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HomeMy WebLinkAboutMiscellaneous - 337 PLEASANT STREET 4/30/2018I 11356 Date .......... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING at .......... SP�s ...... This- Certifies that .................................. ................................................. has permission to perform ... --+-'-0 ............................................................................................... 'Id' plumbing in the biji ings of ..... t .................................. ............................... at ... I ......... eAec North Andover, Mass. Fee.Ljj. " ... Lic. No.4. ................................................................................. PLUMBING INSPECTOR Check # �- ��/ �M i5 h 8 (l'S WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING 5THERF INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES I NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Yq OTHER TYPE OF INDEMNITY D BOND 0 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 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will bei jpliance wit ®SII7,A01111- PLUMBER'S t provision of the 1Massachusetts State Plumbing Code and Chapter 142 of the General Laws. sl NAME�gw�es i LICENSE # MPA JP Q CORPORATION ®#®PARTNERSHIP 0# LLC COMPANY NAME C nc ,i h— -� H ADDRESS CITY .�U�Sh_ __..._.._....J STATE V-11 ZIP g © 2 — _ TEL FAX CELL 11 EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 ulqv POWNER TYPE OR PRINT CLEARLY CITY c, ower MA DATE /�_/ ( PERMIT# JOBSITE ADDRESS Pie -0,5k OWNER'S NAME 2 e r'►�✓�✓�? ADDRESS TEL FAX L---. _._.tl OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL �] NEW: 0 RENOVATION: REPLACEMENT: 0 PLANS SUBMITTED: YES ® NOQ FIXTURES -1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _. I ! DEDICATED GRAY WATER SYSTEM r.___._ DEDICATED WATER RECYCLE SYSTEM I 41—D DISHWASHER ._.–.__!.i€ -.-j DRINKING FOUNTAIN_!I .__._...._fi FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK i I !. ---_ _f 1 LAVATORY _ (. _ f i ___1 ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILE" URINAI ! WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING 5THERF INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES I NO Q IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Yq OTHER TYPE OF INDEMNITY D BOND 0 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 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will bei jpliance wit ®SII7,A01111- PLUMBER'S t provision of the 1Massachusetts State Plumbing Code and Chapter 142 of the General Laws. sl NAME�gw�es i LICENSE # MPA JP Q CORPORATION ®#®PARTNERSHIP 0# LLC COMPANY NAME C nc ,i h— -� H ADDRESS CITY .�U�Sh_ __..._.._....J STATE V-11 ZIP g © 2 — _ TEL FAX CELL 11 EMAIL orl z w LU The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dna Compensationlnsurance Affidavit: Builders/Contractors/L+lectricians/1'lumbers. TO BE FILED W11TH THE PERMITTING AUTHORITY. Name (Business/Oigariization/Individual): Address: tp// City/State/Zip: Are you an employer? the appropriate box: vlr.e9 (L Co n`�V\ 11- 36 6 -?, Phone #: 1.E] I am a employer with .. employees (frill and/or part-time).* art time).* 2.rcin I am a sole proprietor or partnership and have no employees Working for me in any capacity. (No wotkeis' comp. insurance required.] 3,❑ I`am a homeowner doing all work myself (No workers' comp. insurance required.] t 4.F]I am a homeowner and will be hiring contractors to conduct all work on my properly. 1 will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no, employees. r 5.❑I am a general contractIo : and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance? 6. ❑ We are a corporation. and lis, officers.have exercised their right of exemption per MGL c. 152 81(4) and We have no employdes. [No workers' comp. insurance required.] 71— ", ,2 S, Type of project (xequired), ' 7. [1 NeVd6nstr66ti0n 8. [] Remodeling 9. ❑ Demolition 10 [] Building addition 11.0 Electrical repairs or additions 0"pjUmbing repairs or additions 131] Roof repairs 14.[] Other *Any applicant that check's box #1 must also fill out the section below showing their workers' compensaflon policy information: Homeowners who su— - ' .his 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 state whether of not (hose entities have employees. If the sub -contractors have employees, they must provide their workerscomp. policy number. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company S if ins Lic Expiration Date:. Policy it or e - ..• • I' Job Site Address: 3 3% Yltk-S�1it� ell City/State/Zip: N, ii''`4o 4 / 0 1`�`{ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby erti � under tliepaiinss and ofperjury that the information provided above is true ana correct. Offzcial use only. Do not write in this area, to be completed by city or town official 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 Phone #: Contact Person: Information and Instrnctions 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 o£hi�re, 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 ofthe foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receivet'ok 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 commonvc,ealtlf 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 certificates) 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 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 industrialAccidents. 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 thai 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 s (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia N Date................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,L: - This certifies that ......... ...... (. .............................................. has permission to pi--- ...... ........................................... wiring in the building of.... 9 ...... ....... wp.AA ................... at ...... 3-3-7 irth ........................................................................ ... . . ....... N , Andover, Mass. Fee -a . .......... Lic. No .................. ...... ............. ELECTRICAL INSPECTOR Check# i — 3 ,i �'uU(kn Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Occupancy and Fee Checked [Rev. 1/071 (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 TY E ALL INFORMATION) Date:D `S City or Town of: NORTH ANDOVER To the Inspect r 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<3 `-j R,o�rasetin l St Owner or Tenant P -e -e-1 -%oyy I H 0 nkp� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate ]Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cir -�r:-Ar, 4C-1 Mc -L' AuJe-<_ Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ .m No. of Meters No. of Meters hum C ► c-C4AiTs Comnletion ofthe following 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 0- Swimming Pool Above ❑ In- ❑ rnd. rnd. W-0—.0meig ting Batter Units its No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number Tons J.K.W No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir SecN . o De ices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors Total HP WirinNo. Telecommunications No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of El ctrical Work: �j> (When required by municipal policy.) Work to Start: 111115 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE VERAGE: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains and pen Itdes ofperlury, that the information on this application is true and complete. FIRM NAME: J t -Cr" LIC. NO.: Licensee: aA)e.r`L1-1 Signature LIC. NO.: 12111 R— (If applicable, rater "exempt" in the li ease number it n .) Bus. Tel. No.- � Y ?1-) 1 Address: .d 6 G,Z� �' . . D b Alt. Tel. No.: 43 SV- as *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an / electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass R Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Sign re: Date: ROUGH INS CTION: Pass M V Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: - Date: FINAL INSPE ION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: cc --- Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com n 0 The Commonwealth of Massachusetts { Department of IfidustrialAceidents 1 Congress Street, Suite 100 Boston, MA. 02114-2017 +www.mass.gov/dia +v SJ'y. Workers' Compensation Insurance Affidavit: Builders/Contxactors/Electricians/i'lum ers. TO BE FILED WITH THE PERMITTING AUTHORTTY. Name (Business/Oigariization/Individual): A Arlraec• I I (A) Ckavm J1, 63oa4 Phone #: 603 Are you an employer? Check the appropriate box: l.Q I am a employer with employees (frill and/or part time). 