HomeMy WebLinkAboutMiscellaneous - 30 MASSACHUSETTS AVENUE 4/30/2018 (4)C/)
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TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
hiiscertifies that ... . ........................ :� ........... A ........................ I ...............................
has perinission for -gas installation ..................... ... .. . ...... . ...
P
)I bO ON oil -
in the buildings ofA.... ......... ..... 1-5 .............................
at ..... a2� ......... � A.V .. . ............. . North Andover, Mass.
Fee.Roob -7-n, -)
.::� ...... Lic. No . .......................... .....................................................................
GASINSPE&OR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY , AIO�'r# AIVDOUty- MA DATE IPER'MIT#
JOBSITE ADDRESS 3 0 +Uc-
JOWNER'SNAME J)ISC
GOWNERADDRESS 30 AVE --JjTE 6&79300 jFAX=
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL D
PRINT
CLEARLY N E W: Ej RENOVATION: El REPLACEMENT: PLANS SUBMITTED: YES D NOW
APPLIANCES -1 FLOORS-
BSM
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/ SPACE HEATER,
ROOF TOP UNIT
TEST
UNIT HEATER
LINVENTED ROOM HEATER
WATER HEATER V%
6THER Fois Pipikdwl 50
=
fr-
10 1 11 1 12 1 13 1 14
Irk, INSURANCE COVERAGE
f '" -, "
I have a current liability insurance policy or its substantial equivalent which meets the requirbments of M G*L. Ch. 142 YES (K NO
I IF Y(�U CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX 13ELJ0'W
LIABILITY INSURANCE POLICY Fx-1 OTHER TYPE INDEMNITY F-1 13OND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application Will be in compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUM BER-GASFITTER NAME \Al"1114-A IT, Rk-OTet.0- JLICENSE 00,231 SIGNATURE
IMP ED MGF El JP [K JGF [] LPGI E] CORPORATION [J# PARTNERSHIP 01 #= LLC [3#=
COMPANYNAMEI 188,11 R'\4#7-6te 10*# ADDRESSI :23,7, /h401i0-Srehb ST,
CITY j STATE �ZIP [ 09r qt-( - TEL
FAX LT---= CELLjq;9- Q-�=E?6071 EMAIL 's on
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The Commonwealth of Massa chusetts
Department ofIndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
...... ...... % 111111 www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH T19E PERAUTTING AUTHORITY.
Aimlicant Information Please Print Legib
NaMe (Business/Organization/Individual):—,6#1/1 1Q11C H-rF72 Int 14
Address: �XXX SIT,
City/State/Zip: IP t—:7*6W ;Inl& 019�'V Phone #: 97,? 97S_,k772_9
Are you an employer? Check the appriopriate box:
1. 1 am. a employer with - �_ �! employees (full and/or part-time).*
.2. 1 am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.FJ I am a homeowner doing all work myself [No workers' comp. insurance required.] t
4.FJ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5.FJ l;arn a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors , have ei�ployees and have workers' comp. insurance.1
6.F-1 We are a coiporation and its officers ' have exercised their right of 'exemption per MGL c.
152, § 1(4), an4 we haveno, ��pl8yees. [No workers' comp. insurance required.]
Type of project (required):
7. F1 New construction
8. Remodeling
9. El Demolition
10 Building addition
11. FJ Electrical repairs or additions
12. Plumbing repairs or additions
13.E] Roof repairs
14.E] Other
*Any applicant that checks b6x#lmust also fill out the section below showing their workers' compensation policy information.
t
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tContractors ' that check this �ox must -attached an additional sheet showing the name of the sub -contractors and state whether or.not those entities have
employees. If the sub-co'n"traciors havei e6ploy'ees, 1hey must provide their workirs'comp. policy number.'
I am an enip loyer th at is p iovidiiig workers I comp ensation in su ran cefor my employ ees.' Below is th e p olicy an djob site
information.
Insurance Company Name;
Policy # or Self -ins. Lie. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00
and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cert�fy under thepains andpenalties ofperjuyy that the information provide ab, ve is true and correct.
Sia ature: 9�v� D; 116
92a 9-.p,57A7.7_9
Official use only. Do not write in this area., to be completed by city or town official
City or Town:
Perinit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact
Phone
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
W �_r .
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
expres's or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having riot more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill -out the workers' compensation affidavit completely, by checking the'boxes that apply to your situation and, if
necessary, supply sub-contractoi(s) name(s), address(es) and -phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Depaftment of Industrial
Accidents foi confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city.or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law o*r if you are required to obtain a workers'
compensatioii'policy, please call the Department at the number listed below. Self-insur6d companies shlould'enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in _(city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
0-e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
1p�
10620
This certifies that..,94 .............. / /ZX -4&
........... .................................... . .
has perrmksion to perform.4w-�.10.4.�..I.ka . ........ :-;"o/// . .........
plumbing in the buildings of ... ...
at ...... �O B ..... �e .................................................. , Morth Andov**e**r**,****M*'**'a*'s*'g**.
Fee/., ..... Lic. No. 4P�.,2� ....... �.?t. &.1414
g........... ;r .........................................
Check L MBING INSPECTOR
Date.Z6� .......
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
P
TYPE OR
PRINT
CLEARLY
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY
MA DATE 7-3 —3!�Iqjj PERMIT# Zt
JOBSITE ADDRESS
0 MA -SS
/+/c:F
OWNERS NAMELD,-sau(�ax-�-§-�-,..
OWNER ADDRESS I., 5,4MC-- TEL FAX
OCCUPANCYTYPE COMMERCIAL [a EDUCATIONAL
NEW: 0 RENOVATION: EO REPLACEMENT: Ell
FIXTURES I FLOOR- BSM
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
6T-H—ER 1104
RESIDENTIAL F-11
PLANS SUBMITTED: YES 01 NOW
10 1 11 1 12 1 13 1 14
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent Which meets the requirements of MGL Ch. 142. YES [,-X-] NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [4 OTHER TYPE OF INDEMNITY D BOND Ell
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
SIGNATURE OF OWNER OR AGENT
CHECK ONE ONLY: OWNER Ej AGENT 101
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application Will be in compliance withAll Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME L wab)tai Q, I Ri-am-' -----IILICENSE# []�0�23cl SIGNATURE
MP Ell JP [a
CORPORATION nj # PARTNERSHIPP-0 LLC 0�
COMPANY NAME Rl-1/fWX o4fW -11ADDRESS
CITY L,&j et/
=STATE ZIP LO,
FAX L CELL 1�268-S-?&-qj EMAIL
-*1) 37,
TEL
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The Commonwealth ofMassachusetts
Department ofIndustriqlAccid�nts
Office of Investigations
600 Washington Street
Boston., MA 02111
www.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractor6fEle,ctriciansfriumbers
Applicant Information Please Print Legibly
Name (Business/Organization/fndividual): 65
Address: 32- MimOCIe7t& .27-,
I
City/State/Zip: A47Y, W4fs Phone -?S- 2-7 2-9
Are you an employer? Check the appropriate box: -
Typo of project (required):
El I am a employer with
4. El I am a general contractor and 1
6. El Now construction
employees (fiffi and/or part-time).*
have hired the sub -contractors
:
7. El Remodeling
2. K I am a sole, proprietor or partner-
listed on the attached sheet.
ship and'have no employees
working for me in any capacity.
These sub -contractors have
workers' - comp. insurance.
8. E] Demolition
9. El Building addition
[No workers' comp. insurance
5. FlWe are a corporation and its
10.E] Electrical repairs or additions
required.]
3111 am a homeowner doing allwork
officers have exercised their
right of exemption per MGL
11.0 Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.Q Roofrepairs
insurance required.) t
employees. [No workers'
13.El other
comp. insurance required.]
*Any applicant that checks box 4f must also fill out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they aire doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContraotors that check this box must attached an additional sheet sbowIng the name of the sub-contraotors and their workers' comp. policy information.
lam an employer that isproviding workers'compensation insuranceformy employeeg. Below is thepolley andjob isite
information.
Insurance Company N
Policy 0 or Self -ins. Lic.
Job Site Address:
ExpirationPate:
�City/State/Zip:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
ofup, 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 DIA for insurance coverage verification.
I do h ereby certlo un der th ep*s andp en aldes ofperjury A at the information provided above is true and correct.
Phone#: '� N' 't -7- F2 '2 2-2
Offlelaluseonly. Do not write in this area, to he completedly cl(p or town offt"clal.
City or Town:
Permit/lAcense 0
,-2 —3, —,-A 0 / Y
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Flumbing Inspector
6. Other
Contact Person: Phone#:
Information and Instruction -8
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract ofhiro,.
express or implied, oral or written.,,
An em y two more
,ployeils defined as "an individual, partnership, association, corporation or other legal entity, or an or
Of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also statesthat "every state or local licensing agency shall withhold . the issuance or
renewal of a license or permit to operate a business or to constiruct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states'Weither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic workuntil acceptable evidence of Compliance with the insurance
requirements of this chapter have beenpresented to the contracting authority."
Applicahts
Please fill out the workers' compensation affidavit completely, by checking ffie boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If anL1_C orLLP does have
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date'the affidavit The affidavit should
be retumedto the city or town that thie application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
Compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the �ppropriate Eno.
City or Town Officials
Please be sure that the affidavit is complete and printedlegibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in 60 Permit/license number which will be us d s a ef r c nu b r. addition, an appli ant
0 a r 0 an e in a In c
that must submit multiple permit/licenso applications 'M' any given year, need only -'submit one affidavit indicating current
Policy information (ifnecessaty) and under "Job Site Address"the applicant should -write "all locations in —(city or
town)." A copy ofthe affidavit that has been officially stamped ormarkedbythe city or town maybe provided tothe
applicant as proof that a valid affidavit ii on file for firture permits or licenscs. A new affidavit must be fillqd out each
year. Where a home owner or citizen is obtaining a license oip-ermit not related to any business or commercial venture
(ix. a dog license or permit to burn leaves etc) said person is NOT required to complete this affidavit.'
The Office of Investigations . would like to thank you in advance -for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The CommojawealthofMassac�hj� -tt,
�se q
Department of InduMal Accidents
Office offilvestigatims
600 Washington. Sfxeet
BostQnMA02-111
Tel, # 617-727-4900 oxt 406 or 1-877,MASSAF
Revised 5-26-05 Fax 6 17-727-7749
VAVW.M,q.,Z.Q anvhfi'n
Date ..... 9,09*v/**�*`/"- .....
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
\
plumbing outhe
............. / - �L .....................
--- _'-`__ __-No. .... .................
^_�-........................................................
PLUMBING INSPECTOR
��/L/�/��
.~/+ '��
�heck# _________
T,
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
I
lowCITY
0 CfCPL
— - __11 MA DATE[ -20 I'LL 11 PERMIT
JOBSITE ADDRESS rtz/tF OWNER'S NAME 64-y //V J -D �y
POWNER
ADDRESS I S 07-0- TELL92t &�r?�FAX
TYPE OR
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY
NEW: RENOVATION: REPLACEMENT: R11 PLANS SUBMITTED: YES Ell NO 0
FIXTURES -1 FLOOR- BSM 1 2 3
4 5 6
7 8 9 10
11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIUSAND SYSTEM 1___JI __j =I
DEDICATED GREASE SYSTEM _AL., I L�� L A _j
DEDICATED GRAY WATER SYSTEM I
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/ AREA DRAIN L __JI
INTERCEPTOR (INTERIOR)
KITCHEN SINK _j _j __j
LAVATORY I
_j _____j ....... ... j _—I
ROOF DRAIN
SHOWER STALL
SERVICE / MOP SINK
TOILET 11 _j
URINAL f
WASHIAG MACHINE CONNECTION ------ L. -J ___J1 J
'i
WATEk HEATER ALL TYPES
WATOR PIPING _J
OTHER = f 1===
L------
L77 I 7j] 3 _-I
I F III III III III il==
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 01 BOND Mi I
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have , the insurance cove rage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER F-1 AGENT 101
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision ofthe
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME LVM/17" 3" kl'ctff�fk LICENSE# FiO�Z3'r_ I SIGNATURE
MP D jPW CORPORATION Fjl# PARTNERSHIP D1 # LLC Ek
j DRESS 2-32- h4tA,4SA4+D Sr,
COMPANY NAME AVJ-724L P -i�-* __7' AD I
C I TY L01 ---I t;�� STATE � ZIP TEL A
--- ] EMAIL
FAX CELL &8T_7 �! x
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The Commonwealth ofMassachusetis
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DepartfnentoflndustrialAccidii�ts
Offlce ofifivesfigations
660 Washington Street
Boston., MA 02111
vww.massgov1d1a
Workers' CompensationInsurance Affidavit: BuRders[Contrat
Name CJ3usinoss/Or�anizationftdi-vidual):
Address:
city/State[Zip: /N o*,h* 91, 01J`1V Phone #: �,2S- 9 7S-2- -2 2-9'
Are you an exinployer? Check the appropriate box:
Type of project (req-dred):
I am a employer with
4. n I am a general contractor and 1
6, El Now c6ustractioll
-LE1
- employees (fall andlor part-time).*
2,. 1 am a solD proprietor or partner-
have liked the sub -contractors
listed on the attached sheet. T
7. [] Remodeling
ship and:lavono.employees
These sub -contractors have
8. E] Demolition
worldug forma inany capacity.
workers' comp. insurance.
9, E] Building addition
[No work -ors, coj4p. jnsuranca
5. El We are a corporation and its
officers have'exercised their
1011 Electrical repairs or additions
required.]
3. El I am a honeowner Ung all work
right of exemption per MGL
11. F4 Plumbing repairs or additions
myself Vo workays, bomp.
c. 152, §1(4), and we have no
12.P Roofrepairs
insuranceregaired.) t
employ 06S. rNo workars,
13.E] other
comp. insurance required.]
