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Miscellaneous - 34 RALEIGH TAVERN LANE 4/30/2018 (2)
x �w � of NoRry qti r _ 00 3� G LO T; k y 7f SSA CHUSE PUBLIC HEALTH DEPARTMENT Town of North Andover Community Development Division CERTIFICATE OF COMPLIANCE As of: 6/20/2013 This is to certify that the individual subsurface disposal system has been installed in accordance with the provisions of Title 5 of the State Environmental Code: Complete Repair and Construction of an On -Site Sewage Disposal System By: Jaynes Kellett At: 34 Raleh!h Tavern Lane Map 107A Lot 0105 ,,North Andover, MA 01845 of this fife shall�not be construed as a guarantee that the system will function satisfactorily. Michele Grant Public Health Agent 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ci�:oo CD C CD o 0 CD v m � C z o ° N v d y v w � w v Q 3 a - K C'? 1 I c O N N m N 1 I N 1 ! iD i 1 1 PM (D rr (D CD a 2 a 2 ^ 0 O n CD ;a uI C m '< �� -1 S to I N I bM(D O 7 ::TfD 'O -1 :3 O O K E (D 5 � O- rD N O ! 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C � L C al 3 v C t3yo �yN UILUDJ� JOO�� O� �o JD/nolpua Jacf 'UIU/ m�) +C`o OO°�00p Q � . C � L a' UILUDJ� JOO�� O� JD/nolpua Jacf 'UIU/ SIN 0 .I NAP ��NpQp �sr NO -1. SEE TOWN OF NORTH AN AK SE 420RS MAP #107.A LOT #105 DEED B00 # 01 PAGE #119 E.N:9.R.D. FOR SITE. 2. ZONING DISTRICT 15 R2 (RESIDENCE 2) po �I 0 0 STEPHEN E. IZ 20 "L7 PIN KI, R.L.S. DATE _ LEGEND if (] SB DH STONE BOUND DRILL HOLE N/F NOW OR FORMERLY W.F.D. WOOD FRAME DWELLING BIT. CONC. BITUMINOUS CONCRETE FND FOUND STY. STORY 000o STONE WALL EDGE OF WETLAND A 4A WETLAND FIELD FLAG I r-% r L.1%11 APPROXIMATE LOCATION OF EXISTING LEACHING FIELD PLAN OF LAND- IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR ROBERT BAKER 34. RALEIGH TAVERN LANE NORTH ANDOVER, MASSACHUSETTS 01845 SCALE: 1"=40' DATE: MARCH 20, 2017 0 20 40 80 120 � 1 MEP�RIMACK INEERING S 'RVICES 66 .. ARK STREET ANDOVER, MASSACHUSETTS 01810 978 475-1448 PHONE. (978) 475-3555 "'_4X: EMAIL: MERRENG@AOL. COM N/F 'SND ) 6�v Dory 9 4`3''F NSF <I ND LOT 11 AREA=45,531 S. F. 1A 23315' =1.0452 AC. �• EDGE OF BORDERING WETLAND DELINEATED BY NORSE ENVIRONMENTAL SERVICES, INC. (APRIL. 2013)-, S46 .:?",l 'A PROPOSED co 0) ADDITION f:. �7'_i� 3A 106' 14' 20' I I" 52' 7j� 4A RA EY' STY. N 46' LC) 2 STORY � �, w.F D• cN 50r � N v \5A I 'O 0 OZ 2 x ^ O \ 6 7A \ m 00 pca �— 8A R-150.00' L-135 F� o \, Np' ti .J 62, 'V497 s,� p TAVERN 8 p 4 V F60y NO TES 1. SEE TOWN OF NORTH ANDOVER ASSESSORS .MAP #107.A LOT #105 DEED BOOK #14201 PAGE #119 E.N.D.R:D. FOR SITE. 2. ZONING DISTRICT IS R2 (RESIDENCE 2) r �I ♦\r 3/20/17 / STEPHEN E. PI KI, R.L.S. DATE PLAN OF LAND APPROXIMATE LOCATION OF EXISTING LEACHING FIELD F- H LiJ z z Ldm z IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR ROBERT BAKER 34 RALEIGH TAVERN LANE NORTH ANDOVER, MASSACHUSETTS 01845 SCALE: 1"=40' DATE: MARCH 20, 2017 0 20 40 80 120 AfERRIMACK ENGINEERING SERVICES 86 PARK STREET AlW O VER, MASSACFIUSETTS 0.1810 PHONY (978) 475-3555 FAX.: (978) 475-1448 EMAIL MERRENG@AOL. COM LEGEND , 0 SB DH STONE BOUND DRILL HOLE N/F NOW OR FORMERLY W.F.D. WOOD FRAME DWELLING BIT. CONC. BITUMINOUS CONCRETE FND FOUND STY. STORY 0000 STONE WALL 'fl/' EDGE OF WETLAND 4A WETLAND FIELD FLAG S46 .:?",l 'A PROPOSED co 0) ADDITION f:. �7'_i� 3A 106' 14' 20' I I" 52' 7j� 4A RA EY' STY. N 46' LC) 2 STORY � �, w.F D• cN 50r � N v \5A I 'O 0 OZ 2 x ^ O \ 6 7A \ m 00 pca �— 8A R-150.00' L-135 F� o \, Np' ti .J 62, 'V497 s,� p TAVERN 8 p 4 V F60y NO TES 1. SEE TOWN OF NORTH ANDOVER ASSESSORS .MAP #107.A LOT #105 DEED BOOK #14201 PAGE #119 