2. I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. I am a homeowner doing all work myself [No workers' comp. insurance required.] t <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑I am a general contactor and l have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workerscomp. insurance.T 6.F1 We are a corporation and its. officers have exercised their right of exemption per MGL c. 152 1(4) and We have no employees. [No workers' comp. insurance required.] 7qa"�)- Type of project (required): 7. ❑ New'constxuotion 8. Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions jZQ Ptumbing repairs or additions 13: Ro6f repairs 14. [] Other — on that check's box #1 must also fill out the section below showing their workers' compensation policy information. Y applicant i *Any ap lican who sub affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not (hose entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name:, Policy # or Self -ins. Lic. Expiration Date: City/State/Zip: Job Site Address: ompensation policy declaration page (showing the policy number and expiration date). Attach a copy of the -workers' c Failure to secure coverage as required under as vildpenalties2i, §25A is form of criminal STOP WORK ORDER punishable nd a fiby a ne of up to $250.00 a and/or one-year' imprisonment, day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. I do hereby cer ,rjnde pains andpenalties ofperjury that the information provided above s true and correct. Official use only. Do not write in this area, to be completed by city or town official. 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 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, or the receivefor 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 req'W"red." 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=contractors) name(s), address(es) and phone numbers) along with their certificates) 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 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. 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 "fob Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia CFANS Ett ISSUES THE FOLLOWING AS. 'A 1E0 JOURNEYMAN .;EL TEVE;N R ROY 11 WEST CHAMBERLA;I;N_RD>.; I MAC 1711 :>;:;N;O: 03054-40 0 D TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that...:.. ............................. has permission to perform plumbing in the buildings of ............. ................. at ..... �.�...`:. %......... ,North Andover, Mass. Fee! ...... Lic. No. 9 p C� PLUM /;e4NSPECTOR Check # `30 a/ 7728 03 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location 7 )wners Name of New M' Renovation M Replacement ' FIXTURES :•`D 9 I 00' 1 00• 1 00:• 1 00:• t 00• '� r Date --os-/o l O� r2�1�0�✓l Permit# ag Amount �— Plans Submitted YesNo (Print orCompany e) p y I I� \ Check one: Certificate InstallingCom an Name_ I/ I) M Corp. Address ' O v ❑ Partner. usmess elephone FimVCo. Name of Licensed Plumber. 12.w2to��-1 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy jug- Other type of indemnity ❑ Bond ❑ Insurance Waiv - I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three is t� ature 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 instal erformed un er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu apter 142 of the General Laws. By: �g o icense um er /Type of Plumbing License Title j City/Town icense um er Master Journeyman ElAPPROVED (OFFICE USE ONLY IL Date .. `?:.".. �. P'. 0�'....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......................5 W G � 1&� l has permission to perform ... zm?!U<Cf ............................................................. wiring in the building of A���' /L�sBi ........................................... 3 LF%S'T -Sr .............. North Andover, Mass. ►t ......�......... ............... Fee ................ Lic. No. ✓, �p CTRICAL INSPECTOR E E Check # qb a 60$_ i. Commonwealth of Massachusetts Official Use Only Pcmtit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MFC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFD �TION) Date: L/ -/D - D 6 1 � /Jpr/j jL To the Inspector of Wires: City or Town of: 41011 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 337 R1,x_AH sA1-t T ST Owner or Tenant Aewl/ % ?1z1 6,0V 1,1 Telephone No. gjt-l�„3- Owner's Address tsoml? - Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. 