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HomeMy WebLinkAboutMiscellaneous - 34 EDMANDS ROAD 4/30/2018909 Date.?.:, -kA . (. L TOWN OF NORTH ANDOVER , PERMIT FOR PLUMBING 4 This certifies that ..T...�/� F''.�. L. v.'� art.. 1���•w1,3E e........ . has permission to perform ...... plumbing in the buildings of at. . 3, u . I~ 0.Y1.).A. ... ov.). ?.... . , North }}A��nd��over, Mass. Fee .3.Q, C. �?.. Lic. No. �.�. 5a 3 ...... C;.,� „`�"a........ . PLUMBING INSPECtDfi-- Check # I U2 r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS _ 3 y L iJmg v.�s '� Owners Name &A1A,1* Z;Nyey/,G%/ Date Building Location Permit # �` c � Amok Type ofOa1 Jupancy LL a -6L 1) L; New Renovation Replacement ` Plans Submitted Yes No FIXTURES (Print or type) Check one: Certificate InstallingCompanyName HA- -&)MN 0 Corp. Address . a ` i3e x 6 j�, 11 Partner Business Telephone 75'j . , 0 Firm/Co. Name ofLicensed Plumber. 0—M /Wale/41W Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate boat Liability insurance policy ® Other type of indemnity 1:1 Bond Insurance Waiver. L the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance r� Owner ❑ Agent 0 I hereby certifythat 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 perfmmed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Plu nbii and Chapter 142 of the General Laws. WORM 01 Duumca riumoer Type ofPlumbing License Title .. Cm'/TO"m cense Numoer'Master Journeyman APPROVED lou osa oNLY 7791 Date.... ..a b :.f. !...... TOWN OF NORTH ANDOVER Vow r -I s PERMIT FOR GAS INSTALLATION This certifies that.. �... ��1. L i !�"'� "'� �Lt-vti A has permission for gas installation . r'A" ....... in the buildings of ...p .......... atu ...1:- P r') . r`1 !`11n. S 04,0'P . �.�N--o.�rth Andover, Mass. Fee. f> . Lic. No. GAS INSPECTOR Check # 10-2 t MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS d l Building Locations 1 4 iI R#Nils Permit # Owner's Name Amount $ New D Renovation 0 Replacement � Plans Submitted11 1 (Print or type) Name //,# �� Check one: Certificate Installing Company / j� '✓ �" ST Corp. Address �� � Partner. /?ilia usmess a ep one j7 p- =� �—G Firm/Co. Name of Licensed Plumber'or Gas Fitter %Q/ly A!k 11a4,14A--,- INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes.0 Noo If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity ❑ Bond 13 Owner's insurance Waiver: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 1 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 State Gas Code and Ch pter 142 of the General Laws. By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber f�? grLJ-3 Gas Fitter License lNumber 0 Master 12 Journeyman F C4 a O x F Z' I F F > Z F w O O O Z F Grn V w Q x t� � d rn � C x a C � � � > U Oj Z c x rs >o x F EW 3 p a o fs, o° Ew h W SU B-BASEM ENT 0 n' > C6 F O BASEMENT IST. FLOOR 2ND. FLOGR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR Ffl! (Print or type) Name //,# �� Check one: Certificate Installing Company / j� '✓ �" ST Corp. Address �� � Partner. /?ilia usmess a ep one j7 p- =� �—G Firm/Co. Name of Licensed Plumber'or Gas Fitter %Q/ly A!k 11a4,14A--,- INSURANCE COVERAGE Check one: I have a current liability Insurance, policy or it's substantial equivalent. Yes.0 Noo If you have checked Yes, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity ❑ Bond 13 Owner's insurance Waiver: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent 13 1 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 State Gas Code and Ch pter 142 of the General Laws. By: Title City/Town, APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ® Plumber f�? grLJ-3 Gas Fitter License lNumber 0 Master 12 Journeyman F -, 9 4,,- -9 11, Wte ....... TOWN OF NORTH ANDOVER 0 4L PERMIT FOR WIRING This certifies that ......... U. X -E ..... kur.,/LP5 ...... z has permission to perform ....... .,Or" ..... . . ............ wiring in the building of .......2, --v .................................. —) - -, Mass. at .......... ......... North Andover, Fee.. Lic. No,-).. .......... jv CTRI Check# z L! eCj;AkLf �SPECMR 7' (foinnwnweaGth o�aaaachu�eifa Offi ' 1 Use Only cc� cc77 Permit No.y/ 2 aLJePartme►zt o�..tire �erviced Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 IN INK OR TYPE ALL INFORMA TION) Date: S -2-q-10 City or Town of: d i{ AN Dot/ 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_15- A /kJ A hlD,�, Owner or Tenant A Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building gl�r_01/elc_ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t2r 4 j i t2CD 149A1.4,c/Q Completion of the 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 Swimming Pool Above E] In- E] rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I.Number I Tons ....... ....... KW ......... No. of Self Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of WaterKW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Wor 5±_v U . (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties ofperjury, that the information on this application is true and complete. ^ FIRM NAME: U E 6 RO S &I—E�f �l L LIC. NO.:� U ZI ,% / 1 Licensee: Un,�"]!1 �4ti P_:>(1kG Signature LIC. NO.: (If applicable, enter "ex m t" h he license number line. Bus. Tel. No. Address: - 8� fJ 0 X SSS YC-Y-if03y r %d-= fit 6 % Alt. Tel. No. *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 a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Date : 2, - .I . o TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSAC NUS This certifies that ..... e' 5. ..j _......................... . has permission to perform ....(.47 .^ ..12.e✓'1.vAR-'z...-....... plumbing in the buildings of ...1. oy-tok .�!� t t� .�J.� L/j...... at .., `{... lf?? . qr? S........ , North Andover, Mass. Fee........ Lic. No .......... ........................... y PLUMBING INSPECTOR Check # _`p �""-- 8666 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv 600 TT'ashington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):TeS ,u,OL'$ urr�,dl jqn � Address:_ApQ City/State/Zip: W429,'2,512,W4 aZis7s— Phone #:_ Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.X I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑Roof repairs 13. ❑ Other _ ______ _--.......... r � =: V sw c;ui cue Section CelOW �neR mg ::....: ,Vo r — ' policy mformati=. b _..w ..tF:T�:.um.-�..S..tlOa Sirs.. 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 -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceyWfjy under the pains and penalties ofperjury that the information provided above is true and correct Phone #: 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): I. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone ft: as Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners,. are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be -,.turned tothe city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 uTwvT.mass.govfdia MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date ,5-2 / -/D Building Location�/ 7 _ Dlt'i .tl S , Di2 it Permit 4 Amount Owner ✓ l�il/w.