E.N.D.R:D. FOR SITE. 2. ZONING DISTRICT IS R2 (RESIDENCE 2) r �I ♦\r 3/20/17 / STEPHEN E. PI KI, R.L.S. DATE PLAN OF LAND APPROXIMATE LOCATION OF EXISTING LEACHING FIELD F- H LiJ z z Ldm z IN NORTH ANDOVER, MASSACHUSETTS DRAWN FOR ROBERT BAKER 34 RALEIGH TAVERN LANE NORTH ANDOVER, MASSACHUSETTS 01845 SCALE: 1"=40' DATE: MARCH 20, 2017 0 20 40 80 120 AfERRIMACK ENGINEERING SERVICES 86 PARK STREET AlW O VER, MASSACFIUSETTS 0.1810 PHONY (978) 475-3555 FAX.: (978) 475-1448 EMAIL MERRENG@AOL. COM N N X D _n W 0 Ori a) CL n y p '� O' < O !A C- O °h u m m 3 d �d Ln n rp a 00 �p O O. to C fD m 0 m = M D W ,C rt v p m pr p fD - O O tC d y N y m m 01 rr m 7 m m m m v to N r �-i Z(iniRrNrNrj W WA,T <G o = okr44000 0 aDOc) mm s 770 OD0(-q ��^ xm X;o D S V) o 0 D D> m m D ZZ 0 m-0 om� -�� Ir �r OCL m O r W O— i A b b < �+ rt tO In = T m m m o� Q° D I I D D 0D t73 r Dom o m X� (n (A o X O v o 0 o z -<X zc as w i Z 3 V) Dm r o Ln. M D fD G) I 2 N O1 X w On T O m r V) O O n m CL D i m= mo n cu T D g a n rt 0 0 3 � C V) r 'p 0 D � ori 6 m of 0 H r v O 0 O o 0 o v N m o, o w a o. 01 m m a m mm v a D rn y U) rt � 2 < O JON Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that(,- �.' Q-- � ,A .. 0-4, It --4 has permission to perform . tM9Z"C,.a4-� r �t�ing in the building of......,.....�i1............................................................................... at ........N �..�..1.. -.. ........ , North Andover, Mass. .................. Fee..... f -........... Lic. No I!? I ......'...1.................................................................. ELECTRICAL INSPECTOR Check # ) 222— f Commonwealth of Massachusetts o Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS A Official Use 0 y Permit No. Occupancy and Fee Checked tev.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 PRINTININKOR TYPEALL INFORMATION) City or Town of: NORTH ANDOVER By this application the undersigned gives notice of his ox her int( Location (Street & Number) Owner or Tenant /! 6_11 Owner's Address . grL,,Y Is this permit in con' ction with a building permit? Yes Purpose of Building C� L C, l h Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Nature of Proposed Electrical Work: Date: To the Inspector of Wires: perform the electrical work described below. Telephone No. No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Overhead ❑ of the Undgrd ❑ Undgrd ❑ VWle No. of Meters No. of Meters by the Insnector No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans 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 No, of Total Transformers KVA uminaire Outlets No, of Hot Tubs undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. Generators KVA uminaires Swimming Pool Above ❑ In- rnd. rnd. ❑ o, o mergency Lighting Batter Units eceptacle Outlets No. of Oil Burners Licensee: S _ Signature LTC. NO.: i I q �,)_ 5 %fapplicable, enter `exempt" in the f'cense nu r line.)Bus. Tel. No.•,S"-Zfr - (/S )-9T7 FIRE ALARMS No. of Zones witches rofDryers No. of Gas Burgers No. of Detection and Initiating Devices anges No. of Air Cond. TotTons No. of Alerting Devices aste Disposers Heat Pump Totals: Number Tons KW ..................................... No. ofSelf-Contained Detection/AlertingDevices ishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection ryers No. of Water Heaters KW Heating Appliances KW No. of No. of Signs - Ballasts Security Systems:* No. of Devices or E uivalent Data Wiring: No. of Devices or Equivalent ydromassage Bathtubs LOTEIMMER: No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent IN Xttacn aaamonal detail tf desired, or as required by the Inspector of - res. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CBECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) t cert'y, under the pains and penalties ofperjury, that the information on this application is true and complete. /� FIRM NAME:. E D W A e-,� .q - LTC. NO.: X03 6 � A Licensee: S _ Signature LTC. NO.: i I q �,)_ 5 %fapplicable, enter `exempt" in the f'cense nu r line.)Bus. Tel. No.•,S"-Zfr - (/S )-9T7 d Address: QCQc a3�jQ Alt. Tel. No.: � *Per M.G.L c. 147, s. 57-61, security work req es 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 Signature Telephone No. PERMIT FEE: $ l ❑ 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 4 �\ 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 1 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 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: k. Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: ` Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: y ROUGH INSPECTION: Pass F?1 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL SP TION: Pass V Failed Re- Inspection Required ($.) ❑ Inspectors Co nts: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhoid@townofinerrimac.com The Commonwealth of Massachusetts 07 Department oflndustriglAccWd is Office of Investigations VV 600 Washington. 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): G—,b Address: City/State/Zip: 6�k� jPhone #: Are you an employer? Check the appropriate box: Type of project (required): L a employer with 4. F1 am a general contractor and I 6. E] New construction oyees (full and/or part-time).* 71am have hired the sub -contractors listed on the attached sheet. �• ❑Remodeling 2. a sole proprietor or partner- ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.E1 Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11. E] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs required.) insurance . re uired employees. [No workers' 1311 Other comp. insurance required.] xAny applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they a -re doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis box must aftached 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 N Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the AIA. for insurance coverage verification. I do hereby certify under the pains and pe jaloes of perjury that the Information provided all ove is true and correct Date: 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: _. Phone f 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please 0 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 mumber(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 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 onlysubmit one affidavit indicating current Policy information (ifnecessary) 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. Anew 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: Tho Commonwalth of Ma.,ssachvsetts Department ofIndustdai Accidents Office ofIavestigat ions 600 Washirt&a Wet BosfonMA02111 TQJ, # 617-72.7-4900 oxt 406 or 1-8,77, MASSAk`B Revised 5-26-05 Fay ,# 617"727"7749 0 ki ki 0 r%lxlll-l^kl e%r- mm^r -AD ........... TOWN OF NORTH ANDOVER. PERMIT FOR WIRING Thk rprfifip.-, that I)b V � � W - M,-�& � has permission to ..... wiringin the building of....... .... ..................................................................................... at ............ �4 .......................................... ... .... North Andover, Mass. ...... .... ... ....... ..... Pee .............................. Lic. No. .. vz�� ....... ELECTRICAL . kL . IN . spEc . roR ....................... Check #24o�a f e Commonwealth of Massachusetts Official Use Only M Permit No. 19 Department of Fire Services Occupancy and Fee Checked l� BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All Nvork to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of Ns or her intention to perform the electrical work described below. Location (Street & Number) :Y1 R,, [t21kAVF—?,N Owner or Tenant S-110,4 Telephone No. I Owner's Address A,vcrz!j Is this permit in conjunction with a building permit? Yes ❑ No EZ (Check Appropriate Box) Purpose of Building 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: (J t ' seeP t.� �U M ca"i � �S A,01> Completion of the following table nnav be waived bi, the Inspector of Wires. r No. of Recessed Luminaires No. of Ceil. Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs I Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. o. of Emergency Eighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons No. of Alerting Devices No. of Waste Disposers p eat Pump Totals: um er I ons I ' "—' o. of elf -Contained Detection/Allerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW ecurity ystems:* No. of Devices or Equivalent No. of Water KW Heaters o. o o. o Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Y3 TelecommunicationsNo. of Devices or E uivalent OTHER: Attach additional detail if desired or as required by the Inspector ojHires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties f perjury, that the information on this application is true and complete. A FIRM NAME: I viQ W Nte•2�t LIC.NO.: �1d Licensee: Signatu e r� LIC. NO.: df applicable, enter "exempt " in the license nunibe • Itn V. Bus. Tel. No.: Address: y����� 7/L. et% Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, decurity 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 SignatVe Telephone No. PERMIT FEE. S Mai 23 2013 5:46PM Kellett Excavating Corp. 781-595-3330 p.l 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfigations, ` 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ayplicant Information Please Print Legibly Name (Business/Organizatimtllndividual): David W Meehan Address: 4 Mulberry Drive Peabody, MA. 01860 Phone 4:978-535-4022 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp, insurance requited.] 5. 0 We are a corporation and its 3.0 I am a homeowner doing all worts officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp, insurance rmuired.l Type of project (required): 6. 0 New construction 7. 0 Remodeling S. ❑ Demolition 9. 0 Building addition 10.0✓ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. t Hamcowners who submit this affidavit indicating they are doing all work and then hire outside contrac*m must submit a new a Idtrvit indicating such. Tontractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities halm employem if the sub -contractors have crnployees, they must ptvvide their --vrkmts' comp. policy number. lam an employer that is providing workers' compensation insurance for my empJ4 vees. 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 theworkers' 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 hereb , ce under thepains yafnd enaldes o r'u that the information provided above is true aid correct Sitmature: W_.