*Any applicant that checks box M must also fill out the sectionbel6w showing their Workers' compensation policy information.
t -Homeowners who submit ihis affidavit ind!6atinjthqkAi�dqlngaUworK and then hire outside contractors must submit anew affidavit indicaffigsuch.
tContractors that check thisbox. mustattached anialdditional sheet showlagthe name of the sub-contraotors and their workers' comp. policy information.
w is AeF lie an j h site
I am an employer that isproviding workers' coniquensallon insurancefor mY elnpkeeffl- Belo 0 Y do
tnfoymadon.
Insurance Company
Policy # Or SON. iM. LiG. ff: Ex0ration D ate:
Sob Site Address; Pity/Statp_/Zip:
Attach a copy of tDo workers' comp ensationp olley declaration page (showing the policy number and expiration date).
Failure to secure coverage.as re h dunder Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties of a
quffe
line. up to $ 1,50 0.0 0 and/or one -ye, ar im-prig ortment, as well -as civil p onalties in the form of a S TOP. WORK ORDER and a fmo
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigatio-w of thoDIA for insurance, coverage verification.
I do hereby certijy under thepains andpenaftles ofparjury that the information provided above is true and eorrect.
-Tho.neg: q7,f-97S_�?-72-9
off,-cial use oply. Do not write in 61s area, to be eom
plefed by ci6l or town offichd
City or Town:
Permit0cense 0
9Ejai,;
? 2-0 /,Y
Issuing Authority (circle dne):
1. Board of Health 2. Building Department 3. Cltyffown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
ContactPerson;
Phone 9:
r.
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide, workers, compensation for their employees.
Pursualit to this statute, an employee is definea as every person k the service of another iiader'any contract of hire,.
express orimp&0, oral orwrittem"
An employdis defined as "an individual, partnership, association, cotporation or other legal entity� or anytwo, oxmora
of the for6j6 - lui engaged in ajoint enterprise, and including the legal representatives of a: deceased employ
receiver or'trtiste e -'of an hidividual, partnership, as�ociatlon or other legal entity, employing empl 'es. � qi�, or the
oye ff6wever the
owner of a dwelling hous a having not more thaa three apartments and who resides therein, or the o epupant of the
dwelling house of another who employs persons to do maiatenance, construction or repair workon su6h dwelling house
or on the grounds or building appurtenant thereto shallnot because of such employmentbe, deemedto be an employer.,,
MGL chapter 152, §25C(6) also states that "every state or lo'cal lie-ensig agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced.acceptable evidence of compliance with the insurance coverage required."
Additionally, MaL chapter 15�, §25C(7) states "Neither the commonwealth nor any of its p olitical subdivi'sions shall
enter into any contract for the performance of public work until acceptable evidence of compli�iico with the insurance
requirements of this chapterhavo beenpresented to. the contracting authority."
Applicants
Pleas.o.fill out the workers' comp ensailon affidavit completely, by checking the b oxes that apply to your situation and
if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) alongwiththeir certificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members orpafters, arenotrequiredto cany workers' compensation insurance. If ariLLIC orLLP doeshave,
employees, a policy is. required. Be advised thattbi� affidavit maybe, submitted to the Department of Iudustrial
Accidents for conffimation of inmance c
overage. Also be sure to sign and date the affidavit. The affidavit should
be retained to the city or town that thb application for the. permit or license is being requesteq, not the Department of
Industrial Accidents. Shouldyou have, any questions regarding tho law or if you are required to Atain a *orkers,
compe , nsationpolicy., please call the Department at the number listed below. Self-insured companies should entertheir
Self-insurance license number on the appropriate he.
City or Town Officials
Please be sure that the affidavit is complete and printedlegibly. The Department has provided a space at the bottom
Of the affidavit fOrYOU to fill Out in tho (Went the Office of Investigations has to contact you regarding the applicant.
Please be -sure to f Kin the permifflicense number whichwill be used as a reference number, Inaddition.,anapplicant
that�aust submit multiple pormit/license applications in any given ye . ar, need only submit one, affidavit indicating curr6ut
policy infonnation (ifnecessmy) and under "Job Site Address'; the applicant should write "all locations in or
town)." A 60py ofthe affidavit that has been offlGially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit -is' on Me - for bitura p'ermits or licenses. , Anew affidavit imist b o ffflQd out each
year.'Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture
(i.e. a dog license orljeimit to bum leaves etc.) said -person is NOT required to complete, this affidavit,
The Office Of Investigations . wouldlike to thankyou in advance for your cooperation and shouldyqu have anyguestio�s,
please do not hesitite, to give -us a call.
The Department's address, telephone, aiid fax number:
Tho CQm- monweml& of M a -ftq
p�sophv�,, -
Papartment of fhdusftial Auddanta
OxcedlawatfgAawn
60 Wuhijo()
-a Sft��.t
Bwton, MA 02111
tel. -9 617-7.2,7,4900 Qxt 406 ox 1 -8,77 -MS
SAFF,
Revised 5-26-05 FaY, 0 617-727-7749
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No Date
TOWN OF NORTH ANDOVER
-IN01
Certificate of Occupancy $
A I S, Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee S,�A15; $
TOTAL $
Check# M -3
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TOWN OF NORTH ANDOVER '
PERMIT FOR WIRING
I
This certifies that ..... .. . .. ...............
has permission to perform
.............................................
wiring in the building of ............
at....................................................................... ... .. . North Andover, Mass.
�To ......
ui Fee 42.5 ........... Lic. No;,?.�'�S� ................ ........... ......
RLE��CrRiIcAL IiN�SPECTOR
Check #
9243
2012 Massachusetts Electrical Code Amendments 527 CMR12.00 § Rule S.: In accordance -with the provisions of M.G.L. c. 143, § M, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. 01 c. 166, § 32, an P
electrical permit shall be issued to the person, firm or corporation stated on the pem-dt application. Such entity shall be responsible for the
notification of completion of the work as Pquired h6M.G.L. c. 143, § 3L.
Permits shall -be limited as to the time of ongoing construction activity, and may be -deemed -by the -Inspector-of Nires abandoned-and-inv.alid-ifhe--
or she has determined that the authorized work has not commenced or has not progressed dun�ethe lifteding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
El The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 23 8 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act Ruthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence?' during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012,
rRule 8 — PermitfDate Closed: z ZZ -3 All ***Note: Reapply for new permit 114�
OPermit Extension Act — Permit[Date Closed:
'IN
Official Use Only
(flmmonwea& ol MamacLeffi
Apartment ol3ire Sorvices Permit No.. i�p zZ.?
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code i(N�EC)1/27 CMR 12.00
(PLEASE PPJNTIN INK OR 7TPF, AL INF -9 TION) Date: CN/azo/0
City or 117own of: AV19W = To the Inspect& of Wires:
By this application the undersign6d:gjVe� notice of bis or heljn
_AenVon to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Telephone No.
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 UndgrdE1 No. of Meters
New Service Amps Volts Overhead [:J Undgrd [:1 No. of Meters
Number of Feeders and Ampacity
I Cnmnlpfinn nfthp &IInufi.a t�hl, -- h. oL�
No. of Recessed Luminaires
No. of Cefl.-Susp. (Paddle) Fans
No. of
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above In
grnd.
No. ot Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
[NNo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
I nitiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
er .1
f I tj
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I--
-FK—W
............ ..........
N f Sel � ontained
0.0 t . / 1,
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
I ""I Municip
Local F1 ConnectiF' ElOther
on
No. of Dryers
Heating Appliances KW
S . ecurity Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP --[Telecommunications
Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value o Electrical Work: (When required by municipal policy.)
Work to Start: ", Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE-C-0—WE'RE—GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such aerage is in force, and has exhibited proof ofi�ame to the perpit issym ffice.
CHECK ONE: INSURANCE)y BOND F1 OTHER F1 (Specify:)
I certify, -under thepains andpenalties ofperjury, that the information >on t is true and complete.
FIRM NAME: S 1eV&tf=,(- Avc,! LIC. NO.: a?SI'S C,
Lic'eiiseei: Signature LIC. NO.:13911WO.5
�� �Wll
(If appl er 11 ex I 'n' th h 4,Fe nhbe� line.)
Bt
e is. Tel. No.:4
- �) - V) Ihpa- I I y
Address: ffd/07P Alt. Tel. No..-Y11Y'-,1!5W
*Per M.G.L. c. 147, s. 57-61, security work requires Department ofk%bfic S ty"S"License: Lic. NolS-3s; 0aZ36 ��Z
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one F1 owner D owner's nt.
Owner/Agent
Signature Telephone No._ PERM1T FEE:
/4
11
COMMONWEALTH OF [AASSACHUSEI-TS
t7 -
CONTRACTOR
moil, WTSM- W! I
ISSUES THIS LICENSE TO
SURVEILLANCE SPECIALTIES LTO
ARTHUR J WROME fly
600 95SEAkCH
WILMINGTON MA
07/sI./10
r -pp'n") j -(P,,kf jig, I
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DEPARTMENT OF/PLIBILIC SA"FETY
S - License
Number: SS CO 000723
Expires: 05/22/2011 Tr. no: 206.0
S -License: SURVEILLANCE SPECIALITIES
ARTHUR J BOURQUE III
600 RESEARCH DR
WILM!NGTON, MA 01887
Commissioner
COMMONWEALTH OF MASSACHUSET7S
Ej K,
RCM iwMWC1AN
ISSUES THIS LICENSE TO
0-
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ARTHUR J RGORQUE III
116 LOCKSLEY ROAD
LYNNFIELD MA 01940-14
3920 D 07/31/10 359051
n. non
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Date ..... ) ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... 1�-b ... / ...................................................................
............ ....
has permission to perform ........ -5-e-,!f &-& � ...... �jy,�.-
...................... ...
wiring in the building of ... Z,.,V.4 t.-, a C;
at ......... 3 1
.............................. — Mass.
', 7 ..... . North Andov7
Fee.. Lic. No.0-1��— ... ..........
Check #
8977
L
<Lx (flrnmonweafilt ol Maijaclutieft-i Official Use Only
5 2pparlf"nt S .. icej Permit No. 271 V7 7
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
LRev. 1/07] (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance, with the Ma.ssachuserts Electrical Code (NNIEq), 527 CMR 12.00
(PLE,4SEPRNTIjVIVKORTI'PE4LLLNrFO4,VL4TION) Date:
0
City or Town of: ",e7 To the Inspector of TViiles:
By this application the undersigned gives notice of hisbr her intention to perform th described below.
e ekctrical work
Location (Street & Number) (3 se -II& /4c- 1 .
Owner or Tenant LZU Y—e- r) 6.4 04— Telephone No.
Owner's Address
Is this permit in konjunction with a building permit? Yes
o (Check, Appropriate Box)
Purpose of Building Utilitv Authorization No.
Existing Service Amps Volt� Overhead E] Undgrc!F� No. of Meters
New Service Amps Volts Overhead U,clgrd No. of M,ters
Number of Feeders and Amn-:16tv
Location and Nature of Proposed Electrical Work:
a U
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
-C jig��,,ur uj t, ire3..
No�. of ota
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming P61 Above Ei In-
El
170. of Emergency Lighting
2rnd. 2rnd.
Battery Units
No. of Receptacle Outlets
No. of .0 if Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
—ro—tal
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump -[Number
I.Tgn W
..........
No. of Self -Contained
Totals:
Detection/Alertinz Devices
No. of Dishwashers
Space/Area Heating KW
1:1 Other
Connectio
No. of Dryers
Heating Appliances JKW
Security Svsterns.!,�/
No. of Water
No. of —No. of
hlp--- q
Z or F uivalent
Heaters KW
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
ations i riivna
ces or Eq ent
OTHER: ILI V/
Estimated Value of Electrical Work: -796 --�ft uuumunut aerait y desired, or as required by the Inspector of Wires.
—. (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersiened certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
Z�
CHECK ONE: INSURANCE [Z BOND [I OTHERE] (Specifv:) Self Insured
I certify, under the pains andpenalfies ofperjury ' that the i�;(ormation on this application is true and complete.
FIRMNAME: ADT Security Serv-Jces NO.: 4/115:,
Licensee: Mark A. Brophy Sionatu e
__ U- LIC. NO.: C-45
flf applicable, enter o. exempt " in the license number line.) -
Bus.Tel.No.: 603-594-5928
Address: 18 Clinton Drive Hgllis, _nH
Alit. Tel. No.:
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. 00953
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature b6lo,.v, I hereby waive this requirement. I am the (check one) 11 owner El owner's agent.
OWner/Agent
Signature Telephone No. `EE: $ 6z
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Date ..... . - . 1-5-- . - .. 4 .. g .
.. ........ . ... ..
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ............... 3��115 4 A4 41--e-7—
............................................ ................................
has permission to perform ...... kl/ ..... 4.1 S ...............................
wiring in the building of ........ eo ........................
at ....... ...... 191,145;7 ..................... . North Andover, Mass.
........ ......
Fee ... Lic. No. ��AM .......... 4 ....... ........
ELEcrRICAL INSPE6)6R
Check
6459
z- Commonwealth of Massachusetts
A
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
KI-Icial ( �:�e 011k
Permit No.
!CLIpancy and Fee Checked
�R�ec- 9,051 (leave [11
I ank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
M I %� ork to lie lie rtbrnied in accordance X% it ll t1le \1 "Issachusetts 1� I cc trica I C Otte (\lj-,C). 517 (A I R 12.00
WL E, ISE PRIN T /N INK OR TYP LL =ON) Date:
Citv or Town of: V> To die Inspcklor ol Wires:
By (his application tile Undersigned gives iloticc�'of his o'l-,Licr int t . t erforni tile electrical work described below.
'2
Location (Street & Number) ff Ws�;
Owner or Tenant
Owner's Address
elephone No.
Is this permit in conjuncti a build* �t? Yes No OF 1/0,
LA (Check Appropriate Box)
Purpose of Building N#Mirix? V Utility Authorization No.
Existing Service Anips /Volts Overhead UndgrdF-1 No. of Meters
New Service Amps Yolts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 01 np ?iv Ir(I'd
Complelion ol 1he fiVlowhvQ lable mov be waned bi, the h1Sj)eL't0P 01'11ires
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swi mming Pool Above o In- El
gi-nd. grnd.