✓a/rhea. n i New Renovation Replacement " Plans Submitted Yes No FiXTi T1Z Tr Cc (Print or type) r� r Installing Company Name 2 E.SE.t�D ES / z i1B�.tii ! A V,7,W4 Address _ Q LOC 4A1 14(1-0-WA-n.,;fe,2rt1.9 if �� T Business Telephone %�/ _ S� _ -7,9 7 Check one: Certificate ❑ Corp. ❑ Partner. ❑ Firm/Co. Name of Licensed Plumber: 1VELSa,CJ Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity11Bond ❑ 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 usetts State,P g Code d Chapter 142 of the General Laws. By: iona ira n Title Type of Plumbing License �_� City/Town rl-censIvUM6/r'_— Master ® Journeyman APPROVED (OFFICE USE ONLY ❑ � - Date ......':........2- z -ege.................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that......... ....... �.T �?7'z ..... has permission to perform ...... ................... wiring in the building of .....0............z ................... at ......... 4b ............. North Andover, Mass. Fee .7...Lic. No. ................ f0 D�y� LECTRICAL INSPECTOR Check. §0 06 ' l-consnsonrtraaLlh o��c//,213at�a� _`1J.parEn,�ni o�Jir� �swi.css BOARD:,OF FIRE PREVENTION REGULATIONS Cif Gal se Only Permit No. 6 Occupancy and Fee CheckedJ_ [Rev. 1/071 leave blank) APPLICATI,ON FOR PERMIT TO PERFORM ELECTRICAL WORK All wort: to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN RX OR =.&.4 -LL LVF0RM4TIOA2 Date: cv- / L/- ar City or Town of. o.A"/-;�1 To the Inspector q," Wires: By this application the undersigned gives notice o his or her intention to rform the electrical work described below. Location (Street & Number) �� C/ IAAAX Owner or Tenant ,[7p �iI=�,�j���� Telephone No. - O'wner's Address • Is this permit in conjunction with a buildirig permit? Yes ❑ No (Check Appropriate'Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Und;rd ❑ No. of Meiers Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ecessedAL' uminaires ENNoo No. of CeiL-Susp. (Paddle) Fans o. o Transformers eta KVA uminaireOutlets No. of Hot Tubs Generators KVA No. of Luminaires Swimmin-Pool A ove ❑ n- tv 2rnd. ornd. 111n- o Emergency El Battery Units Lighting No. of Receptacle Outlets No. oron Burners FIRE ALARMS FN(,. of Zones Iryo. of 5witc hes No. of Gas Burners no. of uetecrion aria ln.d2tinz Devices Yo. of Ran �s No. of Air Cond. oral g Tons No. of Alerting Devicrs No. of Waste Disposers ear ump tum tier oas o. o Self ontatned- Tot:ls: - Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑Municipal-- ❑Other Connection No. of Dryers , Heatine Appliances KW ecuriry yste-.s:* No. OTDevices or F_' uivalent NL -0- o a[er o. o. o. o HeKW Data WirinoJJ - aters Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of MotorsTotal HP a eco..imunicat ons. wing: i.} No. of Devices or Equivatent nTHER: Attach additional detail if desired or as required by tf;e hu-pector of Wires. Estimated Value of Electrical Work: /�D (When required by municipal policy.) . Work to Start: ' Inspections to be requested in accordance with MEC Rule 1.0, 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 ® .BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete- FIRM ompleteFIRM NAME: �-( S�CU,rt'r Sc rCCPS LIC. NO.: I S3 3 Licensee: C/. %I,'i1 �7 r1, 7-,4//o/L- Signature (/fopplicable, enter -exempt "in the license num er line.) ' / Bus. Tel. No.: Address: ,Q 0 L l AJI-01_ /yo %(S khq 4001? _ Ala Tel_ No.: •Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: - Lic. No. S C: 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, 1 hereby waive this requirement. I am the (check one) ❑ owner 11 owner's aoe t. Owner/Agent Signature Telephone No. [PE"TT FEE: $ 7 i .x.CC) �c— E� U�� (-jC � UO n o 4- 0 C: O C) ON U) N 0 U CN aD p w .Q Q J W \\�l✓l O W Cj CN V J , Q O U CD LL F. U cr U W U U) � L in o V W LLL W co `U C o \ Q to R' M N 1 \ o w XILL ILL 00 0 (v " o o U OJ W Q UM U U N E F q cn LL a C) H z xQ d Q' iri ei �0z SwW .0 � c �' o C E .X V O a) 1UJ a Ctf �.