4; 2 73c Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters A New Service t?00 Amps /Zo /af/y Volts Overhead ® Undgrd ❑ No. of Meters d' Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ('mm�latinn of the following table may be waived by the Inspector of Wires. Cb No. of Recessed Fixtures - - No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above In -o. Swimming Pool rnd. ❑ rnd. ❑ o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection andInitiating No. of Switches No. of Gas Burners Devices No. of Ranges No. of Air Cond. Tonsl No. of Alerting Devices Heat Pump Tons KW No. of Self -Contained No. of Waste Dis posers P Totals: I.Number Detection/Alerting Devices No. of Dishwashers S ace/Area Heatin KW P g Local ElMunicipal Other Connection No. of Dryers ry -. Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Suits Ballasts I No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail J desired, or as required by the inspector mires. 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 ❑ BOND ❑ OTHER ❑ (Specify:)p/a,�36xloli w (Expiration Date) Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: '41 -IV -06 Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the�pat sand penalties of perjury, that the information on this application is true and complete. FIRM NAME: / OUL cS�T/aQ �l�IfTYN� �FL,�cT -7-1ye LIC. NO.: 1 JF11' e4 Licensee: GIStiO6>f St /UtZ it:W Signatur Q LIC. NO.: 1,5' !cr/G'l' (Ifapplicable. enter "exempt " in the license number line.) Bus.Tel.No.;���'�S Address: �P•O• /.3o y fr Tlz cc+st'S/3U2V e",4 o/ lr?l Alt. Tel. 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 PERMIT FEE: $ S'S • `yO Signature Telephone No. ! ,I 2 n Location �7 3 r (p ,4 S No. Date 9- % —U S TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ iO a Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 180 Check #8-)S8 18537 _ -tfA`L' Building Inspector It 1.1 Property Addr -- Ss- 1.2 Assessors Map and Parcel q5 . o Map Number Number: 0070 Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area Fronts ft 1.6 BUILDING SETBACKS M Front Yard Side Yard Rear Yard Required Provide Required Provided ReqWred Provided 1.7 Water Supply M.G.L.C.40. 34) Public ❑ Private ❑ 1.3. Flood Zone Information: 1.8 Zoee Outside Flood Zona ❑ Municipal Sewerage Disposal System: ❑ Ou Site Disposal System ❑ SECTION 2 - 2.1 70wnof Record Z- 4A.1 - Name (Print) Address for Service Signature Telephone i 2.2 Owner of Record: Name Print Address for Service: /.Gz. Q-79-5 &9 - 5?,0 L JEl. all/1� ✓- �. v1�V alw l.aavl• ..a 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: Address Signature 3.2 Registered Home Improve m )mvaily Name Contractor Telephone License Number Expiration Date Not Applicable 0 I Z61WQ3 Registration Number nauresa �� Expiration Date SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 Workers Compensation Insurance affidavit must be completed and subs t 5 this application. Failure to provide this affidavit will result bignea amaavn nuacneo r ea ...... A,, No ....... U SECTION 5 nescrl Non of PrOPOSed Workcheck.e a bk New Construction ❑ Existing Building ❑ RepWs) ❑ Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 1 3RCTim 6 - F.CTIMATF 1 VnNRTD1TrT1rnN rneTc 1 Item Estimated Cost (Dollar) to be Completed by permit applicant OFFICIAL USE ONLY .. I . Building / (a) Building Permit Fee Multiplier / 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) x (b) �j 1 0 U 4 Mechanical (HVAC)/ 5 Fire Protection 6 Total 1+2+3+4+5 Check Number uX1%,aav11 to v"iIfill2%V lIlvM"'M11V1'q 1V D14 %-VJPLCLL'1J&" W"Afm 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, ��h t��.l C N t4 & L� as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name /134 Signature of Owner/Agent NO. OF STORIES SIZE OF FLOOR TINIBF.RS 1 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION SIZE OF FOOTING MATERIAL OF CHRANEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS I SIZE 3 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,S150A. The debris will be disposed of in: F ST'S% (Location of Facility) Signature of Permit Applicant �= —7— Date Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector AT-HOME SM Installed Siding and Windows '5 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registr4tion), 126893 Expiration0,312006 Typo Supplement Card THE Home Dep94i-Home ur'vi61 STUNROEUN 3200 COBB GALLERIAt.P��.Y#20 ALTANTA, GA 30339 Administrator Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 345 Greenwood St. Unit 2 - Worcester. MA 01607. 