-N-5—.o-T7F`ffi-e rg ency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pu
Tot
Tons
1I.K.W.1-1-1-
No. of Self -Contained
Detection/A lerting Devices
No. of Dishwashers
Space/Area Heating KW
Local E] Municipal 0 Other
Connection
No. of Dryers
Heating Appliances KW
Security S stems:*
No. of 6evices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. "ydromassage Bathtubs
No. of - Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
A flach at Idifif ;I fell detail ifdc,�ircd. or as I vq I I I rcd hJ I lie I of. u/I I 'if e:;
Estimated Value ot'Epctrical Work: (When required by municipal policy.),
,c I e
kk ork to Start: Insp tions to be requested in accordance with vlEC RLIle 10, and Upon completion.
a th
INSURANCE COkERACE: Unle waived by tile owner. no permit for the perl'ormance of electrical work may iSSLIC L1111CSS
L
i _, I nL, -age or itS SUbstantial C(iLIiVd1CI I
-aIlL
(lie licensee pro\, ides proof of liabih y i1IS1IIaIlCC inClUdill'i conipletedoperation-covei it F IQ
y
rL
It) , c,
LIII&I-Si-ned certifies that SLIch co n -age its in l'orce, and has c,diibitcd proofors,
1111C to tile PCHIlit iSSUin-4 office.
(SpCc1l`y:)
RANC1
]ECKONE: INSURANCl- 1;3(.) Nil) E I
I certyj,, nuder the puh1sjj.Ud witaffiev ol' erfitry, t 11 e ii!fiminalion on ihis a1)p1jcejtjj)jj is liwe mid conilVetpi
FIRM NAME:— U(, 21AVee, 3-�� 1, 1 C. l'i O.Wo 33>
Licensee: L-e-�T Signature LIC. NO.:
(11,applicai)lc, Bus. Tel. No.:
Address: Ait. Tel. No.:.-
"SCCLII-ity SySt011 Contractor License reqUircd for this ��ork; if appilca e license number licre:
OWNER'S INSURANCE WAIVER: I arn aw;.ire that the LiCCIISCe d0eS ;701 have the liability iIISUrance coverage nc,,rniall�
icquired by law, By nl�'Sillllatffc below, I hereby waive this requirement. I arn tile (check one) 0 owner [:1 owner'-,; ;igent.
Owner/Agent
3ignature Tcicphonc No. PF- RMI T FFE:
7- ll -e6
Date...............................
,ORT4�
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
K.
This certifies that .................. ............................
has permission to perform .... )rz-
...... .................................. ...........
wiring in the building of .......... ...............................
at ............... ...... O'V .... Nor I th Andovei , Mass.
S7 A/S
Fee..................... Lic. No . ........ ................
ELECrRICAL INSPEMR
Check #373?>
6780
Pen-nitNo.
6 z
Department of Fire Services
Occupancyand Fee Cliecked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfori-ned in accordance with the 10assachusetts Flectrical Code (IMF(j, 527 CN/IR 12.00
WL F-4Sf, PR INT IN INK OR TY -PE ALL I !�-ORMA TION) Date: 0� A-2, o (9
City or Town of: To the Jndiectov�f
By this application the unders]-. otice of his or her ntention to perform the electrical work described below.
Location (Street & Number)--.-- -J:Q 4!d -
Owner ol-Teliant
Owner's Address
Telephone No.
Is this perinit in conjunctionV ith a building permit? Yes F -1V
0 LL4 No (Check Appropriate Box)
Purpose of Building EON Utility Authorization No.
Existing Service — Amps __Volts Overhead Und-rd No. of Me ters
6 No. of Meters
Ne -w Set -vice Amps Volts Overhead Undard 1F
Number of Feeders and Ampacity
OCatiOD and Nature of Proposed Electrical Work:
Combletion ofthe rollo-wing-tzrble may he w(7ii,p(I hv ihi, Impprinr n1 [.T/;,,,.
Fo- of —Recessed Luminaires
NO. of Ceil.-Susp. (Piddle) Fans
NO. of Total
Transformers KVA
N6. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
i ?
Swimming Pool Above o In El
-No. of Emergency Lighting
grnd. grnd.
No. of Receptacle Outlets 12-
No. of Oil Burners
-Batter-y-Units
FIRE ALARMS No. of Zones
Nio. of Switches
No. of Gas Burners
No. of Detection and
Initiatin- Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Number
I Tons
.............
IKW
No. —ofSelf-Contained
— ------
Totals:
1
1)
Detection /A1 ertin a Devices
No. of Dishwashers
f
Space/Area Heating KfW
unjcip�l
Local 0 'M Other
Connection
No. of Dryers Heating Appliances KW Security Systems:
No. of Devices or Equiv2lent
N6. of Water No. of No. of
KW I Data Wiring:
Heaters
— ----- — Signs Ballasts No.ofDevices.orEg
No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring:
No. oi'Devices_-or,,E(juivale-ni..-.-----I
OTHER:
4 IL C LAI t -
V Attach additional detail if desired, or as required bY the Inspecfor of Mres.
E'stimated Value of Electrical Work: !�� (When required by municipal policy,')
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unitss
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such cove L�e is in force, and has exhibited proof of same to the pen -nit issuin /offil
CHECK ONE: INSURANCE [V BOND 0 OTHER El (Specify:)
-tify, -ination on this application is true and o n ete.
.1 Cei under thepains and
penalties ofpeijiir that-tAe infoi
FIRM NAME: -7'c
LIC. NO.: 4,� 3.
Licensee: Signature LIC. NO.:
(Jf*applicoble,enterf-exe t"inthelicensenuin in e.)�)
, A IfiAo Bus. Tel.
Address: Ssq Ehid(Aem.� Alt. Tel. No.:
Security System Contractor License rj#uired for this work; if applicable, enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilivj insurance coverage noyrrially
requiredbylaw. By my signature below, I hereby waive this requirement. I am the (check one) El ovmer -DOWI-Iel`��a��el)t.
Owner/Agent V El -04' 1
,Signature Telephone No. PERMIT FEE: $ /ZL5- ------- J
m
7- lo�e6 /�-;Pl
q*
Date.�,�- 1'7,,1,6
......... j-e�x .................
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
4L
This certifies that—,, f'41. 1.'e ........................................................................
has permission t�/perform .... ...........
wiring in the building of ......
........... . ..... ....... .......
or
at ort
.....................
. .......................... ............ h Andover, Mass.
Fee,/ -.,.0 ........... Lic. No. .. . .......
Check #
6648
-kl
�f� .
I
a.
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. 41
Occupancy and Fee Checked
[Rev. 9/051 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALIAINFORMATION) Date: InAA J7. 06
ecVr of Wir"es:
City or Town of- Ain di U M To the J�S�'
By this application the undersignAAgives'notice of his or her �itention to perform the electpical work described below.
Location (Street & Num
Owner or Tenant
Owner's Address
Is this permit in conjunc * with a building i mit. Yes El
Purpose of Building n: "il C-/jA Z&/Y
Telephone No.
No LLI (Check Appropriate Box)
Utility Authorization No.
Existing Service Am. Volts OverheadEl Undgrd No. of Meters
New Service Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: - t
Completion of thefollowing able may be waived by the In ector of Wires.
No. of Recessed Luminaires
No. of Ceill.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming P'ool Above o In-
grnd. grnd.
Bo. 0 Emergency Lighting
attery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
—
No. of Alerting Devices
No. of Waste Disposers
HeaTF_um__p7NuTber
Totals:
I
Tons
I
I
I 'K.W
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local 0 Mun'C'PP' El Other
Connection
No. of Dryers
Heating Appliances KW
--ITO.
Security Systems:*
No. of Devices or Equivalent
No. of Water
Heaters KW
No. of of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring.
No. of Devices or Equivalent
IOTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [_1 BOND F1 OTHERE] (Specify:)
lcerttfy, under thepain it pe lt*eso!f erjury, that the infSj_mation on this application is true and complete.
FIRM NAME: r7eec; YZ LIC. NO.-M3�3
Licensee: 9 F6017e17 tJubW Signature LIC. NO.:
(Ifapplicable, endr "exem Bus. Tel. N
in the I , icensenumberh
Address: L -ell ic, kA Alt. TeIL-N - 'ja?k
*Security System Contractor License req6ifed for this work; if applicable, enter the license number herd�- & 34 5-- � 5k �g,
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverag`enormally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner 11 owner's agent.
Owner/Agent
Signature Telephone No. FERMIT FEE:$
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Location
No. Date
TOWN OF NORTH ANDOVER
Check
1 93�2
Building Inspector
Certificate of Occupancy
$
CHUS
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee S160
$
TOTAL
$
Check
1 93�2
Building Inspector
Location
No.
So A" 6
Date 64/0
TOWN OF NORTH ANDOVER
0
Certificate of Occupancy $
CHU Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee Slo-/j $
TOTAL $
Check #
19,394
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t%ORTH
Zoning Bylaw Review Form
0
Town Of North Andover
Building Department
1600 Osgood Street, Building 20, Suite 2-32
North Andover, MA. 01845
Phone 978-688-9545
Fax 978-688-9542
Street:
30 Massachusetts Avenue
Map/Lot:
215
Applicant:
Sign Center for RiverBank
Request:
Internally lit roof sign
Date:
6-13-06
Please be advised that after review of your Application and Plans that your Application is
DENIED for the following Zoning Bylaw reasons:
Zonina District: GB
RAMP(iv fnr thp ahnva is checked below
Item # Special Permits Planning Board Item #
Item Notes
Site Plan Review Special Permit
Item Notes
A
Lot Area
F
Frontage
I
Lot area Insufficient
1
Frontage Insufficient
2
Lot Area Preexisting
2
Frontage Complies
3
Lot Area Complies
3
Preexisting ' frontage
4
Insufficient Information
4
Insufficient Information
B
Use
5
No access over Frontage
I
Allowed
G
Contiguous Building Area
2
Not Allowed
I
Insufficient Area
3
Use Preexisting
2
Complies
4
Special Permit Required
3
Preexisting CBA
5
Insufficient Information
4
Insufficient Information
C
Setback
H
Building Height
I
All setbacks comply
1
Height Exceeds Maximum
2
Front Insufficient
2
Complies
3
Left Side Insufficient
3
Preexisting Height
4
Right Side Insufficient
4
Insufficient Information
5
Rear Insufficient
I
Building Coverage
6
Preexisting setback(s)
1
Coverage exceeds maximum
7
Insufficient Information
2
Coverage Complies
D
Watershed
3
Coverage Preexisting
1
Not in Watershed
4
Insufficient Information
2
In Watershed
j
Sign
3
Lot prior to 10/24/94
1
Sign not allowed X
4
Zone to be Determined
2
Sign Complies
5
Insufficient Information
3
Insufficient Information X
E
Historic District
K
Parking
I
In District review required
1
More Parking Required
2
Not in district
2
1 Parking Complies
3
1 Insufficient Information
RAMP(iv fnr thp ahnva is checked below
Item # Special Permits Planning Board Item #
Variance
Site Plan Review Special Permit
Setback Variance
Access other than Frontage Special Permit
Parking Variance
Frontacie Exception Lot Special Permit
Lot Area Variance
Common Driveway Special Permit
Height Variance
Congregate Housing Special Permit J/1 &
J/3
Variance for Sign
Continuing Care Retirement Special Permit
Special Permits Zoning Board
Independent Elderly Housing Special Permit
Special Permit Non -Conforming Use ZBA
Larqe Estate Condo Special Permit
Earth Removal Special Permit ZBA
Planned Dey!�!=ent District Special Permit
Special Permit Use not Listed but Similar
Planned Residential Special Permit
Special Permit for Sign
R-6 Densitv Special Permit
Other
Watershed Special Permit
Supply Additional Information
The above review and attached explanation of such is based on the plans and information submitted. No definitive
review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the
applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading
information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to
be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be
attached hereto and incorporated herein by reference. The building department will retain all plans and documentation
for the a file. You mu t fil ne building permit application form and , beg n t permi ing process.
g Department Official Signature AppliCfion ReCeived Application Denied
'r I
Denial Sent: If Faxed Phone Number/Date:9A— ��j —
Plan Review Narrative
The following narrative is provided to further explain the reasons for denial for the building permit
for the property indicated on the reverse side:
Form
e
e -rence
ea sons" or,�,]Oi�u nee.L,,,,.
f A BVICO 0;
P
Z
J/1
A Variance from the Zoning Board of Appeals is required from the provisions
of Section "6.5 Prohibitions: 1. No sign shall be lighted, except by steady,
stationary light, shielded and directed solely at the sign. Internally lit signs are
not allowed." of the Zoning Bylaw
Conservation
Department of Public Works
J/3
Section 6.4.3. "Non-conformance of Accessory Signs: Any non-conforniing
sign legally erected prior to the adoption of this provision, may be continued and
maintained. ... No existing sign shall be enlarged, reworded, redesigned, or altered in
any way unless it conforms to the provisions contained herein. Any sign which has
been destroyed or damaged to the extent that the cost of repair or restoration will
exceed one-third (1 /3) of the replacement value as of the date of destruction shall not
be repaired, rebuilt, restored or altered unless inconfortnity of this Bylaw." There is
insufficient information to determine if the existing sign conforms to the
requirements for wall or roof signs in the GB Zoning District per the provisions of
Section 6.6.D.1' L Primary wall and roof signs attached to or part of the architectural
design of a building shall not exceed, in total area, more than ten percent (10%) of the
area of the dimensional elevation of the building as determined by the building
frontage multiplied by the floor to ceiling height of the individual business or as
specified in applicable sections of the by-law." A dimensional Variance -may be
required from the Zoning Board of Appeals.
Other
BUILDING DEPT
Referred To:
Fire
Health
Police
X Zoning Board
Conservation
Department of Public Works
Planning
Historical Commission
Other
BUILDING DEPT
ZoningBylawDenia12000
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Setting the Standard for Over 45 Years
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Audrey Peterson'
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ProjeCt Coordinator
V)
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F 978.521.2192
0
audrey@thesigncenter.com
W"
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AN�
VA
June 9, 2006
Town of North Andover
Attn: Building Inspection
400 Osgood Street
North Andover, MA
Subject: Sign Permit Application
Enclosed please find a sign permit application for River Bank located at 30 Massachusetts Avenue. We
are requesting a permit to replace the existing roof sign, directional wall signs, and monument sign.
Roof Sign — 89" x 324" x 6", construct of aluminum & flex face, bracket mount to roof.
Directional Wall Signs — 24" x 18" x.125", construct of aluminum, flush mount on wall.
Monument Sign — 144" x 60", paint existing sign, re -letter with vinyl copy.
I believe I have enclosed all the support materials required for this process. Enclosed you will find the
application, drawings, check in the amount of $100, and proof of insurance. I appreciate your help with
this project and if you find any part incomplete please contact me at 978-372-3721 and I will be happy
to send you additional information.
Thank you for your time,
Audrey Peterson
Project Coordinator
The Sign Center Inc
www.thesigncenter.com 40 Orchard Street Haverhill, MA 01830 978.372.3721
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UU,
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June 9, 2006
Town of North Andover
Attn: Building Inspection
400 Osgood Street
North Andover, MA
Subject: Sign Permit Application
Enclosed please find a sign permit application for River Bank located at 30 Massachusetts Avenue. We
are requesting a permit to replace the existing roof sign, directional wall signs, and monument sign.
Roof Sign — 89" x 324" x 6", construct of aluminum & flex face, bracket mount to roof.
Directional Wall Signs — 24" x 18" x.125", construct of aluminum, flush mount on wall.
Monument Sign — 144" x 60", paint existing sign, re -letter with vinyl copy.
I believe I have enclosed all the support materials required for this process. Enclosed you will find the
application, drawings, check in the amount of $100, and proof of insurance. I appreciate your help with
this project and if you find any part incomplete please contact me at 978-372-3721 and I will be happy
to send you additional information.
Thank you for your time,
Audrey Peterson
Project Coordinator
The Sign Center Inc
www.thesigncenter.com 40 Orchard Street Haverhill, MA 01830 978.372.3721
ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID 751
INSIG-1
DATE(MM/DDNYYY)
12/05/05
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
TD Banknorth Ins Agcy Inc (SF)
P.O. Box 9040
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICY NUMBER
Springfield MA 01102-9040
Phone: 413-781-5940 Fax: 413-733-7722
INSURERS AFFORDING COVERAGE NAIC #
INSURED
iNSURERA: HANOVER INSURANCE CO. 22292
INSURER 9: Twin City Fire Insurance Co. 29459
i
TDBanknorth Ins. Agency, Inc.
Insignia Inc DBA Sign Center
Jason M Kahn
INSURER C: Hartford Fire Insurance Co 19682
INSURER D: Nat'l Union Fire Pittsburgh PA 19445
40 Orchard St
Haverhill MA 01830
C
INSURER E7
rnWC0AnCQ
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, 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.
1 No
LTR
IoNkSuRN
TYPE OF INSURANCE
POLICY NUMBER
POLICY EF-F-EUIV-E-
DATE (MM/DDNY)
?MI-CY EXPIRATION
DATE (MM/DDfYY)
LIMITS
FAUTHORIZEE iiPRESENTATIVE
u 0
GENERAL LIABILITY
i
TDBanknorth Ins. Agency, Inc.
EACH OCCURRENCE $ 1,000,000
1AMA1 1111 -NII
ES (E. occurenC.) s 300,000
PREMI�l
C
X COMMERCIAL GENERAL LIABILITY
OBSBAPJ4769
12/01/05
12/01/06
MED EXP (Any one person), $ 10,000
—7 CLAIMS MADE FX� OCCUR
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE s2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG s 2,000,000
RO
LICY J Cj 7 LOC
PO PE
A
AUTOMOBILE
LIABILITY
ANY AUTO
AMN663183903
12/12/05
12 12 0 65
CO BINED SINGLE LIMIT
(Eam.ccident) $ 1,000,000
BODILY INJURY $
(Per person)
X
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $
(Per accident)
X
X
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
AUTO
HANY
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE s 2,000,000
AGGREGATE $2,000,000
D
7X OCCUR CLAIMSMADE
EBU9038191
12/12/05
12/12/06
$
�DEDUCTIBLE
$
X RETENTION $10,000
WORKERS COMPENSATION AND
WGSTAIU-
X I TORY LIM TS E
B
EMPLOYERS' LIABILITY
ANY PRO PRIETOR/PARTNER/EXEC UTIVE
OFFICER/MEMBER EXCLUDED?
08WECGU7291
12/12/05
12/12/06
E.L. EACH ACCIDENT s500,000
E.L. DISEASE - EA EMPLOYEE $5001000
Des, describe under
ECLAL PROVISIONS below
E.L. D SEASE- POLICYLIMIL $ 500 000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS
To provide evidence of insurance.
CERTIFICATE HOLDER CANCELLATION
GENERIC
SHOULD ANY OF THE ABOVE 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 DO SO SHALL
For Insurance Purposes Only
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
FAUTHORIZEE iiPRESENTATIVE
u 0
i
TDBanknorth Ins. Agency, Inc.
ACORD 25 (2001/08) @ ACORD CORPORATION 1988
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Zoning Bylaw Review Form
Town Of North Andover
Building Department
1600 Osgood Street, Building 20, Suite 2-32
North Andover, MA. 01845
Phone 978-688-9545 Fax 978-688-9542
Street:
30 Massachusetts Avenue
Map/Lot:
2/5
Applicant:
Sign Center for RiverBank
Request:
Internally lit roof sign
Date:
6-13-06
Please be advised that after review of your Application and Plans that your Application is
DENIED for the following Zoning Bylaw reasons:
Zoning District: G13
Remedy for the above is checked below
Itern# Special Permits Planning Board
item Notes
Site Plan Review Special Permit
Item Notes
A
Lot Area
F
Frontage
1
Lot area Insufficient
I
Frontage Insufficient
2
Lot Area Preexisting
2
Frontage Complies
3
Lot Area Complies:
3
Preexisting frontage
4
Insufficient Information
4
1 Insufficient Information
B
Use
5
No access over Frontage
1
Allowed
G
Contiguous Building Area
2
Not Allowed
1
7n-Zi-iff-ic . i . ent Area
3
Use Preexisting
2
Complies
4
Special Permit Required
3
Preexisting CBA
5
Insufficient Information
4
Insufficient Information
C
Setback
H
Building Height
I
Ail setbacks comply
I
Height Exceeds Maximum
2
Front Insufficient
2
Complies
3
Left Side Insufficient
3
Preexisting Height
4
Right Side Insufficient
4
Insufficient Information
5
Rear Insufficient
I
Building Coverage
6
Preexisting setback(s)
I
I Coverage exceeds maximum
7
Insufficient Information
2
Coverage Complies
D
Watershed
3
Coverage Preexisting
1
Not in Watershed
4
Insufficient Information
2
In Watershed
j
Sign
3
Lot prior to 10/24/94
1
Sign not allowed X
4
Zone to be Determined
2
1 Sign Complies
5
W Insufficient Information
3
Insufficient Information X
E
Historic District
K
Parking
1
In District review required
I
More Parking Required
2
Not in district
2
Parking Complies
3
in -sufficient Information
Remedy for the above is checked below
Itern# Special Permits Planning Board
Item # Variance
Site Plan Review Special Permit
Setback Variance
Access other than Frontage Special Permit
Parking Variance
Frontage Exception Lot Special Permit
Lot Area Variance
Common Driveway Special Permit
Height Variance
Congregate Housing Special Permit
J11 & 'Variance for Sign
J13
Continuing Care Retirement Special Permit
Special Permits Zoning Board
Independent Elderly Housing Special Permit
Special Permit Non -Conforming Use ZBA
Large Estate Condo Special Permit
Earth Removal Special Permit ZBA
Pla nned Development District Special Permit
Special Permit Use not Listed but Similar
Planned Residential Special Permit
Special Permit for Sign
R-6 Densitv Special Permit
Other
Watershed Special Permit
Supply Additional Information
The above review and attached explanation of such is based on the plans and information submitted. No definitive
review and or advice shall be based on verbal explanations by �he applicant nor shall such verbal explanations by the
applicant serve to provide definitive answers to the above reasons for DENIAL. Any inaccuracies, misleading
information, or other subsequent changes to the information submitted by the applicant shall be grounds for this review to
be voided at the discretion of the Building Department. The attached document titled "Plan Review Narrative" shall be
attached hereto and incorporated herein by reference. The building department will retain all plans and documentation
for the ab(ye file. You must file a n b 'Id g permit application form and beg' permitting process.
t
Building Department Official Signature ebeived Application Denied
-L
Denial Sent If Faxed Phone Number/Date:��—. , -
Plan Review Narrative
The following narrative is provided to further explain the reasons for denial for the building permit
for the property indicated on the reverse side:
Review Reasoni for Denial _&8 law Refe
Y rente A
Form Item
Reference
J/1 A Variance from the Zoning Board of Appeals is required from the provisions
of Section "6.5 Prohibitions: 1. No sign shall be lighted, except by steady,
stationary light, shielded and directed solely at the sign. Internally lit signs are
nnt nlinwPii " nfth� 7 ...... D-1 ,
Rafarrad Tn-
Fire
Health
Police
J/3
Section 6.4.3. "Non-conformance of Accessory Signs: Any non -conforming
sign legally erected prior to the adoption of this provision, may be continued and
maintained. ... No existing sign shall be enlarged, reworded, tedesigned, or altered in
any way unless it conforms to the provisions contained herein. Any sign which has
been destroyed or damaged to the extent that the cost of repat'r or restoration will
exceed one-third (1/3) of the replacement value as of the date of destruction shall a . or
be repaired, rebuilt, restored or altered unless inconformity of this Bylaw." There is
insufficient information to detern-ime if the existing sign conforms to the
requirements for wall or roof signs in the GB Zoning District per the provisions of
Section 6.6.D." 1. Primary wall and roof signs attached to or part.of.the architectural
design of a building shall not exceed, in total area, more than;ten percent 0 0%) of the
area of the dimensional elevation of the building as determined by the building
frontage multiplied by the floor to ceiling height of the individual business or as
specified in applicable sections of the by-law." A dimensional Variance may be
required from the Zoning Board of Appeals.
DeDartment of Public Works
Planning
Historical Commission
Other
BUILDING DEPT
Rafarrad Tn-
Fire
Health
Police
X Zoning Board
Conservation
DeDartment of Public Works
Planning
Historical Commission
Other
BUILDING DEPT
— "&-Y . -v
MI
E
m
Commonwealth of Massachusetts
Permit No.
Department of Fire Services
j Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS ![Rev.9,051
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Ml %% ork to lie performed in accordance %% ith (lie Nlassachusetts Electrical Cotle 517 CAIR 12.00
(PLEASE PRINT1,VIAWOR TYILL =TIOX) Date:
City or Town of: To 117c h7.s-1?Acior'o1JVi1-es..
By (his application tile undersigned :;ives noti'ce'of lik orber intentio perform the electrical work described below.
�'2 Z., Ao
Location (Street & Number) X-,� ff 4&;
Owner or Tenant 1;�-60AII J.'f jo9kohif6' Telephone No.
�Owner's Address / -
0 F-111,
Is this permit in conjuncti th a building perml 7 Yes No Lj (Check Appropriate Box)
Purpose of Building_ Noirrlcl-4 / t Utility Authorization No.
Existing Sery ice Amps Volts OverheadEl UndgrdF-1 No. tit Nicters
New Service Amps Volts Overhead n UndgrdF� No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
&A
Completion (?1'1hefi)11oiving ahle mav he waived hy the lnsl)ector qflfires
No. of Recessed' Lu in inalres
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminairc Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
%bove Ei In
Swimming Pool 0
grnd. grnd.
-No. oll Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Numh..er
Tons.
I
No. of Self-C6ntained
Totals:T..
I
Deftection/A lerting Devices
No. of Dishwashers
Space/Area H eating KW
1 lun""pal
Local El N - 0 Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water
No. of No. of
Data Wiring:
"eaters
signs Ballasts
No. of Devices or Equivalent
No. Hydromassage BathttiU§ . jNo.
of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
ifel"Sired, or (IS I-cquired hj I h e h Lyll C 00i ' G'/ 'i I C.".
Estimated Value of Epctrical Work: (,When required by municipal policy.).
�k ork to Start: ins P ctions to be requested in accordance %ith NIEC Rule 10, and upon completion.
INSURANCE CMERACE: Unle waived by tile owner. no permit for the performance of electrical work may issue L1111CSS
the licensee pro,,ides proof of liabil' v insurance inClUdimi "cornpleted operation- cOVera2C Of- itS Substantial UJI-liVilIC11t.
11 y
Undcrsi-ned certifies tlllt Such CO Ta -e is in fiorce, and has ux1libited proot of -,;ainc to the pernlit office.
'-c `
El
('I IECK ONNE: INSURANCE: [;()N,, D 0171112"R 0 (Specify:)
I cerfqjy, wider the ptth1SJjU(1 enaN't-s ol e t //,It t The h!fimmution on ihis eipplication is true and eomplef
11 C. (6333>
X
Fl.RNI NAME: 4 j 1 7
Licensee: L-mT vov :iigllaturel/ C/2111,/ '-,A�rq LIC. NO.:
hC/ L'(1 'It I&V i,1,11 Bus. Tel. No.:
AV 2�� Alt. Tel. No.:_
*Security Systein Contractor License required for this work; if applicable, enter the license number licre:
OWNER'S INSURANCE %AIVER: I arn iware that tile Licensee d0eS ;701 have the liability insurance cov,.:rage nornlall�
icquired by law. Byflly Signature below, I hereby waive this requircincilt. I arn the (check one) [:] owner [:] owners :iyent.
Owner/Agent
Signature cif-plione 'It PERMIT FFF,'
i
N2 3273 Date .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........... 'T . . ....................................... T"..( ......
has permi ssion to perform ..... Of..E� ... c� ......... ......... ................
A:0 41 -11 It
................................. .... .......................
wiring in the building of ...... ...'T
. ........ ............... /, North Andover, Mas
Fee.�.') f ........... Lic. No,"4.�z� ... E.-
ELEcrRICAL INSP*
Check #
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Office Use 73
C114c (gommunwralo of 149-asgar4auffs Permit No.
ihpartment of Pubfir —9-afitV Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 L 3/90 (leave blank)
APPLICATION FOR PERMIT M PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527,PR 12:00
(PLEASE PRINT IN INK OR E AqLL INFORMATION) Date/vt-4 ?,(-/
City or Town o /chi J; it/& To the lnsga-c—tor'�f wire
The udersigned applies for a permit to perform the electrical woA described below.
Location (Street & Number) . 3 0 ;M ASS /dLrr
Owner or Tenant 6A W np, )Ice V A <4
Owner's Address lc�
Is this permit in conjunction with a bUilding permit: Ye (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead Undgrnd 0 No. of Meters
New Service Amps Volts Overhead Undgrnd El No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work bde,
No. of Lighting Outlets
No. of Hot Tubs
No. of Transformers Total
I
KVA
No. of Lighting Fixtures
Swimming Pool Above In
11 1:1
grnd. g,rd.
Generators KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
No. of Ranges
No. of Air Cond. Total
tons
Initiating Devices
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Sounding Devices
No. of Self Contained
,No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local Municipal [I Other
11
No. of Dryers
Heating Devices KW
Connection
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. at Motors Total HP
OTHER:
(4- 1 0 CA
T I lv� (!�, d 5 t -Soi I <1
Gu n, w i n4 * f -o yz up t ce- :t--' , N:1�1
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES X NO C I
have submitted valid proof of same to the Office. YES K NO C If you have checked YES, please indicate the type oyboverage by
checking the appropriate box.
INSURANCE X BOND 0 OTHER 0 (Please Specify)
Estimated Value of Electrical Work $ (S�pirafion Date)
Work to Start
Signed under the Penalties of perjury:
7 --
FIRM NAME
Licensee
Inspection Date Requested: Rough Final
LIC. NO.
LIC. NO,
s. Tel. No. y -d- 6-,5
Address J�- 6;11(gle�f0lya ALI-) 44112OZ14--,12 AAA&PAIt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature an this permit application waives this requirement. Owner Agen
(Please check one)
Telephone No. _ PERMIT FEE $ SO
(Signature of Owner or Agent) x-6565
If,
Loc ation—
No.'
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
14
CHU
Foundation Permit Fee $
$
Other Permit Fee
TOTAL $
4
Check #
14 �� 33
Building Inspectof/
TOWN OF NORTH ANDOVER BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
for Official Use OnI
BUILDING PERMIT NUMBER:
DATE ISSUED:
I
C&,,—
SIGNATURE: /V/V,
Buildi or of Buildings
Commissi$!� �r�� Date
1. 1 Property Address:
1.2 Assessors Map and Parcel Number:
,36 MW15 4kz
2.
Map Number Parcel Number
1.3 Zoning Information:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area (sf) Frontage (ft)
1.6 BURDING SETBACKS (ft)
Front Yard Side Yard
Reu Yard
Re(pired Provide ReqWred
Provi&d
red
Provi(w
1.7Water Supply M.G.L.C.40.954) 1.5. Flood chiformation:
1.9 Sewerage Disposal System:
Public 0 Private 0 zone - Outside Flood Zone 0
Municipal On Site Disposal System 0
2.1 Ownerof Record
� ,� A///? —A- ,v c e 51fl1i1t1C--r 1-31flvl,.I_ 36 'A�X-5-5 4Vgf-
Name (Print) Address for Service
Signature�-� Telephone
7JF,:3 7 3
2.2 Author&.d Agent
Name Print Address for Service:
Signature Telephone
3.1 Licensed Construction Supervisor Not Applicable 0
1�e, V/ Irfl CS Q 3472' 1/ 19
AddreA License Number
Licensed Construction Supervisor: f — / - 2
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
e'//V
CompanyName'.
Registration Number
Ae—
M.P.$— 37
Address
-� 2 f .3 7XV333
Expration Date
Signatd, Telephone
0
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411 A'l _A 1 /10 as Owner/Authorized -
'674
Agent f -
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief
Signed under the pains and penalties of pedury
//0
Print flarne
Si�i;aWof Owner/Agent Date
001,01.1 01Y.,
, 01' ' "Aff 1100"QW-0-2
Item
Estimated Cost (Dollars) to be
. . . . . . . . ... NO
Completed by applicant
permit
1. Building
//Roo
(a) Building Permit Fee
Multiplier
2 Electrical
(b) Estimated Total Cost of
Construction from (6)
3 Plumbing
Building Permit fee (a) x (b)
4 Mechanical (HVAC)
5 Fire Protection
6 Total (1+2+3+4+5)
Check Number
NO. OF STORIES SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TRvMERS I ST 2 ND 3 RD
SPAN
DEMENSIONS OF SILLS
DEMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HEIGHT OF FOUNDATION TBICKNESS
SIZE OF FOOTING x
MATERIAL OF CBRVNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
W
.. .... ...
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the -denial ofthe
issuance of the building permit.
Signed affidavit Attached Yea ....... 0 No ....... 0
S910 A 'bis S SUM 'TO
5.1 Registered Architect:
Name:
Address
Signature Telephone
;;6
Area of Responsibility
Registration Number
Expiration Date
Name:
Address:
Signature Total
Not applicable 0
Registration Number
Expiration Date
Name:
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Area of Responsibility
Registration Number
Expiration Date
Name
Address
Signature Telephone
Not Applicable 0
Company Name:
Responsible in Charge of Construction
7aw I —M 7
New Construction 0
Existing Building 0
Repair(s) [I
erations(s)
Addition 0
Accessory Bldg. 0
Demolition
Other [I Specify
Brief Description of Proposed Work:
0 A-3
0
0
IA
IB
62�
B Business
0
BUILDING AREA E)USTING (if applicable) PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floor (st)
Total Area (so
Total Heip-lit (ft)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 10a Owner Authorization - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Hereby authorize
My behalf, in all
Owner of the subject property
relative two work authorized by this building permit application
Signature of Owner Date
act on
USE GROUP 7heck as applicable)
CONSTRUCTION TYPE
A Assembly
0 A-1 0
A4 0
A-2
A-5
0 A-3
0
0
IA
IB
0
0
B Business
0
2A
2B
2C
0
0
0
C Educational 0
F Factory 0 F -I 0 F-2 0
H High Hazard
11
3A
3B
0
0
1 Institutional 0 1-1 0 1-2 0 1-3 0
M Mercantile
0
4
0
R residential
0
R -I 0
R-2
0 R-3
0
5A
5B
0
0
S Storage 0 S-1 0 S-2 0
U utility
M Nlixed Use
S Special Use
0
0
0
Specify:
Specify:
Specify:
COMPLETE THIS SECTION IF EXISTING BU]ILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR
CHANGE IN USE
Existing Use Group:
Existing Hazard Index 780 CNM 34:
Proposed Use Group:
Proposed Hazard Index 780 CMR 34:
BUILDING AREA E)USTING (if applicable) PROPOSED
Number of Floors or Stories Include
Basement levels
Floor Area per Floor (st)
Total Area (so
Total Heip-lit (ft)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 10a Owner Authorization - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Hereby authorize
My behalf, in all
Owner of the subject property
relative two work authorized by this building permit application
Signature of Owner Date
act on
FORM U - LOT RELEASE FORM
INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from
Boards and Departments having jurisdiction have been obtained. This does not relieve
the applicant and/or landowner from compliance with any applicable or requirements.
I*****************************APPLICANT FILLS OUT THIS SECTION""""' I
,spi,L)C'e W00-0
APPLICANT SAO,k,%� 'EAJJ((,
Q
LOCATION: Assessor's Map Number.
SUBDIVISION
STREET Al A
M
RECOMMENDATIONS OF TOWN AGENTS:
CONSERVATION ADMINISTRATOR DATE APPROVED
DATE REJECTED
COMMENTS
TOWN PLANNER
COM
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMME
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERMATER CONNECTIO
DRIVEW
PERMI
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECT
Revised 9\97 im
PHONE
PARCEL
LOT (S)
ST. NUMBER -3-0
USE
TE
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers'Compensation Insurance Affidavit
Name Please Print
0
Name: ee_ IAL�
Location: =,!gWA e,,
-7(
citv A Phone # f 7F 3 V-3 3
I am a homeowner performing dfl work my�self.
F-1
j��l 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.
ComRany name:
Address
Cily: Phone#:.
Insur-ance.Co.. Policv#
cot"pa
�m.t name:
Addm- ss
CU. Phone
and/or one years' irnprisOnMent-as-WeU-as-ciAl,penaltiesinJhelc)rmjof-a-S.-TUP�.VVUKK-UmJv-KAno-a-nne-C)r4w-f-M
understand that a copy of this statement maybe forwardedto the Office of Investigations of the DLA.forcoveraige v
do hereby certify under the pains and Pen of pequry that the information provided above is true and correct
eupila;iii,=
-agwristrne. I
'-114 x , -) J
2F 3 7 Y 11-3 3-P
Print name Phone.#
7A,cM :7 only do not wite in this area: to be completed by 7771=77al'
City or Town Permit/Ucensing
Building Dept
El Check if immediate response is required E] Licensing Board
El Selectman's Office
Contact person: Phone Ej Health Department
Other
fown of Aorth Andover
Building Department
27 Charles-Stroet
North Andover, Massachusefts 01845
(978) 6.88-9545. Fax. (978) 688L9542
DEBRIS DISPOSAL FORM
0
0 4
In accordance with the provisions. Of MGL c 40 s 54, and- a condition of
Building-perinit.# the debris resulting frorh the work shall.be -disposed
of in a properlY licensed so -lid waste disposal facility as defined by MGL c 1,1, s I 56a.
The debris will be disposed of in /at:
1AIrA--
e-
5
Facility location
-70 7
Signature OfApplicant
----------
Date
NOTE: A demolition permit from the Town of.North Andover must be obtained fort'
project through the Office, of the Building Inspector. his
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Location S19 <- -
No. — rl _57' Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
CHU
Foundation Permit Fee $
Other Permit Fee 0 P $ —5-0
TOTAL
Check # p6 20 A (
,V V 16_A� —
15098 Buildino Inspector
,CERTIFICATE OF USE & OCCUPANCY
TONM OF NORTH ANDOVER
Bui1ding Permit Number Date A) Z/o/
T111S CERTEPI[ES THAT
TIRE BUILDING LOCATED ON 30 MA-s-S'Ao-r- AG d 1Z
MAYBEOCCUPIEDAS 6. (T.C.C. INACCORDANCE,
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH
OTHER REGULATIONS AS MAY APPLY.
t
CERTIFICATE ISSUED TO- 1AWr----1-C-e 234AC
ADDRESS 30 MAS13 A (*.-
A411-1 � 'C -1 -
Building Inspector
(111mmunw# of Ifingoar4artts
101tvartment of Public -*afctu
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Only,
Permit No. 33
Occupancy A Fee Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CM�RA2:10
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date
(X* or Town of NORTH ANDOVER To the TInsector of Wires:
The udersigned applies for a permit to perform the electrical worlqdescribed below.
A -
Location (Street & Number)
Owner or Tenant 1-4 v tte-q c (f >/Vut 4�s o4i�?
Owner's Address -
Is this permit in conjunctl5n with zk buildin permit: Yes No (Check Appropriate Box)
Purpose of Building ud-M/1WW6. /,a I Utility Authorization Nc.
Existing Service Amps Volts Overhead Undgrnd
New Service Amps 'Volts Overhead Undgmd
No. of Meters
No. of Meters
Number of Feeders and Ampacity rr�/— —
Location and Nature of Proposed Electrical Work dlt-,Plcie!� - TZdA—
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of % h setts general Laws
,�assac u
I have a current Liability Insurance Policy including Co ed Operations Coverage or its substantial equivalent. YES
have submitted vali oof of same to the Office. YES NO C:, If y�oou �hav checked please indicate the type of coverage by
djxr
checking the ap riate box.
INSURANCE pecify)
BOND l-- OTHER C (Expiration Date)
Estimated Value of E09hrical Work S
Work to Start W/3 —
Signed under the alties of per
FIRM NAME
Licensee
inspection Date Requested: Rough
ignature
Final
— LIC. NO. A-0213�73
Ad Alt. Tel. No.
dress
OWNER'S INSURANCE WAIVER: I arri"'aware that the Licensee does not�h.le�h insurancBeuscoverage or its substantial equivalent as re -
No
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one) --7<-- /7 /1
(Signature of Owner or Agent)
.'IT I
Telephone No. PERMIT FEE S
x-6565
Total
No. of Lighting Outlets
No. of Hot Tubs
—TGenerators
No. of Transformers KVA
No. of Lighting Fixtures
Swimming Pool Above In-
grnd 0 grind.
KVA
No. of Emergency Lighting
No. of Receptacle Outlets
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARfAS No. of Zones
No. of Detection and
Total
No. of Ranges
No. of Air Cond. tons
Initiating Devices
Heat Total Total
No.
Pumps Tons KW
No. of Sounding Uevices
No. of Self Contained
No. of Dishwashers
Space/Area Heating KW
Detection/Sounding Devices
Local Municipal []Other
11 Connection
No. of Dryers
Heating Devices KW
No. of No. of
Low Voltage
No. of Water Heaters KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of % h setts general Laws
,�assac u
I have a current Liability Insurance Policy including Co ed Operations Coverage or its substantial equivalent. YES
have submitted vali oof of same to the Office. YES NO C:, If y�oou �hav checked please indicate the type of coverage by
djxr
checking the ap riate box.
INSURANCE pecify)
BOND l-- OTHER C (Expiration Date)
Estimated Value of E09hrical Work S
Work to Start W/3 —
Signed under the alties of per
FIRM NAME
Licensee
inspection Date Requested: Rough
ignature
Final
— LIC. NO. A-0213�73
Ad Alt. Tel. No.
dress
OWNER'S INSURANCE WAIVER: I arri"'aware that the Licensee does not�h.le�h insurancBeuscoverage or its substantial equivalent as re -
No
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one) --7<-- /7 /1
(Signature of Owner or Agent)
.'IT I
Telephone No. PERMIT FEE S
x-6565
-N2 01533
Date . ...... .......
............
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .................................................................................... P
. . ;�'r e�t� '
haspermissionto rform . . . ............................ .. I ...............
wiring in the building of ..... .1W
................. (U
L9
...... 0 North Andover, Mass. —
at..& .......... ........ ..... ....................
Fee..................... Lic. No . ............. ...............................................................
ELEcrmcAL INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
PER.AIT NO.
I MAP NO
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS.
PAGEi 1
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
PERMIT GRANTED
�;Alellp-;—1 9
3 PROPERTY INFORMATION
LAND COST 9
EST. BLDG. COST
EST. BLDG. COST PER SQ'IFT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDING INSPEEt-
LOT NO.
2 RECORD OF OWNERSHIP DATE
BOOK PAGE
ZONE
SUB DIV. LOT NO.
LOCATION
PURPO SE OF BUILDING
.94e4g
OWNER'S NAME
OWNER'S ADDRESS
NO. OF STORIE
! � �&—A/' e ) ow
BASEMENT OR SLAB
ARCkITECT'S NAME
BUILDER . -'S NAME NZ 9. �V4 CC .-IA141f, X64
DISTANCE TO NEAREST R-111
SIZE OF FLOOR TIMBERS IST
SPAN
ow
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDE EARA/
S/yd I
GIRDERS
AREA OF LOT py, '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
WILL BUILDING CONFORM TO 11EQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION, IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL G
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3
PAGE 2 FILL OUT SECTIONS 1 - 12
ELECTRIC METERS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
PERMIT GRANTED
�;Alellp-;—1 9
3 PROPERTY INFORMATION
LAND COST 9
EST. BLDG. COST
EST. BLDG. COST PER SQ'IFT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
PLANNING BOARD
BOARD OF SELECTMEN
BUILDING INSPEEt-
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BOB WHITE'S
TOWN LINE RESTAURANT INC.
Tel. MU 9-9714 30 MASS. AVE.
MU 6-4581 NO. ANDOVER, MASS.
SERVER PERSONS TABLE CHECK
14.000 ..... .
Z, W z
I o
INN==
I ��, . 0' PL
836821-W
P. J. DOOLEY CO., INC.
695 Truman Highway
HYDE PARK, MASS. 02136
TO Phone 364-2423
-----Building-De nt
Town of North Andover
North Andover, Mass.
MESSAGE
DA TE 19 7 5 0 URGENT
0 SOON AS POSSIBLE
FILE NO. 0 NO REPLY NEEDED
ATTENTION
SUBJECT --B-Qb WAt
ela-Z line-Rostaurant
Gentlemen:
L e
> Restaurant in North Andover, Mass. has been completed. In addition we wish to
-7�—tat6- that all �v6rik-Ha-s---li-e-6n- J�e-rff o-iiif6T -as -s-Ifo-w-n---6-n--d-r-dWi-n-gs-s-ub-mi-tt-e-d —to �6-uilr---
department. There has been no revision or deviation from the original plan.
SIGNED
REPLY1
C.C. Bob 1�hitels Restaurant
N DATE Of REPLY --------,-.-----
SIGNED
R" - 91/6 /7 '1 -.11
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0
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Building/Frame Permit Fee $ Pq
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Sewer Connection Fee
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TOTAL
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CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number 085 Date "1y 9, 1998
THIS CERTMES THAT
THE BUILDING LOCATED ON Lawrepce Savings Bank 30. Mass Ave
MAY BE OCCUPIED AS Office Space Alteration IN ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
CERTIFICATE ISSUED To Lawrence Savings Bank
30 Mass Ave 4orth Andov
ADDRESS 01845
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TOWN OF NORTH ANDOVER
8
PERMIT FOR WIRING
1`3
.' 1-.. -
S CHUS
This certifies that ......... (2;
..... ........ . ...... . ....... CU
has permission to perform .......... ... . W.
....................... I .......
wiring in the building; of..Oyep-z�-- .... . .... I ..................
at. -?d .... .... . . ..... . North Andover, Mass.
Fee..;?
Lic. ............................................................
ELECTRICAL INSPECTOR
4r
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
The Commonwealth of Massachusetts O!ii�c Use Only
Permit No.
Department of Public Safety
Occupancy & Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 1Z-00 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All voork to be performed In accordance uAth the MaLsachuserts Electrical Code. 527 CM 127,
FORHATIO
(PLF-ASE PRINT IN IM OR TYPE 4LL XN N) Date. 3 ��/0011
City or Town of A AJQ�^ To the Inspector ofwires:
The undersigned applies for a permi to perform the electrical work described below.
Location (Street & Number) IN 5s 34-avA J%,,4 k) ftone SA/i q, &r k
LS
Owner or Tenant
V
Owner's Address 5 OWN%7f
Is this permit in conjunction with a building permit: Yes 21� No 11 (Check.Appropriate Box)
Purpose of Building C.*Ift eA C,1 I% I Utility Authorization NO.
Existing Service Amps Volts Overhead Undgrd No. of Meters
New Serv-ice Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity,
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
Total
No. of Transformers KVA
No. of Lighting Fixtures
Swimming Pool Above M In-
, grnd. LJ grnd.
Generators KVA
No. of Receptacle Outlets
No. of Oil Burners
No f Emergency Lighting
Ba�tory Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Municipal Other
Local 0 Connection[]
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
Heat Total Total
No. Of Pumps Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
Heating Devices KW
No. of Water Heaters KW
No. of No. of
Signs Ballasts
Low Voltage
Wiring
No. Hydro Massa ge Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YESg_ NO [] I have submitted valid proof of same to this office. YES Q§ NO []
If you have checked YES, please indicate the type of coverage by cbeck'ng the appropriate box
INSURANCE 0 BONDE] OTHER 1:] (Please Specify) �Iea
Estimated Value of Electrical Work $ -7ExpLration Date)
Work to Start
Inspection Date Requested: Rough Final____�__
Signed under the It' of perjury -
FIRM NAZE _ �/,M a
Liccnsee S - /e� \/ L1)_9 /-/ \.& Signature
LIC. NO. IIS?3 a
LIC. NO. W S9 3 -3
0/�# - - b' G
Address 16 Z_ -6. Ile, Alay'r'.0, 1,14 -flis. Tel. No.(.5
0b-_5 —WY_ -'2
Alt. Tel. No.
OWNERIS INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one) __1
Telephone No. PERMIT FEE S
(Signature of Owner or Agent)
-C.. _4v
A/ Location
No. Date
�0 _*T"'.�,\ -TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
A us
-Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
lg�5_=
$
o�-w
Building Inspector
1.- 10745 25.00 pAID
03/105/97 11-35 Div. Public Works
PERM IT NO. 7:7
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
vPAGE 1
MA 4-40.
LOT NO. 41:5100 6--
12 RECORD OF OWNERSHIP IDATE
BOOK '.PAGE
ZONE
SUB DIV. LOT NO.
LOCATION
7
PURPOSE OF BUILDING JWPH C* _,Alf
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT*S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION �1�111141(1
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUfREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
-,,� ,e
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3
PAGE 2 FILL OUT SECTIONS I - 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED
SIGNATUftE OF OWNER OR AUTHORIZED AGENT
FEE
PERMIT GRANTED
19
k7
3 PROPERTY INFORMATION
PLANO COST
EST. BLDG. COST
EST. BLDG. COST PER 80.*FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
:p/
OWNERTELJ f
CONTR . TEL. #
CONTR. LIC. #
H.I.C. Af
BUILDING RECORD
OCCUPANCY 12
LINGLE FAMILY
STORIES
MULTI. FAMILY
OFFICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE 2 13
CONCRETE BLT_ PNE—
BRICK OR STONE
�ARDW D
—1
PIERS
TLASTER
(51RY _VVALL
'7NFN
3 BASEMENT
AREA FULL
FIN. B M T' AREA
1/1 1/2 %
FIN. ATTIC AREA
tLO B M -T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
B
1
2 3
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
HARDVJ'D
_�OMMCN
�SPH TILE
STUCCO ON MTS—ONRY
STUCCO ON FRAME
BRICK ON MASONRY
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONC. OR CINDER BLK.
WINING
STONE ON MASONRY
ji
STONE ON FRAME
SUPERIOR POOR
ADEQUATE NONE
5 ROOF
10 PLUMBING
GABLE
GAMBREL
I
HIP
BATH 13 FIX.)
MANSARD
'5431,LET RM -,(2 FIX.)
FLAT -11
SHE D
WA
ASPHALT SHINGLES
L
WOOD SHINGES
KITCHEN
SLATE
NO PLU�BING`1-
TAR & GRAVEL_I_
STALL SAOWER
ROLL ROOFING
ODERN FIXTURES
TILE FLOOR
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FORCED HOT AIR FURN.
TIMBER EMS. & COLS.
STEAM
STEEL BMS. & COLS.
HOT W T'R OR VAP
WOOD RAFTERS
AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
GAS
7 NO. OF ROOMS
B'M'T
lit 3rd
CTRIC
NO HEATING
vl�
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.
I� o\
1.
FORM U - VERIFICATIOIN FORM ,
A
INSTRUCTIONS: This form is used to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law,
regulations or requirements.
****************Applicant fills out this section**
APPLICANT:
/4)
e- Phone
LOCATION: Assessor's Map Number Parcel
Subdivision 'Lot(s)
Street St. Number
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
driveway permit
i ire Department
re Dc m6fw
/V
Received by Building Inspector Date
U
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PF.R'%IIT-N(;. , v&,;, APPLICATION FOR PERMIT -TO BUILD NORTH ANDOVER, MASS.
PAGE I
MAP +40.4:20Z,
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK ;PAGE
7j,') N E
SUB DIV. LOT NO.
ATION C?
PURPOSE OF BUILDING
OWNER'S NAME
NO. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING v
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES — SIDES REAR
GIRDERS
AREA OF LOT 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
WILL BUILDING CONFORM TO REQUIREMENTS OF CODEz--
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
ezecl 0-a-7-0
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS I - 3
12
PAGE 2 FILL OUT SECTIONS I
C)
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
DATE FILED $010
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E
PERMIT GRANTED
CR� 19
CDevia i 3 m
C wou I
cv /0 �-
A r— '00�
d) IL 107v,.?
V(rcf,r
3 PROPERTY INFORMATION
LAND COST
-EST. BLDG. COST
_EST. BLDG. COST i'ER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
e- ��-
OUILDING INSPECTOR
OWNER TEL# 4�9' :::; 495��9
ONTR. TEL. # -!r-or- ;jP001,47
CONTR. LIC. # 40 1
H.I.C. #
70
BUILDING RECORD
I OCCUPANCY 12
SINGLE FAMILY
S,_ORIES
MULTI. FAMILY
OF FICES
APARTMENTS
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
__ 3 1 2 13
PINE
CONCRETE
CONCRETE BL'K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
_�RY WALL
UNFIN.
3 BASEMENT
AREA FULL
FIN. 8 M T' AREA
114 1/2
FIN. ATTIC AREA
t!O 8 M T
FIRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
B
1
3
DROP SIDING
WOOD SHINGLES
CONCRETE
EARTH
_�ARDVV D
CCMfAC;N
_MSPH. TILE
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK--dF4 MASO—N—R-Y—
BRICK ON FRAME
ATTIC STIRS. & FLOOR
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIO
ADEQUAETE QgNRE
10 PLUMBING
5 ROOF
GABLE
GAMBRELI
I
A
BATH Q FIX.)
_�Ip
MANSARD
TOILET RM. 12 FIX.)
FLAT
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
MODERN FIXTURES
TILE FLOOR
DADO
_LILE
6 F ING
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
AS
OIL
IM T
Ist 3rd
ELECTRIC
NO HEATING
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.
A 0
FORM U - VERIFICATMN FORM
INSTRUCTIONS: This form is use d to verify that all necessary
approvals/permits from Boards and Departments having jurisdiction
have been obtained. This does not relieve the applicant and/or
landowner from compliance with any applicable local or state law..
regulations or requirements.
****************Applicant fills out this section*/!�k***,***********
,_�PPLI CANT: Phone V
L,LOCATION: Assessor's Map Number 60 Parcel _000 5—
Subdivision
V9,"reet
Lot (s)
St. Number lffzv
************************Official Use Only************************
RECOMMENDATIONS OF TOWN AGENTS:
Date Approved
Conservation Administrator Date Rejected
Comments
Town Planner
Comments
Food Inspector -Health
Septic Inspector -Health
Comments
Public Works - sewer/water connections
driveway permit
Fire Department aw 44zw��;
Received by Building Inspector
Date Approved
Date Rejected
Date Approved
Date Rejected
Date Approved
Date Rejected
Date
Yllf,
r
FR 2 A mw
DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Num.ber: Expires: Birthdate:
CS 067560 A/2511999 10/25/1966
Restricted To: 00
SHAWN K TWOKEY
21 LAKE JOY RD
ANDOVER, KA 01810
HOME IMPROVEMENT CONTRACTOR
Registration t"419
Type - DBA
Expiration 09/10/98
TWOMEY CONSTRUCTION
AUN M. TWOMEY
ADMINISTRATOR qLOVE JOY RD
ANDOVER M - A - 01810
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No. Date
1 41
TOWN OF NORTH ANDOVER
1 T3 05109711:53
25. M PRI Vilding Inspector
Div. Public Works
Certificate of Occupancy
$
'Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
1 T3 05109711:53
25. M PRI Vilding Inspector
Div. Public Works
PERMIT NO. (no !7
- MA� 4-40/.5,�,p7 >
APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS.
IV/ PAGE I j
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
;AGE 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
W"I'DATE FILED— 2
ATURC'YF-OWNER OR AUTHORIZED AGENIf
F E E
PERhNT GRANTED
19
JAN - 6 ir)07
m
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
L&2 " a u
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
NUILDING INSPECTOR
OWNER TEL. # 7- IISI-
CONTR. TEL# 19
4= Al -foi
CONTR. LIC. #
H.I.C. # /0
LOT NO.
2 RECORD OF OWNERSHIP DATE
BOOK ;PAGE
ZONE
SUB DIV. LOT NO.
LOCATION _?
40 'e�� �,
ggj�, a_
PURPOSE OF BUILDING golor,,�
OWNER'S NAME e_ 15;ly1km /-U/) �,--
e",:I,e
Nd. OF STORIES SIZE
OWNER'S ADDRESS
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIM13ERS IST 2ND 3RD
BUILDER'S NAME
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
19 BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
;AGE 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
W"I'DATE FILED— 2
ATURC'YF-OWNER OR AUTHORIZED AGENIf
F E E
PERhNT GRANTED
19
JAN - 6 ir)07
m
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
L&2 " a u
EST. BLDG. COST PER SQ. FT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
NUILDING INSPECTOR
OWNER TEL. # 7- IISI-
CONTR. TEL# 19
4= Al -foi
CONTR. LIC. #
H.I.C. # /0
13
BUILDING RECORD w;
I OCCUPANCY 12
SINGLE FAMILY S-ORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILL=�—�OiFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA -
APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
0
CONSTRUCTION
2 FOUNDATION
8 INTERIOR FINISH
3 1 2 3
PINE
CONCRETE
CONCRETE BL'K—.
BRICK OR STONE
D
PIERS
_j!ARDW
PLASTER
(�RY _VJALL
UNFIN.
3 BASEMENT
AREA FULL
1/1 1/2 %
FIN. B*M T' AREA
FIN. ATTIC AREA
NO 8 M'T
HEAD ROOM
FIRE PLACES
MODERN KITCHEN
4 WALLS
9 FLOOR$
CLAPBOARDS
B
1
3
DROP SIDING
WOOD SHINGLES
—
—
_�_O_NCRETE
TARTH
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
—
HARDW'D_
_C0MfACN
_X -SPH. —TILE
STUCCO ON MASONRY
STUCCO ON FRAME
BRICK -UN- WAS5_NTT_
BRICK ON FRAME
ATTIC STRS. & FLOOR
CONC. OR CINDER BLK.
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR I I _P200 "R
_�_DEQUATE I NONE
5 ROOF
10 PLUMBING
GABLE
dip
BATH f3 FIX.)
GAMBREL]
I
MANSARD
TOILETAM. 12 FIX.)
FL—AT1
SHED
WATER CLOSET
ASPHALT SHINGLES
LAVATORY
WOOD SHINGES
KITCHEN SINK
SLATE
NO PLUMBING
TAR & GRAVEL
STALL SHOWER
ROLL ROOFING
DERN FIXTURES
TILE FLOOR ---
TILE DADO
6 FRAMING
11 HEATING
WOOD JOIST
PIPELESS FURNACE
FbRCED 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
GAS
'
7 NO. OF ROOMS
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S u
Date.................... .. . .........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... ............. A.:�.s . ...................................... T
has permission to perform ........ ....... ..........
... 0 ...... . ............................... C�
wiring in the building of .......
at ..... ....... North Andover, mass.
......... /Z ............
Fee.. Lic. No. -"f ....... . ....
T INSPECTOR
6-+
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
EMU Me Commonwealth of Massachusetts nfilce us* only
Department of Public Safety rere6i X0.
occul""CV 4 ret owelied
0 BOARD OF FIRE PREVENTION REGULATIONs 527 CMR IZ= 3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All %mrk to bo palormed in acc9rdshc, wilh he M&&"C1ku&#ns F
Jgclrlc&l Code. $27 CMR 12-9-M
(PLEASE PRINT IN nM OR Tn
/ E ALL INFORM&TION)
f Data I / YO 4'/
City or Town 0 so �j �50 --------
To the Inspector of Wires:
1he undersigned applies for a permit to perfor'm' the electr
-6 41&1 work described below.
14"CiGn (Street Numbor�..
Owner -or Tonant
AA-wYUre-e
Owner's Address
Is this permit in conjunctiq I i h a building mit. Check P, I
W t permit: Yes No (Check Appropriate Box)
PurP034 of Building. k' -,Utility Authorization No.
Existing Service __.Amps Volts Overhead El UndgrdC] NO- of Haters
New Urvice
�mps —Volts Overhead C3 Undgrd C3 NO- of Haters
Numb -or Of Feeders and Amnatiry I ------
Location and Nature of Proposed Electrical Work
U-------
No. of Ughting outl
*cs AM TNO. of HottTubs
No. of Lighting Fixt No. of Transformers Total
ures Swimming Pool Above r7 KVA
6 In-.
1* grnd. L_j grnd Generators KVA
No. of Receptacle Outlets NO - of Oil Burners No. of Emer ency Lighting
n,g
No. of Switch Outlets No. of Cas Burners Battery U t3
TIRX ALARMS No. of Zo I
No. of Ranges No. of Air Cond, lot OC --- �*NO- '10f Detection and
Heat ns
No. of Disposals lot To ;--� Initiating DgViCell
No. of aL
P=03 1CW No. of Sounding Devices
No. of Dishwashers
ISPaca/Area Heating XW No. of Self Contained
No. of Dryers Heating Devices Detection/Sounding Devices
KW Local C3 Municipal
No. of Water Heaters KW No, of — Connect ionO Other
Low V-01tage
Si,ns Ballasts
ns
No. Hydro Massage Tubs
Total HP
NO. of Motors
----------------
INSURANCE COVERAGE. Pursuant to the rkquirements Of Massachusetts General Laws
*1 have 4 current Liabili�y Insurance Policy including Completed Operati6jnj, Coverage or 3 subst nti
equivalent. YES Er NO (:] I have submitted valid proof of same to this of _jt al
If You have checked YES, fice. YESEj No 13
Please indicate the typ of cf�,eXage by checking the appropriate box.
INSURANCE Z BOND*C] orMp (Please Specify;
Estimated Value of Ele�ctrical Work S pfracion a-cU
Work to Start
__4 Inspection Date Requesteds Rough ----- Fina I
Signed under the 111ties o6erjur'y:
FIRM NAME 41A
Licensee LIC. No. AS7_33�
150 LIC'i NO.
Address.5 &/
t1jr-T—al. -No. -3
�_,Yfv EFt: ITIal. No. _,!�p
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not he
12- _hve the insurance coverage or its sub-
stantial equivalent as required by Massachusetts Ceneral-rTws, and that my signature on this permit
application waives this requirement. Owner Agent (Please check one)
Telephone NO.
gnacure oz Owner or Agent) PERMIT FEE S
CA tf 10�t
Location
No. Date
VORT)f
:-.-:,JOWN OF NORTH ANDOVER
imimid1w S Certificate of Occupancy $
Building/Frame Permit
Fee $
Foundation Permit Fee $
C"
Other Permit Fee
Sewer Connection Fee
Water Connection Fee
TOTAL $ ;?2 Boo
4 2 164413, sec.,- -
�-, 8"q 5 �
4-12 BuildinglInspector
al 228.00 PAID
n1A/Pj06 13:32
Div. Public Works
PF,R.%flT NWw-
4 MAP i-40.
4
APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. / PAGE I
INSTRUCTIONS
SEE BOTH SIDES
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 7�51f-t�
DATE FILED
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E Z,�= 6 —1--
("C
PERMIT GRANTED
'96
--� /03 -7�o —
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. F -r.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
SUILDING INGIPRC T0lt
OWNER TEL. #
CONTR. TEL. # 37 1� If -3 3
CONTR. LIC. # Y-7:�/
H.I.C. # 3:2
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK '.PAGE
ZON E
SUB DIV. LOT NO.
LOCATION :?0 m4s -5 /-FVF-
PURPOSE OF BUILDING
OWNER'S NAME �kIV,he:4V,CM 1�;A_Vjr4C c
NO. OF STORIES LIP Sat
OWNER'S ADDRESS ty) P65 A-V F-
BASEMENT OR SLAB
ARCHITECT'S NAME
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME
Tk-'I I � o Co, -,.-t -f- cik� -P/,/ c -
SPAN
DISTANCE TO NEAREST BUILDING
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISTANCE FROM LOT LINES - SIDES REAR
GIRDERS
AREA OF LOT FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION Ti7 5
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
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 7�51f-t�
DATE FILED
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E Z,�= 6 —1--
("C
PERMIT GRANTED
'96
--� /03 -7�o —
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. F -r.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
SUILDING INGIPRC T0lt
OWNER TEL. #
CONTR. TEL. # 37 1� If -3 3
CONTR. LIC. # Y-7:�/
H.I.C. # 3:2
BUILDING RECORD
I OCCUPANCY 12 _&
§,INGLE FAMILY
ORIES
S_()"
MULTI, FAMILL___:�#[S
N—FIC
E5S
APARTMENTS
CONSTRUCTION
2 FOUNDATION
8 INTERIOR Fl NISH
CONCRETE
PINE
3
2 13
CONCRETE BL*K.
BRICK OR STONE
HARDW D
PIERS
PLASTER
-FRY WALL
�NFIN
3 BASEMENT
AREA FULL
FIN. B M*T* AREA
1/1 1/2 lh
FIN. ATTIC AREA
tLO 8 M T
IRE PLACES
HEAD ROOM
MODERN KITCHEN
4 WALLS
9 FLOORS
CLAPBOARDS
B
1
2
3
DROP SIDING
WOOD SHINGLES
ASPHALT SIDING
ASBESTOS SIDING
VERT. SIDING
STUCCO ON MASONRY
7-0—N—C
RETE
EARTH
HARDNP.1 D
—COMMON
_01 TILE
STUCCO ON FRAME
BRICK ON MAbL)NRy
BRICK ON FRAME
CONC. OR CINDER BLK.
ATTIC STRS. & FLOOR
WIRING
STONE ON MASONRY
STONE ON FRAME
SUPERIOR j POOR
ZE.UATE I NONE
5 ROOF
10 PLUMBING
GABLE
I
I HIP
BATH (3 FIX.)
GAMBREL
MANSARD
TOILET RM. 12 FIX.)
FLAT—
_iHED
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
AS
I 2nd
BLwT nd
I.t 3rd
_'L
ElLiCTRIC
NO HEATING
40
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.
FILE No. 081 1043 '96 11:61 ID:FINANCIAL CONCEPTS INC 1 508 653 0269
A -
FAX TO,
2.2 —me "-& —
F1 newl pas ne.
9 Mercar Road Natick, Massachusetts 01760
Tel. (508) 655-6944
Fax (508) 653-0269
FROM; I.&ZIA14
# OF PAGES (INCLUDIN13' THIS PAGE):
OCT 3 1996
DATE: L-2)1azK�-
JOB
10/03/96 11:51 TX/RX NO.1545
m
P.001
PAGE 1
m
FILE No. 081 10,,,03 '96 11:52 ID -FINANCIAL CONCEPTS INC 1 508 653 0269
alie
AM F. WELD
02 �08
(6-1'7,) 707,1200
-CA VTAR I'
F. GI,0RQAN0 7) 22 7— 1751.1
$,WISE OMER
4
in accordance With SOct
1, EdWard Cli_fton Small
jj%#)LjXW&rahi tact here'
design plans, cOmpUtahi
and that, to the best 0
and specifications cor1f,
Code, all &CCmPtablQ Ong
for the propooed uxe ar�
I
PROJECT NMMER: 1851
PROJECT TITLE:
PROJECT LOCATION:
PAGE 2
n 127.0 of the HassAchusstts Su" Lng Code,
being a registered professional
certify that I have supervised the preparation of all
z and specificatiOns for the rnno !4t*jnPA-1Q Sank
knoWledge, such design plans, 0*MPUt"'Ons, M3ater'ala
n to the provisions of the Xassachusetta State Building
Leering practices and all applicable lawn and ardinanCS9
occupancy.
Lawre-�ce Savings Bank
NAMS Oy BUILDING: Lawr
NATURE 07 PROJECT:
n �A.
subscribed and awarn
my co=izzion 9xpirej
H:De'sign.
OCT - 3 1996
P2 Savings Ba-ak - Headquarters Buildlil,
-z
Signature
beford m6 thin 3rd day ot 2ctober
_/3 Aw--
lqota�Ty Pub
J-
cl—Z I
C
I
10/03/96 11:51 TX/RX NO.1545 P.002 0
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ASSOCIATES, INC
ARCHITECTS
Edward C. Small, AIA
President
I
9 Mercer Road
Natick, Massachusetts 01760
Tel: 508-655-6944
Fax: 508-653-0269
LAWRENCE SAVINGS BANK #1855
NORTH ANDOVEI�, MA
Pe: 486
t ct -25,1996
Date:, cto er-25- 19496
To: Building Inspector
ARCMUCT's REPORT
All work performed to date is in compliance with the original permit documents and the Massachusetts State
Building Code, Sixth Edition.
Exceptions/Modifications: None.
Ln
EdwafcrC. Small, AIA
Architect of Record (Reg. #4742)
cc: D. George
OCT 3 0 1995
C
n RNIon. 0429
MASS.
TH OF MA
0
2455
Date. /*
TOWN OF NORTH ANDOVER
0 PERMIT FOR.GA<INSTALLATION
SA 5
This certifies that ct ('7— !'.� ......
* ;
has permission forgasornstallation
in the buildings of
at M!q ......... North Andover, Mass.
"'fj 9:
Fee
CVA Pglb��PECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Trea�urer GOLD: File
7�,/
ae Commonwealth of Massachusetts 0-iice Use Only
ptrait 56.
Department of Public Safety
occupancy & fee Checked
k)
BOARD OF FIRE PREVENTION REGULATIONS S27 CMH I= 3/90 (leave blan E��
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All *,ork to be performed In accordance with the Massachusetts MectrIC&I Code. 527 CMR 12--00
(PLEASE PRINT IN nIK OR =E Aa INFORMATION) Date
City or Town of lffYI�2,1-eff To the Inspector o?W,
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number)— 3() Rzz A -,e
Owner or Tenant A htk) k-evl ce Aoink-,
Owner's Address SAM e
Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box)
9 --
Purpose of Buildin 4Y-1 ___Ytility Authorization NO.
Existing Service Volts Overhead [I Undgrd No. of Meters
New Service Volts Overbead Undgrd No. of Met e-. s
Number of Feeders and A=pacity —.
Location and Nature of Proposed Electrical Work 12�qcf 3ad Rcy)
No. of Lighting Outlets 7No.
of Z -Tubs
No. of Transformers Total
KVA
No. of Lighting Fixtures
I
Swimming Pool Above In -
grnd. 0 grnd. lGenerators
KVA
No. of Receptacle Outlets
/0
No. of Oil Burners
No f Emergency Lighting
Baitory Units
No. of Switch Outlets
No of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
Detection/Sounding Devices
Murllcip�i Other
Local 0 ConnectionD
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposa�s
Heac Total Total
lNo. of Pumos Tons KW
No. of Dishwashers
Space/Area Heating KW
No. of Dryers
lHeating Devices XW
No. . of Water Heaters KW
N ? , of No. of
Signs Ballasts
Low Voltage
Wirine
No. Hydro Massage Tubs
No. of Motors Total HP
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial
equivalent. YES& NO C] I have submitted valid proof of same to this office. YES Q9 NO 0
If you have checked YES, please indicate the type of ca�v�era e by checking the
appropriate box.
fun 1 1/1
INSURANCE jai BOND F1 OTHER 10 (Please Specify) 717A1,a llle-W(- a,�3z
(Expiq'atidn DaEe)
Estimated Value of/Electrical Work S
Work to Start ;Z Inspection Date Requested: Rough Final
Signed under the/nenalties of neriurv:
,a -zee -r
FIRM rW!E
C -
No. Aq7-3 a
No. 14 S9 3 -3
Address 16 7_ /-1/f
)/f#rus. Tel. No.4,5�tr && br-5
_ Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts Genera ws, and that my signature.on this pyermi�,
application waives this requirement. Owner Agent (Please check one)
I , (
(Signature of Owner or Agent) Telephone No. PERMIT FEE S
Location
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
11 . I Sewer Connection Fee
Water Connection Fee
TOTAL
06/2 4/% .00 06MM 09:30
9..889
Building Inspector
M 00 PAID
Div. Public Works
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OFFICE OF BUILDING INS13ECTOR
TOWN -OF NORT11 ANDOVER
-CONSTRUCTION CONTROL
PROJECT NUMBER:
..PROJECT TITLE1 TL=NA%AT. ptuleput*j
PROJECT LOCATION: LAW - Spkyl k*ep
Owe
NAME OF BUILDING:-LAW90"---*Ay(&1-&5 eolmie.. Wpw�+---
NATURE OF PROJECTs
A ACCOR CE�I H ECTION 127'
CCOR -Te -0 OF THE MASSACHUSETTS STATE BUILDING CODE,
Registration No.
BEING A REGISTERED PROFESSIONAL ENGINE.ER/ARCIIITECT HEREBY CERTIFY THAT 1. RAVE PREPA RED
OR DIRECTLY SUPERVISr.Wi EJR-EPARATION OF ALL DESIGN PLANS, COMPUTATIONS A14D SPECIFICA-
..,.TIONS CONCERNING:
V
ENTIRE PROJ .see it' ECTURAL -5 T RU CT U RAL --I MECHANICAL f --- I
r
CkL
FIRE PROTEC specify)(—_)
Z
0A
K�IIOWL-E!'WIGZ, SUCH PLANS,
FOR THE ABOVE NAMED P D THA rip,
T, TO T ME 0
COMPUTATIONS AND SPECIFICATIONS MEET THE'APP' I' E PROVISIONS OF THE MASSACHUSETTS
STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES.
.. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY.
I FURTHER CERTIFY THAT I SHALL PERFOR.4 THE NECESSARY PR`FESSlCNAL SERVICES AnD BE
-`-PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETER11INE THAT
THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING
PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED 1, SECTION 127.2.2:
q
1. Review of shcp drawings; sanples and cther subH-ttals of the c=tzactor as required by the
wnstructicn =ntract docunmts as submitted fcr building pe=. -,i-., and apprm-al for canforrmtyce
to the design ccncept.
2. Review and approval of the quality ccntzrol proce�,uxeis for all code -required ccntrolled
rmterials.
3. Special architectural or engineerir-S p—
z-fessicnal.insp-ecticn of critical wnstrir-tien carFcnents
requieing controlled rmterials cr ccnstructicn specified in the accepted engineering practice
standards listed in Appendix B.
.RURSUANT'TO, SECTION 127.2.3, 1 SHALL SUBMIT WEEKLY
A PROGRESS REPORT TOGETHER
�I.TA FERTIVIFINIr COMMENTS TO THE NORTH AND,%)VER, BUILDING INSPECTOR.
:-UPON COMPLET1.011; OF THE WORK, I SHALL SUBMIT A FINAL RE AS TO THE SATISFACTR.,
.�C0e.PLZTICN A11J)-- READINESS OF THE PROJECT FOR OCCUFANC
4A UNW-F
'SUBSCRIBED AND SWORN TO BEFORE HE THIS DAY OF 19 9&' Dorothy A. Foskett
ublic
Na�CrY P
My Commjs�jon E)VIres'March 8,2002
PUBLIC MY C01-iMISSION EXPIRES
�� g7 j? - 6 'y �- -2--
j
CERTIFICATE OF USE & OCCUPANCY
Town of North Andover
Building Permit Number Date
THIS CERTIFIES THAT
THE BUILDING LOCATED ON
MAY BE OCCUPIED AS I . ACCORDANCE
WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
T
of, CERTIFICATE ISSUED TO
0
ADDRESS 1-4
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G*S*D
ASSOCIA
COMPUTER AIDED DESIGN
ARCHITECTURE
PLANNING
INTERIORS
DEVELOPMENT CONSULTING
FIELD OBSERVATION REPORT
PROJECT: Lawrence Savings Bank - Third Floor Tenant Division
DATE: July 12, 1996
FIELD REPORT NO: #2
REPORT PREPARED BY: Greg Smith - GSD Associates.
WORK IN PROGRESS:
Site visits to the construction site were conducted on July 11, and again on the morning of
July 12, 1996. The Contractor has subdivided the spaces as shown on the plans. The
sprinkler head addition and relocation work has been completed. The electrical work has
generally been completed, lights were relocated for the new corridor and the new partitions,
Exit lights were added and relocated for the new layout. However, there are three locations
where there needs to be additional emergency lights. According to the bank representative
Mr. Bill Mann, the electrician will be in on Monday July 15, 1996 to complete this work.
Doors on all of the corridor walls were not yet installed. Interior partitions are mostly
completed except for final finishes.
OBSERVATIONS:
We observed the third floor emergency lights in the early morning of July 12 with all
lights off except for the emergency lights. There are three additional locations where
emergency lights need to be installed. One emergency light is to be located in the
corridor by the front elevator. One emergency light is to be installed in the tenant
space between the high density files and the new tenant separation wall. One
emergency light is to be installed in the corridor leading to the back stairwell. The stair
wells are lighted by emergency lights.
As was noted in the previous report, the bank building has an existing emergency light
circuit system installed with an emergency generator system within the existing
recessed lights.
Sincerely
GSD Associates
pGregory . Smit
pry
_ _nrn i
Architect
Distribution to:
T 1996
Mr. Bob Perrault Lawrence Savings Bank
Mr. Ken Surette N. Andover Building Dept.
Mr. Red Zinno Contractor
File: LSB-OBSV.002
�� r-1 7: r� p, 7 -'- �'. - ,
-- TELI-(508) 688-5422 FAX. (508) 975-1033
855 TURNPIKE STREET N. AN;OVER, MA 01845
2 Lawrence
Savings Bank
July 17, 1996
Mr. Gregory P. Smith
G.S.D Associates
855 Turnpike Street
North Andover, MA 0 1845
Re: Field Observation Report #2
Dear Greg,
P 0. Box 988
Lawrence, MA 01842
508-725-7500
FAX 508-725-7607
This letter is in reference to the above Field Observation Report. On Monday, July 15, 1996,
Steve Juba of Juba Electric completed the installation of the three emergency lights in the
locations that you specified.
I believe this completes all of the requirements necessary for the Bank to receive its occupancy
permit.
We are ready for your final inspection. Would you please notify Town Hall so that the occupancy
permit can be obtained.
Very truly yours,
(2p§PeFrreault
Executive Vice President/
Treasurer
RPP/fpg
KL
7 1996
"2'r"CQ
�l
Town of North Andover Of SORT).1 I
OFFICE OF oz.
0
COMMUNITY DEVELOPMENT AND SERVICES
146 Main Street
North Andover, Massachusetts 01845 13 SACHU5
(508) 688-9533
CONTROL CONSTRUCTION - SECTION 127.0 M.S.B.C.
CERTIFICATE OF ENGINEERING/ARCHITECTURE
BUILDING INSPECTOR
TOWN OF NORTH ANDOVER
146 M.AIN STREET - TOWN ILZ��LTTLJ ANN`EX
NORTH AN-DOV`EER, MA 0184-5
GEN71EMEN:
.Lj
1, GREGORY P. SMITH HEREBY CERTIFY THAT THE TENANT SEPARATION WORK
CONSTRUCTED ON THE THIRD FLOOR OF THE LAWRENCE SAVINGS BANK, 30
MASSACHUSETTS AVE., NORTH ANDOVER, MA WAS DESIGNED TO CONFORM
WITH ALL RESPECTS TO THE MASSACHUSETTS STATE BUILDING CODE AND ALL
APPLICABLE FEDERAL REGULATIONS AS SHOWN ON THE PLANS PREPARED BY
OUR OFFICE DATED 6-10-96 AND REVISED 6-28-96. BASED ON MY
OBSERVATIONS OF THE WORK DURING CONSTRUCTION, AND TO THE BEST OF
MY KNOWLEDGE, INFORMATION AND BELIEF, THE WORK WAS DONE IN
CONFORMANCE WITH THE PLANS PREPARED BY OUR OFFICE.
AUTIMORIZED SIGNATURE:
DATE:
REGISTRA'fTON STAIMP: Jk-6(V&8>
D ARCII
yp
LO ONDERRY.
Nn
Air
!A-
NOTE: Z*71GINNEEIV "WET STAIMP" MUST BE AFFIXED TO THIS FORM.
LL
wl FL
BOARD OF APPEALS 688-9541 BUIL.DING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNLNG 688-9535
W 6�
G*S*D
ASSOCIATES
COMPUTER AIDED DESG. N
ARCHITECTURE
PLANNING
INTERIORS
DEVELOPMENT CONSULTING
FIELD OBSERVATION REPORT
PROJECT: Lawrence Savings Bank - Third Floor Tenant Division
DATE: July 29, 1996
FIELD REPORT NO: #3
REPORT PREPARED BY: Greg Smith - GSD Associates.
WORK IN PROGRESS:
Site visits to the construction site were conducted on July 22, and again on the morning of
July 29, 1996. The Contractor has substantially completed the most of the work indicated
on the drawings as of the July 22, visit. Emergency lights were added to the existing
emergency circuit, sprinkler heads have been added and relocated, and walls have been
constructed. However, the lever action door hardware specified was not yet installed and
temporary hardware did not meet Accessibility Codes. The Fire alarm horns and strobes were
not installed in the individual tenant spaces as shown on the plans.
OBSERVATIONS:
1 It was noted during the July 22nd visit that the contractor should remove all
wedges from the stairwell doors holding them open. This was completed
during the visit.
2. The bank representative stated that the three emergency lights previously
requested by our office, by the rear exit door, the bathroom hallway and the
office area by the high density files, has been completed.
3. During the July 29 visit all fire alarm horns and strobes were observed as
indicated on the plans.
Based upon the site observations made and statements by the Owner's
representatives, GSD Associates certifies that the work has been completed to the
extent required by the plans.
Sincerely
GSD Associates
6�fj m i nth
Gregory
Architect
Distribution to: Mr. Bob Perrault Lawrence Savings Bank
Mr. Ken Surette N. Andover Building Dept.
File: LSB-OBSV.003
TEL: (508) 688-5422 FAX. (508) 975-1033
855 TURNPIKE STREET N. ANDOVER, MA 01845
G*S*D
ASSOCIATES
COMPUTER AIDED DESIGN
ARCHITECTURE
PLANNING
INTERIORS
DEVELOPMENT CONSUL TING
FIELD OBSERVATION REPORT
PROJECT: Lawrence Savings Bank - Third Floor Tenant Division
DATE: July 12, 1996
FIELD REPORT NO: #2
REPORT PREPARED BY: Greg Smith - GSD Associates.
WORK IN PROGRESS:
Site visits to the construction site were conducted on July 11, and again on the morning of
July 12, 1996. The Contractor has subdivided the spaces as shown on the plans. The
sprinkler head addition and relocation work has been completed. The electrical work has
generally been completed, lights were relocated for the new corridor and the new partitions,
Exit lights were added and relocated for the new layout. However, there are three locations
where there needs to be additional emergency lights. According to the bank representative
Mr. Bill Mann, the electrician will be in on Monday July 15, 1996 to complete this work.
Doors on all of the corridor walls were not yet installed. Interior partitions are mostly
completed except for final finishes.
OBSERVATIONS:
1 We observed the third floor emergency lights in the early morning of July 12 with all
lights off except for the emergency lights. There are three additional locations where
emergency lights need to be installed. One emergency light is to be located in the
corridor by the front elevator. One emergency light is to be installed in the tenant
space between the high density files and the new tenant separation wall. One
emergency light is to be installed in the corridor leading to the back stairwell. The stair
wells are lighted by emergency lights.
As was noted in the previous report, the bank building has an existing emergency light
circuit system installed with an emergency generator system within the existing
recessed lights.
Sincerely
GSD Associates
Greporly�. S)mit
Architect
Distribution to: Mr. Bob Perrault Lawrence Savings Bank
Mr. Ken Surette N. Andover Building Dept.
Mr. Red Zinno Contractor
U-Aul L
File: LSB-OBSV.002
JUL 15 1996 1 1
FAX.- (508) 975-1033
-855 TURNPIKE STREET N. ANDOVER, MA 01845
Location :f) o -
No. Z (;2 Date
4
0
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
--*-�E!Ulldlng Inspector
06/20/% 13:11
25-00 PAID
Div. Public Works
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