\ Z w' N <So O °O x 9 `�z N G ~ Q Z vT N � � O 0 M w -o M N Z p Lin = f 0 (j w M W z o w '� O I i to OC C] Z ri W Y? w > W n jj) Q (9 c JW W cr 11 Z = K W Lt1 Q l E Q Z fl401 Q Z a r+ r •c O o N) C1 c W J - Z, '4 OC r+ T- d O Location 3.4 15i 6-M t.'k Ill 0 S No.,' SZ Date NORTH TOWN OF NORTH ANDOVER 0��•�•O '� 1ti0 O? •_1 ` OA 9 Certificate of Occupancy $ Building/Frame Permit Fee $ b''^°"'�t�' Foundation Permit Fee $ ssACMUSE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ uilding Inspector 1044 1/24/% 11:26 35. oo pRID Div. Public Works PERJIIT NO. APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. Q LOT NO. 00 -%s- I 2 RECORD OF OWNERSHIP IDATE BOOK ;PAGE I ZONE SUB DIV. LOT NO. LOCATION & PURPOSE OF BUILDING OWNER'S NAMEl__ J_ . /, 14 NO. OF STORIES SIZE OWNER'S ADDRESS r ! /+ /1'' Ll'/`j�l�j(�( BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME IDd •em L..s SPAN -- DIMENSIONS OF SILLS DISTANCE TO NEAREST BUILDING DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION 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. 1 FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 r 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 SIGNATURE OF'OWNER OR AUTHCfR AGENT FEES PERMIT GRANTED 19 ! V ._I� -� I�� �C � Vit• � � .1'F is OCT 3 PROPERTY INFORMATION LAND COST EST. BLDG. COST S� •/ fin .uD EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BUILDING INSPECTOR OWNER TEL. # 66)�7— 36C CONTR. TEL. # CONTR. LIC. # I H.I.C.# 1/3 �S� 1 OCCUPANCY MULTI. FAMILY OFFICES APARTMENTS _ SLATE CONSTRUCTION 2 FOUNDATION _ TAR & GRAVEL 8 INTERIOR FINISH CONCRETE _ 3 1 2 13 CONCRETE BL'K. TILE FLOOR PINE AIR CONDITIONING TILE DADO RADIANT H'T'G BRICK OR STONE 7 NO. OF ROOMS UNIT HEATERS HARDW D GAS _ OIL PIERS ELECTRIC PLASTER _ DRY WALL _ _ UNFIN. 3 BASEMENT AREA FULL FIN. B'M'T' AREA _ '/. 1/1 3/. FIN_ ATTIC AREA 4 WALLS II 9 FLOORS CLAPBOARDS B 1 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW0 ASBESTOS SIDING COMMCN STUCCO ON OR CINDER BLK. ON MASONY 711 WIRING R 5 ROOF II 10 PLUMBING GABLEHIA �I BATH 13 FIRS _ GAMBREL MANSARD TOILET RM. (2 FIX.) FLAT SHED WATER CLOSET WOOD SHINGES I 11 HEATING KITCHEN SINK r Z t SLATE NO PLUMBING _ TAR & GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ HOT W'T'R OR VAPOR TILE FLOOR _ AIR CONDITIONING TILE DADO RADIANT H'T'G 7 NO. OF ROOMS UNIT HEATERS BUILDING RECORD 12 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. 1 A 6 FRAMING WOOD JOIST I 11 HEATING r Z t 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 7 NO. OF ROOMS UNIT HEATERS GAS OIL B'M'T 2nd _ lst 13rd I ELECTRIC NO HEATING i i, c Q. O a E•r_4 =� O N 4-) 4J 0 O w j-) 0) U -j 4- O '- a) N O A V- L .,I Qr O J-) O 1 C 3- r0 C O U C O_ •^i •-1 ...r O N U (n > Qr C) ri o L U U U L p U C O L 4 L 0 4- U cn a-� to c (n C U) E C U C U H (a LJ i0 0) m r J (D .� > M d Rf p O rrs w 00 I U- X: —1 • U W 0'10 H U m r J ¢ c J N .`�• x M a m Z ¢ p W U- oE: tom !� D Z 4.3 W ~_ Z m O L N '-• c n .� •� o m Lu E V) (I1 O� f.0 l0 •N. �• Q m O © m e Q W H iy _ CL 2 > N I WO 0� C O W M O N a) m o (f) S- C 1 t0 t Y Z •.-1 M ti o m w O O N M 00 00 F- W U WIx N 4 • • N H i Q� F -F- W Q o o .: .w J ►- V) F- Q ^ w ti :..i ^F— C t ! aW0 .-4 U U Z w W J 3., •- Z .n co N L M W N U J 2 Z W C Q H Z U'0) LLJ or c U ] U --r F- O �> J Z V) O H W `UP93 I��EIIEI� f • _ 1. .... _ _ _ .. �...