508-756-6686 - Fax 508-756-2859 - Toll Free 800-657-5182 -*FROM : KIMBLY FAX NO. : 6033629679 Aug. 30 2005 09:10AM P7 t Llldfv V IMPROVEMENT CONTRAL'T Sold. Fumished and Installed by: Branch Name:/ ,V-..— Date: _ THD At -Homo Services. Inc. d/hla The Home Depot At -Home Service*: % 345A Greenwood Street, WoroeMer, MA 01607 Brandt Number �_ Jab k: r x103 Toll Free (800) 657-5182; Fax: 508-756-2859 — F.,WW I00 73-2694160 ME Lie M C 02139 R! Cont. I.ie11 16421 CT Lich 565522; MA Homo lmpmvetaeat Czn rm161 R* At176893 Installation Addrem: 33-7 a/ City State Zip Home Address: (If different from Installation Address) City State zip Prailm Ini'armatiau: IlweJYon ("Purchaser"), the owncts of the property located at the above inatailatian address, Off to contract with Home Depot U.S.A.. Inc, ("Home Depot'i to famish, deliver and arrange for qtc i119taliation of all tttatenals as described on the attached Spec Sheet q; incorporated h4ltaa by.ieference and made a pan hereof. Home Depot reserves the tight to cancel this contract if, upon reAngw0os of 00 job. Herne Depot determines that it cannot perform its obligations due to a structural problem with the home or because work required to compktte the job was not ineluded in the contract. .. . AMOUNT s 9 CONTRACT *LESS DEPOSIT 11 BALANCE DUE ON COMPLETION $ Minimum 16% of Contract Amount due upon execution fthtscontr L Indicate Payment Method For >aALANCE DUE ON COMPLETION! �Tv UVOBEIT PAYMENT OPTIONS, (Subiecr to fund veriliodio% aallor credit appwel.) 1. Chock, COW= Check or us Postal Sm its Moony Oedgr (Made auy.M. to The Home Depot) 2. C." Cud• .odor Act primeot cptiow - Cirele One halal.. Vico MapssCatd Diccovar Aumicaal'xpwa The Home Depot Emma Impuyv4mat Loan Qhe Home Oester emelt rant pv4it.l Ctelt(t S l( ( HIL & FMCC ONLYI AcdlF. w- Fxp, Deter- Name,: it appom ae CWA6 n Frc'.D►tn .By aty1our sip to— below, I/we agree to .now Hamm Depot to charge the above n;fe nemd cnsdit anal firthe depoo indiratad. clef s Sipstuto Dare HII, or ADCC Authoriaation,470&116 Vega -at ku!!! Pa went # 4x7 %_3 CQ 16 Purchaser agrees that, immedi dely upon satisf cry completion of the wont, Purchaser will exec and y any balance due. Purchaser aly� be jo k scut rallyp6Eigat�d and liable her ut� r�n.;r � 1f�9� f..rf L fjj'�'C 4C CVntQeIA -+rem t: i<fit5 genment I achment i cEuding any .taring agreement, car between I e paroes and can not be amended modified unless in writing in a separate agreemn 65T riL1QI 05 NOTICE TO PURCEIASER pt„l T4 Do nut sign this contract hefare you read it. You ore entitled tos. completely tilled -in copy or the coat+ It to protect your rights, Do not sign any� Completion Ccrtifkate or agreement stating that you aro s I. this project is complete- Law pro home repair contractors from rueatinl( or accepting a by the owner prior to the actual completion of the work to be paformed under the contract. a Completion Cenificate der. a�ri % � the complete agreement ped by beth parties. ou sign- Keep I entire project Certificate sipc4 You oaay caac A Ihis tragsaotion of any timefetor to m(dnittht of the third business day atter the date of this contract_ lice Notice of Gtneailation for an explanation of this right There will 6e a scrvim charge equal so 25% of the contract amount if the job is cancelled by Purchaser AFFER the third basisers day. BY MY/OUR SIGNATURE BELOW. IIWE AGREE TO BE BOUND BY 'fHF TERMS OF THIS CONTRACT. IIWE ACKNOWLEDGL RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. By MY/Ouk SIGNATURE BELOW, UW$ UNDERSTAND THAT THE AGREEMENT IS SUBJIX.T TO REVIEW OF MYK]Uk CREDIT HISTORY AND VWE AUTHORIZE HOME DEPOT AUTHORIZED CON &ACTOR, TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN WDEPENDF„NT CREDIT REPORTINC`r AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERT T SI S R ERRORS. DO NOT SIGN TUIS CONTRACT IF THERE ARE ANY BLANK SPACES. SUBMITTED BY: OA 6, Date: -� Sde%COD AM ACCEPTED BY: Date: /z�l� _ Dare: omeowaa< NOTICE ADDITIONAL TOWN, OWDITIONS AND WARBANT19b ARE STATED ON THE AMRSE SIDE ANA ARE rAAT OF THIS CONTRACT WIAt - Am.ch Re Yellow - Cbnosw Pick - sols cotwho s "'FROM : KIMBLY FAX NO. : 6033629679 i —OAJ SIDING SPEC SHEET Branch Ofc: S 1 DESCRIPTION OF WORK Branch #: Home Phone #: ,r Customer Name: WorklCell Phone #: • 5 E-mail Address: Installation Address: P—W 9b""Pda°" Siding Drop Location: A J -_4L A„ /Y, ,,OR Dumpster 1_ocatiow rk• .._ ..... 1�C+,.'I{re'F%h AREAS i47M`rQlY .yg.c.:csrr.•.• ,-,., ._, ......-..