patio Door Performance Cent6r of Glass Performance Data ; ........................ I ....................... I A, 1 14 4.1% FJ Tramon �'n wood" Rat 092 191 64 A I 41% 0.90 6C. �`O W Fkad bmm 1% ',0`49,,�, -M 0.92 1 QW, 65% b Too 191 41% 68% Ufrofte Cimino Path Door 0 87 181 K 42% -71 4 21K AmftasW A" Top, Spft%C U2 rk". V 172 ZQ 53% A C&MOM AMk4 MW&sk �;j -v Wood"k ftow 050 4 104 4% 6 W., -M - 1_4 Cament Migure, Amhq AI�",` 102 ��,Ijb%_-,, 33% M "1 0.49 �,, V. ...... . . . ............ ...... .... I ....... ... 104 ij Clio ii" " I (400 Sarin) 34% 6ft .. . ................ . ...... ...... ........ . . ......... . X,� IN 050 104 C "p", , � iM� t1ball C oval 7 34 60% Perma-ShbW Patb Doc; Mp, 60% 0,49 101 32% Barman- GNbu Palb Door ........................ .. ...................... R, . . . . . . . . . . . . . ............ ................ . ........... .... . .......... ....... ............. . .. . . . .. .... .......... . ...................... ..... ........... ...... 1""' 60% 101 J! W C 80 hou I'M 0. 4:1 32% 04 kt, 31% 61% am WWWM/Skylots Oftillefto 42 0.4 102 �3% M .......... ............................... . . ........ ... . ................. . ... . . . .. ...... .............. . ... ........... ....... .... ..... . . . . . . . . . . . ............ H 62 101 25% 6W, Lm hated (al pmamAO 1 �._ _� . . i I'll OA .- A, � _gz�� id , T� ,j A k 25, Camank /An*% TVWask Woodw!Mir Twom 0.36 76 t z 24% PIMWO umft: I ''1 .1, 3 74 0,35 1, - ;3T 75 23% ""IT % 57% Climb Tar, Eft*Al UP, Cftk OW 75 2.4% "14 57% �54 Penx&SbIzV* palb Dmi, FmIC 1111NOW 34 W� 73 -N 5 KI.., 73 AA 22% 22 % Filuvrane, Atch Whkalk Roof W161111MWISONOW"M 3 71 1_111�1,29,*�,,, 1 73 5-t Ve :14 22% ON LA 13 —8b A(Mi IrM_")_ 1,35 M 73 LAI 1 58YO "High -Performance" (HP Low -E) and "High -Performance Sun" (HP Sun) are Andersen trademarks for Low . -E glass. Page I of 2 $04 qmftwft 6 z t CO ts Cl 0 C.3 Cc Co 0 C/) u U) or - Cam CD CA x co �Cls go CO t14 to :1 0 —co r. x ZW w CO 8 cf) o CO ts Cl 0 C.3 Cc Co CIO. CM!B C=,* COD Cam CD CA r= 00 go C-3 5 9 Cc,: coo LU -0 0 Is ts CD CL= 0 ca cm C.3 CD 0= OR. 3: cm 4D A .0 CD Do, ca m CD 0 CL C-2 CIO. CM!B C=,* E CA ca cc CD CD CD CD cm I-- 441 cz F. Cf) z 0 Cf) rn Cf) z 0 u C/) Ne . u u 0 !9 4-j u E z I COD CD CA .9 CD L- CL C CO3 C CO2 cc cc CL CO) is CL CM CL) co co C CD CD CL CM49C cc C) CD .10.6 2c ca CD CL CO) LLI w U) 09 uj uj 1% uj LLI U) CD Cam go v CD c 5 9 Cc,: coo LU -0 0 CL= LU ca cm C.3 CD 0= CO2 CL Go 4D cc .0 CD E CA ca cc CD CD CD CD cm I-- 441 cz F. Cf) z 0 Cf) rn Cf) z 0 u C/) Ne . u u 0 !9 4-j u E z I COD CD CA .9 CD L- CL C CO3 C CO2 cc cc CL CO) is CL CM CL) co co C CD CD CL CM49C cc C) CD .10.6 2c ca CD CL CO) LLI w U) 09 uj uj 1% uj LLI U) Date. A�.- z f ........ TOWN OF NORTH ANDOVER 1-0 PERMIT FOR GAS INSTALLATION This certifies that .......... has permission for gas installation ..... ................... in the buildings of ... (' . �.� �-1 ...................... at .... ............ North Andover, Mass. Fee ... ... Lic. No.. J. .. ..... ........... ........ G'XS INSPECTOR Check# ) //,�, t 4171 MASSACHUSETTS UNIFORM APPLICATON FOR PERMrr To DO GAS Fri'm (Type or print) Date lok NORTH ANDOVER, MASSACHUSETTS Building Locations Permit"# Amount $ ul, fuoj-4�j A1140 61 Owner'sName ��(Jjfj nc_//e NA-) New Renovation Replacement Plans Submitted (Print or type) Address ,,— (-T ,,� �h Business Telephone Name of Licensed Plumber or Gas Fitter V157 - one:. Certificate Installing Company Corp. 1:1 Partner. 