�-mow s o , f M v a W fp 3 µ :2Z = 0 U) W to Z U ZO O !q- U �¢ ¢ 4~ w a U) m 1,n p Cc 0 �. a=�w oo Q 1,r (G IN Q�aZ Z cr cl1 to 0 0 �(Z'}a w ww m i /W 1 li W 00 o lZS 6 vz w ` z 0 va1m X -4 41 Ad 0 �Moo(a v z W •.fie sem. LL W "'i m r- z > •', t .2 O N 4z 1q ca O C 0 W V4 w 10 4W -" -'-- 111111 AWN61 INI - - - --- '1a, � w / W W • , � o w VI < U O LL O i W LL. N O w O O C.) LU Zu J V ® J z O O J IL a y tl mF J U. Z Q `O` O r o w Z Z N Ix d w0 1 a So ®g Q wZ0 U- �� 000 W M 11141,1IN1 -- a W fp 3 µ :2Z = 0 U) W to Z U ZO O !q- U �¢ ¢ 4~ w a 0 u z 0 M M ' z W U � 0 W -1 3 IT z W 0Hz(D QJ�at 0 iz 2 m o z V 0 �. 1,r (G IN cl1 to 0 1 r- /W 1 li W 00 0 0 0� 0 va1m X -4 41 Ad 0 �Moo(a v z W •.fie sem. n W "'i m r- z > •', t .2 O N Ix to 4z 0 1q ca O C 0 W V4 w 10 JJJ0 ° ,19 m 49Q XIS , 0 u z 0 M M ' z W U � 0 W -1 3 IT z W 0Hz(D QJ�at 0 iz 2 m o e r� / // 1 i Bio40 17 71: ic I i I „ , I i I I/ Location a No. f MM Date , TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ J§ev�e°��QQCbnnection Fee $ Water Connection Fee $ TOTAL $ ,,5-L.- Building c. Building Inspector Div. Public Works PER-31IT Nd. / S S 11 10 A APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP h40. LOT NO. 2 RECORD OF OWNERSHIP DATE (BOOK :PAGE ZONE SUB DIV. LOT NO. 1 i �1 OCATION3,l C �A� _f f 4JC) rQlia��ti-z/�{ BA W PURPOSE OF BUILDING �jTi�iP �C�c^-J'l�•c�F l�wesZL�vC� OWNER'S NAME Af Ak-'^ NO. OF STORIES SIZE WNER'S ADDRESS,,/JJ N ) BASEMENT OR SLAB - ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD UILDER'S NAMEd r" SPAN --- DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET POSTS DISTANCE FROM LOT LINES - SIDES REAR " GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION 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 1 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 i SIGNATURE OF OWNEWORA[UTHORIZED AGENT FEE'�Ss�•� PERMIT GRANTED \AA I`r` 1 � `� . 19 OWNER TEL. # /�NTR. TEL. #.ro 7 y CONTR. LIC. # 1 / $_ ¢ 3 PROPERTY INFORMATION LAND COST 4 EST. BLDG. COS A' n in EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY WARD OF HEALTH PLANNING BOARD WARD OF SELECTMEN BUILDING INSPECTOR 1 �I OCCUPANCY SINGLE FAMILY STORIES _ _ MULTI. FAMILY OFFICES _ APARTMENTS KITCHEN SINK _ SLATE CONSTRUCTION 2 FOUNDATION I—II 8 INTERIOR FINISH CONCRETE _ PINF Id II 13 I? CONCRETE BL K_ DRYWALL UNFIN. BASEMENT AREA FULL FIN. BM'TAREA '/. '/v '/. FIN. ATTIC AREA NO BMT FIRE PLACES HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 DROP SIDING CONCRETE _ WOOD SHINGLES EARTH ASPHALT SIDING HARDW D _ ASBESTOS SIDING COMMON _ VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK N MASONRY ATTIC STRS. & FLOOR BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING 5 ROOF II 10 PLUMBING GABLE I HIP GAMBREL MANSARD FLAT SHED BATH (3 FIX.) TOILET RM. 12 FIX.( WATER CLOSET _ _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR 8 GRAVEL _ STALL SHOWER _ 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. d COLS. STEAM STEEL BMS. d COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GA OIL 1st 3rd NO HEATING { I BUILDING RECORD 12 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. C r - x tfl- ON td w w W aG O w cncz v cn 0 U z p w to O a E .2 U G x a p w z �+' p w C x a O w ► 1 w p a u u cn C u. p � O w' C x w W v W ,~, U) v E U) uj OmM6 O z c c as c = v O i C +D O N = _ VO V CL o. :RCc :om N 0 m C3 o. N E � CD :0 0 cam �F G.= L m m t c_ :W_j m ._ _O 'fl � . L C C N O O N R m o .cm CD rn CM o Q ;o CO) 'o 203 m N O L L3 :coo cm H N m c C = m Jz 0 N y LLi 4 � � � t m r=... O 'ca rte. •.- � •N y E V V N o m o=== -o y a m O N� O N •- O x R ocl cm L�� 0 U N J z CD E LL . c C3 ~ o coLU zCL O D y c z } F- I CO C7 C:) z w Q� H O O mm U z W o O i � coCJL D O l� O �Q ca o R c Q vJ -p z ccm V CL y O C CIO W V) C3 FQ z z � cr Q w w Cl- cn HOME `MPROVEMENT lype.