� _ rt.,«o 5/23/13 Phone #: 878-535-4022 Ojj;cial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (cirde one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• Mai 23 2013 5:46PM Kellett Excavating Corp. 781-595-3330 p.2 IF (-COMMONWEALTH OF MASSACHUSETTS LECTRICIANS , R.F�a'�,S�EREDIWASTER ELECTRICIAN ISSUES THE ABOVE LICENSE TO: DtE VID 4 ' ME E H'A N 4 HUL'SFORY DRIVE PEAR.ODY MA 01960-444'* C i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING (Print or Type) C NORTH ANDOVER Mass. Date 1 �� s 3uilding Location Permit # . Owners Name • New -7 Renovation Replacement Plans Submitted D FIXTUIR (Print or Type) Check one: Certificate Installing Company Name %�/%//�G �/yl�jT/�F/�,r{� ®MCorp. Address. --:57SX.//ygt/�j �� Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 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 coverages. Signature of owner/agent of property Owner 17 Agent M 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 Insulations performed under' Permit issced for this application will -be In comptianoo with all pestlnent provisions of the Massachusetts State Gas Code and Chaptes 142 of the General Laws. By YPE LICENSE: Z Plumber �-- Title Sfitter- si nature of Licensed City/Town: Master Plumb or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) License Number _ to v► v z � t» c a W !- 4 Y a [C d to tR N < w tt w O 00 a o cr; z w tw- N� W z LEIz a to W * 4 Q r c �' c4u W o W f- to z J H < z I.. W ac w t7 ¢ O? W W Z ,d W ' O W O N = tz z o sua—ssa�T. , 6asEMEHT / f IST FLOOR 2HO FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR TTX FLOOR STH FLOOR (Print or Type) Check one: Certificate Installing Company Name %�/%//�G �/yl�jT/�F/�,r{� ®MCorp. Address. --:57SX.//ygt/�j �� Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 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 coverages. Signature of owner/agent of property Owner 17 Agent M 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 Insulations performed under' Permit issced for this application will -be In comptianoo with all pestlnent provisions of the Massachusetts State Gas Code and Chaptes 142 of the General Laws. By YPE LICENSE: Z Plumber �-- Title Sfitter- si nature of Licensed City/Town: Master Plumb or Gasfitter Journeyman APPROVED (OFFICE USE ONLY) License Number 16 Date . /. . /1/4? ......... i t NORTH .1 TOWN OF NORTH ANDOVER A PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation ..1� h !9 ! �, ........... in the buildings of.5v1,3j!.t,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, at 3Y. A. i!.". �.. R R. .. , North Andover, Mass. Fee. y Lic. No.. .9. 3... O. ��t as 1,. 1��65114:4 40-00PAIDGAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File ' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING �••� (Print or Twel 4 NORTH ANDOVER, , Mass. Oats zlZL,..Ise Building �!/� .�E Permit -,2 � J Locstlon NN&me�',W' New er/ Renovation ❑ Replacement ❑ Plans Submitted: Yes ❑ No. ❑ FIXTURES a Check one: Certificate Installing Company Name 15Qd!/.� eZVe1i1/6/��-- Address se, !%/l�ioti� (3 Partnership ❑ Firm/Co. Business Telephoned Name o1 Licensed Plumber INSURANCE COVERAGE: cnacx 1 have a current Ilabllty Insurance policy or Its substantW equivalent Yes No ❑ If you have checked y1j, please Indicate the type coverage by checking the appropriate box A Ilabllty Insurance policy . Other type a( 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 slgnatur• on this permit application waives this requirement. Check one: SIgnOwner ❑ Agent ❑ alure o er a Owner s silt I hereby certfty that 0 of the delaAs and Information I have submitted for entered) In above appikatlon are true and &=;rats to the best of my knowfedpe and that all pfumbing work and Installatlons performed under the PemA Issued for this applloatlon wt7 be in compffance with to Winent provf ions of the Massachusetts State Plumbbw Code and Chaptr 142 of the A laws. ey Slgi6ture of Licensed Plumbw Tule lJanse Number—� City/Town Master Af f'nOWD (OFFICE USE ONLY) Type of Plumbing License:Journe yman 0 log tic Is s i3 •• 4K « a W X es J s a s a V< 31s M 0 4K a a J M a rj ~ s f' U 1�1rr 1tt < l a a _ s F U s sr et o • a< a 1• s i< 1- a ay i `• o < 1S a<< i rt a i. 0 a O 16 V XIA><_ _ W 1 a s s s ei 7we a o o r<• as suit—IsIMT. eAe[M[lyT11 A 16T FLoon / 2NO FLOOR alto FLOOR 4TH. FLOOR STH FLOOR STH FLOOR. ITH FLOORjilt sTH FLOOR — Check one: Certificate Installing Company Name 15Qd!/.� eZVe1i1/6/��-- Address se, !%/l�ioti� (3 Partnership ❑ Firm/Co. Business Telephoned Name o1 Licensed Plumber INSURANCE COVERAGE: cnacx 1 have a current Ilabllty Insurance policy or Its substantW equivalent Yes No ❑ If you have checked y1j, please Indicate the type coverage by checking the appropriate box A Ilabllty Insurance policy . Other type a( 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 slgnatur• on this permit application waives this requirement. Check one: SIgnOwner ❑ Agent ❑ alure o er a Owner s silt I hereby certfty that 0 of the delaAs and Information I have submitted for entered) In above appikatlon are true and &=;rats to the best of my knowfedpe and that all pfumbing work and Installatlons performed under the PemA Issued for this applloatlon wt7 be in compffance with to Winent provf ions of the Massachusetts State Plumbbw Code and Chaptr 142 of the A laws. ey Slgi6ture of Licensed Plumbw Tule lJanse Number—� City/Town Master Af f'nOWD (OFFICE USE ONLY) Type of Plumbing License:Journe yman 0 2635 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .Az ctC.tf.e !? .... .................. has permission to perform ....c.?t i v w . ! ............... plumbing in the buildings of ............... at .? � ..i Vit. 41'-. 7.1„ .. -1�7 il,. r!? k . .... , North Andover, Mass. P Fee. yG, ' .. Lic. No...%5,�',� . ... .... .. .�,�.. . PLUMBING INSPECTOR 10/05/95 14.35 40.00 PAID WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File 8* m O o c° m Dm m = a r CL c n o m c c j o'art m z CD 'm T 3 O O m O TI 0 = m 3. m 00 1 -• c z CD CD m -n 3 CD �' CD = CD 69-69696969694n O z (r(l O W C N m 1821 04 PAID v CD 11 fn m 0 > i > i 0 � m m N r � r r c c a a j -4 00 z z a a N W z N -I A c 0 J 0 z N m O A f r r y m C A rmi m -1 a 1 m> -4 z w m> C r n I 0 * Z o A Z r 0 0 D n 3 D v n C 0 0 0 O n 3 0 A 0 i a O A a m L 0 < o 0 a v m 4Z1 m ° 0 A z x 0 Z N z Z > m z X v pi zA o x i z f z 0 -4 w Z ° w N 1 z 0 s x -4 A m m 1 0; ? 0 m O A f r r y m C m m C N> m C>> m o N o N D to N D m> C r n I 0 * Z o A Z r 0 0 D N 0 Z 3 D 0 mm C 0 0 0 O n n m n m A m 0 A a A a m L 0 > m 0 r 4Z1 m ° 0 A z x 0 Z N > A Z > m z pi zA o x i z f z 0 -4 I A x m > m N n 0 > O z -4 A m m 1 0; ? 0 Zm�iy N I c r C O > m O 0 C z < C H � 3 z 0 - N • z p. 0 O . m 0 m m \ > � > A � m N C N C a C N C M N m m 0 ° m Z N m m ZO 0 C 9 N r r r r Z A r0 O x i m _ z a r m Z i 0 m m 0 z z 0 Z 0 0 0 0 O m z a r O A 0 0 A 0 w C A z z z z a I n z ° > 0 y 0 r tll i m r > m a r O 0 � n m n m n m°< r 0 Z D z 0 m N r a A N i 0 o 0 v 0 o 0 A a z z m f f ra o I i ul I A > r 0 >N z m m Z f > r > Z I N ti E A A z m D Z m x I ° m Z m N 0 0 � w A ° ID m C 9e O V W m 0Q m �' W (6 WW u Z Q� N0 _a �I Z�z 0 j LLZo Ooa a Z=N emu W Wog 0)w Z 1-00 u1nI QZF. 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STRUCTURAI:'ENGINEERS ! DENCO ENGINEERING, INC. AMS . NF.IP YORK - SLl�UyV/i�V�LtW .GiaLyQ.,4�1Ity7rlYLiU -------- NEW 1519 148 Park Street 0. .: NEW 0.` 1 -- 1196 1�J.t1 01H64 vENoI - 2009 North Reading, MASSRChUar'T'TS '8669 � - 7487(617) 944-8440: (508).66.4-6733 coim.cFICUT -- MODE ISLAND ------ 3017, %EN[tMI! DZIi:7I5-6N, RE Mf; ER - AMERICAN SOCIETY OF CIVIL.ENOINEERB PROFESSIONAL ENGINEERING SERVICE ,SINCE 1956 7 1 LI 4 K,. .�i. , . 'SHEET NO.I Of !06 H4 3 ,1 ' [�,ALai6H': rAvF U LauE.. � ATE D2� �.�g 3 DRAWS ar 1 ri i3y., ._.._. REVISED DATE' 1993,Col. DENCO ENGINEERING, INC: D�IERi `� . �21SWoGU (paoafz_ �l:da2- AMS rL, 0. I 0 w- 38O to7 cs Cg1�00`. 2t�: l:: USE' 3 x.Rl LYI. = �'�ta. 2 ' `'l'iv,2M, SEAMS 1.3: FI A tJ��Q3 = W 9 LV L D o S I ? f, w9l L� � (paoafz_ 0. to7 GAgLL WAu, +gµ ; tdo ptti kOF ttfj a' K�T14 DMMM *- cm usE 3!�k92I.v�. l►v►��� 2cx��-t G I R.��.�„ f15 kl9 1-1c,2g. �3 S�t�rPsa� sr�o�c-�-Is* ccs Fc� Cc) A-1Aj'5, ca F LV L 9 Location R/) It, f / �'`P�y 1M No. � Date %ORT" TOWN OF NORTH ANDOVER Oi t�an ,a',,t• O a L . 1 Certificate of Occupancy $ s,cMu4tt' Building/Frame Permit Fee $ ` Foundation Permit Fee $ Other Permit Fee $ TOTAL $ `3 L Check # 5 /,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: / �� DATE ISSUED: SIGNATURE: Building Commissi er/I for of BuildingsDate SECTION 1- SITE INFORMATION 1.1 Pr etty1:ddress: 3 of 1.2 Assessors Map and Parcel z© ? Map Number Number: f Parcel Number �c (� veru L.f7 -3g I �h Address/for Service Signature 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Area (sf) Frontage ft 1.6 BUILDING SETBACKS ft Address for Service: Front Yard Tele one Side Yard Rear Yard Required Provide ReqWred Provided Re red Provided Telephone Not Applicable ❑ 1.7 Water Supply M.G.L.C.40. § Public 0 Private ❑ 54) 1.5. Zone Flood Zone Information: Outside Flood Zone 0 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Fra S7-, G,Llt Name (1? int) �c (� veru L.f7 -3g I �h Address/for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Tele one SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Constr4ction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contr ctor 51XinC Not Applicable ❑ Company Name it�- t� f hb/ 67 Th �/([ t C� l�l/[� 7 T Registration Number Addres � R"i4l'' �4� v �� Expiration Date i nature Telephone e 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 ....... ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: 16 CLd�e d_ Tvvo Lip YL SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant QFFIC)CA,L USE' ONLY 1. Building Q� G'J (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) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER GENT OR CP_NTRACTOR OPLIES FOR BUILDING PERMIT I, as Owner fed Agent of subje roperty Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name K Si manure of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS I ST 2 3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE Town of North Andoverof No oTH �Y6 0 Building Department o 27 Charles Street North Andover, Massachusetts 01845 4 ?,, (978) 688-9545 Fax (978) 688-9542 94 CO[KICWwKR V1 �9ssAcHus���y DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s150a. The debris will be disposed of in /at: _ r Facility location Signature of Applicant //// 3 0 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print am a homeowner performing all work myself. Phone 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. Policy.#' 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 $1,500.00 andtor 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. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under tpb pains and Signature Print /i 6- erjury at th information provided above is true and correct Date f 3 ev Phone# Official use only do not write in this area to be completed by city or town official' []Check d immediate response is required Building Dept Contact person:_ Phone FORM WORKMAN'S COMPENSATION ❑ Building Dept ❑ Licensing Board ❑ Selectman's Office ❑ Health Department ❑ Other L = NONE IMPROVEMENT CONTRACTOR Registration' 100833 Expiration 06/24/2002 Type: D8A THOMAS R08ILLARD SIDING tg�as Robillard I1 Filbert St ADMINISTRATOR Methuen MA 01844 9 _. C/) m m C/) m CA CD .n Z CD C' r- d C L CDo p C� c CCD O .. .. CZ O � O C= CD CA 'O CD O to y O CO) n• O CO2 Im CD C) CD CD CO) CD CO) O CCD CDO 1+� C/) n O z cnC C W�� p O C• y O r H = dO K O y cc7'm z 7D O N � � y 14 10m d C y N PI O o IE m a > > N ; O E, co O o Z®.nCD c s=7: �. cos CL np� vicoCL O ? � bO O O N CD O O ,V' C CD •O•►. CAA s N N CLW: cr C 5. ca ib �=;' ' P. o W N C � 1 mn:: IrE. Cos .411111M. moo: co �.. 'oma• - N .. CD a� C d =C', tri o=: G • 2 cn 27, Cl) A ° Fj G ,� 7d r� :o w �-� 41 z�Poo °� a C �" P:l G r W °? ` c x a 0 �3 G7 rzr d (nal n '. F y 0 °� x O b y z � CAb H O y0 0 x w 0 0 c -;eA—\ y� The Commonwealth of Massachusetts Office Use Only Department of Public Safety Occupancy No. BOARD OF FIRE PREVENTION REGULATIONS 527 COIR 12:00 Occupancy 3 Fee Checked 3= (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Masswnusens Elecatcal Code. 527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date � City or Town of _ / ri 1V4:) To the Inspector of Wires: -The undersigned applies for a permit to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address __ lip Is this permit in conjunction with a building permit Purpose of Building Existing Service New Service Number of Feeders and Amps/. Amps I Volts (Ch&•;k Appropriate Box) Authorization No. Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Location and Nat -e of Proposed Electrical Work Pe, w) lel .ta.Q w j w j• )VP Q . " f w 1-� No. of li htin Outlets No. of Hot Tubs Ni TOTAL No. of Transformers KVA No. of Lighting Fixtures Above In Swimminq Pool crnd. ❑ grnd ❑ Generators KVA No. of Receptacle Outlets 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 Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal Local ❑ Connection ❑ Other No. of Ranges — 0g0 / TOTAL No. of Air Conditioners TONS No. of Disposals HEAT TOTAL TOTAL No. of Pumos TONS KW No. of DishwashersSpace/Area Heating KW No. of Dryers Heatina Devices KW No. of Water Heaters KW No. of No. of Signs Ballasts Low Voltage Wiring No, of Hydro Massae Tubs No. of Motors Total HP OTHER: tNO'JMAM t c:UVt:hAc;E: Pursuant to the requirements of Massachusetts General Laws ,� I have a current Liability Insurance Policy �'c1cluding Completed Operations Coverage or its substantial equivalent. YES >M NO O 1 haave submitted valid proof of same to this office. YES C£�NO O It you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE L1 BOND ❑ OTHER ❑ (Please Specify) (Expiration Date) Estimated Value of Electrical Work S Work to Start % z z �J " O� Inspection Date Signed under the penalties of perjury: FIRM Requested: Rough . 1��/ Final f/G G Licensee Address .LIC. NO. 9,!6�22Y _ LIC. tel. No. 31 d Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one) S--��(Signature of Owner or Agent) Telephone No. PERMIT FEE ,�s' Date ...... 2581 ORTN TOWN OF NORTH ANDOVER 0 i PERMIT FOR WIRING This certifies that ....... ..... .......... has permission to perform ........ P.e. 4m ....... it— ...{tL••••••5 wiring in the building of ..... F -p -q-0 ........�!.A.............................. at .......... 3Y ...... Q. cr f(.y .. # North Andover, Mass. Fee ... 7d. td)... Lic. No. ................... E . .... CTR . ... ICA . ... L N....SP . .. EC . .... TOR ................. C � ", jwp WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File