64hj EEjFirm/Co. INSURANCE COVERAGE Check o s I have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked yes p]W cate the type coverage by checking the appropriate Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver I am aware that the licensee does Bot have the Insurance coverage required by Chapter 142 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement of Owner or Owner's Check one. Owner 13 I hereby certify that all ofthe 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 ed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts Stater7e and ChaiRter 14/?f the General Laws. City/T(7w—n (OFFICE USE ONLY) Signature of Licensed Plumber Or barFtttep Plumber 0 Gas Fitter License Number Fa Master '3oumeyman RON 13RD. FLOOR 16TH. FLOOR me: (Print or type) Address ,,— (-T ,,� �h Business Telephone Name of Licensed Plumber or Gas Fitter V157 - one:. Certificate Installing Company Corp. 1:1 Partner. 64hj EEjFirm/Co. INSURANCE COVERAGE Check o s I have a current liability Insurance policy or it's substantial equivalent. Yes NoO If you have checked yes p]W cate the type coverage by checking the appropriate Liability insurance policy Other type of indemnity Bond Owner's Insurance Waiver I am aware that the licensee does Bot have the Insurance coverage required by Chapter 142 ofthe Mass. General Laws, and that my signature on this permit application waives this requirement of Owner or Owner's Check one. Owner 13 I hereby certify that all ofthe 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 ed under Permit Issued for this application will be in compliance with all pertinent provisions ofthe Massachusetts Stater7e and ChaiRter 14/?f the General Laws. City/T(7w—n (OFFICE USE ONLY) Signature of Licensed Plumber Or barFtttep Plumber 0 Gas Fitter License Number Fa Master '3oumeyman Date.A�.. Iil ..... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .6�2' "� d" -, / 1h, el- -, ......................................... has permission to perform .... ........................... plumbing in the buildings of ................ at....) .... (� 4�' '0� y 0, / ", . .......... ......... North Andover, Mass. Fee. Lic. No.. .. ......... PLUMBING INSPECTOR Check# 2 "G( — 5 4 10 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS /0 h 7 /6,9- -3 P-,O"r) Building Location Owners Name �(— Permit # Type of Occupancy Amount New Renovation Replacement Plans Submitted Yes No 0 1-1 . 0 FIXTURES (Print or type) el Check one: Certificate Installing Company Name rid(lu, Corp. Address Q1— All /1/, E] Partner. Business Telep MOne Y 12Y -77 5Z7 Firm/Co. Name of Licensed Plumber: ( ,a K ( ) c�auat � Insurance Coverage: Indicate the Sype of insurance coverage IYY checking the appropriate box: Liability insurance policy Other type of indemnity Bond P I Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent El 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 installatio perf d u der Permit Issued for this application will be in n " u comp husett t e Plu 9 de and Chapter 142 of the General Laws. liance with all pertinent provisions of the Massac ive in By: Tignature Of Llcensea Flumner I/ Type of Plumbing License Title 7 -C2 11-/ City/Town se Numoer Master Journeyman E] APPROVED (OFTICE USE ONLY Date.. ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ......... 5�./P.c ............... . .............................. ...... .... .... ... has permission to perform ... :�� E, t U k (- --- c) P G. P. 4).D .............................................. .... ... .... z ....... wiring in the building of ..... C ) �- 'i &�) � A -j ......................................................................... C � A -P (A) P 011 Jat ......................................................................... ...... . North Andover, Mass. (.(A ......... ..... . ....... Fee .... ...... Lic. No. ...... ................. ELEM . ICAL .&§P . ECTOR ................. Check # 3 L 4 -�-- Official Use 0ifly Commonwealth of Massachuset Permit No. Department of Fire Services OCCUpancy and Fee Checked BOARD OF FIRE PREVENTION kEGULZIONS / 0 1. Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO'PERFORM ELECTRICAL WORK All work to be performed in accordance wit], thqA4assachusetts Electricifl Code (MEC), 527 CMR 12.00 J (PLEASE PRINT IN INK OR TYPE ALL INFORMA TION) Date: F�ehlruqwq &1&0014 City or Town of: ko ir-liq dove r To the Inspector qflftf�eyl By this application the undersigned gives notice'of I-Fis or her intent] oil to 3erform the electrical work described below. Location (Street & Number) , /� () � a 115 11/? R ^ () 17) 1` Owner or Tenant _Mdr Owner's Address -19 Telephone No. 9�3-63,'S'-S(Z`7 Is this permit in conj unction with alb jilding permit? Yes No Tr (Check Appropriate Box) Purpose of Building Utility Authorization No._ Existing Service /00 Amps /,ID/AYOVolts Overhead [0" Undgrd No. of Meters, New Service Amps L,�OLIA'bVolts Overhead Undard No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: sp ?(ace 4� o, hp if jk, - I I -,- L I Completion qf 1he following table incti, he icuived hi�_the Inspector oflVircv. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets Noi of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above o In- of Emergency Lighting girnd. gyrrid. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS �No. of Zones No. of Switches No. of Gas Burners No. ot'Detection and Inifinting Dol'i— No. of Ranges No. of Air Cond. Total Tons ....... .... No. of Alerting Devices No. of Waste Disposers Heat Pump Number ' Tons I KW I No. of Self -Contained No. ofWater KW Totals: Data Wiring: Heaters Signs Ballasts Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local E] Municipal 0 Ot her Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. ofWater KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: I No. of Devices or Eouivalent OTHER: Attach adilitional iletail �f(Lyired, oi- as requireat 13v the Inspector o * / Wircv, INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work Illay issue 1.1111CSS the licensee provides proof of liability insurance Including "completed operation" coverage or its Substantial equivalent. The undersigned certifies that Such Cover ge is in force, and has exhibited proof of sarne to the permit issuing office. CHECK ONE: INSUI WBOND El OTHER El (Specify:) (Expiration Date) Estimated Value of Electrical Work: 'NIA (When required by Municipal policy.) Work to Start: 'AA, /0 Inspections to be requested in accordance with MEC Rule 10, and LIP011 completion. I ceiiij o peipu:)), ta tl ' /' -1 1011 .ii, under tfie'p'ah s andpenalties tl t te ii� (n Id on this application is true and complefe. I LX M . E�4�1 LIC. : FIRM NAME: UL,2 NO. on, oo Licensee:<SQ-11, Signature OW 7 &"LIC. NO: (�foppflcahle, enter "eXein it? the ficense innyl)er line.) Bus. Tel. NC 1)A AA 14— Q IR-lq Alt. Tel. No.: Address: 9�2 �fmy-. OWNER'S INSURANCE WAIVER: I arn aware that the Licens96 does not have the liabilitylinSUrance coverage normally a required by law. By my signature below, I hereby waive this requirement. I arn the (check one) El owner El owner's a -crit. Owner/Agent Signature Telephone No. 7PERMI T FEE: $ '0 0;* TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING This certifies that ...... ............................ .... . ............ ....................... hai permission to perform ..... e, ........... ..... ................. I ...... I ....... ... wiring in the building of . ....... C ......................................... at ........ .... CXI.'.'�.'ax .............. '/-'North Andover, Mass�� ':y ............................... .-. . . . ............. Fee .... ........... Lic. NO.. ..... ELECTRICAL INSiECTOR Check # 51- 4 1 Commonwealth of Massachusetts Official Use Only Department of Fire BOARD OF FIRE PREVENTION APPLICATION FOR -DER All work to be performed in ac( ordwic it (PLEASE PRINT IN INK OR TYPE AL ffF70A City or Town of: a 1% By this application the Llnderslgle�gives noticy, h s or Location (Street & Number) -1!3 a� AIJIL/L Owner or Tenant I'Ar Owner's Address IQ .1 a Is this permit in conjunction with a' uildingy permit? Purpose of Building Existing Service Amps lo�_06AJ�! volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Permit No. ?rvices Occupancy and Fee Checked ,4ULATIONS [Rev. 11/991 (le, ,lve blank) TO PERFORM ELECTRICAL WORK the Massachusetts Electriul Code (M C 527 CM R 12.00 70]v) Date: ?e_4nrnryn,7U-.r_�q �,O To the Inspector qf'Wles: lei, intention to perform the electrical work described below. Yes El No [V (Check Appropriate Box) Utility Authorization No.— &1A Overhead P/ Undgrd 1:1 No. of Meters OverheadEl Und-rd [_1 No. of Meters 'VIC-0 i-1— Af )'V-)'iAQ 1'tA� I�T rL , CoInpletion of the following table inai, be vivived bv the hispector qflYirc.�. No. of' Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlet No. of Hot Tubs Generators KVA No. of Lighting Fixtures 1 1 LA_ i Swimming pool Above El El gyrnd. gi-nd. ot Emergency Lighting BatteLy Units 0 No. of Receptacle Outlets No. of Oil Burners FIREALARMS [No.ofZones No. of Switches No. of Gas Burners U No. of Detection and InitiatinLy Devices No. of Ranges No. o Air Cond. Total Tons No. of Alerting Devices I No. of Waste Disposers Beat Pump I. oils KW I So. of Self -Contained Totals: Detection/Alerting, Devices mullicip,al 0 Othe 1. No. of Dishwashers Space/Area Heating KW Local 0 Connection No. of Dryers Heating Appliances KW ;Security Systems: No. ol'Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent 1 No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: 6 1 1 No. of Devices or Eauivalent OTHER: Allach additional detail il*(Lyired, or its required bl the Inspector ol Win�s. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue L1111CSS the licensee provides proof of liability insurance Including "completed operation" coverage or its Substantial equivalent. The Undersigied certifies that SLIC11 cover gre is in force, and has exhibited proof of sarric to the permit issuing Office. CHECK ONE: INSUI 7BOND [I OTHER El (Specify:) Estimated Value of Electrical Work: 91A (When required by Municipal policy.) (Expiration Date) Work to Start: .2 e;��10q Inspections to be requested in accordance with MEC Rule 10, and upon C0111pleti0n. I certift, under the pains andpenalties Q pejui- the infin-niation on this application is true and complete. y, t tat FIRM NAME:. (h U1,; LIC. NO.: Licensee: J-6k0l, I J5 tt S Signature LIC. NO.: (�f applicable, enter "exempl, " in the lice4ise nund?4, line �us. Tel. _% Alt. Tel. No.: Address: q —of OWNER'S INSURANCE WAIVER: I arn aware that the. fire, Inot have the liability insurance covet -age normally required by law. By irly signature below, I hereby waive this requirement. I arn the (check one) [:1 owner El owner's agent, Owner/Agent Sianature Teleplione No. PERMIT FLE: $ Date... 41- - Z- - - - ' / - 0 q 4, TOWN OF NORTH ANDOVER 0 PERMIT FOR PLUMBING CM This certifies that ............ ........ has permission toperform'�.Az--'X' /* plumbing in the buildings of ........ . ::�K� ............ at' -3 ......... .......... North Andover, Mass. ILIIM.1�4 1111 ECT.R. . . Check # 5'.1 7 0 i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBIN (Type or print) NORTH ANDOVER, MASSACHUSETTS /C le� Date 2� Building Location Owners Name Permit Amount 00 Type of Occupancy New Renovation 'Replacement Plans Submitted Yes No rl h–j . 1:1 El FIXTURES (Print or type) Check one: Certificate Installing Company Name 6 "M I K)6 -V fil '6t,471V /L/�— El Corp. Address 0 ",7Z & e le- 13-1-artner. kvu 1,0 A 4:�Vz Busines � 9 -?-K -7-�-) 1111;9 1?1 1:1 Finn/Co. Name of Licensed Plumber: 01/1YRI-S (!