- L i I a, 0-1 N / 2i/ 55 808 STANLEY �,A'ITN7 .,iI m i i 1 7 N; G a7 C. i"i R P 7-,N ROBERT 5;1;1 - [?i 711 -2711 "r OSTER RD ADMINISTRATOR -C i LWKSEU,-,Y !4ir" "" Suggested Affidavit for Home Improvement Contractor Permit Application For Office Use only NAME OF CITY/TOWN Permit No. %102Ttt iiWD1py1SrZ_ Date AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, inprovement, removal, demolition. or construction of an addition to -any pre-existing owner -occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exceptions, along with other requirements. / 0012 Type of Work: S74C — ele: Est. Cost_ Address of Work 3 y 0— 0/1'a Owner Name: Date of Permit Application: &P4.z /o /g y'3 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under $1,000 _Building not owner -occupied _Owner pulling own permit _Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent he owner: Date C ntracto me Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name Q, �r t 5-8 V Date ... /�IZ14� . . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that _ . -.!. .......... � ....... . .... . has permission for gas installation) . _ . -�� .tel. . i� �il� D /lJ . m the buildings of `.��%.. ... �. � :-.-� ..�................... . 22�1 �y f at•�! 7. <.AJ� �1% .` ........ North Andover, Mass. Fee,SA R. Lic. No.37Y,15 .. .......................... GAS INSPECTOR Check # "4557 C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFI' (Print or Type) _ fib. AIJ 00 U G1L , Mass. Date 26611 Permit Building Location. 34 Cp HAQOS 1W Owner's Name &/J" a k f DPU H /a (09yo? /�/_ A /Type of Occupancy ESI DGO1: New ❑ Renovation ❑ :)�' Plans Submitted: Yes[] t:, Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE; MA 01840 Business Telephone • 6 8,7 -110 5 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # X7 Corporation 1862 ❑ Partnership ❑ Firm/Co. It�.URANCE COVERAGE: a current liability Insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy K Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: signature of Owner or Owner's Agent , Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and aaxu�te to the best of my <nowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all >ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/ i TvDe of Ucense: pit, Plumber Signature of licensed Plumber or Gas CIM 9Gasfitter �.i � 5 Master License Number aty/ITown Journeyman v'F'11iOVED (OFFICE S ONL V • .. ■�������i�����t���t>l��RME■ N KNEE .. ■EENNEEMENNEENN MENEM tno •• ■��������.����������r�■ Ems Installing Company Name BAY STATE GAS COMPANY Address 55 MARSTON STREET LAWRENCE; MA 01840 Business Telephone • 6 8,7 -110 5 Name of Licensed Plumber or Gas Fitter Francis X. Corkery Check one: Certificate # X7 Corporation 1862 ❑ Partnership ❑ Firm/Co. It�.URANCE COVERAGE: a current liability Insoura❑nce policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes If you have checked res, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy K Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: signature of Owner or Owner's Agent , Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted (or entered) in abo plication are true and aaxu�te to the best of my <nowledge and that all plumbing work and installations performed under the permit issu f r this application will n mpliance with all >ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (/ i TvDe of Ucense: pit, Plumber Signature of licensed Plumber or Gas CIM 9Gasfitter �.i � 5 Master License Number aty/ITown Journeyman v'F'11iOVED (OFFICE S ONL z o N�•�� _,L� � ��:. ..�,„. ..:'+,-^moi-,..~ Z O z d 3 v z• 1- F - u N J (y 2 O � N � 1i tr o z d a 0 0 U. u 3 z G O J w f In a U I I J IL CL a w w LL ui w X U ~i w x N z o N�•�� _,L� � ��:. ..�,„. ..:'+,-^moi-,..~ Z O z d 3