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Miscellaneous - 313 SUMMER STREET 4/30/2018
313 SUMMER STREET JI, 210/107.A-0169-0000.0 i I INCIDENT REPORT Todays Date: 49Z f 792 Address: Map: I OI# Lot: Date of Incident: 014 7-4 2 Inspector��Vlllo Description of Incident:SLG 1`f-70,-, 7l.5 Departments Notified: lP-g� ��G G • '-�� -�...s-�-w'-•:� vq._�6� � � .e^ ,3'.r. .+ - -.' �:.. lam~ °s$x �J!-,� - ,yP. a�'�?'rr+-. �.r, pys?p .. .+ �_ „f�.a 'r�� ���•� -- �7� V R L�' 1 � � s 'i .��� �'��<f� ✓+'� o;c;�• ter,.,. .rte.:, ;. �._ `�.,`'l� 171u �- 4' ''ltd._r ✓ I �•�1=:Irl�-� SCS 1 O �Q•!j i�i�� A��` �R� ItM AX sir ; �,�,4 j� ,,. �q map �§ ��'•.� �~ /1 T } � f �� ;h:�i `,1 �` � f i F`�..^ ",L,gip`'} •�; . . , '� �1 -� f. "�' �''�' n � �,�,�; �' - 3..,r t a,1�. J' r �, -� Y y -.. ��. t": - ;•.:. �,� � s._-�p�+.��/r' �'• � , •' �r-..n, �;�= "'' r� .�. t, , .ri�y _ ' A,.t._� 'i ` t+. .. i ,a vi{ a •n 't'.°'i, .�r� dew44 ' •,r�- r- J r t '. t•`a ��. � •'.` ..cam L--. a 1 �' ; - r- ���. A�N yy 1 Ov �� r T /\ / }i!, 1 ?�r^`%�. 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NORr�y TOWN OF NORTH ANDOVER � � p PERMIT FOR GAS INSTALLATION g3,�CHUg� This certifies that .. ....... ................. has permission for gas installation .... uu' ?. -............................ inthe buildings of................................................................................................................... at.....�' ..�. ...... .......lti!.c4!k .C .............. .., No A over, Mass. Fee......... .... -. ....... Lic. No. ........................ ........,�,....:.. ...........'................................ GAS N PECTOR Check# D 3 .- U 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY MA DATE - �� PERMIT# (� JOBSITEADDRESSif OWNERS NAME t.T OWNER ADDRESS TPYPPENOT OCCUPANCY TYPE COMMERCIAL DJ EDUCATIONAL[ RESIDENTIAL CLEARLY NEWid RENOVATION:D REPLACEMENT:[3 PiANS SUBMITTED: YES El NO 13 APPLIANCES I FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER _.._I --. _..-. - •___-_ -- _J --_-- COOK STOVE f DIRECT VENT HEATER - DRYER - •-- -.._ -.--__ ._ __ _ _ FIREPLACE FRYOLATOR FURNACE T-1 . ► i _ .... GENERATOR —1 —..._ GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN -i POOL HEATER _ __--- - _ _- 1 ROOM/SPACE HEATER ROOF TOP UNIT -_ I TEST ^- UNIT HEATER - 1 1 _._.._.-.J .._ __-- _._-.. _.._... _._i .._...__ ( � UNVENTED ROOM HEATER _ „J ._ .,,,_I WATER HEATER----- G :J OTHER _ _J — �— INSURANCE COVERAGE have a current liabillky nsurance policy or its substantial equivalent which meots the requirements of MGL.Ch.142 YES fjKO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OFCOVERA E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLiC _ OTHER TYPE INDEMNITY E-] 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 0 AGENT SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and Information I havesubmitted or entered regarding this application are true and accur o the best of my knowiedge and that all plumbing work and Installations performed under the permit issued for this application will be In compliance W ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME - Z��Y LICENSE# SIGNATURE MP MGF[] JP EI JGF E] LPGI® CORPORATION Pf# PARTNERSHIP[ # LLC COMPANY NAME: DRESS CITY apt Q6� STATE ZIP TEL 7 J — FAX _ — CEL 7' �57 EMAIL _ i vr+ G/� t 3L GENERATOR APPLICATION DATE: LOCATION: 3 (-5 OWNERS NAME: II'�l Il�►� GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: PHONE NUMBER: �7� X97 - QS- 17 ELECTRICAL GAS SIDENTIA COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT: *PLANNING APPROVAL (IF IN WATERSHED) *CONSERVATION APPROVAL e_ L4,614 North Andover MIM" November1 girl"iHaSf{ S t 3t" 1}e g;`.•"� a x�5 ,va':ti, 5� .` Yt tT .w,'!•. r• c,yi� 48' i,•t r,x '`x- t 31 i;a x L 4P yt t'} i �t '"y',".: �'•i i� � f..J .:y'" rt1= x+q?s+i; !v J.'T. >i \ 'i$, _r t, ;.,� eV -�4e,p+L er' Jaa � r�^ "" s � •f.�„r.,.e� Y� � i tyt . t•5\ 7sfir ` ' ��, t`�` y3r •sf �!� S. gyp? °.1. 3a�2, '°,"�'7 i+ yM w. +rx/'{4.✓..,• yfxa"'.•..... ;^yw• qtr,!rWift.s S '�i ar t � M1r1t7• r 1Fa1 rr 5.. � r.wEa,^' 1;: x ,qy_.; tpy..M a 7 .D:.r... ,y.4* t #�• �yC, . � r afN St,?'4 V (,�!( r i t'`� �ti';x'r.r 7 t{a a` + �"G,• rgr,1 ai�, r4,.°t .iti `i Nl, \� 4 k�... 0�7��,r 3., r�k,�k�,s9 4" - vxcpA .t d . � �! t Sr r�•.. fia 3 br - x i r �:5 R� �T til.',to�x -„'" x, � i9�4 h \ a `l ,.a) , �. • .} a ly ~— ( '11 ul3 Fy 4 h{i✓+` f JS•t -OPA . �c. }a •s �;.r { /"� r' fr ,� ` i/. +w.r ` '!�.,,. 1 ti Y�§+-. �. r}. , ",+d't 4 y� ,� " r" ��. 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Valley Planning Commission(MVPC)using data provided by the Town of "to North Andover.Additional data provided by the Executive Office for planning purposes only.It may not be adequate rEnvironmental Affaim/MassGIS.The information depicted on this map is �• r legal boundary '.r • - - - - • • •- 1* MAKES NO .O COMPLETENESS,THE ACCURACY, • �SUITABILITYOF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 46 AS LIVE ANY LIABILITY ASSOCIATED WITH THE USE. MISUSE OF - THIS .- IJ sl -� North Andover Board of Assessors Public Access Page 1 of 1 NORTH North.: Andover Board o Assessors 3:ee;+. ...e• • OL �y '4r•o rA'S9 SS��HUSE Property Record Card Click Seal To Retum Parcel ID :210/107.A-0169-0000.0 FY:2014 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge Search for Parcels F-F-1 Search for Sales ` Summary OWN Residence Detached Structure - Condo 313 SUMMER STREET Commercial Location: 313 SUMMER STREET Owner Name: MILLER,SUSAN M Owner Address: 313 SUMMER STREET City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:6-6 Land Area: 1.01 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 3069 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 528,700 538,900 Building Value: 330,200 330,200 Land Value: 198,500 208,700 Market Land Value: 198,500 Chapter Land Value: LATEST SALE Sale Price: 1 Sale Date: 05/18/1995 Anus Length Sale Code:F-NO-CONVNIENT Grantor: MILLER RICHARD i C Cert Doc: Book: 04260 Page: 0001 http://csc-ma.us/PROPAPP/display.do?linkId=2440382&town=NandoverPubAcc 11/13/2014 Date.. ......................... NORTH 16 TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41 CH it ................................................... This certifies that ... ......I.................. has permission to perform ............................................................................... wiring in the building of...... .................................................... North Andover,Mass. Fe�............... Lic.No.............. .............. ELECTRICAL INSPECT, R Check # 9.0.46 Commonwealth of Massachusetts Official Use Only Department of Fire Services PernntNo. BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked '90 [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:/09-g - 7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) �3 1 j Solon? eA S I Owner or Tenant D i g t fri s t. t.-a Telephone No. Owner's Address — Is this permit in conjunction with a building permit? Yes ❑ No ' ., � (Check Appropriate Boz) Purpose of Building ?? 6i r- T1 t jc— Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd g ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: Completion of thefollowing table may be waived b the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 0.01 Total Transformers KVA No,of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- F1 0.o mergency ig g d• nd. Batte Units No.of Receptacle Outlets No,of Oil Burners FIRE ALARMS No.of Zones _ No.of Switches No.of Gas Burners f No.-of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ___.....__..........._....._..__..... _.__. - Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal 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: i Si s Ballasts No.of Devices or Equivalent i No.Hydromassage Bathtubs No.of Motors Total gp Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of ElectricK,Work: ���0 (When required by municipal policy.) Work to Stare /— 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 JR BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalde o perjury,that the informa n ori this application is true and complete FIRM NAME: ,. _ r-JL Cit;_ LIC.NO. Licensee: ;s � G'' �t7/? d Signature ��-� )__� CN/ LIC.NO.•`�o��'� (If applicable, enter "exempt"in the licens nu fiber 1' e.) Address: 10, „rid'-"A % €ft- r'" IA't� ' f 9(v Bus.Tel.No.:";` �: Alt.Tel.No.:�.��'�r_ *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent SignatureTelephone No. PERMIT FEE: $ (1O f i i � "�, ,�..: is �. �,.., 'f �� } . . ' t 4 1 _ i The Commonwealth of Massachusetts Department of Industrial Accidents , I Office of Investigations 600 Washington Street ,i Boston, MA 02111 I}j www.nsass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARRlicant Information Please Print Legibly Name (Business/Organ ization/Individual); Addressf ; City/State/Zip: n j A /µ 1' R Phone#: . .� < / t Are you an employer?Check the appropriate box: 1 11 am a employer with 4, Type of project(required): ❑ i am a general contractor and I (� employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.0 I am a.sole proprietor or partner_ listed on the attached sheet x 7• ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me.in any capacity, workers' comp.insurance. [No workers'comp, insurance 5. ❑ We are a corporation and its 9. Building addition required.) officers have exercised their l0.0 Electrical repairs ts or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No•workers'comp. c. 1.52, §1(4),and we have no 12. Roof insurance required.]t ❑ repairs q ] employees. [No workers' comp. insurance required..] 13.n ether *Any applicant that checks bro)lfl must also fill out the section below showing their workers'compensation policy information. t Homeowners 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-contnrctors and their workers'comp,policy information. 1 am an employer that is.providing:workers'compensation insurance,for my employees: Below is the policy and job site . information / /l • Insurance Company Name: Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address:S13 City/%te/Zip•Ii%f 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 WO RK ORDER an of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the office f d a fine Investigations of the DIA for insurance coverage verification. I do hereby certify under tepains and enalties ofperjury that the information provided above is true and correct Signature: - � Date: Phone#: , '� F only. Do not write in this area,to be completed by city or town officiaL n: PermitlLicense# hority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbin Ins g pector son: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other-legal entity,or any two or more of the'foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,br 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 anothenwho 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`(either 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-contractors)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 cavy workers'compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,nofthe 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 J 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%viIl 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 r 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 bum 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 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.govldia ,.- Date. /U ..f. . .. .. 40RTIy TOWN OF NORTH ANDOVER F 9 PERMIT FOR GAS INSTALLATION !. �1SSACNUSE�Ay ^1 This certifies that . . . :ra.f - . '.=%�4 �: -~ j, has permission for gas installation r:: '�- tl - f �•� in the buildings of .`. .� ::t ,'•• '`. . . . . . . . . . . . . . . . . . . . . . . at �. G -z ,.. . .�:�.:. , North Andover, Mass. Fee=�e?. .�. .. . Lic. No./ ./`f GAS INSPE,C�019 Check# 69 r MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations i) 1�1 Q N r I Ar` Permit# Amount$ Owner's Name New❑ Renovation Replacement Plans Submitted � w x - vv�� U x H Z O p w F C7 w d x z F v� C a > W w W . . x a Wa w w H W H x x z w > w z O z O x o a > SUB-BASEM ENT B A S E M ENT �- IST. FLO O R 2ND . FLOOR 3RD : FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR 8.TH . FLOOR (Print or type) Check one: Certificate Installing Company NameCo rp. Address Partner. O usmess a ep one . . .•1 Firm/Co. vr Name of Licensed Plumber or Gas Fitter I i( , 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 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: Signature of Owner or Owner's Agent Owner 13 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 S ate Gas Code and Chapter 142 of the General Laws. I B Signature of Licensed Plum er Or Gas Fitter tl Title Plumber L City/Town Gas Fitter iL censeuT Master APPROVED(OFFICE USE ONLY) M Journeyman r i 'L.U,> 7onwe,Qla of 1tlassachuseft f. D parlrrcerzt Of Industrial A=id, ✓ ,. � LCe of IKVBS'�IaQt101L4 GOD a litchi►t n Street Lr 7 BOA° , MA 02111 Workers' Cam enatio n . P Insitranee. A' cant information. A��� But'It�ers/Coatxaeforgoe . ctneia>ns /Piambers . . Pi _ ease Print L N"ne. (Businr-WDr eoizaiionAndividuel)• •bf Address: S Phone P , AtT you ata e U Io p ycr'i Chet:tt.tbe appropriate-box: I:Q l'am a erstployer with 4. ❑ I aan a Type of Protect( . loyees(full sndlor * general contactor and I . . • "eq°1r�: 2 am.asole.. or . nave bred the srrb M ttr 6• ❑New constl•ueiion . PeePn�or Pte - listed on the attached sheet 3 7. ship and nava no empioyteS . Q'Remodeling working forme in e Sins-eortizacfors have [No woijuns Ca �'c==ity. wot kers' comp.in 8' Q Demoiitiori' comp camp.S. (] We Ce 4. ❑Buiildi regM Md J are a.corporation and itt; nS addition of cors have excrccised their 10.0-El 3•❑ I am a homeowner doing ail work right repaire Or additions mysei£[Novmir rs' of exemption por MOL 1 IQ?.Dumb :=It re t 4 IS2, §1(¢y,.and•we have no 'rr8 repaulr or additions d-� .•OruPjaye es:[No wo12.I[�]Ftoofrepairs + ti �P• .irlaumnCt- uired. 13-L1 Other CPP tam dyer rhecics r b�#T must elan fill Dards= fi txcnmi Wvw mer#arho adbmit this sffidayrt wi Showing thdrworkaQ'c �Caattactots dist t:h Firing they an ttoing ah oesetion Paiiry m{� tm . eo}t dila boz rtuut WiFM nti fham hiis outside Cott an aticF.�fiaasl +tuts must aht:er Shaw' eubmit a new afttdn tree vtt' Deme of the suh.couttaetvcs and dmir wartyion. � ��yer that.is,�,avviac►tg:werk,.-�'cor;�sersc��,�sara�rre or faTQ.jot Insurance,Company Nwne: J Poliey#or Self-ins. Lie.#: - Job Site Addrms• ; A1#aah a copy of the workers''ca, CttylSttrte2tp napeasation Policy decjaratioo showi. Failure to Secure Covera a as Pam( b the Pnitcy Dumber and e fine g required under Secdnn 25A of MC3I,C. 152 cars Iead to tiro i YPit�tlOM da*4 . up $1,5XOD and/or one-year imprisonment,as weal as eivtl o on of ciiin al of up to X250.00 a pentilties in the form of a S70P WOR1{p petaihes of a Investi �3 against the vic►Iator. Be advised f}tat a e of this RDF1t and a fine gations of the DIA.for irratuance coverage verifiCat;on; oPY stat>;rrsent may be forwarded to tiro Ott of I do hereby certify ander the pains tread erialei P a J're7Uy Jifiar the infnrmafioam ' . Si :._ p traded about is brise rrnd Qon Date: � 1 Phone W 0&0. Do not.write in ffibr au e4 be conaplatad by ci�or town.Off=iaz City or Town: Issuing o Permit/L=nce# Aatthority(cir�cie one): I. Board of Hearth L Sueirfing Dsp�iaent 3.CitylTow la t;Ierlt 4. Electrical Inspector 5. PI 6 Offie'r umbing Inspector Contact Person: Phone#: tnTormatlon a- Ild Instructions Massaehusetts General Laws,chaptnr I S2 requires all cmp 10yera to provide workmt' compensation fnr their employers. Pursuant to this statute,an aroyee is defined as"..:every person in the service of another under any contract of hire, express or implied,oral or written," ' f` An em?16per is defined as"an individual pwtnership,$sortation,corpm-afion or other Ito entity,or any two ormorc of tine foregoing engaged in a joint enbrrprise,and includi"S tiro legal rr presemtativex of a deceased employer,ark receiber orbvstme of an individual,partnership,associatian or other legal tartity,employing employees 'iiowevcrthe own6r.of a dwelling house having not moan than three,apa r tm=ft and who resides therein,or the oceupartt.of the dwelimg house of another who employs persons m do maiznrnaaee,construction orrepair wdrk on such dwellinghouse or on the grounds or building appurtenant thermtn shall net b=a=of mub employment be de erred.tD be an employer," MGI, chapter IS2,123C(6)aim states that"every state ate-kcal licensing ageacf shd withhold the issaanmor renewal of a license or permit to operate a business or im construct baikrmgs in the commonwealth for any appricanf who has riot produced temptable envidence sf eompfiaace with t ie.insurance coverage required" Additiomliy, MOL chapter I S2;§25C(7)ststms"Neither thc'commonwealth nor any of its-political e6divisiom shad natter into'say contract for the pexforrnmtce ofpublic wane tmtll•aaceptab evidernce of camPliuiiux with the insiaancx requmsmetds.of this chapter have been presented to-fim mc3mt acting authority." Applicants Picast fill out die workers',compensatim affidavit comp14--tely,by checking the boxes that apply to your situation and,if necessary, supply subrcortor(s)riame;(s),ad&ess(es)S1,d phone ruuanber(s)along with their cesrtificate(s)of intatra= Limited Liability Companies (I LC)err Limited'Liability.Partnerships(LLP)•with nu•cataployees othertim the members or.parb=,arc not mquired,to=Ty.worken'oci.Tnpmsation insaxan= Van LLC or-LLP does hive employees,a policy is required. Be advised that this affrd.—m*may be submitted to the Depwtramntt of industrial Accidertts fur confrrmation ofinsunance coverage:. Aim [tie sure to sign and date the affi&At The affidavit should be.returned to the city or town that the appfication for the peimft.or fiomm is being mquestL-4 notthe Departmeatt of Industrial Accidents. Should you have any questions regar-&s the.law or if you are required to obtain a workers' aoMpensation polio,pima -call the Department at the-nurmberr•listed Wow. Self-insured oompanim shouid m Tt rthcu sml irssua>,nce license nurnbmr an tip appropriate Inas, City or Town Officials Mease be sure that the afadavit is complete and printed 6-gibly. The Depwiment has provided a space at the botmm of the affidavit for yo¢to fill out in the event the Office of Investigations has m contact you regarding$re apprx=t Please be BUM to fill in the permit/license nu tuber whieb v►-i71 be used as a mfermncc number. in addition, an zopli=d that must submit multiple Pwmit/iicensc appiiC:1dom in any given year,need only submit one.affidavit indicating-ourrent Policy"unformsfion(cif necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy dem affidavit that has b=officiak stamped or marked byihe city or town may be provided to the applicant as proof that a valid aff davit is on file for mount permits or licenses. A new affidavit must be Med out tach year. Where a home owner or citizen is obtaining a tic-em= or permit not related to any business or commercial v=tMM (i.e. a dog license or permit to bum leaves este.)said perm is NOT.rmqui rd to-complete this sfndaviL The Once:of Investigpstions would lulus to thank you in advance for your coupe ration nnd:shuuld you have any questions, please do not,hesitate to give us a call. The Depm mont's address,telephone and fax number. The Commoawca.th of Massac hose= Diel a eztt of lmdus dW Ac6dezft 4ffice•off Lavtsttiezfions 600ashiugtan Street BakM, MA 02111 Tel#617-727-4904 i)ft 406 or 1-8.77-MASSAFE Fax 9 61 7-727-774 Revised 5-26-QS wwwmamgovid a p Date. N2 4452 "�1DTM,tiO TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING & ,SSACHUSEt This certifies that . 1 .x.4 . . .� .✓.�.cs'.(.s . . . . �� . .r?�. . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . . . at . . ? -. . . . , North Andover, Mass. ccyy Fee:?7.�.Lic. No.. G'. . . . . . . .. . . . . . . . . . . . :. . . . . 'PLUMBING INSPECTOR Check # �' Z WHITE: Applicant CANARY: Building Dept. PINK:Treasurer r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT .0 DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date Building Location 313 Su �(11 Owners Name gm/�� Permit# y 4! 2— Amount Type of Occupancy New Renovation Replacement ®_. Plans Submitted Yes D No FIXTURES wCnx a !�Cn �" E~ W a W F. d W q ►.a F4 a ' A G�; A a H a s C Cn a a A a d F Cn d a d m 5LR1M BAER M IS'>v FIOClt M Y Oaz l anEi>L 5M HfM 6M H-a t Mi FIOCR M HfM (Print or type) n Check one: Certificate Installing Company Name 1,f i �u rrs '( �'� Corp. Address a J oi-/PLc It-1IE= Partner. Business Telephone 2?y )" c� S=' (j Firm/Co. Name of Licensed Plumber. 4 Jr.!9,0 Insurance Coverage: Indicate the type of insurance coverage 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 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 _ der Permit Issued for this application will be in compliance with all pertinent provisions of the Massae etts State Plumb' C e and Chapt3I of the General Laws. By: mgn4ulre oi Mcensouer Type of Plumbing License Title City/Town ►cense um er Master Journeyman APPROVED(OFFICE USE ONLY Date. . "pRT" TOWN OF NORTH ANDOVER Of •1fp . . PERMIT FOR PLUMBING ,SSAtNUsf`t This certifies that . . . . . . . . . . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . . plumbing in the buildings of /r . . . . . . . . . . . . . . . . . . . . . at. . . . . . . . . . . . . . .�., North Andover, Mass. . . . . . . . . . . (-J . . . . . . PLUMBING INSPECTOR Check # Or! f 5190 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) H .,_ 5, 10 NORTH ANDOVER,MASSACHUSETTS j Date V°�- ©,� Building Location �" �L)VAAMf '• p ' Permit# • �� .. Amount Owner jM iLdlz "` New Renovation Replacement Plans Submitted Yes No ❑ FIXTURES a W ~ W U O W a O 45 a x 04 �4 ° W O ►� SLRaM RASE>M M FUM A M)FLOOR 3MRDM 4HI>IDM 5M Hf [t 6M FLOCIR 81H HJOOR (Print or type) �t Check one: Certificate Installing Company Name /VM/9T� �l��'�dS�� ❑ Corp. Address c3 A4AW-1 is P ►`�`I 0 1 F61 Partner. Business Telephone 111, O7 0,;,60 Firm/Co. Name of Licensed Plumber: 6 >%VAJ Insurance Coverage: Indicate the!pp-of insurance coverage by checking the appropriate box: Liability insurance policy El 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 Massachu tts State Plum ing Code and Chapter 142 of the General Laws. BY: -jignatureorLicenseariumDer Type of Plumbing License Title 10>01Ci[y/ License Eriourneyman um er Master APPROVED(OFFICE USE ONLYONLY NoDate.................................. 40RT" 3? 1 0 TOWN OF NORTH ANDOVER 0 0 PERMIT FOR WIRING * o T- CHU This certifies that ............ .................11 ................................. ................... has permission to perform ............. ......... ........................................................... wiring in the building of........ ...............—/ ........................................................... at...............- ...... .North Andover,Mass. .......................................................... Fee....................... Lic.No/.,......,.o.... .................................I............................. "ELECTRICAL INSPECMR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer T IEC0AW0AT' ]�TH0FAuma1U,SET S Office Use only DLPARTA4EW0FPUBUCS4a"7Y Permit No. BiOAROOFFIREPREYEN170NREGUTA770NN527CMR12W. Occupancy&Fees Checked APPLICATTONFORPERMIT TOPERFORMELE=CAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 -� d�� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date s Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. 16 PARCEL 6 Location(Street&Number) �� n, p.,, -e,l Owner or Tenant (,C h u A p M j i l /P ig— Owner'sAddress Is this permit in conjunction with a building permit: Yes[:3--go (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 2-0-0 Amps L?2 / Z YJ Volts Overhead 71-Underground E3 No.of Meters New Service Amps Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 0)tc5Ym- P�Sk l� I' C-) l k No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA 6 ` ground El ground No.of Receptacle Outlets No.of 0d 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 40 .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• "� hmaailocCo�aage.Plushtr�b�theiagt>IIernaisoflVlaSsada�tsGaladlLaws IbaNeaamwLiabkyhstaa PdLyt<dxbngCmTikot ' oritsst1sbialegtiala1 YES M—NO Iha%eafindbdvalidpoofofmmtotbe0ffim YES1NO F-1Tyeuha-,edvdmdYESS,*asemdce flEr Wof=uagebyd=kingthe INSURANCE ©BOND r 11-ER Q ( may) EstinajcdV&rc(Elecftic;AWc&$ WC&toSW 5-- 7 9g 9^ Lv-v h Tochm &Regnmd Ra# `® —/— Z °'�© Final �� P swrdunci.x %,a=0f-rW-1 r. Mu a F1A�ME 9 z vn I�� Lit seNo. 11 S BLE"I STelNo. ek-L z'tz ate G o A1LTeLNa J OVtl,WSINSURANCEWANE,IamawmethattbeLic wdoesmthmetheiristm=cu, rWccitsskgfftdegtrivalartasm4medbyMambug&Ctn-alLam andthatmysig ikmcartlnspeanitapphcabmwm*0thisregvtmut (Please check one) Owner Agent Telephone No. PERMIT FEE$ Signature ot Uwner or Agent 7 f Dation �- - ,�-- .>- -'✓ NQ. L-2,_5 Date /l r, E; �aRT„ TOWN OF NORTH ANDOVER p D p • s :'a , Certificate of Occupancy $ Building/Frame Permit Fee $ a7 s�CHus - t Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Z 13733 J1 Building Ins&ctor e7 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING x xi � 3a p f qg ar BUILDING PERMITNUMBER: �' DATE ISSUED: � � Q ... r. SIGNATURE: OR/M Building CommissioTjn4Etor of Buildings Date Z SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: O /0-7 4169 Map Number Parcel Number 1.3 ZoningInformation: 1.4 Property Dimensions: 3-1 ` 371e Zoning District Proposed Use Lot Areas Frontage fl 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: N lic ❑ Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System ❑ S CTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record RI Cwu,�o C /�'I t LLLs� 313 S�P►1Yh l�c�. �'T: Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Numbermn Address D �Ino&t& 973" Y70"/9,20 Expiration ate Signature Telephone r.. 3.2 Registered Home Improvement Contractor Not Applicable ❑ 159-449ti1 W"-wC.El, 61: NN&AL CatuTr4A—, -Qaf'. :?.,17 Company Name 10919 Registration Number Ut� 2 P', Address l Lac.a o... stn 97U q70 /98,3z Expiration Date i na5� lure — Y Telephone i SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildinpermit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building Ili' Repair(s) ❑ Alterations(s) G1 Addition ❑ Accessory Bldg. ❑ Demolition 6l' Other ❑ Specify Brief Description of Proposed Work: .eV\0UC' G—�►371A/6 7=/VI'uL)' RX►, RZoF 4, (W STQCT- 14L'bY A7-77C )=LooZ v�TJ t �,aGL 4.poa,r-\w.1ro�� P-oor� 1 s TD 20' QwQ AS W- �— .rte. n 9-11^4s-C2 2Q. Rr'►►, 6Ui ' eXIX�W SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(8)X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 0o O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, k!A4Q c, ,l ,as Owner/Authorized Agent of subject property Hereby authorize is Lel to act on My behalf,in all att r lativ 4o work authorized by this building permit application. 3� A O Signature of O Date SECTION 7b WNER/AUTHORIZED AGENT DECLARATION 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 EQ 14/V tA.w Lcze- Print Name Signature of Owner/Agent Date NO. OF STORIES SIZE z2x, BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 c?C 2 r")"J I 3 SPAN 7z:=4 a DIMENSIONS OF SILLS 2 Z DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHTT OF FOUNDATION THICKNESS lc9j SIZE OF FOOTING X MATERIAL OF CHIMNEY 1 t.L IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL.GAS LINE i FORM U - LOT RELEASE FORM ... ..,: x:. �. ti 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. AFPLICANT FILLS OUT THIS SECTION "APPLICANT. RICI-�l�.GL�J AVL PI~ONE LOCATION: Assessors Map Number D � PARCEL SUBDIVISION LOT (S) /\—STRI=rT S ST. NUMEER OFFICIAL USE ONLY [RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH OATE.APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED cV Q DATE REJECTED COMMENTS PUELIC WORKS -SJ=YY ER/WATER CONNECTIONS CRIVEWAY PERMIT n� FIRE DEPARTMENT w i RECEIVE:-) EY EUILDITJG iNS?ECTCR " DATE hW 2 9 Revised 919;im Mai,ri" R - Wi©►T'I/�i v CSN �. DEPARPENT OF PUBLIC SAFETY ` < CONS TRUCIION'SUPERYISOR LICENSE )°/ Gc�y� 3 Nb Expires: Birthdate 03/23/2000 03/23/1962 Z' x PI `�`� c 4 Restf-� 4---O 00 BRIAN,ALANLER �`— x 66 YILON00D RO ANDOVER, NA 01810 .� ge HOME IMPROVEMENT CONTRACTOR Reyistratioq 104991 Type - INDIVIDUAL - Expiration .I 01/16/00 ! BRIAN LAWLER GENERAL CONTRACT- Wan ONTRACT Wan A..Lawler' ADMINISTRATOR 6 Wildwood Rd. ;- - Andover MA 01810 The Commonwealth of Massachusetts �1 Department of lndustriaUccidents Iq � � Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Yi/y L4ys/oEF-4 Please Print Name: N2)P14 LAW 21 Lt-i�- Z Lccaticn: 313 .Symm eE J City /N/. AH,0"IUC"L InA Phone ���-- `y'vkiL, C��u j 1 am a homeowner perrcrming all work myself. I am a sale proprietor and have no one Working in any capadry I am an employer providing workers' compensation for my employees working on this job. Comoanv name: �Lie9N L/�(,J( o'L (,1 tvNCz-4oq L CGK1MCT04 Address 66 ( J/Lz(.-)oaD leo, CiN: /1 Yqo Phone r q 70- y7v- IFS Insurance Co. EL-ECJ Policy-- 536147U G Comoanv name: Address I Phone Insurance Co. Policy Y Failure to secure coverage as require✓under Sec;icn 2�A or MGL 152 can lead io the imeesiiicn cr crmir.al penalties of a fine up to 61,500.00 and/or one years' imorscnment as'Neil as c:vii penalties in the form of a STCP'NCRK CRCE?and a rine cf(5100.00) a day against me. I understand that a capy of this statement may be forwarded to the Office of Investicaticns of the GIA for coverage verincatien. I do hereby certify under the pains and penalties of perjury that the information provided accve is,rue and correct. Signature pate 3 �6 Print name 219:11�iV s9 L^JLeoL Phone T 97, V7(- 52 . Offic:ai use only do.not write in.this area to be completed by city ar:own cmciai' City or Town Permit/Licensirc Building Dept ❑Check.r immediate response is required ❑ Licensing Board ❑ Selectman's Ofrice Contact person Phone ❑ Health Department Other 1 A 4 v �Y • -� tJ ILD t GAs1EmCWT .. . A — Wfoi SUMMER S TR EE T I HEREBY CERTIFY THAT I HAVE EXAMINED THE PREMISES AND FOUND THEM EITHER, VACANT OR OCCUPIED BY THE OWNERS. ALL VISIBLE ENCROACHMENTS AND BUIILDING 8)SHOWMENTS ARE N ON SAID OWN L OTS)ARE N. THE ON01T"HE GROUND S SN ON THIS HOWN AND., AT'THE TIME OF CONSTRUCTION, ARE IN CONFORMANCE WITH ZONING LAWS, AND WITH THE BUILDING LAWS AS THEY PERTAIN TO ZONING,OF THE CITY/TOWN OF PLOT PLAN OF LAND I FURTHER CERTIFY THAT THE ABOVE SHOWN BUILDING LOT(S)S ARE NOT LOCATED IN THE FLOOD HAZARD AREA AS DEFINED ON F.I.A. FLOOD HAZARD BOUNDARY MAPS FOR THE �� of its CITY/TOWN OF pjofLT A A N r M ek MASS.' S m R RoaI�DTti ANI Wet .MASS. THIS PLOT PLAN HAS BEEN PREPARED FOR MORTGAGE. 1r 4�1 PURPOSES ONLY AND REPRESENTS THE RESULTS OF A TAPE r PL SURVEY. IN THE ABSENCE OF MONUMENTATION APPARENT 01';AaE . ' LOT LINES A8 REP ENT D�SYEN OR yE LINES � A ilra.3(l92Y HAVE BEEN HELD """�;? ' SCal&of 1" sem....,. Ftll SIGNED . aTCNt,a ,:�' —�... ._'—�� �'h F" ' DRAKE A$SOCIA TES, INC. DATE ..�_..._ ` .,.�.C.,_.....�..,.-_ : 770 Qmw St., Fmmf677-04�,Mme• { f V2, rTO+} --7q i 6 of N ``� �� s v � a 1 NORTH Town of ,: r No. O LA o dover, Mass., COCHICHE WICK ADRATED P' �� S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System � BUILDING INSPECTOR THIS CERTIFIES THAT..................... ."..4004d........... ..... ........:................................................................... Foundation has permission to erect...Poo.r% . buildings on .... .......�.v�.�.�.r.......5...:. • Rough to be occupied as � �..ICAds � *4ve* . Chimney . d . ................................................................................................................ ................... 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. A"/ '7 /0 / 6 P PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. _ Rough • Final PERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STA Rough .... ... ........:........................................................................ Service BUILDING 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 FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. f • ,�, -� is �� ' �, �,.� �'/ t' �,.. �',�_t�tL ,� : J i l`—_ 'Y�.��• ¢fid,� �. � t��-C�,. �I 4.r�t_t } vi iJ f _>H�.✓.�� � � �C._- r-,VA Of" �r P ! t BALL ► { > vi 4 off} T— I (o„ OC, — -- ()l 4 Ni AK ' � wr t • ATd D t*) [�-r t cors S� OC-T— N� -i-TfC_ �ts�a a2_ �"��� �•Ys7 � o i'2- �1 DGS L— ! lC� aA 1/2 rr P�YV� 4 GN t4--2> = 1 I q3I o ,Z-�v 0. �����ZXy 16 r� c>C. `t LiI I( Ii 1 t I a f -17f _ :i �3�-����:-ate •�,� -�� .S-�_ r i �IEuJ �F�r � n�:R4ER � WIIJDc>W LION - �I _III Location � � - No. .1 Date NORTH TOWN OF NORTH ANDOVER 3?�:,.�•o .1tio .. a a � �o Certificate of Occupancy $ SACMUS t� Building/Frame Permit Fee $ a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i Check # 3 / Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER.. DLTE ISSUED: _ Q SIGNATURE: � C Building Commissioner for of Buildings Date SECTION 1-SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 2&5 si, ® i Map Number Parcel Numb 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard R 'red Provide Required Provided Re fired Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner Record ��—°-- Ax&t oe— Name(Print) Address for Service: �t Signaturw Telephone O 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ 3ZI&V c1,wt-Q—JC- Licensed Construction Supervisor: G7 O Cp bj 6 License Number Address / G% 9 7 y-'A7C] —Z2 cG�� _ Expiration Date Signature Telephone r 3.2 Registered Home Improvement Contractors n Not Applicable ❑ v 31V6/`/ (,�/LC!� �WyL �jN 1•`/�I UES a Company Name M v Registration Number r r Address 7/6/Zo dZ L470 Expiration Date ^ Signature Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......fir No.......❑ SECTION 5 Description of Proposed Work(check au applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) V" Addition ❑ Accessory Bldg. ❑ Demolition Other ❑ Specify Brief Description of Proposed Work: ►sTiN6 Y�i'iZa,IQy/ �/�r'��Y t2�-i, �i 1 .1f�, CJS i� Gx(Sj?'J6 lam//NAc�W S �+- SJc�02� /2 L i`Q CRTC Pr1T2—'ACAJ -&Ajilc t,Jwa-+w 'In1s Cl N -Vy //VSvug7iV'Q , w i/L.vG t-kv973/N6S /�t/'�S71s�,, GHIIi•v6-73 �ccOQfiVr; SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be MOFFTCIAL�USE Completed by permit applicant 1. Building (a) Building Permit Fee off. 5-z U O Cj Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing O O Building Permit fee(a)X(b) 4 Mechanical (HVAC)/ 5 Fire Protection 6 Total 1+2+3+4+5 O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS GENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Pas Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matte elativ to wak authorized by this building pennit application. 41 6?/ Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 1ZI d9N (�W(�� 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 &IZI PW �AV1/l_lr Print Name 2&t, � 0. -'3/go /0 2 Si ature of Owner/A ent Date L NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TRVMERS 1 2ND 3 RD SPAN DIMENSIONS OF SILLS DIN ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i The ComrrtorcweaCth of W=achuse= ~ i Department of InduAT alAccidents Office of Investigations 600 Washington Stmet (Boston, WA 02111 Workers'Compensation Insurance Affidavit APPLICANT INFORMATION Please PRINT Legibly Name: lq/y L/\X�/ � Z L-))CK /Vi/Lil— oz- <g t.�•»2 Location: 313 SywtMc,C A; q7S City, Vin/L)o VCPL Telephone#: -8646D 13 I am a homeowner performing all work myself. O I am sole proprietor and have no one working in my capacity Fri am an employer providing workers'compensation for my employees working on this job Company Name: f,->)a)/9/y Address: I L13 W Cy 040 p City: /��U � I� Telephone#: QZU— q70_`/v3 Insurance Company:A!L/-wr7c. G H ,--,,� Policy#:°-=MMP=- ZZAw16JQ W Wo 0 30150 p ❑I am(circle one) sole proprietor,general contractor or homeowner and have hired the contractors listed below who have the following workers' compensation policies: Company Name: Address: City: Telephone#: Insurance Company: Policy M Company Name: Address: City: Telephone#: Insurance Company: Policy#: Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 15B can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information above is true and correct Signature:. . /'. �i �- Date: p2U�0 2 Print Name: Ad2419N L4W Phone# Official Use ONLY-Do not write in this area o Building Department City or Town: Permit/License#: ❑Licensing Board ❑Selectmen's Office ❑Health Department E)Check if Immediate response is required 0 Other i INFORMATION&INST ucnONS I Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law" 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 section 25 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, 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 in the workers' compensation affidavit completely, by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for.confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"-or if you are required to obtain a workers' .compensation policy,please call'the Department at the number listed below. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. 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 Fax# (617) 727-7749 Telephone# (617) 727-4900 ext. 406, 409, or 375 I 1 _ _ `c3 t, -b89- �34�b ( Q 9 t 1 4 1 �� u NORT#q Twn o of 4Andover .. ° No. 4 J o = = �A o dover, Mass., COC MIC ME WICK S RATED 7 4 BOARD OF HEALTH Food/Kitchen PERMIT D , Septic System BUILDING INSPECTOR THISCERTIFIES THAT...... ..... ........ ..11.r...........................I....... ..�.......................................................... .... Foundation has permission to erect. .. . .....M�'�..�... buildings on .. .. ..... ..V..!!N...M!1 .r............... Rough to be occupied as.......X. ....4.. .r!1/..�..... � A.4w.....w.;gAsws.,*:..�0� r4 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-La s rel Ing to t e Inspection, Alteration and Construction of Buildings in the Town of North Andover. 1 ip ' / � / is PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N S AR S ELECTRICAL INSPECTOR C Rough 0060^............. ... .. ................................ .. ......... ............................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough 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. Smoke Det. SEE REVERSE SIDE J 7 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,SSACHUS This certifies that ..... .............. .................... has permission to perform-.,...,.:t< .�::n.... ................. wiring in the building of..... ................................................... at... ........ .. ... ................ .. .North Andover,Mass. X Fee.. ........... Lic.No. ....... ...... .. . ... ... ....... ELECTRICAL INSP ECMR Check # 27HC0"0NffEMTH0FM4MaAaM office use only —_-�• DF.PARTMFM'OFPUBLICS9FB�Y BOARDOFJWPI?E;2MONV Permit No. ' P 1��1G��1A1701��SS27GtOt12� occ 14=CY&'Fees Checked 70 APPUCATTONFOR PERAW TO PEUORMELECMCAL WO ALL WORK TO BE PE"MIM IN ACCORDANCE WITH THE MASSACI IU33 M ELECTRICAL l� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) ,52?cam 12 QQ Date Town of North Andover The undersigned applies for a permit to perform the electrical work described below. To the Inspector of Wines; Location(Street&Number) �vyaz Owner or Tenant iCL1 IR r �l/ ev- Owner's Address v m O r 's this permit in conjunction with a building permit: YesM No � � (Check Appropriate Box) —C 'urpose ofBuilding _ki k e fJ `�e t--,c, A- t C�ri� Utility Authorization No. :xisting Service Z�_ Amps IZo/ZvoVolts Overhead OPT Under p=W C . No,ometers Amps few Service / Volts Overhead C3 Q UndMgtourxl � No.of Mks umber offeeders and Ampacity )cation and Nature of Proposed Electrical Work i I a v r- Io.of Lighting Outlets No of Hot Tubs No.OfTnrufomxrs Total o.ofLightiogMu-res . r� 3wimmin;Pooi Above BQ , . ' KVO .. . G K VA >_of Receptacle Outlets �, ( No.of Oil Bufoers , Na ofFm PUP Lighting Battery[Jnits -of switch Outlets l No.of Gas Bumets of Ranges CbeS Ta No.of Aii Card. rata) FIRE ALARMS V Tans No:of Zoaft of Disposals © No.of Hem Total Total Na ofDrdeetiew"d ofDishwaghers -Too KW' lberices Space Ara Heating KW r Na ofSogadm IDevras No.ofWCappioed: ofDtyer1? Hesti t)evices KW ]L]LOWUeteftiawsarraiugijyy oMuoieipal Other )f Water Heaters SEW No.of No,of Codons si Bailasis tydiu Massage Tubs No.of Motors Tool HP ef' Pll�tartb�enegitorle���iaiealIa►es ' >�ntLr tyk= nwPdfgyttxltrdr)g YB )xrWedraldp�oafofsamr bthe0�YES t yjathatedtedy� _ L.J 1e6est 0 1NtE .. BOOM on"t blit- - �.`� � �►" .- � , r r k CIts 1 � 3 ✓yt 12 t I No ->o VSOR )2-(, 04 229.4 .4 y � Td Iva &-0'3--?2-C,- �- I ll�Si)RANt WAIVER;larnau►�atethattheLoensedoey @)e' AILTdNa ecn sp=TII teppfiC3bMwai%4Nthisr8gL- x G* asmwWbyMmdasftGarnalLaws reek one) Owner � Agent ©y Telephone No. PERMIT FEE$ Z/D 1 3773 Date........... ... t' NORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING ArwU This certifies that ...... ....................................................................................... has permission to perform ..... .. tv........., .............1..................... wiring in the building of............M.L. .............................................. _3 -3 -r"64 NorthAndover,M -at............./..✓.............................................................. .......t.7 J Fee.../. . j:......... Lic.No. ELECTRICAL INSPECTOR Check # . q Official Use Only— Permit No. 37Z�3 ;i �f�ed'Yl2?�ZCf72Zf/$�f.C'?�f d��?2�S.S�C•'�SS?'I.S -004v." °a( ski Occupancy&Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 112:00 (Please Print in ink or type all information) Date L5 (? ^-U2 To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the a rical work described below. Location(Street&Number Owner or Tenant Owner's Address_ >r Is this permit in conjunction with a building permit Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceAmps Volts Overhead ❑ Undgrnd ❑ No.of Meters I New Service Amps Voits Overhead ❑ Undgmd ❑ No.of Meters Nu;ber of Feeders and Ampacity Location and Nature of Proposed Electrical Work Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above ❑ In ❑ No.of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di sal No. Pumps Tons KW No.of Sounding Devices No./of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage t.No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Complet Operations Coverage or its substantial equivalent YES= NO = hawed valid proof of same to the Office .—-�, _ if ave checked YES please indicat a of coverage by checking the appropriate box INSU"mi = BOND = OTHER (Please Specify) ���Ch :W Q 5i L _C '7T— (Expiration Date) Estimated Value of Electrical Work$ � ��– Workto Start J` G to? Inspection Date Resquested Rough Final signed under-the Penalties of perjury: FIRM NAME��j LIC.NO. Liensee�//r�>�f 1e���/P Signature �V� LIC.NO. � © ? Bus.Tel No. P<0'3"99` c� a& Address lti CP l–Q&� Alt Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have he insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my,signature on this permit application waives this requirement. Owner Agent (Please Check one) 'C Telephone No. PERMIT',EE $ S ^ (Signature of Owner or Agent) Date.. ... . . .. . . .. . .... . . . . 40RTH 0TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �+CHUS This cerSfies that . . . . . . . . . . . . . . . . . . . ... . ... . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Andover, Mass. Fee..... . . . . . . Lic. No.,. '. .. . . . . . . . . -'z.. . . . . . . . . . . . GASIN�PE&OR Check# .'-"f,.