�,6 Alwb Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity El Bond Insurance Waiver: 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner F1 Agent F1 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 instoations performed under Pen -nit Issued for this application will be in b compliance with all pertinent provisions of the MassachuAtts Sta - , J2+lugKjgg Code and Chapter 142 of the General Laws, APPROVED (OFFICE USE ONLY Type of Plumbing License 12- 91V License 114umoer Master ED Journeyman 11 Date. tv. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ...... C, ........................ . ........................................ A Cjlof I 1 (0 Aj YL f �- has permission to perform .... ............................................. kj . C)CIr . - ....... . .... ........ wirina in the buildina of M (11'ell '4 V ........... / ... ...... at ...... 3 ... .......................................... . North Andover, Mass. 0 1 ?0 X� De(CIA )A Fee ...... Lic. No. L 0�11 Muw (Oul ll�-- ............. ........................................ . .................... Check # ELEcrRICAL INSPqMR 5139 Commonweaith of Massachusetts T! Department of Fire Servi s BOARD OF FIRE PREVENTION RE ULATIONS official U Permit No. "q Occupancy and Fee Checked 917t L[Rev. 11/99] (leaveblank) APPLICATION FOR PERMITAO PERFORM ELECTRICAL WORK A I I work to be performed in accord ance wi , the M a ssachuscas Electrica I Code (MEC), 527 CMR 12.00 (PLEASE PkINT IN INK OR TYPE. 4LL TJOAr) Date: r City or Town of: To the In ector qf'Wires: jig �4 VQ -Y �j r -o By this application the Unders] �s notice f hfor her intention to perform the electrical work described below. Location (Street & Number) -9 1 eijaA Owner or Tenant Owner's Address Telephone No.9 7s-�099 -7 Is this permit in conjunction with'a building permit? Yes M No El (Check Appropriate Box) Purpose of Building 1\ — 'P Ial Utility Authorization No. A Existing Service.�,06 Amps lc�IOIAqe> Volts Overhead 9/ Undgrd El No. of Meters New Service Amps Volts Overhead El Undgrd 0 No. of Meters Number of Feeders and Ampacity U i6o Avn p 4n 6�j cevr4 jr- 11vt fh4 0� b ttv_ 14 &-"IQ e - Location and Nature of Proposed Electrical Work: r) I I J & Compleli6n qf1hefollowingiable wai,be waivedbi, the Inspector 0/ lVire.s. No. of'Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans INU. of i otai Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA Above E] In 1'q-0. 01 Emergency Lluilting No. of Lighting Fixtures Swimming Pool grnd. grild. El Battery Units No. of'Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. ol'Switches No. ot'Detection a�ld iNo. of Gas Burners Inifintina nAllippe No. of Ranges No. o Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons I KW I No. of Self -Contained Totals: Detection/Alerting, Devices No. of Dishwashers Space/Area Heating KW Local EJ Mun"'Plal El Other Connection No. of Dryers Heating Appliances KW Security Systems: No. ofWater No. of No. of No. of'Devices or Equivalent Heaters KW Data Wiring: Signs Ballasts No. of Devices or Equivalent No. Hydromassa(ye Bathtubs No. of Motors Total HP Telecommunications Wir�'ng: el No. of Devices or Eumvalent OTHER: A flach a(lifitional tletail �f(le�yireil, oras requireil b) the hispector o'l lVil es, INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may iSSLI(-, L1111C.S.S the licensee provides proof of liability inSUrance including "completed operation" coverage or its Substantial equivalent. The undersigned certifies that Such coverW is in force, and has exhibited proof of sarne to the permit iSSUing Office. CHECK ONE: INSURANCE BOND [I OTHER El (Specify:) (Lxplratlon Date) Estimated Value of Electrical Work: 1A (When required by Municipal policy.) Work to Start: q / /0 q Inspect'jons to be requested i n accordance with MEC Rule 10, and upon completion. I certift, under the pain,.8� anelplenalties that the h?formalion on this allplication is true and complete. 1�j & k4^- 'L LIC. NO.: A FIRM NAME: AA , TA' E to r--hn�O- 12 Mole- ignature Licensee: S�10 Z1AA,3 S el /J/U LIC. NO.: (�fapplicable enter 1. exenipt " ill the IW'se munixy, Ime.) 61 Bus. Tel. No.: Address: �ii a I V -S-Umet!�91 I- 0�-,A I AAA Alt. Tel. No.: OWNER'S'INSURANCE WAIVER: I ani'awar int the I icensey. doedsnot have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I arn the (check one) [j owner El owner's aocilt. Owner/Agent ERMIT FEE: S Sionature Telephone No. FP I fLocation__aC�API,--) PC No. .5- / f7 Date -3-10 -0Y "ORT#q TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 1;15 17111 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING 41 BUII,D1NG PERM[IT NUMBER: DATE ISSUED: Ay SIGNATURE: //0 —77Z of Buildings Date BuilTng Co SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: L.0, IDA. Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 94- �', r-, (4k3q Zoning District Proposed Use Lot Ar6i (st) Frontage �ft)' 1.6 WELDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 30 :2 L) 3-c> t7 ly M.G.L.C.40. 54) 1.5. Flood Zone 1.8 Sewerage Disposal System: 2W-11`�97 Private 0 Zone Outside Flood Zone municipal --A On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHEP/AUTHORIZED AGENT 2.1 Owner of Record ai�e (1�rint Address for Service Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor� 0 License Number ddress 4-3 3 51� Expiration Date Sign6re Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 \ 6?, &, f �-,- 9 '.,)k " I I,:-- L— 1-7— L U) L U L4 CoInpany Aame U Registration N11—Mber A Expiration Date Signat&r,e Telephone T M X z 0 01 0 z M 90 0 M z G) I SECTION 4 - WORKERS COMPENSATION (MG.L C 152 § 25c(6) I Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... 0 No ....... 0 SECTION 5 Desctiption o Proposed Work (check applicable) New Construction 0 Existing Building 0 Repair(s) 0 Alterations(s) Addition Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: 3, SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY 1. Building qv C/� (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction Plumbing Building Permit fee (a) x (b) .3 4 Mechanical (HVAC) 5 Fire Protection Total (1+2+3+4+5) Check Number .6 SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLILES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property H�reby authorize- to act on My beha/ If, in all matt rs� relative to wolk uthon"zdd-Ky this building permit application. f L \ 2 (-Z -t 1 0 SigftatL��e -of Owner ' Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 0 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 Not 14 �X -Z' �'? g �Sl 1, Signature ofOv=�Ajea Date NO. OF STORIES 4-�.WSIZE I Yk -A-3 J� BASENIENT OR SLAB 7SPAN S Sl L0( ND RD IZE OiF FLOOR TINIBERS 2 3 DRAENSIONS OF SILLS 1. DIDvENSIONS OF POSTS DINENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLD) OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS: This form is used to verity that all necessary approvals/permit fro s In 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 k LOCATION: Assessor's Map Number --- z -1D SUBDIVISION STREET L^J RECOMMENDATIONS OF 'T OWN AGENTS: PHONE�6? —�--53 3 1' PARCEL-Q�,. LOT (S) ST. NUMBER_ USE ONLY**************** CONSERVATION ADMINISTRATOR DATE APPRO VE13 DATE REJECTED ��OMMENTS TOWN PLANNER FO, INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH PUBLIC WORKS - SEWER/WATER DRIVErh P F RE DEPARTMENT_ RECEIVED BY BUILDING -INSPECT Revised 9197 im DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE- REJECTED. DATE North Andover Building Department Tel: 978-688-9545 DEBR.IS DISPOSAL FORM In accordance with the provision of IVIGL 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 IVIGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) Signature of P�rC!7Applicaht bate NOTE: Demolition permit from the Town of North Andover m*ust be obtained for this project through the Office of the Building Inspector The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print 6 --- Location: 3 C - city tJ Phone am a homeowner performind all work myself. F-1 I am a sole proprietor and have no one working in any capacity -16 1 am an employer providing. workers' compensation for my employees working on this job. Company name: Address 21 Phone #7 - - Insurance Co. Poligy # L�— C- k -t -L,71 Company name: Address Cily: Phone #7 Insurance Co. Poliqf Failure to secure coverage as, required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to $1 ' 500.00 andfor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy q�.;his statement may be forwarded to the Office of I nvestigations of the DIA for coverage verification. I do herby c0Wwfder the �oains and peaqies of p" that the information prokled above is true and conect. Print name Official useonly do not write in this area to be completed by cAy or town official' nCheck if immediate response is required Building Dept Contact Phone FORM WORKMAN'S COMPENSATION ie# Building Dept Licensing Board r-1 Selectman's Office Health Department Other It FEB. 4.2004 10:51AM COGNOS CORPORATION (781)229-9844 V" = ON ;r� Al *e& :�d NO. 604 P. 2 90 0 -e ,0,-Vgn,--gz? A r- C 6� 5 0 '?-9 V45 11 6 t b 4 3 f) 1) tu I " 60 1 VK'Ckckt'.-"q -'k' ll� / C'kk� (A) fo, -e ,0,-Vgn,--gz? A r- C 6� 5 0 '?-9 V45 11 6 t b 4 3 f) 1) tu I " 60 1 VK'Ckckt'.-"q -'k' ll� / C'kk� (A) jr mmmy armW " nm r= mmon Am 'D ro = am rair marnme is no= jw 2WZ lOr Aff SHOW An MAT jr jWjrg WAFojtv 'MW XDMMG MUZADOMS "aaam opmqm Paw mritsm & Lor Zwe 1 1 YURTHU W71=r Me DWSU&g ig )My. Loamb J71 )VAAWL AM JfAZM ANJU AS SHOIN ON PAM f eso4o pa poo 'Am rm PuRpmrs - mor NOR Do r hotwmar mmmarm rAM MOM XVSUMC iNcomS - 1"leo 7 ?7 PLOT PLAN DJUVM roi? Noi- IMCMMCIC RYWHRINNO Savloss GO PAW SVMgr ANJ)OVRJ?, MASSACHUStrTS 01810 It 18 -9 6ld 1709'ON 40 C42�11 M786-622(Tez) woilbNocfdo:) SON90:) WUTG:OT f 0002'0 '93J 20 vz v--- 6ld 1709'ON 40 C42�11 M786-622(Tez) woilbNocfdo:) SON90:) WUTG:OT f 0002'0 '93J If - �717 S, 7-q ^'%.k m %A 70 713 > c V% Li S, 7-q ^'%.k z W�4 M 1709'ON 0086-622(T8Z) NOIlUdOddOO SON500 WU2S:OT 0002*V '93J 713 z W�4 M 1709'ON 0086-622(T8Z) NOIlUdOddOO SON500 WU2S:OT 0002*V '93J 9'd 1709 *ON Av --MT910 LP kc AM I I Z 511 Ils F q P086-622(TOZ) NOIibdOddO3 SON900 WU2S:OT fpOOZ'V a t709,om 20 9z it F V�,86-622(TGZ) HOIiUdOddOD SON903 WUTS:OT 17002'V '93J I rAL VTX X ;Z, Ar W 4Z F2 V P> lZI 31 A e'd 1709'ON M6-622(Tez) Noiiudoddoo SON90D WH2S:OT 0002'0 '93J Z'd 1709"ON P. _q �% � -4 2 VU 704 m I 25 V, VV86-622(Tez) woiiudoddoD SON903 WU2S:OT 0002'V '63- FEB. 4.2004 10:50AM COGNOS CORPORATION (7BI)229-9B44 (G 17) 5-10 - 1. eQ� 0, C)� r �� 0, 3 Cie, NO. 604 P. I I /V �t C. -r-o 2 ye, ot.,-r 'T � i -t) WVJ-Le� U -)e- /?Ce� &44_,V E/-ee.-4r�-k AfOA�) crf o"L-CM41 �-Ls LLb ce 66,,s 4-e— fla4 s &,,gl �:. �5,b 4J 621� "Rpt qn, M m m X m m X (A m CA 5 m CO) CD a z CD CL =r CL F >co CD CL cr =r CD 0 CO) 10 CD C CD -C2. col 0 CD 0 =r CD -0 I"t CD a .CO) CD CO) z CD CD W I n 0 C/) 0 C/) z ca -*,= -0 = --4 Ti- to 10 cr 0 So 10 CA co ErK , A'Ags !R n �R :7- cm CA 0 CLO m T (D Z 0 ar LA. :;i Er =r CD CO) a 64 =cD ..4. CD -4 CA CD CO 0 ZIC C2 C.) 4ow-i Co a' CD CA CL a' cc CL Ogg... dc CD CD CD co 'o =CI) CD OCS, CR cr C12 -CCD 14 =r CO) CA , CD 0 Cc*, =r CD CD IF, lop C$ coo =rlob: CD i1v CL cl c C2 C, C/) 0 C/) z oil Ti- i Ls T Fv 'IV cc S- co "X �* A o t I m �j �R :7- ;,c; ro x a' rL w C/) CA T (D CA M. w M z 0 0 19 0 44i CD PI Date ...................... ORT01 -14, TOWN OF NORTH ANDOVER 'to '6'6 PERMIT FOR GAS INSTALLAT This certifies that .......... ............................. has permission for gas installation ................. in the buildings of ....... ................................. at ................ North Andover, Mass. Fee. Lic. No .......... ............ ............. GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTH ANDOVER Mass. Datec?'_z Ituilding Location IA J) Permit # 7) Owners Name&,^ '4 314t,"t-jers New 77 Renovation IL-1 Replacement Plans Submitted F I X T L.TP E- 5 (Print or Type) Installing CoMpany Name� Address 12, 4evleil P(,- I �e, ng Business Telephone: Check one: Certificate Corp. Partner. Firm/Co. 2qq-7Q?s-_ 1 11 F . n Name of Licensed Plumber or Gas Fitter C) IM/ IMS Insurance Coverage: Indicate the type of insurance bverage by checking the appropriate box: Liability insurance policy r�� Other type of indemnity 0 Bond 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 owneriagent of property Owner 0 Agent 1 hereby ccray that all of the dcuilsand information I have submitted (or entered) in above application are true;nL ap t h best of my zrz�ewa ti e I ith knowledge and titat aU piumbing work and InSCALlations perfomicd unde. Permit issued for this application will -be L9 om in pcztln=t ,enczzi Laws. i provisions of Lho Masuchusctis State Gas Cude and Ch&Ptct 142 of Lho C T1 By Title C i ty/Town: APPROVED (OFFICE USE ONLYJ TYPE LICENSE: Plumber Gzisf itter- L Master Journeyman signZIL re 1�f Licensed P1umb'Z__r/-p,r \�asf itter License Number LU LU (a P >* 0 cc tu W o CC LU > LU 0 0 W C3 z CC 'U LU W P W P. U. W W > 0 0 o 1Aj 0 > SUR—BS'MT. [BASEMENT I ST FLOoft 2ND FLOOR 3RQ FLOOR 4TRFLOOR STH FLOOR 6TH FLOOR 7TK FLOOR STRFLOOR (Print or Type) Installing CoMpany Name� Address 12, 4evleil P(,- I �e, ng Business Telephone: Check one: Certificate Corp. Partner. Firm/Co. 2qq-7Q?s-_ 1 11 F . n Name of Licensed Plumber or Gas Fitter C) IM/ IMS Insurance Coverage: Indicate the type of insurance bverage by checking the appropriate box: Liability insurance policy r�� Other type of indemnity 0 Bond 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 owneriagent of property Owner 0 Agent 1 hereby ccray that all of the dcuilsand information I have submitted (or entered) in above application are true;nL ap t h best of my zrz�ewa ti e I ith knowledge and titat aU piumbing work and InSCALlations perfomicd unde. Permit issued for this application will -be L9 om in pcztln=t ,enczzi Laws. i provisions of Lho Masuchusctis State Gas Cude and Ch&Ptct 142 of Lho C T1 By Title C i ty/Town: APPROVED (OFFICE USE ONLYJ TYPE LICENSE: Plumber Gzisf itter- L Master Journeyman signZIL re 1�f Licensed P1umb'Z__r/-p,r \�asf itter License Number I oz: 06 I IN'd MEMO so= mom FL 0 LEJ rr-::�- :;:7 1 Elm ME 0 LEJ rr-::�- :;:7 1 77 < �sz ZZ a IF 119-16Z jjl-:� 11 ---A 0 119-16Z j nj >< 2L Li �sz 0 0 A Rg 4EEEEEE�Fr Q) x �Z/ CJD av X �Zl �z ZZ Z Z All E4 > Z RL/ z Q) z z - - - - - - N Q) �Z In x \I) z 06 7 119-16Z j nj >< 2L Li �sz 0 0 A Rg 4EEEEEE�Fr Q) x �Z/ CJD av X �Zl �z ZZ Z Z All E4 > Z RL/ z Q) z z - - - - - - N Q) �Z In x \I) z QV 0.6 A 7- > ft 014 CIO) Q Q) 91 A 7 Z ol Kol- �Z RV 016 ft 014 CIO) Q Q) 91 Ci Q� A 7 Z ol Kol- Ci Q� 91. ou I IF �z kA ZZ z kz i o FJ -1 ME MM ME I Moo] z z RL/ RL z �7- )1A 57< , 2L/ ME MM ME I Moo] z z RL/ RL cz I kA RL Z < !SZ 0, El Q) 21 > 2L <Z I�A �Zl RL > lu -- - --------------- — --- A c 77 X z 0 A� !. (Z� �— < 2s \ �) Z 0 L ��s �u lu > z 7 �J' l< cz :3 < < Cil JU Iz Lu N U� 06 > tj Vl- �3 2L ;5 L 12A >< z u U :7 -3 N >< N ---' W N Z- N ::E �\ I "Ooo, WC\/ 5; N Q) 21 > 2L <Z I�A �Zl RL > lu -- - --------------- — --- A c 77 0 Z:E Z 06 �3 2L Z- "Ooo, or Z up 06 Ir I 2L up RZI or w Q) 21 > 2L <Z I�A �Zl RL > lu -1.11 zi� 2x 0 MIR :7 Q) 0 Z 06 -1.11 zi� 2x 0 MIR :7 Q) Q) < z < I\A < Z�z Cj Q) lu �u �3 z 7 < Oil- I N t '-�- N �- C 1. 1 > < Ci, �- C 1. 1