-.._..... . to , be SIDED PRODUCT '• PROFILE CORNERS Front Premium Clapboard Dutchlap Standard EJ Left Distinction Back Beaded Designer 1F1;;1 Right Triple 3" Roughsawn ShakeslRounds Hand Split' ri'U Other ��� Other. Rounds Waite Only AREAS to be COVERED OLOR• Other Area Front Left Rack RI ht Soffit & Fascia Frieze Board 2 Soffit Only ' Fascia Only Tuck Fascia PVC Alum. Coil or Vert. Soffit 2 Cover Frieze Board with: Aug. 30 2005 09:07AM P1 AMJ,34U Spec Sheet #: /_ Job #: Siding Outside Comers INSULATION 31W D or 314"D New Gutters & DOVM Spouts Yes No 0 L__fT` Gutters & Down Spouts to be ed in existing locations, s noted below. � - t Q OLOt Awnings up to 8' _WrK ews r Doors s f `yL StaWindows Stone Doors Awnings Over 8' Garage I Pati --Beer Burglar Bars " Xisbng Shutters Double Garage Door • In certain markem, Burglar Oafs cam be removed, but not reirwalied. Build Out Frame Yes No= If Yes: Vinyl/WoodM Aluminum Only Hhere naW sling is to qe installed. Home Depot wilk NOT remove asbestos malarial. a.. ` r Y 1 N Double S' Soffit Color: �—�� Front Beaded 0L_J location: _,_' Left 5 While or Canyon Tan ONLY YIN COLOR" Back Right Wrap Porch Beams Wrap Parch Pasts Y I N "COLOR" Knee Braces IV Triangular Gable Vents Specify the locations: GA13LE VENTS Q L_�q Rectangle Octagon NEW SHUTTERS # of Pairs "COLOR' Louvered Raised Panel I haus reviewed and agree with the job specalcail If rotted wood is discovered AFTeR removing the existing siding, or if it could not be identified at the time of sale, there will be an additional charge of $4,00 per Sq. Ft. for Plywood and $5.o0 per Lin. Ft. for Dimensional Lumber. a'i iI . —1 Date: P11 a� *,aoa sFC.e.vs 9 C � CD O � O H C •: VO V CLIO O. to A C ico CD E a O m Z� tsH 0 is M all J� mm o CM m h C C r h m :•O O m CD a dCt �7 V N Z O 00 O C d Q O m c Q = m m=.. C IV H C OZ m w W 0 � :s C _,,, •�• two CL C = �... co LU � "IMM s C f- z Slm co O Z p_ O y C2 c I C c' c y CD OCID M �O CL.IN �. as G3o e_�v o a E CI)a ce OCL. C3 CD cc C c Z G3 C3 CL L.i VA c C C C cc C43 0 N W W cc W cc a a a � � a U Aco U w ii U aG UM C7 w A w co ° z cn o cn 9 C � CD O � O H C •: VO V CLIO O. to A C ico CD E a O m Z� tsH 0 is M all J� mm o CM m h C C r h m :•O O m CD a dCt �7 V N Z O 00 O C d Q O m c Q = m m=.. C IV H C OZ m w W 0 � :s C _,,, •�• two CL C = �... co LU � "IMM s C f- z Slm co O Z p_ O y C2 c I C c' c y CD OCID M �O CL.IN �. as G3o e_�v o a E CI)a ce OCL. C3 CD cc C c Z G3 C3 CL L.i VA c C C C cc C43 0 N W W cc W cc 1 cis J�� N° J 0 Date ................................ C TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ? ............................................................................................ has permission to perform ... ..... :............................................ wiring in the building of/,./..:..:z... ::�.......... �"............... at............. ................ .................................... ,North Andover, Mass. Fee:.?:�r. ..... Lic. No42y'/a................................................................ • a ELECTRICAL INSPECTOR 08/25/98 10:03 35.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer ` A`:i:e Pse th.Iy p - a The Commonwealth of Alassoch etts t•.•rrlt Vin, D Deportment of Public Sofcty Occupancy S Fee Checked 41 BOARD OF FIRE PREVENT10N REGULATIONS 527 CMR 1200 3/90 itea�e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Macsachusetu Electrical Code, S27 CMR 12:00 (PLEASE PRINT IN In OR TYPE ALL INFORMATION) Date 8- 7 ge City or Town of /VooeTH �iVDO✓E.e To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 337 -yVeEEr Outer or Tenant 1,9 /y/ $—reigT -,Q)V Owner's Address SAME C9�8� ems-�3o9 Is this permit in conjunction with a building permit: Yes ❑ No ❑X (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps_ / Volts Overhead ❑ Undgrd n tin. of Meters _ flew Service Amps / Volts Overhead ❑ Undgrd ❑ Oto. of Meter, Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Installation of Alarm System No. of Lighting Outlets No. of Hot Tubs ' No. o£ Transformers Total KVA No. of Lighting Fixtures $ g Above In- Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets P No. of Oil Burners , No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No, of Soundin Devices g No. of Self Contained Detection/Sounding Devices Local [:]Municipal Connection❑Other No. of Ranges Total No. of Air Cond. tons No. of Disposals No.oPumps f HeeaatTotal Total Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No. of Water Heaters KW No, of No. o Signs Ballasts w Volta a Alee QirinL, emAtZe No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work S /400400 Work to Start F_ /3— 98 Inspection Date Requested: Rough Expiration Date Final P -&--94P Signed under the penalties of perjury: FIRM NAME A.D.T. SECURITY -SYSTEMS NORTHEAST INC. LIC. No. 1231C Licensee DONALD A BROOKS Sign, a NO. 12 31 C Address 60 William Street, Wellesley, v7n r8ls. el. No. 413-739-44n0 Alt. Tel. No.