`3' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (flint or Type) cA4Q�LAW , Mass. Date : 2c02- Permit # Building Loca'on C� /3 c qU dl�(/!r Z/ Owner's Name IRA )1// df�Le'Z2:� Ak Type of Occupancy. FSI 7t N>> r L New ❑ Renovation ❑ Replacement @� Pians Submitted: Yes❑ No p Y W `may Z f', y N V y ¢ y rt O y S F5- W J y W H a a1 M' = fl 2 0 W ` W r 0 0 ,0 �. y O W < _ = 1- w > W W y 4 ft O W W f1 J — < = y y a s W t• W V Sit Y W < Zr. ~ t' } 0 m Z 0 2 W 0 f~A S W > It W < < O O W O W f- oC = O d W a .d v r= > O SUB-8SMT. BASEMENT 7 ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company NameAE(Z T A . `#AM Al Twp X20 Check one: Certificate Address 3L L'DA c H/h A ry Corporation M E T N U E rJ 01 A U Partnership Business Telephone "1 1 2--'Firm/Co. Name of Licensed Plumber or Gas Fitter :2 r)jjE i`T A. S A M M rq i rq jeLD INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.. Yes lid" No ❑ If you t*ve checked yes, please indicate the type coverage by checking the appropriate box A liabilityjnsurance policy 0 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: Owner[] Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the pem** —irAued for this application ' be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of=nur ws. By T of License: C� Plumber Licensedu or Fitter Title tter er License Number 8333 City/Town Journeyman APPROVED O I BELOW FOR OFFICE USE ONLY FINAL. INSPECTION SKETCHES . PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING I NAME A TYPE OF BUILDING ' LOCATION OF BUILDING PLUMBER OR GASFITTER LIC. NO. PERMIT GRANTED DATE 19 OAS INSPECTOR Locations3 No. �� c� Date 3- /o NORTH TOWN OF NORTH ANDOVER o?O•`t`•D I•,hO R O 41 F 9 ' Certificate of Occupancy $ .itis Et�'4 Building/Frame Permit Fee $ y sACHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # y� 16213 Building Inspector i TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. 0 DATE ISSUED: /� Q 3 SIGNATURE: .� Building Commissioner/1for of Buildings Date Z SECTION 1-SITE INFORMATION . I 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: wig ,313 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private ❑ Zone Outside Flood Zone 0 Municipal 0, On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 2.1 Owner of Record 121 Q+ o /-N 313 S vMMTW- 'n Wt Name(Print) Address for Service: X84- aaea Signature Telephone (Q W 2.2 Owner of Record: Name Print Address for Service: O Z rn Signature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: L O License Number GG wILOWIN O AVOO VCe- 10W. 0i3io '91 Address �. De/ y 97b- `�7o-/ 9 S'3 Exp3t;o K Signature Telephone r 3.2 Registered Home Improvement Contractor Not Applicable ❑ v SROQ.-4 4A.WLLr11?— GL tiLr2QL cc&.,'roeAt"4 Company Name /o y 99 m Registration Number r (I C ti►/«eUl�aro kO A&APPy4roL /yl/q t' Address �`/c y 478— f76►/?,n Expiration Date /1 Signature Telephone G) SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) Q-' Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: ftMoO 6`+L amt QST� iW/ ; ,irl rl ray c�x�.3TrivG �XTuLc� Gamic w�', 601—n .T'Up.3 f AAM: t., 1r7X7 UrC d—J Ly/NQ Oc�J . SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Oa O Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X (b) 3 O 4 Mechanical QIVAQ 5 Fire Protection 6 Toto 1+2+3+4+5 O O O Check Number I SECTION 7a OWNER AUTHORIZAT ON TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as OlAmer/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building penmit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief NZI R/y Print Name 3A O L 3 s i ature of Owner/Agent Date NO. OF STORIES SIZE r BASEMENT OR SLAB SIZE OF FLOOR 112VIBERS 1ST 2 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DiM1-NSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUIL DING CONNECTED TO NATURAL GAS LINE North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL. c11, S .150A. The debris will be disposed of in: c4At,T-141-J-fIra- (Location of Facility) Signature of Permit Applicant %� a Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector _ a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ,w Boston, Mass. 02111 1b Workers'Compensation Insurance Affidavit Name Please Print I j Name: Location: City Me 'A.000y a:WL Phone # 4 79-16t7- &M I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name. L,rc,WLNY4 Address /0\Noa V'C2 IVs! 0)8J 4 City &N#ZO V C;4.- Phone#7 978- 76 — 9 d3 Insurance.Co. .�L40Q I G C14.4/tT LO- 1.14C. Policv# wev 1003 o 19 0 0 Company name: Address City: Phone#• Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.0 and/or one years'imprisonment_as we[Las_civil.penattiesin2helnrm-d-aST_OP WORK ORDFR,and_a.fine._of_($]DO.DD)-aidayagainst_me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i l do hereby certify under the pains and penalties of perjury that the information provided above is bye and correct. Signature Date V1o 0 Print name Phone.# 17b- Y'74-/?43 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing. Building Dept E]Check if Immediate response is required 0 licensing Board p Selectman's Office Contact person: Phone#: E] Health Department Ei Other . • I • i ,+ �ie �pomr9nonu�ral!/ o�✓l�aasac/.�aella ` l1 ' BOARD OF BUILDING REGULATIONS { License: CONSTRUCTION SUPERVISOR Number:.CS 000261 Birthdate-4312311962 Expires` 03/23/2004 Tr.no: 19480 Restricted: 00 BRIAN A LAWLER ' 66 WILDWOOD RD ANDOVER, MA 01810 Administrator + .rim- �.-_._.�.....-...-�•.��. .-...•.�•�.......��•-+�.+�-- y.� I I p /re yr i»szmzontuea� o�✓�aasac�tT�ael1' Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR t Registration 104991 Expiration: 7/16/2004 `Type: DBA BRIAN LAWLER GENERAL CONT 9Aan""LaWer 66 Wildwood Rd. Andover,MAO Il Administrator .,Q N • � KKc a n r It o ; � T � � C� to ;ra r NvRiM Town ofover Y No. ti o S * °` _ ... h co A_��A COCHIC dover, Mass., 3 /ad 7� ORATED P,Pp�,�C7 S H E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....70.�.�,.4 a r� � #r r ......................... ..... ........................................................................................ "" Foundation has permission to erect.. ... ................................ buildings on ...... ......................................................... Rough to be occupied as � ..r.5 . A ...........1. . ......... . . a.�. t ................................... Chimney provided that theperson 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. �, ' t �, ,� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU ON STAR S ELECTRICAL INSPECTOR ( Rough ........................ft..................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Rough Place on the Premises — Do Not Remove Fina, No Lathing. or Dry.. Mall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. ' _. .. _ �..r-r _.r•.%. .. -f{' wlA.,� ...H.IlI�"�y...r i.J�. 1' f.. ......-. ,i�. �. Date..... . 3? 0.,e`"-g�"�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING SSACMU This certifies that .....1`..�.C ' ...�~ ....................... . !!.................... has permission to perform .......P).�4.14.....t w! ........ .f'.l v` ........... wiring in the building of....O.�.C,k7........ .4. .l. ................................. at`.......31.3... 6.r..:W..?0!.rz5,T.............. ,North Andove ass. F e. !� .... Lic.NoM...l ....... . ..1.............................. 71 f f ELECTRICAL INSPECTOR Check # 700 { 4416 I 7BEC0W0NWE4LTH0FMgSS'A011, JIS— � office Use only DEPARTMMOFPUBLICS41M Permit No. BOARD 0FFMPREVM0NREGUL4T101 N527CMR120 PAPPUCATIONFOR Occupancy&Fees Checked PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3`2 e, 0 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) Owner or Tenant �; ►rYt (C�'�- Owner's Address Is this permit in conjunction with a building permit: Yes© No (Check Appropriate Box) 4 Purpose of Building 5 Pr+k Pe t.'e>V P't I CS"'*- Utility Authorization No. Existing Service Z00 Ampsi W Volts Overhead 0 Underground No.of Meters / New Service Amps / Volts Overhead r-1 Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work- ;;?t->0 Pit r P71+i; 4- N14, o.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures L Swimming Pool Above Below Generators KVA ground ground No.of ReceptacRe Outlets No.of Oil Burners No.of Emergency Lighting Battery Units It No.of Switch Outlets 27 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 Pu s 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' It mnCeCaurdgm%suantbthete panaJsafMas whsftGunWLam [ha%eamnatLiabi*h>sur =PciitygdxE gC,aroftCoAaaWcritsWmtFrialequivalslt YES ® NO F Iha,,esu ntedNehdptodafsmmio heOffm YES F)wlmedvdtedYES,pl=nlic lzthetAxcf=eaWbydrdtatgthe PsISURANICE BOND Q OUIER Q ftwespecify) 3 lavahtecfF7edtica(Wak WakbSM ? hgvdrnDt*ReWe*d Rough 3"2("` 3 Final S' tmder�ieP�tlties -. FIRM NAME i L El tl~c_'Yr it- Sc r v 1"L-C- Signal= e liar>seNa i 2 3 Etit i'2 L'toa Q ` l BusutesTel.Na F�3-q7..0 �- 3&31 r rnt' arm 1 1Zlc L`la�»t `�a�., Fj (IS C�V4 C,31 q4 A1tTeLNa 6,63- tl E` S&I 4 Cel I ---�.. OWNER'S INKRANCEWAIVER, amawaethattheLice4�edoes�n t Gm al Laws andtvtrnysgudtaemduspwnimwai.cs#istacltmen att. (Please check one) Owner Agent Telephone No. PERMIT FEE c s v • �-rte . mThe Commonwealth of Massachusetts .U.:. , d Department of Industrial Accidents aW Office of Investigations Boston, Mass. 02911 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for rry employees working on this job. Company name: Address Cifir.•_ .. . Phone# • Insurance.Co: PolicV# Company name: Address City Phone#• Insurance Co. Policy#' Failure to secure coverage as required.under Section 25A of MGL 152 can lead to the Rion of criminal penalties of•a fine up to$I 5W.00 and/or one years'imprisorment-as_YedLas_cbA oenaltiesm-ffielarmW a 7DPYAORK O.. a1d afine-cf_($1jW m)-aliw against- ;i I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. N !do hereby certify under the pains and penalties of periury that the information provided above is true and correct. Signature Print name Pbone.#. Official use only do not write in this area to be completed by city or town officiar City or Town PermitlLicerisirg D Building Dept [']Check if immediate response is required I] Licensing Board r p Selectman's ice Contact person: Phone# Health Department I] Other Date�....& n o ��o TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING s o •'a �,SSACMUS� This certifies that z �. . . . . .` ? - ' . . . . . . . . 'has permission to perform . . . . . . . . . . . . . . . }plumbing in the buildings of'. . :. . . . . . . . . . . . . . . . . . . . . a at. , North Andover, Mass. Fee. `j'. . . . .Lic. No.f''f . . fti� ' -.r �, 1,r. . . . . . . . . . . . . . . . MMIfuG INSPECTOR Check # i E' �13' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUk i (Type or print) A NORTH ANDOVER,MASSACHUSETTS 11 • Date `d Building Location 3�� -5umNeiz OwnersName 1 aR, Permit# S s" Amount y� Type of Occupancy New ® Renovation Replacement Plans Submitted Yes ® No El-' FIXTURES Ln rc a H U H x W H a � Ha w SWIBM >�Sav>avr ISL HjaR 2M HJ0M 3M FLOCl2 4IH RfM M FLOOR 6M FIOCR 7IH RfM SIH Rfm (Printor type) Check one: Certificate Installing Company Name :[NMNN Nvy' lc.� ® Corp. Address °� BRP�I fz') I& Nam " '-MA. a1869 El Partner. z Business Telephone 61-78 Bp'7 a)00 Firm/Co. Name of Licensed Plumber: 6hAWA.3 N1 J Insurance Coverage: Indicate±qo1ype of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 1 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 Massach efts State Plbing Code and Chapter 142 of the General Laws. By: Signalure or i7censeaum Der Type of Plumbing License Title 10% City/Town icense Numoer Master Journeyman APPROVED(OFFICE USE ONLY I Date..!�-..,3-2-3.......... + TOWN OF NORTH ANDOVER PERMIT FOR WIRING SAcmU This certifies that ..... ............ ....� .................................... haspermission to perform-,!!: ............................................ wiring in the building of.......-. i.-. ............................................ at...... 61........ . ................... ............ North Andover,Mass. Fee 5257Z... .... Lic.No............. ELECTRICALINSPECTOR—'*****— Check # /0u/2- 4430 . THEC0MM0NWF9L7H0FM4MCIYLNLM Office Use only DEPARTMENTOFPUBLICS4FM Permit No. BOARDOFFMPRE[EWONRWUL4T OAN527CMR12.0 IP Occupancy&Fees Checked .. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 r !' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date �7 7-©. 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) Su Owner or Tenant 'Vete io I'6,4 Owner's Address --30" e- Is a e- Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / olts Overhead Underground No.of Meters 1 New Service )100 Amps f�Volts Overheadt�Underground EJ No.of Meters Z Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /� ` a �-_ No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures / Swimming Pool AboveBelow Generators KVA / ground ound 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 i Tons No.of Disposals No.of Heat Total Total No.of Detection and pumps Tons KW Wtiating Devices No.of C{ihwashers Space Area Heating KW No.of Sounding Devices j No.of Self Contained 1 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 Ir>StrdnceCa#rjgrt R�ss�r�btftetegtatana�ofh hsel�Ga�'alLaws Ihmea=utL bkyhrtr&=Pdx,,yni&gC a CoAWcrtsskshtialeWhdlat YES NO Ilime submilk-4 dptt of btheOHioa YES M NO IfjwhawdtadWYES,plemisrcethetAieafoom�d@eby zg�te INSURANCE BOND� t7II-R ftmeSpe* 7 t C JVa IAUA10 / 0 6 4 Esr¢n*dV"off1Cft al Wolk$ WaktDStalt Q htspeWmD*RegtrtsWd Rao ' ,j- d Final Sigredurtria�iePkofpajtay G ! q� 2FIRMNAME WNkX 0-42 �, = ff2Sigrwe eo leloi4 � �,[,� BtsirlessTd.Na�� 1✓y�// V�Q AILTdNa OWNER'SPsBURANCEWAIVER;I.amawatethattheLjmw them%xm o7maWants&*sMrtWequi4 ttasmgLmedbyN4mmdudisCeia liavA andiiatmysigiaMmcn spamgappkEdaiwai%,esft aerial (Please check one) Owner AgentED Telephone No. PER MIT FEE� O` M The Commonwealth of Massachusetts Department of Industrial Accidents 9 v, Office of Investigations Boston, Mass. 02911 2 Workers'Compensation Insurance Affidavit Name / Please Print Name: IN e ct Vtrl - Location: Ci6A2 Phone # 7�J / /_7 I am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Address City Phone# Insurance.Co. Poligy# Company name: Address City: Phone#- insurance Co. Policv Failure to secure coverage as required.under Section 25A or MGL 152 can lead to the-imposition of Criminal penalties of,a fine up to$11500.00 and/or one years'imprisorxnent-as_welLas_ciW penaltiesin-theinim- f aMW VADRKARDER,-md a fine-d_($'iW-�M-aidw againstmp- I understand that a copy of this statement may be forwarded to the office of Investigations of the DIA for coverage verification. h /do hereby certiiry under the pains and penalties of perjury t at the information provided above is bye and correct. Signature pate Print name Pbone.# Official use only do not write in this area to be completed by city or town dficiar i City or Town Perrrrit/Licerisirg 0 Building Dept OCheck d immediate response is required L.1Ce),Wng Board p Selectrnan's Office Contact person: Phone#: Health Department E] Other