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Miscellaneous - 310 GREENE STREET 4/30/2018 (3)
Cj O M m C/t =1 3859 TRAVELERS J� The Travelers Indemnity Company P.O. Box 1450 Middleboro, MA 02344-1450 01/21/2016 City of North Andover Building Inspector 120 Main Street North Andover MA 01845 Insured: Jeffrey Ahern Claim Number: HXV8988 . Policy Number: OCDN63-992759093-636 -1 Date of Loss: 02/14/2015 Loss Location: 315 Greene St North Andover MA To: Board of Selectmen Building Commissioner Inspector of Buildings Board of Health A claim has been made involving loss, damage or destruction of the above captioned property which may either exceed $1,000 or cause Massachusetts General Laws Chapter 143, Section 6 to be applicable. If any notice under Massachusetts General Laws Chapter 139, Section 313 is appropriate, please direct it to my attention and include a reference to our insured, the policy number, the claim/file number, the date of loss, and the location. If you have any questions, please feel free to contact me at (508)946-6643 or email me at VDAVI DSO@travelers.com. Sincerely, Claim Professional (508)946-6643 Ext. 946-6643 Fax: (877)786-5584 Email: VDAVIDSO@travelers.com On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Signature Date P0062 F3162C1516022003859 00001 N c: _ _ - �--"_ - -_- -- - - Elderly/Handicapped Housing No{i h AI over Housing Authority Page 1 of 2 ii r G � North Andover Housing Au or Home Staff&Boa rd Housing Opportunities Resources Directions Elderly/Handicapped Housing The North Andover Housing Authority has four state-aided public housing developments for elderly/handicapped persons. These developments are administered under the Massachusetts State 667 Program. ts for elderly/handicapped persons. These developments are administered The North Andover Housing Authority also has two federal housing developmen under the Federal 107 Program. Handicapped applicants must have a verifyable disability of long and continued duration. Massachusetts State Developments(667)Program: Fountain Drive,East Water Street,North Andover Cff This complex consists of 40 one-bedroom units.The on-site community room is a populari spot for residents to enjoy Bingo and 45's. Bingham Way,First Street&Maple Avenue,North Andover F'Lsto This small development of 45 units is located in the downtown area with stores and restaurants available within walking distance. Foulds Terrace,Route 125 North,North Andover Y'"gym This 52 unit development,located off Route 125,offers a nice community room where residents meet to relax,have a cup of coffee or just sit on the porch and wa'� t� cue"comings and goings". O'Connor Heights,Second Street,North Andover O'Connor Heights has 20 units and 2 five-bedroom con regate units. Congregate residents enjoy daily home-making services that include a meal plan,laundry and groceTysl'itlpping,as well-as other supportive services. Eligibility: To be eligible for the State 667 Program,applicants must meet the following criteria: • Elderly applicants must be at least sixty years old • ity of long and continued duration Handicapped applicants must have a verifiable disabil • All applicants are subject to income limits,which is a gross income of less than 80%of the median income for the area Applications: To apply for state-aided elderly/handicapped housing,please complete and submit a universal standard application form. The application can be downloaded by clicking below,or can be obtained from our office at One Morkeski Meadows,North Andover,MA 01845. httl)7//www.mass gov/hed/docs/dhcd/ph/publichousingapplications/standapp doe(htto//www mass pov/hed/docs/dhcd/ph/pubilchousingappilcations/standapp.doc) If you are in an emergency situation,you may download a universal emergency application for state-aided housing to submit with your standard housing application. httl37//www.mass.gov/hed/docs/dhcd/ htptjblichousingapl)licationslemergar)l:)pdf(http//www mass gov/hed/docs/dhcd/ph/pubiichousingappiications/emergapp.pdfl Federal Developments(107)Program: Morkeski Meadows, Waverly Road,North Andover,MA 01845 This is a 60 unit apartment style development. Many of our residents enjoy playing Bingo and 45's in the Community Room. McCabe Court,Belmont Street,North Andover,MA 01845 This 45 unit development is within walking distance to the downtown area where residents are close to many stores and restaurants. Eligibility: To be eligible for the Federal 107 Progam,applicants must meet the following criteria: • Elderly applicants must be at least 62 years old. • Handicapped applicants must have a verifiable disability of long and continued duration. • All applicants are subject to income limits,which is a gross income of less than 80%of the median income for the area. The income limits apply to the state and federal developments. • The current income limits are: One person: $45,500 Two people: $52,000 Application: 1/6/2014 North Andover MIMAP January 28, 2014 f eet ¢4.. �, S � �i•F `ti tf g' Ci `.,kms _ �.,• ':" 4 ,� Gr i .r s 'yew s l Interstates SIR G/r j�s Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads l Meters Data Sources:The data for this map was produced by Merrimack C r EasementsPORT" Valley Planning Commission(MVPC)using data provided by the Town of pf , 'G o r.4ti North Andover.Additional data provided by the Executive Office of E3 MVPC Boundary ? yt +.CO Environmental AffairslMassGIS.The information depicted on this map is Parcels4 for planning purposes only.It may not be adequate for legal boundary definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING (r >< THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY 'F 1 ' # OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT �o ♦- ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF THIS INFORMATION SSACHUS� 1"=92ft •�° 9 0 f r/ Date. .1--7-I+. . + TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING • o + J SACMUSE� � r This certifies that has permission to perform . . . plumbing in the buildings of . . .�4 o!L at. . .3 c, . ... .. . . {. . North A dover, Mass. Fee.1 U Lic. No.. 1(6-.2-.y. . . . . . ../• ��. . . . . PLUMBING INSPECTOR Check # — MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:f North Andover MA. Date: 08/11/2011 Permit# t s Building Location: 310 Green St. Owners Name: N.Andover Housing Authoity Type of Occupancy: Commercial ✓ Educational Industrial Institutional Residential �a New: Alteration: Renovation: Replacement: ✓ Plans Submitted: Yes No FIXTURES z z o Lu z Y V N a z H Y } cn -j V W z z �a z cn a N z a 0 M Q w Q a a Z ag z W y Z o a Q Y 2 0 0 ~ = z Q L 3 a Y a = W W W N _ Q O Q Q 0 = � Q Q Q Q F Q m In o u_ 0 2 Y J J W fn to H O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 Tm FLOOR 8 Tm FLOOR Check One Only Certificate# Installing Company Name: Compass Plumbing& Heating, Inc., , _ _ `/ Corporation 2923 Address: 50 Oliver Street Suite 107 City/Town No. Easton State:'MA ' Partnerships Business Tel: 508-238-3479 Fax: 508-230-0288 - -- -— Firm/Company m Name of Licensed Plumber: Marc Niosi INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YesFv,rN0 _f If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy I✓ Other type of indemnity Bond __ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent ' Signature of Owner or Owner's 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. By P4 i f Type of License: Title ��� 7 j_0 Plumber gnature of Lice sed Plumber Master City/Town Journeyman License Number: 11624 APPROVED OFFICE USE ONLY FORTH oAM, ® tAndover 1 ,Y) �, _- _ _ dover1 Mass. 8 3 -1�/ 4 RY 0� O�.MSC ME WICK y� 1 G` '�q ATED PPG �y 4 BOARD OF HEALTH 1 PERMIT T D Food/Kitchen Septic System �r�, BUILDING INSPECTOR THIS CERTIFIES THAT./..ver�..!� Amdever.....A.pm AAON...... ... .................... Foundation ;;/P?C�"has permission to erect... PCli ............... buildings on r * !N� � s • Rough g ...~ ... . ........ to be occupied as Clew q+.+.rW.......Tmw t r`.......o ��C�� ��Z/ ' � himney ....................................................................... . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and BY-Las relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 42 a leis aQ PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough to N"'+ r •� I � � Final PERMIT EXPIRES IN 6 MONTHS C0144tr V e-400a ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TAR S Rough O � � � ... .. ........ ........ .............A..................................... Service BUILDING INSPECTOR final ek v "r, a Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal Wo- Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. GENERAL BUILDING NOTES/CHECKLIST-NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS,ADDRESS, AND PERMIT(COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip-Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girls-solid brick or steel plate bearing at foundations %"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. Check headroom clearances-stairways, under beams Attic Access. (min. 22x30 w/3'headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. %of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber- Finish Smooth parging, clean joints, 8"solid @ combust. Surf. DECKS: Separate permit required: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. Date.......... 6.......�,�.... t �aORT11 1 3?;.,;�`` :•�,,"�o� TOWN OF NORTH ANDOVER 0. PERMIT FOR WIRING SSACMUSEt This certifies that 171'e�J-... '......,.5 .�... ..........i........... `"......... has permission to perform ... ..<., ...i J�.��. ..,/..2:t�......../.... wiring in the building of l... / .�..*. • : S' .............. . ..�..1?.'................... at..... ✓ zo.�.'?fv ..... .................... .North Andover,Mass. Fee..A .. .... ................. ........... LECRCALINSCl! � 'v Check # Commonwealth of Massachusetts' Official Use only Rim Department of Fire Services Permit No. �� 7 BOARD OF FIRE PREVENTION REGULATIONS 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 ALI.INFORMATION) Date: City or Town of: �r��,� _ To the Inspector of Wires: By this application the undersigned gives no 'ce of his or her intention to pe orm the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction th a building permit? Yes No ❑ Building Permit# Purpose of BuildingUtility Authorization No. Existing Service Amp / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ` h- Z7 A,-- Completion ✓rCom letion o the followinz table may be wa' d by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting rnd. grnd. BatteKy Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalTons No.of Alerting Devices No.of Waste Disposers Heat um Number Tons KW No.of Self-Contained p Totals: ..... ................ .. ... ................ ... .............. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsNo.of Devices or Equivalent q OTHER: 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 covera e ' orce,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:-f. / I certify,under' /, nder the pains and penalties of perjury,that the information on this application is true and complete. Current Insurance certificate must be on tle in o r office and affidavit must also be filled out with each application. FIRM NAME: - �h x Z` c C.NO.:Af Licensee: .+: a Signature LIC.NO.: 3 (If applica e�enr exempt"in the license number line.) Bus.Tel.No.: Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Lice see does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL 1.ROUGH INSPECTION: Passed—KFailed—[ ] Re-inspection required($50.00)- [ ] Inspectors'comments: (Inspectors'Signature-no initials) Date 2.FINAL INSPECTION: Passed— Failed—[ ] Re-inspection required($50.00)-f ] Inspectors' comments: 2, (Inspectors'Signature-no initials) Date 3. UNDER GROUND INSPECTION: Passed—( ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: , (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)- ( ] Inspectors'comments: (Inspectors'Signature-no initials) Date 5.INSPECTION-OTHER: Passed—( ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. aDate....../..:..2.. .`..�. . v Of NO oTM,ti TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ,SSACMuSE� This certifies that � ..< has permission to perform ..... !r.!'.................................... wiring in the building of.... T/. 1........... at.............../........_.......... .....�..: .......... . ...t,North Andover,Mass. Fee...rW......... Lic. A ....... -�! l s� .�•�,.l�j ........... ELECTRICAL INSPECTOR Check # !_V�f Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Z/ 7 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked V�X'j [Rev. 1/07] (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 W INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER z S U By this application the undersigned gives notice of his or er' to tion to perform the electrical workles nbed below. Location(Street&Number) Owner or Tenant may, 4� _ �f'I't Tephone No. Owner's Address Is this permit in conjunction with a No building per t? T• ❑ (Check Appropriate Boa) Purpose of Building Y? IS Yes,J1 1�1 "Utility Authorization No. �7-'7 _ Existing Service ps / Volts Overhead ❑VUndgrd Und rd g ❑ No.of Meters New Service Amps ' Ol 2yZ� Volts Overhead ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: a Completion of the followin table may be waived by the Inspector of Wires. 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 SwimmingPool Above In- o.o mergency ig g d. ❑ rnd. � BatteryUnits — No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and InitiatingDevices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers Heat PSP Number .Tons_._ KW _ No._of Self-Contained Totals: "' Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Mumcipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems: No.of water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Si s Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electric ork: �/ (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 coveraW is in force, and has exhibited proof of s to ert issuin o e. CHECK ONE:.INSURANCE BOND ❑ OTHER ❑ (Specify: � �/ .�Z�S/� fy, under the pains awe Ities of a ju that the i;{form �this application is true and complete FIRM NAME: �,� _1d ,pt,�i ( (,� LIC.NO.. Licensee: h �tJ Signature (If applicable, en "eximppt"in license number lin . j LIC.NO.: Address: J ��n !17 d Bus.Tel.No.: *Per M.G.L c. 147,s. 57-61,security wo requires Department of Public Id ety License: Alt.Tel.No.:AT �o. o OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the Iiability insurance lcoverage normally required by law. By my signature below,I hereby waive this requirement I am the(check one) ❑ owner ❑ owner's agent Owner/Agent Signature Telephone No. PERMIT FEE. $ Location ' No. Date N�RTh TOWN OF NORTH ANDOVER F 9 ` Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # f U U G/ Building lnspey TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 1 ,777DATE ISSUED: /C f n r 3 SIGNATURE: .,.� Building Commissioner r of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: M b e O(�l(` �- 1.2 Assessors Map and Parcel Number: O (3�r ,n�f Sal 3 ✓e(,,, ' �Q Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Diii d Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R rtxl Provided v 1.7 Water Supply AGLCA0. 34) 1.5. blood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No rn 2.1 Owner of Record Name(Print) Address for Service f Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 3.1 u►icensed Construction Supervisor: Not Applicable ❑ Licensed Construct o Supervisor rj ! a 6 License Number Aaaress /D/he 1l- s Expi�onDate Signature Telephone r 3.2 Regi Home Improvement Contractor Not Applicable ❑ Company Name �3 9 ✓ rn io Dr Registration Number r e 4ht el -P� Addre r �— /o �G /PT`/U Exptra /� Si ature Telephone Yi SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes....... No.......❑ SECTION 5 Description of Proposed Workcheck all applicable) New Construction ❑ Existing Building Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: �C c SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFIC1,4L USE(}NZ,y Completed by permit applicant 1. Building e d (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property ^ Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief i Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIvMERS 1Sr2 ND 3 RD SPAN DRvIENSIONS OF SILLS DEVIENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confunnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or 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 pen-nits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts 1 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (13usiness/Organization/Individual): /2 n0- Address: IQ DQbTp,� �(` IV f, J City/State/Zip: 1) t'ye-rs, Asy OJ9a3 Phone #: 9�2 'L-24 t. Are youof employer?Check the appropriate box: Type of project(required): 1. am a employer with 6 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 7. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 'T ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 LF Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12. oof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. t I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers comp.policy information. I am an employer that is providing workers'compensation insurance for7:,0P3krn loyees. Below is the policy andjob site information. Insurance Company Name: •_-,S , —Co. Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: r � �� ,� �-i City/State/Zip: � ' � � � _/yam Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby rti/y under the pain and penalties of perjury that the information provided above is true and correct. Si nature: Date: ` 0 77 Phone#: - NZ_M? S/ Official use only. Do not write in this area,to be completed by city or town glficial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: CSR BB DATE ACORD (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE BAYST-2 0( 26 05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Charles F. Murphy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 14 Storrs Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Braintree MA 02184 Phone: 781-380-0599 Fax:781-380-0686 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Ins. Company 13196 INSURER B: Josephine Christopolous dba Bay State Painting INSURER C. 10 Danielle Drive INSURER D: Danvers MA 01923 INSURER E: COVERAGES 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. RATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A ][ COMMERCIAL GENERAL LIABILITY NPP924592 12/10/04 12/10/05 PREMISES(Eaoccurence) $ 50,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $E AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F_I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE' $ H yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: Reroofing of gazebo and garage plus seven buildings at McCabe Court, North Andover, MA - Section 00499 CERTIFICATE HOLDER CANCELLATION COMOFMA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Commonwealth of Massachusetts DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN North Andover Housing NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Authority IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR One Morkeski Meadows North Andover MA 01845 REPRESENTATIVES. AUTHO E REP SE TATIV ACORD 25(2001/08) ©ACORD CORPORATION 1 7�.m»io rakw/lt rr Board of Buildin R ��� UQ g egolations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only = Registration: before the expiration date. If found return to: 131926'Expiration: Board of Building Regulations and Standards 10/6/2006 One Ashburton Place Rm 1301 1Y13e DHA Boston,Ma.02108 BAY STATE PAINTING CO.- PETER CHRISTOPpULOS 10 DANIELLE DRIVE _ DANVERS,MA 01923 -Administrator I Not valid without signature y North Andover Housing Authority Joanne M. Comerford, Executive Director One Morkeski Meadows (978)682-3932 North Andover,MA 01845 (978)794-1142 FAX (800)545-1833 Ext.378 TDD jcomerford@northandoverha.com SECTION 00621 NOTICE TO PROCEED PART ONE—GENERAL 1.01 NOTICE TO PROCEED To: Josephine Christopoulos Bay State Painting Company 10 Danielle Drive Danvers, MA 01923 DATE: September 27, 2005 PROJECT: McCabe Court, North Andover, MA: Re-Roofing North Andover Housing Authority One Morkeski MeadowsC— -c� North Andover, MA 01845 /o // O You are hereby notified to commenc wo according with the agreements dated September 15, 2005, on or before October 17, 2005 and you are to complete the work on or before January 15, 2006. North Andover Housing Authority One Morkeski Meadows North Andover, MA 845 y: Joanne Comerford Title: Executive Director NOTICE TO PROCEED Page 1 of 1 Equal Housing Opportunity NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: r, r' (L cation of Facility) f , Signature of P rmit Applicant Fire Department Sign off: Dumpster Permit Date c `- North Andover Housing Authority Joanne M. Comerford, Executive Director One Morkeski Meadows (978)682-3932 North Andover,MA 01845 (978)794-1142 FAX (800)545-1833 Ext.378 TDD jcomerford@northandoverha.com September 9, 2005 SECTION 00499 NOTICE OF AWARD PART ONE—GENERAL 1.01 NOTICE OF AWARD To: Josephine Christopoulos Bay State Painting Company 10 Danielle Drive Danvers, MA 01923 Project Description: McCabe Court, North Andover, MA: Re-Roofing The owner has considered the bid submitted by you for the above described work in response to its Advertisement for Bids dated July 25th and August 1St, 2005 and Instruction to Bidders. You are hereby notified that your bid has been accepted for items in the amount of $86,500.00. You are required by the Instructions to Bidders to execute the Agreement to furnish and required Contractor's Performance Bond and Payment Bond within ten (10) calendar days from the date of this Notice to you. If you fail to execute said Agreement, to furnish said HUD form 2530 within three (3) days and to furnish said Bonds within ten(10) days from the date of this Notice, said Owner will be entitled to consider your rights arising out of the Owner's acceptance of your Bid as abandoned and the Owner will be entitled to such other rights as may be granted by law. NOTICE OF AWARD Equal Housing Opportunity � 4 IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed in three (3) original counterparts as of the day and year first above written. Bay State Painting Company (Contrac ) ATTESTBY: 1ZJ21Z/�� TITLE: LQiC� ( rint Name) Business Address: BY: North Andover Housing AWhority J24e Comerford TITLE: Executive Director Business Address: One Morkeski Meadows North Andover,MA 01845 Certifications: I> ertify that I am the sole proprietor of the Company named as contrac r herein;that said c tract was duly signed for and in behalf of said company,by me as its owner. CONTRACT Page 2 of 2 NORTH Town of 19Andover No. 2 No10 o �F_L AEover, Mass., COCHICHEWICK I. 7�ADRATED �y BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT. ............................................................. ,.*006�j .. Foundation haspermission to erect................... .................... buildings on .............. ................................... t......................... Rough t0be OCCUpled as.. ............................................................................................................................ Chimney provided that th erson acce. g this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisio of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR . ...................... ...... Rough 4.L4� ...4.'d Sevce INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. Transmittal The Schofield Corp. 197 Main Street North Reading MA, 01864 Date: January 7, 2005 To North Andover Building Department Electrical Inspector Re: Elevator Installation North Andover, MA We are Sending You: Shop Drawings Prints Plans RSamples Product Data Change Order Specifications X]Correspondence Contents Copies Date Submitall ID # Description Status 1 1/7/2005 NA Title Building Permit For Your Desc. Use hese Are Transmitted as indicated below: E]For Approval Ej Approved as Submitted Resubmit_Copies for Appr. MX Your Use Approved as Noted Submit Copies for Distrib. [:]As Requested FIReturned for Corrections Return_Correct Prints 0 For Review and Comment n E]For Bids Due: nPrints Returned After Loan to Us Comments: Mark Fowler of MEF Electrical Corp instructed me to give this permit to you to sign off on the electrical work at the Elevator installation at Morkeski Meadows for the North Andover Housing Authority. At the time that you did the inspection, the permit was with me. Therefore, you could not sign it. Please call me if you have any questions Thank you. Copy to: File NABD Signed: Page 1 of 1 N° . `/ I Date..... ............ NORTI� or°;t�`` TOWN OF NORTH ANDOVER , ' PERMIT FOR WIRING SS cm SE's This certifies that has permission to perform ............................... ............................;—a............... wiring in the building of...............::...................:..........................:..........c...... at :...:........ ........................................................... .North Andover,Mass. Fee�rrf.... .. Lic.No............. .%.............. ....... ................ ELECTRICAL INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer TBE CA0MW0NWE4LTH0FAf4S&4QKSE77S office Use only DEPARTAffiW0FPUBL1CS4FE7Y Permit No. BOAM 0FMEPREVEVH0NRWM4TI0AS527CW 12-00 Occupancy&Fees Checked Go 4 VAPPUCATION FOR PERNff TO MFORM ELE C 0 ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL COIDME, 27 L I :OOW' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dat Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 3167 P74, 14�pf?doul� Owner or Tenant Ale,, XX dnyjy-- Xa/m) 5 Owner's Address Is this permit in conjunction with a building permit: Yes M No /R (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead r7 Underground No.of Meters New Service Amps Volts Overhead r--J underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work A/�p 6�� L X Y-- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA �Zz T ground E] ground ri No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and .1 Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local "l Municipal M Other No.of Water Heaters KW No.of No.of ) E] Connections Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 0 C22 eq,4,Co-A A U COArdg�L Pt19Jfft1DftW#MV1S LMNS IbmeaamutLiahT6yhm= ' irduding, YES NO E:] IfUNe%hni1Wdva1idP,o0f0f1 iodrOffiop—YES NO r7 lf�w hmedvJW YES,pkmwdcae#r1�peofmvaWbych�mg1he Wup bcv, INSURANCE BOND OffiER, ftmSpe*) -3 Esd�Va1wdUWftEdWdk$ WcikoStmt r) hq)acfimDWeRapesWd Rao FiffiW Siorml of, , V FIRMNAME L==Nv 76 44� &==TdNTQ 60- 3 -29V�f OWNWS]NKJRANCEWA1VERIamaw=ftfrL==dam not (Please check one) Owner Agent 1:1 Telephone No. PERMIT FEE$ 62 Sep 28 04 02:57p Design Partnership 978-373-6779 p. 1 Design Partnership Architects Inc. Three Washington Square*Suite 400*Haverhill,MA 01830-6139.978*372*9400*Fax:978*373*6779-E-Mail: DPA11@NNO.com September 24,2004 Town of North Andover 120 Main Street No.Andover,MA 01845 Attn: Robert Nicetta,Building Inspector P l o? p Re: No.Andover Housing Authority Elevator Project e ti%e %4' Design Partnership Architects Proiect No.R03-12-125 30 Dear Mr.Nicetta, Design Partnership Architects, Inc. has reviewed the reinforcing for the footing and also the vertical walls.'The contractor is proceeding to place the concrete at the footing,which was placed at the beginning of the week, By September 23, 2004 he was scheduled to install the concrete for the vertical walls; this was competed as of Friday, September 24,2004. Tests were performed by UTS and when the results from the tests are available I will forward them to you. In the meantime, the contractor will be starting the exterior walls probably early next week. There have been inspections on two or three occasions and we are starting to make some progress and wanted to notify you of the status of the project. If you have any questions please contact us at our office by phone at 978-372-9400 or by fax at 978-373-6779 Respectfully submitted, DESIGN PARTNERSHIP ARCHITECTS,INC. Angelo Petrozzelli,President;Member AIA/NCARB Dictated but not read CC:No.Andover Housing Authority(by fax),The Schofield Corp.(by fax) AP/sjh PRINCIPAL * ANGELO PETROZZELLI * AMERICAN INSTITUTE OF ARCHITECTS Date. i 01 NORTp TOWN OF NORTH ANDOVER ..•� 4, TOWN PERMIT FOR PLUMBING SSACMUS� This certifies that . . .« �^/; .�� has permission to perform . . . . . . _ / . . . . . . . . . . . . . . . . . . . . plumbin the buildings gf „��. . .�. . . . . . . !� G. . . ./ . . . . . . . . . . . . .. North Andover, Mass. Fee. Lic. No.. . . . . . . .� PLUMBING INS(ECTOR Check # MASSACHUSETTS UNIFORMPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH AN OVER,MASSACHUSETTS 5e0/1,-? -57IZr20- . + Date Building Location 9 d lGolwfer►/d— /`7'LV&-'Y1T Ownersz Ab�`A /-j j�`�// Permit# p Z Amount Type of cupancy Ife New Renovation Replacement Plans Submitted Yes No FIXTURESCn Cr z a SLB-MM &SEMENr NE 110M Zn HALM j -IM FLOCK 4M FLOCK 5M FLOCR 6M HIM 7M FLOCK 8M FLCICR (Print or type) Check one: Certificate Installing Company Name �GjJ�% /b orp. Address 55- S T Partner. Business Telephone Firm/Co. Name of Licensed Plumber: %/!ej Insurance Coverage: Indicate the type of insurance c6verage by checking the appropriate box: Liability insurance policy 13- Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Stat4or,� n n�pter 142 of the General Laws. BY igna ure o ense EMMET Type of Plumbing License Title 9d40 City/Town icense nArnuer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date. NORTH i Ory` .,ao ,e,ti0 p TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION '�qh SA US This certifies that . . .t.! . . . . . . . . . . . . . . r has permission for gas installation . . . . .j: . . . . . . . . . . . . . . . . . in the buildings of . .,'. � t -�- at s . c : . . . . , North Andover, Mass. Fee.!*,, . . -Lic. No. 7. . . . . . 1 .!� �r .,. . . . . . . . f /�A' ( L �-► k� '(� GAS INSPECTOR* 4 -�Chec�#— !; r % � MASSACHUSEI'IS UNIFORM APP CATON FOR PERMrr TO DO GAS Ff rnNG (Type or print) Date l lop OS NORTH ANDOVER,MASSACHUS TTS Building Locations SE�Io7lrJ S �HsT�� Permit# �� 7 ` Amount$ A C— f�pGi/f6 f J�Scar��j Owner's Name New❑ Renovation El Replacement Plans Submitted /lo w � a U H a a ° U H x a 0 H d o o ] o° z F a� O xWw 3Gccwh. aaow0 a U w A 0 a 0 a w H SUB -BASEM ENT TBASEMENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . F L O O R 6TH . F L O O R 7TH . FLOOR 8TH . FLOOR (Print or type)� Check one: Certificate Installing Company Name �orp. �7 7 �y Address S� 5 1:1 Partner. BusinessTelephone GJj f' �y 7,/7 E] Firm/Co. Name of Licensed Plumber or Gas Fitter FIf SURANCE COVERAGE Check one: ave a current liability Insurance policy or it's substantial equivalent. Yes r] No you have checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy 011" Other type of indemnity 13 Bond 0 Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner E] Agent 0 I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under P it Issued for this application will be in compliance with all pertinent provisions of the Massachusetts-66— 04 of the General Laws. Signatur of Licensed Aumber Or Gas Fitter By. Plumber p6% Title City/Town Gas Fitter License mer GaMaster APPROVED(OFFICE USE ONLY) Journeyman Date.. . . ... . . . . .. . NORTH o? °` TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION s SSACMUSES This certifies that . . . .4. } . . . . . . . . . . . . . . . . . has permission for gas installation(,. in the buildings of . . . . . . . . . . . . . ,. . . . . . . . at . . . —::r.. ... . . . . . .. . -.. ... . . . . . . . . . . .. North Andover, Mass. Fee./V./'.. . . . Lic. No.. . . . . . . . . . . . . . . . . . .! . . . . . . . . . GAS INSPECTOR Check 4 MM%ACHUSEITS UNIFORM APPUCATON FO TO DO GAS FYITnNG (Type or print) Date Z •�7s NORTH ANDOVER,MASSACHUSETTS Building Locations CerN-V 5� ©� Permit# Amount$ Ow is Name /F ,4 T�l.4// l New❑ Renovation Replace e t Plans Submitted El �y x w vi U z x w w a o H x x C z o w E-4 E-4 a z o z w oa v, H O o w a W w z N W O p. x CW W a wE,z z w H a W zw O c4 z Q d Oz a< O a xWx O W r� O 1 0 a U a � A a F+ O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4 T H . FLOOR 5TH . F L O O R 6 T H . F L O O R 7TH . F L O O R STH . FLOOR �. Name or type)/„ /I � �� Check one: Certifi cnInstalling- Company !% [ �orp• ...� Address 5- 4i4j/dYl 51 ❑ Partner. l-,. v✓C�c cc_ D/d Vd Business Telephone ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑/ No❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. ° Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑. Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ i hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations erformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuc Chapter 142 of the General Laws. By: Signature of Li ensed Plumber Or Gas Fitter Title plumber 4 O�17 City/Town ❑ Gas Fitter =see NumVer Master APPROVED(OFRCE USE ONLY) ❑ Journeyman �• Date. . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i ,SS/1cwUS� , This certifies that . . . ,L . j`� `.�� . .4 's . . . . . . . . . . . has permission to perform . . . .. .,.: . . plumbing in the buildings of . . .!.. .. . �:z✓: ,-. �..*.. ���. ��: . . . at . . . . . ` .. _,.,. _,r. . . . . . . . . . . . . . .. North Andover, Mass. Fee.._ . _ rbc. No.. .i -r. . . . . . . . . .... . r'. . . ., . . . . . . . . PLUMBING INSPEOOR Check # 1 MASSACHUSETTS U 14PPLI FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date 111-710:5 ®��� Building Location f'� /�Owners ame �� /` l?4— Permit# Q �/ZNbtrAmount N c Type of Occu ancj lla5Wt'' 77i'fC, New Renovation 13" Replacement Plans Submitted Yes No FIXTURES Cr cf 3 SLsIE R4SffVE1qr M FIDM 2ND HIM y 4MrrJDOR sM>LOM 6M Hj" 7M HJOCIR 8M (Print or type) / Check one: Certificate Installing Company Name lYf�i 'L/�d'���9�17,'d�4l�b - Corp. 76 Address '03:- �� r� u❑ Partner. d v Business Telephone Firm/Co. Name of Licensed Plumber: ��� Insurance Coverage: Indicate the t e of insurance coAerage by checking the appropriate box: Liability insurance policy Other type of indemnity El Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner 13 Agent El I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Pe 't Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P r of the General Laws. By igna ure of LicenseqKFIUMDey/ T pe of Plumbing License Title O/p City/Town License TN11m5er Master Journeyman ❑ APPROVED(OFFICE USE ONLY ....... ... . ......... NORTH 0 TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .......................... .........I.............I .......................................... has permission to perform.....:............:.............................'...=......................... wiring in the building of........ ........................................................................... at.......... ............................ .................................. .North kndover,Mass. Fee..................... Lic.No. .....:.......................... . ..........................e..................... ELECTRICAL INSPECTOR Check # 1 HE(,'UMMUIV VVV AUH UP 1K41'J'A(,H(-/6K11 N Office Use only DEPARTAIEWOFPUBIICSAFM Permit No. :,—U-66 BOARDOFFIREPREVAE VMONREGUTA77ONSM7CMR12:(X! Occupancy&Fees Checked APPLICATTONFOR PERMIT TO RMS GAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE M S C SS ELE O 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / 7— U.S— Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w r es rib e W. Location(Street&Number) , r e, --,y�� Owner or Tenant 11 W,,v-e✓'"� N s'% �,, Owner's Address /1,e — le- s /�� � 5 �� ter/—t,� /�� n Is this permit in conjunction with a building permit: Yes No �� (Check Appropriate Box) Purpose of Building � 5 Utility Authorization No. Existing Service Amps �Volts Overhead M Underground No.of Meters New Service Amps Volts Overhead r--J Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 67 C V-- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round jzround No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP / OTHER• a ksuranoeCovaaga Plus mttothemgmernaitsdMassadmseftCenaallaws ©,. IhaNeaamaYliabt7ayhtsigatrePlilicyittchrlmgCanpleeCo�orAs,a Aatrialecluivalent YES NO IhaNes lufaedva5dpmdofsamebtheOffim YESM CT Ifyou�d�YES� �0fa�lry, cheddnglhe box. �INSU WIM BOND OTHER a (PfeaseSpac�y) �WorkbJStatt /� '7—C?5 Estir WdVatreotBxWral Wdk$ ao FMW Signedund2rT& ofpel 1 FIRMNAME LimrlseNcx Ixatsae�/"(p w .e �'d 1 x sigt ae �� 01 LkffwNo Busa�sTel.No.' ` / OT / Address Z1Ak TeL Na OWNER'SINSURANCEWAIVER,IamawatethatiheLimwdoesmt the it>saa<roemreageorgsabst UeTavdiantasmgmadbyMamdusemcz1ral1_aws and thatmysgnahueendwpetmd ffhcafimwarsthisregtmanaY (Please check one) Owner M Agent Telephone No. PERMIT FEE$ Signature ol Uwner or Agent Date. ..... ... . NORTH TOWN OF NORTH ANDOVER �1 O D ' PERMIT FOR GAS INSTALLATION SACMUSES This certifies that . . ... . . . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . s-/.Q . . . . . . . . . . . . . . . ` ." .. . . in the buildings of . . �V:.� .�.,. .-��. . x-<y. �.� . . . . . . . . . . at ���; , �,-�.f . G <c ;.� �f� ;1 +, cr., North Andover, Mass. Fee. i'1. Lic. No..1 G. .?. . . GAS INSPECTOR Check# J � � MASSACHUSETTS UNIFORM APPLICATON FOR RNff TO DO GASWrING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations Kole— ( Permit# L ,/ Amount$ fi, Owner's Nam 7777 `j New❑ Renovation ❑ Replacement Plans Submitted ❑ a o o x N z o e a o � °o z 9 0 W H z c o x e W � z e a a w H w U o ' pA Gd7 a UO 9 > A a H O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . FLOOR C 6TH . F L O O R 7TH . FLOOR 8TH . FLOOR (Print or type) Che Certificate Installing Company0�etinC'! ��K orp " � Name i Address 55 '� S� ❑ Partner. Business Telephone 7 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Ilay �O INSURANCE COVERAGE Check on . I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked ves,please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity 13Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installationsp9eformed un r Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusettsa ter 142 of the General Laws. ,Signature of Lice sed Plumller Or Gas Fitter Title lumber env Tit City/Town Gas Fitter License mer aster APPROVED(OFFICE USE ONLY) Journeyman Date. O'.".O R' '14,, TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING ,SSACHUSEt This certifies that . . . . .�.7. !. 1. .r'. . ./. . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . . .. ... . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of .i. . %. �.l �-. . f7i �.- �. . . . . . . . at . . . . . . . . . . . . . . . North Andover, Mass. Fee. ,!1. .L . . . .Lic. No.. . . . . . . . . . ..�. . . .�... : -.,-}.r-4..--. . . . . PLUMBING INSPECTOR Check # It MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLU ING (Type or print) NORTH ANDOVER,MASSACHUSETTS Dat Building Location Name Perrmt# Q may/ k— fi�Olo,y�� 77,�Oe-, Amount Type of Occupancy New Renovation ❑ Replacement �' Plans Submitted Yes No FIXTURES E~ Cn a a a a 3prow RASEM[vr II M F10CIR d -IM FLOCIR 4IH FLOM 5M Hj" 6M HlDOR 7M HIM Wi i=D (Print or type) Check one: Certificate Installing Company Name GG Corp. x/ -7 6 Address � '� �� 1❑1 Partner. Business Cf ,u �4,�4 Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the t7 of insurance covofage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond ❑ Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above threeinsurance . tgnature Owner Agent El I hereby certify that all of the details and information I have submitted r entered)in ove application are true and accurate to the best of my knowledge and that all plumbing work and installations ormed undepr9fmit Issued for this application will be in compliance with all pertinent provisions of the Massachusett o e 142 of the General Laws. By: Signature ot Inuenseae Type of Plumbing License Title City/Town i ense mer Master Journeyman ❑ APPROVED(OFFICE USE ONLY r Date......:.................:: ..... y ,LORTH °`,�``°;•'"� TOWN OF NORTH ANDOVER PERMIT FOR WIRING s o• ,?�s �1 �O�An° ,SSACMUS� This certifies that - - . ................................ .. ........................................... has permission to perform " ............................. ............. wiring in the building of.................::.......:.........:.:...�:.. ........................ i at................:.::..:......:.::r.................. ................. ,North Andover,Mass. Fee.................... Lic.No./( (i ............... ✓..:. �, '� ................ ELEMUCAL ImPECTOR Check # r - � 111A UULVMU1V VVP14"H Ula 1 M1"(HUM11 J Office Use only DE AR7A1EW0FPUBUC Permit No. BOARDOFFLREPREVEMON ONS527CM12.-017 I P� Occupancy&Fees Checked APPLICATION FOR PFRMIT TO P CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE M C S SEL IC D ,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover r To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w describe a w. Location(Street&Number) y Owner or Tenant i Owner's Address e�5 ,, A- AJ Is this permit in conjunction with a building permit: Yes 1:3 No (Check Appropriate Box) Purpose of Building Ze.-) • Utility Authorization No. Existing Service. AmpsVolts Overhead Underground No.of Meters New Service Amps olts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 77, w- 7177.r No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Btimers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of ` Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP 1 OTHER• kwar eCoverage.Ru NIODthetagt=entsdMMXhMftGff=allaws �/ Iha%eacumtLiI-*yhmaar=Pb yrEhxir>gCanplee CovQWoritssthgj tepvaht YES NO ihaveakni*dvandpoofofsam k)drOffim YES r7T IfymtnmdaclodYES,plea9eindtcatethetAXCfcovtWby drddrlg / L-11 Ea INSURAN EE BOND MIER a (Plea9e Spaci y) EVimtim D& EstQ;tatbd Valleofl7acttical Wodc$ 4wodcloStatt %'©A 7—4 bpectiMD&Regttested Rough Final t%y An Signedunchr& _ ' ofpajtay �^ FRMNAME ` _S w 1 Yc at w ✓/t1 LrcenseNo. Sign1ae ` f y Z-- LtoerwNO /�� Bushn=TelNoL AddrW--LQ kV �'� Z� Alt Tel No. OWNS SINSURANCEWAIVER,Iamaware dmttheLioe m nothavedVEMMMODWrgeocit Rkst rrialegtmi3laslegtm lMzmdlmMG=WLaws andthatmyagw mcnthispwrxtapplicahmwaivmdislegtrimxrt (Please check one) Owner Agent Telephone No. PERMIT FEE signature of Owner or Agent Date.Z..................: .)....... s ,LORI" °f,•``°;•16 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING ��SS�cHusE� a This certifies that ................. ................................. .:c.....' ...... .................. has permission to perform.. . ,..:.1...............-J. ..................... wiring in the building of...:. ....:............... .........`:......:....!' ...................... at......................:...................:.... ..... ................. ,North�Andover,Mass. �!i rFee ............:.:...:.-.r.. LIc.No.........:.... ..................... _ ELEcrRicALINSrBCroR Check # v I HE(,'UinMU1V WLAL1 H U1'IVIAJ'NF1 ,11 UNL;11 N Office Use only DEPARTAIENTOFPUB SAFELY Permit No. BOARD OFFIREPREVEV37ON ONS527CM12.00 Occupancy&Fees Checked APPLIGATTONFOR PERMIT TO ERF ELE WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE AS S TS ELE ICAL C 2 R 12:00 ) _ (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electi 1 wor d cri ed belo /Location(Street&Number) d 5 X .r 5 j4— ,, . Owner or Tenant 77 67-77 7477! _ w Owner's Address .-r rr r. 1A y- fl" Is this permit in conjunction with a building permit: Yes No a (Check Appropriate Box) Purpose of Building S f Utility Authorization No. Existing Service Amps� Volts Overhead 1:3 Underground M No.of Meters New Service Amps/ Volts Overhead M Underground ED No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Bumers No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Plumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local Municipal r---I Other Connections No.,of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motorsq Total HP 4 J — OTHER• kUXX=Goveraga Plusranttothetagtutar�a�IsotMassact>t ltsGataalLaws IhaNeaumultLiab&yh>snameFbbLyirrkftCorrple CommWcrflsakswn alepv*d YES NO IhavesubrrmedvalidpioofofsamebtheOfca YES IfyeuhavechadadYES,Pkzeindcalethetypeof0DVmWby - INSURANCE BOND [:3 GIIIER (1 eSpeofY) A EVkafi Dale EstirmdValueofFahk$ VodcDoStat 2 De Final ` / Stgurder& of / FIRMNAME Lioe mNo. ��� IuG7"�tC�./Y���« � -�'��c Sigfmue Lioa>seNO f� Business Tel Na Alt Tel Na OWN 'SINSURAMMWAIVER;Iamawaietha drLioa>sedoes; their>s==CD orAS&ksMtIW and dumysignatureonftpai itq*abmwaivesthism4miena1 � � �'� �ws (Please check one) Owner 1:3 Agent Telephone No. PERMIT FEE$ A, signature of Owner or Agent NORTH ToVM of : _ Andover No. /33 C% o doves Mass. 90-m-o'dy LA COC MI CHEWICK ' ' x.95 RATED BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System . BUILDING INSPECTOR THIS CERTIFIES THAT Foundation M M( cl�' has permission to erect.. ..X..�f................ buildi son.4 /.' ...... .... ...................... .. Rough A4 ,t e(., -- to be occupied as..... ney !v provided that the perPhaccepting this permit shall in every respe onform to the terms of the application on file in Final this office, and to the provisions of the Codes andBy-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. CPA %A8 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIOELECTRICAL INSPECTOR N T T Rough ELECTRICAL L ... .....`.'............................... Service..............................................................BUILDING INSPECTOR Occupancy Permit Required to Ocayy Building GAS INSPECTORRough t Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Date.. .J//��: . ... .. .. Of ,,ORT s 1ti0 o� '` TOWN OF NORTH ANDOVER F F • PERMIT FOR GAS INSTALLATION h �,SSACMUSE�t / This certifies that . . . . . has permission for gas installation .f. . .. + f .leq l� in the buildings of�. . . 1. . .. . . . . . . . . .c . . . . . . . . . ... . . . . . at ���. : .!: �.�.il-��. . :�. . . . . . . . . . .. North An over, Mass. FeeA/ �* *f9. Lic. No. C.A,*7.3. . GAS INSPECTOR Check# c� MASSACHUSETTS UNIFORM APPLICATION FOR PERM? TO DO GASFITTI � (Print or Type) NG ' ' d&? �DOU �, Mass. Date_^�/ -�j.00 — Permit# �/� Building Location S Owner's Na e • s T o g " Type of Occupanc New ❑ Renovation ❑ placement Plans Submitted Yes Cl No C W Wu Y w z Ir U) CO co U) o C3 J C0W U m F 2 rn ir W Q w 0 d w C�7 Z Z ¢ _ m Cz7 W O W = w Z Q w -' 4 Q t= 0 m Z O Z w p tom- W X i O z LL D Cr c47 a > o � .tW- O SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR TrH FLOOR 6TH FLOOR Installing Company Name Check one: Certificate Address �'"' [5''� / � Corporation ❑ Partnership Business Telephone 22k- �/�( Q (� �/� .-s ❑ Firm/Co. Name of Licensed PlumbeG of Gas Fitter INSURANCE COVERAGE: I have a currVf liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes [YNo ❑ If you have chscked yes, please indicate the type of coverage by checking the appropriate box. A liability insurance policy LW' Other type of indemnity ❑ Bond ❑ OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Sign iture of Owner or Owner's A ent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best-of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,By P(aea of License � INtumber o _ lIle li? ster ignature of.L nsed Plumber r Gas Fitter Citv/Town aster /� 11 .Inumavman �J� FEE NO: APPLICATION FOR PERMIT'-TO DO GASFITTING Q 1 0WNER�U' y NAME & TYPE OF BUILDING No /�NDa UE i2 Y0 V i t A)C.• LOCATION OF BUILDING: S PLUMBER OR GASFITT.ERi 8 P LICENSE NO: _� 1�3 PERMIT GRANTED DATE: 2000 GAS INSPECTOR i Date/-, e7 t-/ ................................ 0ORTAt 0 TOWN OF NORTH ANDOVER 0 0. 'A PERMIT FOR WIRING CHUS This certifies that .. .."!........................................... oo, .............. ................................. has permission to perform ............... ......................................... wiringin the building of.......................................................... ....................... at............................................................................... .North Andover,Mass. Fee .................... Lic. ....................I . . ......................................... ELECTRICAL INSPECTOR Check # 111L1C.'UIVIMUNVVtALI H UP'MA.SJifl HUJL11 J Office Use only DEPART�VTOFPNUC Permit No. BOARDOFFIREPREVEMON ONS527(M12.W Occupancy&Fees Checked✓ APPLICATION FOR PERMIT TO P ORMELECTIZICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASS CHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date /-3", n y Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w k scribed below. ,{ Location(Street&Number) �; �, ` ��, S Owner or Tenant 41,dXVr p�y�Z Owner's Address 0,1•r_ Is this permit in conjunction with a building permit: Yes P�No (Check Appropriate Box) Purpose of Building /V(,-5,,, , • Utility Authorization No. _ Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No. of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work poi 7tv7.4 -7- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures �� Swimming Pool Above Below Generators KVA --,f1&,J ground El eround No.of Receptacle Outlets / No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons / Il/r<•f A7 • No.of Disposals No.of Heat Total Total No.of Detection and /� / $rr�c�e /y1Gr<%rr,fir•• . Pumps Tons KW Initiating Devices '• IV A. 3 ,/ No.of Dishwashers Space Area Heating KW No.of Sounding'Devices No.of Self Contained a Detection/Sounding Devices &.of Dryers Heating Devices KW Local Municipal Other Connections oNo.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs f No.of Motors Total HP OTHER" /�,S— 09 ¢1 3266 j� «c(.r ��Y t/ ,t r/`E/Ja th Insut =Covw,W-Ptus<rarettothetegt>rtanarts�Garaaliaws IhaveaamaxLiabl7tlyhnu=oePblicyinchxk>gCampl Com$ageor9ss*stm1WeqIivala1 YES NO IhavesutxriwdvaWptoofofsanebtheOffia-YES ffyouhavedtedodYES,pleas:indicate,the rypeofoomer4pby dred>he box. ■■ �� ■■ INSURANCE ' q BOND O HER (P�e*c y) ( ? Estimamd Vahue ofDearical Wodc$ Wodcostatt d Inspe fimD&RaWesa7d Rough Final HRMNAME �'-' +r S �' ef,ea:/�•!✓ilr3 �!,t' . LioarseNo. Li=wNo Busirm Tel.1%. 9-?V-- Alt Tel No. OWI,WSINSURANCEWAIVER,IamawmedmtftI riothawtheinsurarmcoveageoritsabsuldepvalartasopredbyNb%adlsCZGardLaws andthatmysgnalmondrispeuitapphcafionwaivesthisregt>itarlalt (Please check one) Owner M Agent < Telephone No. PERMIT FEE ' signature of Owner or Agent ITW UULVMUIV YYrAL111 Ur 1V1A,1JH 1iUJL115 urnce use only DFPARTAR M'OFPUBAW Permit No. ��w BOARDOFFIREPREVEYHON ONS527CM12:Q0 Occupancy&Fees Checke APPLIGATTONFOR PERMIT TO P ORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASS CHUSSTS ELECTRICAL CODE,527 CMR 12:00 ,LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical w k scribed below. Location(Street&Number) I)l Pe ��.; r./� %ty�.,%, Owner or Tenant Ao v Owner's Address 0,1 Is this permit in conjunction with a building permit: Yes MNo E] (Check Appropriate Box) Purpose of Building V4.5 .. Utility Authorization No. Existing Service Amps� Volts Overhead M Underground No.of Meters New Service Amps /V olts Overhead r--1 Underground No.of Meters _ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work v, 4 No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above 0 Below Generators KVA round ground No.of Receptacle Outlets i No.of Oil Burners No,of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones + Tons � / //s<¢ Hf. `To.of Disposals No.of Heat Total Total No.of Detection and < N-..�i!r ✓/lea,/,:r r.6J�.. Pumps Tons KW Initiating Devices �• y fb 3 Ey„7..'y i;,r srt st--.=•� of Dishwashers Space Area Heating KW No.of Sounding Devicesr No.of Self Contained Detection/Sounding Devices , f Dryers Heating Devices KW Local Municipal Other Connections bf Water Heaters KW No.of No.of Signs Bailasis ydro Massage Tubs No.of Motors Total HP CLOW, overPtuamttatkletacltritana�.s >seflsGalaalIaws Lab�dyhmaanoePt�licyinchlchlgComple_O�el =CovetageerItSSUbstantia MMvalerJ YES NO Valid poofOfSME 10the Offi=YEQ T IfyouhavechaJodYES,peitxcaleftV VofoaWby draNCE BOND Oxa Plewe ) l^ �.�.,,�,y,��,, p�,,�y�.� per,,,{, Estkrr&d VakleofElaarical Wodc$ /j4 13�' o kispectim �' Rough Final iftfiiescf Lioa>�No. //5 r Ze r Sigr=ue l I Lio�eNo �� `S ��'�>- ✓” � �5 Alt Tel No. i— URANCEWANFR;Iamawwdxtthe doesrlothawtheinsuta= orilsstlb ` s1NSig&=ondmpenrritapplicafimwivesthistegttitanat �� a anal�`�� bYM Gerl�alLaws (Please check one) Owner Agent Telephone No. PERMIT FEE ' Signature of Uwner or Agent a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT MEE&RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: �� DATE ISSUED: _ X SIGNATURE: C Building Commissioneffl for of Buildings Date SECTION i-SITE INFORMATION 1 1 P;rper[ Address: 1.2 Assessors Map and Parcel Number. oMap Number �Parcel&M - 1.3 Zoning Information: 1.4 Property Dimensions: ph/Y . < Zoning District Proposed Use Lot Area Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard ide Yard Rear Yard Required Provide ReAuired Provided Required Provided v 1.7 Water Supply M.G.L.C.40.11 54) 1.5. blood Zone Information: 1.8 SewerW Disposal System: Public ❑ Private ❑ Zoee Outside blood Zane ❑ Municipal ❑ On Site Disposal System ❑ JI SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT "'�'L 4 ' `ti!Ct; `,'. , �.lD M 2.1 Owner of Record Name(Pri t) Address for rvice: �V Signature Telephone (� 2.2 Owner of Record: Name Print Address for Service: V M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ �jl 2X� f L onstruction Supervisor: , /� 0 Licensed License Number AddressI G �✓ — /� �✓��/� TG/ �` � J Expirat///io /Dal�tWq�/ 9 Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name M Registration Number r Address r Expiration Date Signature Telephone r SECTION 4-WORKERS COMPENSATION(M.G.L C 152 f 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the ildin it. Signed affidavit Attached Yes... ,:L No.......0 SECTION 5 Description of Proposed Work check ae a ble New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description Proposed Work: C9L "o 47 -a ce SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building n �D© (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x tb> 4 Mechanical HVAC ((J� 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 'T r I, —7l �lf� ' lel as Owner/ su je Hereby authorize /"� �� df'7 ' A� to act on My be if n allematt relative to , rautho by this building permit application. 3 V Signature of ner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION r e-C as Owner/ onz Agent of su Iec property Hereby declare that the statements and information on the foregoing application are Lrue and accurate,to the best of my knowledge and belief l Prtpt Najtle� Si aatturrree�o er/ ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 NU 3 RD SPAN DUV ENSIONS OF SILLS DINIENSIONS OF POSTS DB ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMv EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 1 i ✓1�ce �or�v�rurruuea� u ��i:�ut�u.�eC�d BOARD OF BUILD[ REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 072493 Birthdate: 09/06/1955 Expires: 09/06/2005 Tr. no: 5001 00 t 'BIGNIEW MROCZKA 51 SAWMILL RD DU1`,LEY, MA 01571 Administrator • 3 ti t L Liberty Mutual Group • Liberty PO Box 7202 mutual. Portsmouth, NH 03802-7202 Telephone(800)653-7893 Fax(603)431-5693 February 8, 2005 NORTH ANDOVER HOUSING AUTHORITY ONE MORKESKI MEADOWS NORTH ANDOVER, MA 01845- RE: Certificate of Workers Compensation insurance Insured: MDM ENGINEERING INC 51 SAWMILL ROAD DUDLEY.MA *01571 . Policy Number: WC2-31S-339752-014 Effective: 12/0/2004 Expiration: 12/0/2005 Coverage afforded under Workers Compensation Law of the following statc(s): MA Employers Liability: Bodily Injury By Accident: $ 1,000,000 Each Accident. Bodily Injury by Disease: $ I,U{lU(1(IU Each Person Bodily Injury by Disease: $ 1,000,000 Policv Limits As of this date, the above-rel'erenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is sub ice[ to all the terms, exclusions and conditions.and is not altered by any requirement, termor condition of any or other documents with respect to which this certificate inav be issued. This certificate is issued as a matter of information only and confers no right upon you, fhe certificate holder. This certificate is not an insurance policy and does not amend, extend,or alter the coverage afforded by the policy listed above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notifv you of such cancellation. AUTHORIZED RV.11RESENTATIVE' 1.113ERTY MUTUAL INSURANU UROl ll' 111is lkhiliade is executed by I:18ER'IY vll!'I't!;�1.INSURANCE MOCI'us rovects such msun nw m is mlimled by those comh:ntius. cc: Insured: Producer of Record: MDM ENGINEERING INC O'CONNOR&CO INSURANCE AGENCY 51 SAWMILL ROAD PO BOX 1458 DUDLEY, MA 01571 DUDLEY. MA 01571 u IM)s 1 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Location of Faci ' ) Signature Perm' Applicant to NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector NORTH Town of No. '' '_ 70 T • w �1��+ A � o L o dover, Mass., AS& COCMICMEWICK V ADRATED PC S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT... . ....... iDING INSPECTOR BUIL Foundation ..... ...... has permission to erect....+ .�.. ........... buildings on F..s!444 T �' e! A W141tj Div, Rough ........... ......................... to be occupied as '� kw.; 10 „I .No/A. Al"i .. & &INKS chimney ..... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. r ��` . PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Fina` UNLESS CONSTRUCTIO ST TELECTRICAL INSPECTOR t Rough ......... ..... Service .. . .. .. ...... .. ..................... . BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner ' Street No. SEE REVERSE SIDE smoke Det.