(781) 431-5831 _ .+ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or is sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit _•Q application waives this requirement. Owner Agent (Please check one) 00 Telephone No. PERMIT FEE S 3S Signature of Owner or Agent Location "337 F. 3 �U Date 9 ,aORT1y TOWN OF NORTH ANDOVER , Certificate of Occupancy $ + : Building/Frame Permit Fee $S +e a Ss+CHU Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $� -WBuil spector -� 8079 Div. Public Works PE&JtT NO. t APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. -4�. PAGE 1 MAP KBO. LOT NO. 2 RECORD OF OWNERSHIP DATE (BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAM /7 ('� V NO. OF STORIES SIZE OWNER'S ADDRESS/y �A,� nl ��+'�'LX• BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME `( SPAN DIMENSIONS OF SILLS " POSTS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE i FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED �r%3/ /g q SY�ATUR�E ONER�ffFt AUT RIZED AGENT FEE W [0 PERMIT GRANTED 19 // 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST EST. BLDG. COST PER 64. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY t t BUILDING INSPECTOR OWNER TEL. # / �{ CONTR. TEL. # �/ �L 4 CONTR. LIC. Ji. 3 y 46 V H.I.C.# f� d - c7 J 7 /33S - `17� -- BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY I I Si ORIES MULTI_ FAMILY OFFICES APARTMENTS CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE PINE HARDW D d 1 2 13 CONCRETE BL K. BRICK OR STONE PIERS PLASTER DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B M T AREA 'L 1/1 1/. FIN. ATTIC AREA _ N_O B M T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS II 9 FLOORS CLAPBOARDS B _ 1 _-2-_f 3 I_ _ —{I_ DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING ASBESTOS SIDING VERT. SIDING HARDW D COMMON ASPH. TILE STUCCO ON MASONRY STUCCO ON FRAME _ BRICK ON MASONRY BRICK ON FRAME ATTIC STIRS. 8 FLOOR _ CONC. OR CINDER BILK. WIRING STONE ON MASONRY STONE ON FRAME SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE GAMBREL HIP MANSARD SHED BATH 13 FIX.) TOILET RM. (2 FIX.) WATER CLOSET — FLAT ASPHALT SHINGLES LAVATORY _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR _ TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. _ STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd ELECTRIC _ 1st 13rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. M rA i•+ x o A Cd o as g ua u° N 11) Cd C) z z Q v w° -C 7 a2' v c U C w C) v z z a P -4u -a W 0 � cz G x O w z u w a W x OD a�4 > y U) m G w p u w x 00 P44 ie G w w w A w v C cc z y `� cn O aG G cn O F=4 O z H F- W CL 0 W L z i' C4 0 V r v . J W LJ y H •co L, CL co O CD v CO2 0 C.2 .a CO) C O V d CO) raml L.: O v CD CL CO) CO CM C O D 'Q co W L Co D O O Q Q. ci Q 1-0 C c cc J -O OO Z CD CL CA C J Q z_ J LL Q z U - LU F— z_ � Z � z U-' w 0- v) 5 0 C c C3 C H o c C' o V •ate ; ac m cc :a3c ;L o r: R d N Ea c 0 `1 N : ES L o co V0 y... y. fL is CI C 2L C. = N CAE L r•+ N N C •O C N C V2 cc VE 2 m :st o rn CD °a aCO2s ;mom c m V y o b - ca .� Z o ' c o o CL rn c H y m C C _ m � p N C. LL. r.. C AR Cc N C.t C Z °C•LU E cs -0CO N O LD CD CL 0 CAC2 C42 C) = M.,m� 0 W L z i' C4 0 V r v . J W LJ y H •co L, CL co O CD v CO2 0 C.2 .a CO) C O V d CO) raml L.: O v CD CL CO) CO CM C O D 'Q co W L Co D O O Q Q. ci Q 1-0 C c cc J -O OO Z CD CL CA C J Q z_ J LL Q z U - LU F— z_ � Z � z U-' w 0- v) NORr,,, OFFICES OF: Town of � m APPEALS » NORTH ANDOVER BUILDING '�'°•::.;. a CONSERVATION @g"C.Us DIVISION OF HEALTH PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN H.P. NELSON, DIRECTOR 120 Main Street North Andover, Massachusetts 0 ► 845 In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number _ 3490 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 111, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant i J l Date NOTE: NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector.