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Miscellaneous - 35 WRIGHT AVENUE 4/30/2018
N3 I-- Date .,)... ................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.... � J ,)•_ i 4 +A,n �AL ..- ............��.......................:....................... has permission to perfohn ...... ..;A, ...,.-,. ............... ,J PA+.�oS wiringin the building of� ............ a .....N....,,u.¢.......................................................... �Q............................ ,North Andover, Mass. at ...............� .............................. 4^� Fee . l Lic. No. 1 �G, `.............. ..... b..............�� G —1 ELECTRICAL INS IECTOv R.� Check # I 2 3 PSP ��v2 -1 v,%- Commonwealth of Massachusetts Official Use Only -- Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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 IN INK OR TYPE ALL INFORMATION) Date: 5/27/2014 City or Town of North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 35 Wright Avenue Owner or Tenant Steve Hansen Telephone No. 978-685-2623 Owner's Address same Is this permit in conjunction with a building permit? Yes ® No ❑ BLDG PERMIT # Purpose of Building Residence 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: Installation of a 5.360 kw (16 panels) rooftop solar array No. of Recessed Luminaires _ No. of Ced. Susp. (Paddle) Fans ua— "'" I-EVG Wu1VCu a lrie eG1Vr o wires. o. ° !!1J' ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- El rnd. rnd. o Emergency Lighting Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detect -on an Initiatin Devices No. of Ranges No. of Air Cond. Total Toonsns No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I ....umber Tons o. o Self-Contame Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal F1 Other Connection No. of Dryers No. of Heaters KW ater Heating Appliances KW °' ° No. o Signs Ballasts Security Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommumcationsWiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: $23,719.20 (When required by municipal policy.) Work to Start: 6/17/2014 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 of perjury, that the information on this application is true and complete. FIRM NAME: The Boston Solar Company LIC. NO.: 12689A Licensee: William T. Foglietta Signature LIC. NO.: (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.: 781-462-8702 Address: 10 Churchill Place, Lynn MA 01902 Alt. Tel. No.: 978-836-6?2F, 0 *Per M.G.L. c.147, s. 57-61, security work requires Department of Public Safety "S" Licen 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. $ 'j ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS REGISTERED MASTER ELECTRICIAN THE BOSTON SOLAR COMPANY INC WILLIAM T FOGLIETTA III 10 CHURCHILL PLACE LYNN MA 01902-2719 .: 150499 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER CONTROL # J0500-20 IMPORTANT If your license is lost, damaged or destroyed; is inaccurate; or needs to be corrected, visit our web site at mass.gov/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations. Your license is a privilege, and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 IF www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Legibly Name (Business/Organization/Individual): The Boston Solar Company Address: 10 Churchill Place Lynn, MA 01902 Phone #: 617-858-1645 Are you an employer? Check the appropriate box: LK I am a employer with 20 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I 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.= required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work 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 reauired_1 Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.W Other Solar installation *Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. ' I 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. 'am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insuarance Policy # or Self -ins. Lie. #: WC2-31S-384393-014 Expiration Date: 1/14/2015 Job Site Address: 35 Wright Avenue City/State/Zip: North Andover, MA 01845 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 certify under the pai�"penalties of perjury that the information provided above is true and correct. Phone #: 6178581645 14 Official use only: Do not write in this area, to be completed by city or town official. City or Town: Issuing Authority (circle one): I. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: 02/24/2014 21:01 17815955820 AMBROEE INSURANCE PAGE 01/01 'GATF(Mmowym) AC'OO?& CERTIFICATE OF LIABILITY INSURANCE 12/25/2014_ THIS CERTIFICA7E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATIE HOLDER. THIS CERTIFICATE DOES NOT AFFIRrMTIVELY OR NEWIVELY AMEND, EJCCEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES HOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSLfRI:R(9j AUTHORIZED REPRESENTATIVE OR PRODUCER, AND 7HE CERTIFICATIE }IOLDER. IVI10IRTANT. If to eertHlcate holdgr Is an ADDITIONAL INSURED, the pu9ay(1eal must be entlorseee. If sUBROGAII1014 18 WAIVED, subject 10 Iho Farms and condWans of the potlmy, cer(eln Pollcfes may raquln' an endaraem+rnt. A statement on III% CoWiie to does not amlor +igbts to the ceMcete holder In IIAU Of ouch entlomemenaa . PFODUCER ' Ambrose insurance Agency, Xt� HAM FWONE 781-592 -82001=No nft ArC Yc;7$1—X95-5$: 56 Central Ave. Lynn, MIl4 01901 n0r,R6ss• IFINUM I AFFORMN4 WYLRP99 NAICM woripR,, Colonv INSVRED Th® Boston Solar Co., i SO Churchill. Pl , Lynn, MA 0902 COVERAGES r.FRT1F1e1ATF INIIMCcri. TH18 IS TO CERTIFY THAT 11HE POLICIES OF INSURANCE LIMID BELOW HAVE BEEN ISSUED TO THE INSUP.ED RAMED ABOVE FOR THP FOUCY PER100 INDICATED, NOTWITHSTANDING ANY RECUIRSMENT, TERM OR 001401TION OF ANY CONTRACT OR OTHER DOO,EdENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR M4Y PEF11AN, THE INSURANCE AFFORDED BY THE POLIOMS D,SCRIBEO HEREIN IS SUBJECT TO ALL THE TERNS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RECUCED BY PAID CLAIMS, 4� TYPE of INSURANCEFFQLIUY n� POLICY NlJeA3ER MUID MMA PULICY MIR tIMPTS X CONT/EASCIAL GENERAL LLOBLY Y �, EACW OCGLRABNGE R I ODO 000 GLg1MS MAGE U DGGUR PREMISES Es a rrisneal 8 1010,000 A LIED = A cls rsarl 5 5,000 -- MP40! 03 2/ISA42J18/15'PERSMLBADVIVJURY S 1,000 000 OWL AGGRBtaATE 4JLIIT APPLIES PER POLICY � JECTT ❑ LOC eENEPAL AGCREGAiTE s 2,000,000 I i PRODUCTS - COMP10a Aac S 2,000,000 OTHEFL• ALMONOB1LE LIA01LITY ea eC6,Ghht f 140,000 ANYAUTO ALL DMEC i SCHEDULED BODILY INJURY(Pa pBraun) ! 13 As1Jf98 X AU10sI R NK]NAIAINE0 aOaILY INJURY (Pe. a=ICEIF l' 9 6216592 1/23/ 14112 311 KIREO AUTOS` X AU70S ; S s C UMBRCLLA LEGE x D=rJR EACH OCGLfUeNCE 3 55, 000, 000 xEXCEss teas CLAIMS-MALe x RRU015482750 2113/142/13/'15 AGMEOP.TE s 5 404 a00 I ' OEG � EZGTEI�IT1pNs °.►h'bRKERS COMPEh15ATT{aN S AND eWLOYER$ LIABILITY Y1x I T -run IAw X 3R D CPTI -PMOABER kk{1. ET 9cL�vE I I NfA E.L. EACH ACCIdENT f 1 r 000 , 000 IfArmmr" in NMI �I If s deaaibew" D 'SS�RIP7104OP WC2-319-304393-014 EA- DISEl.9E • EA EMPLOYEEf 1 , 008 000 DPERAMPI3 ]olow E.L DISEASE- PDL•CYLIMIT 1 S 'L 004 000 I DESCRIPTION OF a3ERATIDNR r I_ncAnme I %rtmiri ra oxwren .^d 901 Panel installation Talton Of North Andove3z Attn.: Build-ing Dept. Tama Hall North Andover, MA 01945 SHOULD ANY OF THE ABOVE DESCRIK') POLICIES 61= CANCELLED BEFORE THE EXPIRATION I)AATE THEREOF, P40TICI_ WILL BE DELIVI_IZED IN AGOORDANCE WITH THE POLIGY PROVISIONS, AUTHOP.IzED C 1998-2013 ACORD CORPORATION. All rights reserved. ACORD25(201$104) The ACORD name and logo are raOstored maitcs of ACORD n F m m Z nSO n M0 U) 0 Q6m N 3 =,�t a 0 0 .ch,0 0 ii 0O 0) 7 QQ CLCD N 3 X N C (Dm3.3 p 3 (D s (Q D �0CD O N X- r� N CD CD O � (C) n 3>ac p M (A o1 O y 3 3 f4 N OD U W � Z= N cn os , O 3,CD Cj) rn r >c (D CD 00 Ul IN 3 (D 0D D 2 rno N (1) < (D W (D 3 ------------- -M-16 — – — – — – — – — – — – I I I I -- -- --- -zcn>, Ogg CO) CO) (a �O���mOo X X X ��0mmZO0 i 0 0 O F 7'0 00 0< 5 m m ri p c0 cn 4k Cf) 4t cn 4t TOnm�COD r X O O m0 *cmDz Smi> r. g MC � g �g �n�m0 D - o �_ 3D T c to m m m A�z�- mXm cn cn cn � �" C, 2 ; X Z Z Z ri �>W we n �k I O) < Z : mo o I iV -4 < -u D o�� n oWi < I < m O� y A �c�� n mom o o DgDgDzDgD�+Z 0(a 0)D Cr I CO) XXKzXOm c �� ��D�ncm Z<rj)A y T Z1 x 0 rO N g0 N y �Z00�4m Z � o r �vt yD> ZDV :m 4k romOO� 0 m � �zz 4000 0 ZOO I p Oro 0 z I Oo cT�m gg00 -ni v I NCL mO00 �c mm 00C) n��� c<nn Z0 0 O�zz O C: I mDZp= ��<(� �� Z °5c0 °<Oc �- N�< Z�OQ C0r-m y p< °� 0 2 y m z <0 Dm�D zmm� n co > -n � 0 r m � � N mm= a,0)rn6 m Z m Cl) (A co CP I m A 0 N W m o 0 n z G cogcnoo 'o= I Zr DZ<Um m DW az °< I o� mgmK m 0yz N •e 3 3 m °n y� o '�� O� ZZD c CL I r°e °D 2W yymD@ to W N�O z p0 I a°°Z OZ 0oAo -100-- Ce CI r0 0�o z FN co r O C Z0 ° m �(n com Cg Cg C ro Z p CD � Nomm I �°_ go ogp°Iv <-1n I i �� mrc- m�� I = Z gN z0 0(n 00CD C c mo g m- -n Tv m0 I Ir7U nJ �n i O=� �� �� �m stn mcn Oc I loic, O p m Z� Z� 00 +-0II[ cnm �m m0 'rn Nu, 0 0 M C1 O fD n CL fuO CD °—,Do O � mq CD o 7 �' 0 CD cc N O O = D s (D WRIGHT AVE DRIVEWAY G ■ T E61.39"� N ---..9L �=--► T D z M r- 0 O X M C z � D0 O z C M Next Step Living Inc. Drawing: HM-NSL-05/05/2014 m Customer Name: Sue &Steve Hansen Cn One Line Diagram Address: 35 Wright Ave, North Andover, MA, 01845 Solar Installation Phone: (978) 204-6617/(978) 685-2623 0 D 0 N o rt N 0 O _ 0 0 �°4t 3 o mo o °,o O Q.�r-Qv -n n - N (D (D y c 0o N O N3 v N 0 4 rr T D z M r- 0 O X M C z � D0 O z C M Next Step Living Inc. Drawing: HM-NSL-05/05/2014 m Customer Name: Sue &Steve Hansen Cn One Line Diagram Address: 35 Wright Ave, North Andover, MA, 01845 Solar Installation Phone: (978) 204-6617/(978) 685-2623 0 D 0 r -14e& -a 67,E //- /,--/ _0 > &M /71-� � o Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 5-77 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Jfu [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ( C), 527 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: City or Town of: _ _ yi f©� AV 6VeATo 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) _R� U�9JIL7- &VC- Map: Lot: Owner or Tenant Telephone No. Owner's Address j<j o4l r Is this permit in conjunction with a building permit? Yes ❑ No ❑ Building Permit# Purpose of Building Existing Service /-- D Amps IA6ySellyolts New Service QQ Amps o/ ay6volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Utility Authorization No. Overhead Undgrd ❑ No. of Meters Overhead Undgrd ❑ No. of Meters 1_ '-kKto / -26e4k;iF S 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 Swimming Pool Above ❑ ❑ oLt7F mergency Lighting rnd.d. !grn y Units `'*:n. of Receptacle Outlets No. of Oil Burners ALARMS No. of Zones No, of Switches l No. of Gas Burners No. of Detection and l Initiatin Devices No. of Ranges Total No. of Air Cond. Tons No. of Alerting Devices. No. of Waste Disposers Heat Pump Number Tons KW No. of Self -Contained (^� Totals: Detection/Alerting Devices �J I I of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection . of Dryers Heating Appliances KW Security Systems: of WaterNo. KW No of Devices or E uivalent Data Wiring: Heaters Signs Ballasts No. of Devices or E uivalent . Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Enuivalent HER: ►NCE COVERAGE: Unless waived by the owner, no permit for auucn aaamonat aerau y aestred, or as required by the Inspector of Wires. the performance of electrical work may issue unless the licensee proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such is in force, and has exhibited proof of same to the permit issuing office. ONE: INSURANCE ET BOND ❑ OTHER ❑ (SDecifv:) Value of Electrical Work: (When required by municipal policy.) (Expiration Date) to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. fy, under the pains and penalties of perjury, that the information on this application is true and complete. NAME: LIC. NO.: see: Signature LIC. NO.: u:ss. s. Tel. No.:` ��a 7/S���e Alt. Tel. No.: M,57C', ✓ ER'S INSURANCE AIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's age n -t. r/Agent :ure Telephone No. I PERMIT FEE. $ ty ko (2, Location No. -332 Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a�- 18747 -, _ Building Inspector/ * ^ TOWN OF NORTH ANDOVE-R BUILDING DEPARTMENT �MRmVATF, OR Building Commission r Date 1.1 PvcpatyAddress: 1.2 Assm-as Map and 31 1.6 BUU.DING SETBACK$ (ft) froW Yard Side Yard Rear Yard 11 Flood Zow Svw-pD6poWSy- 11 Qww of Record TC41M -Ole- 12 Owna of Recoid., Nam Print Address for Saview. Telephone 3,1 Licensed Construction Supervisor Address Signmm U000" Not Applicable I;--- LicaseNumber Expirixtion Dee CompanyNam Regidwion Number Address Expimtion Daft " 3 SECTION 4 - WORKERS COMPENSATION tXQL C l52 � 33c{6) Workers Cmnpensation bsunum affidavit must be completed aid. submitted.wiffi this appiicaiion Failure to provide this affidavit will result ' in the denial of theissuaMce of the building it Signed affidavit Attached Yes ....... 0 No.......0. SECTION $ D66iPfifion of Prd ' ' Workrla cttnttq0=Ut Mew Constnrction" D ` Existing Building 0 Repair(s) 0 Alterations(s) Q Addition '0 Accemy Bldg• • O Demolition 0 Other 0 Spec fy Brief Iription ofProposed Work: C-0>ro' F X- ©.n SECTION 6 - ESTIMATED CONSTRUCTION COSTS item Estimated Cost (Dollar) to be x ' -F, Cola lded by permiter heant I. Building (a) But`ldintg Petmit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction: 3 Plwnbing PlumbingBuilding Permit fee t:}. z. (b) 4 Mechanical HVAC ' S Fire Protection s 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER, AUTRORIZATION To 13E COMPLETED WHEN OWNERS. AGENT OR CONTRACTOR APPLIES FOIL .BUILDING PER.t!'ii'I' 1, la as UunerJAufhorired Agent of subject property Herebyauthonize, My behalf all mattersTela 've work authorized by this building permit applicati � Os ture o iC er - papaw — SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION` 1, as OwnalAuthorizedAgent of subject Property Hereby, dace that the statements and int'oamation on the foregoing application are true andkarate, to the best of ray knowledge and belief Print Name Signature of Date NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TltviERS 2 SPAN DIMENSIONS OF SILI S DUYIENSIONS OF POSTS DIMENSIONS OF GIRDERS 10GHT OF FOUNDATION T19CKNESS SizE OF FoonNG x MATERIAL OF CHIMNEY IS ;BUILDINO ON SOLID OR FILLED LANI? IS BUILDIlNG CONNECTED TO NATURAL GAS. LINE rVKM U - LV 1 KCLCAOC rvr%m INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from 13oards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. APPLICANT FILLS OUT THIS SECTION _—*** APPLICANT .�� ���� PHONE LOCATION: Assessors Map Number _ PARCEL �3 SUBDIVISION LOT (S) STREET ��` �,t ��f ST. NUMBER OFFICIAL USE ONL R O ENDATIONS OFT N AGENTS: O ER ATION ADMINIST OR DATE APPROVED C It / DATE REJECTED rnuupws 514J Rjnnro1V4J 14 IACat►� 6c5 iyolea/on dad TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS, DRIVEWAY PERMIT, FIRE DEPARTMENT .7ECEIVED BY BUILDING INSPECTOR DATE_ ROVIOW 8197 JM z 43 W 4' E MAZ N �O N C O cmM O) 'O m 0 cm c �E N m O Z O U O O cm I O 'D ME m m CL O � O cc O a a. cm< Co s cc ) C. O �0,, C CD O C. V H O C ■ C c CL LLI LLI Y/ 19 W LLIW cc v :o`o o. W A m m N C CD G H 'r w o � C~�Z a C C C x .E CL ��0y L C C3 CD CO O O x u o LE v cn W Z w° w�' U w • ao' w V O w chi G w" C7 p rs: G w W AG { rA o cn O cn E MAZ N �O N C O cmM O) 'O m 0 cm c �E N m O Z O U O O cm I O 'D ME m m CL O � O cc O a a. cm< Co s cc ) C. O �0,, C CD O C. V H O C ■ C c CL LLI LLI Y/ 19 W LLIW cc :o`o o. = m m N C CD G H 'r d y"' N mom~ o � C~�Z C ti O C C C •dam .E CL ��0y L C C3 CD CO O a m C :Z O .0� N O Cc N � EQ • :moo o c. N E� :cw smc c_ O �N N 3 ' C A m CcN W y m Qao N O � O .O w N d C Z C3 y O A 'S 2 E MAZ N �O N C O cmM O) 'O m 0 cm c �E N m O Z O U O O cm I O 'D ME m m CL O � O cc O a a. cm< Co s cc ) C. O �0,, C CD O C. V H O C ■ C c CL LLI LLI Y/ 19 W LLIW cc :o`o o. = m m N C CD G H 'r d y"' N mom~ H W C~�Z c +- •aa C W .E CL ��0y C3 CD COD a ID Z .0� N H .aim E MAZ N �O N C O cmM O) 'O m 0 cm c �E N m O Z O U O O cm I O 'D ME m m CL O � O cc O a a. cm< Co s cc ) C. O �0,, C CD O C. V H O C ■ C c CL LLI LLI Y/ 19 W LLIW cc ;41�ry TOWN OF NORTH ANDOVER OFFICE OF BUILDING DEPARTMENT 400 Osgood Street •}4^fin. 4u "rte` G, ;,,,� ��• North Andover, Massachusetts 01845 Gerald A. Brown Telephone (978) 688-9545 Inspector of Buildings Fax (978) 688-9542 HOMEOWNER LICENSE EXEMPTION Please print DATE: I Tt ! / flas- JOB LOCATION: HOMEOWNER Number U Street Address Gey Map/Lot Home Phone Work Phone PRESENT MAILING ADDRESS S'IA City Town State Zip The current exemption for "homeowners" was extended to include owner -occupied dwellings to two units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family structures. A person who constructs more that one home in a two-year period shall not be considered a homeowner. The undersigned "homeowner" assumes responsibility for compliances with the State Building Code and other Applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of North Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNERS SIGNATURE�i�—�% APPROVAL OF BUILDING OFFICIAL Revised 10.2005 Form Homeowners Exemption TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that has permission for gas installation .... X— rte. f? x .............. .... ....... in -the buildings of . . .......................... *-at. ..... (A07. . North h A dove,,Ma,5. :7.fte95".... Lic. No.t..7�... INSR�ECTOR Check # /7 4674 r►, MASSACHUSETTS UNIFORM APPUCATON FOR (Type or print) ,—' NORTH ANDO�'ER, MASSACHUSETTS Building Locations Owner's N TO DO GAS FHTNG Date _ Permit # / Amount $ r _ New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or typ9N t `—, Check one: Certificate Installing Company Name f`t 1 Q ^ ❑ Corp. Address `I ❑ Partner. 1 8 Business Telephone — _ Firm/Co. Name of Licensed Plumber or Gas Fitter ,y, Fre .tIV rzy, INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑"" Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted (or enterea) in aoove appucanon are true ana accurate to the best of my knowledge and that all plumbing work and installations performed under Pemtit Issued for this application will be in compliance_ with all pertinent provisions of the Massachu�" 5tpte Gas K29P and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signatufe of Licensed Plumber Or Gas Fitter Plumber ):V— 41 I Gas Fitter License Number ❑ Master Journeyman x w a U a H x a � w ° U � z o z a w z o w a CA w z z a � ° o z o r pCO x w A 0 a � a � A a H O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2 ND.. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or typ9N t `—, Check one: Certificate Installing Company Name f`t 1 Q ^ ❑ Corp. Address `I ❑ Partner. 1 8 Business Telephone — _ Firm/Co. Name of Licensed Plumber or Gas Fitter ,y, Fre .tIV rzy, INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No ❑ If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑"" Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted (or enterea) in aoove appucanon are true ana accurate to the best of my knowledge and that all plumbing work and installations performed under Pemtit Issued for this application will be in compliance_ with all pertinent provisions of the Massachu�" 5tpte Gas K29P and Chapter 142 of the General Laws. By: Title City/Town APPROVED (OFFICE USE ONLY) Signatufe of Licensed Plumber Or Gas Fitter Plumber ):V— 41 I Gas Fitter License Number ❑ Master Journeyman Date.... ......... i • NORTH pF .ao ,tip TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION s _ a This certifies that......If ....... s has permission for gas installation ..... in the buildings of_.t!,. ....... at . �,�M1. �!C� �c. A .f .!�.l�.C.E ..... North Andover, Mass, *---Fee. '. Lic. No.h 1. ......................... . GAS INSPECTOR Check 45705 MASSACHUSETTS .UNIFORM APPUCATIOM fO r PEMAT TO DO GASFITTING. (Print or T Mass. Date d? 211 Permit t! / Owner's Names Buildit Location, q/)gr' 2D4 r 40 n I 1 jype of Ocxupancy G� New ❑ Renovation. -❑ RepiacementQ,,/ Plans Submitted: Yes© No p . Installing Company Name �� Business Name of Ucensed Plumber or Gas Fitter. Check -one:: CertitKatef ❑ Corporatkon- ❑ Partnership A Firm/Co. INSURANCE COVERAGE: I have a currenVi4bility,insurancepolicy or its sal equivalent -which -meets .the requirements of. MGLCh:.142.• Y No ❑ If you have -checloWaM :plem&dicai *wt pe.coverage-by checking, v-wappaopciate box A liability Insurance policy)( Other-ty m-0,indemnity. 11 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the llcensee.does not have- the insurance .coverage required by Chapter. 142 of the.MasL General.Laws, andatmt.my signature -on Vft-permit-application waives this requirement. Check one: Owner❑ Agent .0 Signature of.Owner_a_�Owmeis Agent , 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application am true and accurate to. the beat of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with aI pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General . T of License: 1 Plumber g " o Ucen um or i � Title Gasfitter _ Master License Number 1310(0, INty/Town Journeyman NoWnNEENUttnE ■���s��t�t�tis�iii�tii�tit■ . .. ■titittit�tiitiii�iii�t�t■ . .. ■ti�i�ii��iiititsiiii����� .. ■ti�itii�■tiitiii�tiitt�t■ .. ■t�tit�ittsis���itiii�tit■ .. ■tttittitttii�iti�iiit�it■ Installing Company Name �� Business Name of Ucensed Plumber or Gas Fitter. Check -one:: CertitKatef ❑ Corporatkon- ❑ Partnership A Firm/Co. INSURANCE COVERAGE: I have a currenVi4bility,insurancepolicy or its sal equivalent -which -meets .the requirements of. MGLCh:.142.• Y No ❑ If you have -checloWaM :plem&dicai *wt pe.coverage-by checking, v-wappaopciate box A liability Insurance policy)( Other-ty m-0,indemnity. 11 Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the llcensee.does not have- the insurance .coverage required by Chapter. 142 of the.MasL General.Laws, andatmt.my signature -on Vft-permit-application waives this requirement. Check one: Owner❑ Agent .0 Signature of.Owner_a_�Owmeis Agent , 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application am true and accurate to. the beat of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with aI pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General . T of License: 1 Plumber g " o Ucen um or i � Title Gasfitter _ Master License Number 1310(0, INty/Town Journeyman z O H V W IL df z J Q Z LL i Q ' 0 O Z H I H N 6 di N. ZO Z o a 0 W O ~ W O Z d O o d d a a J W < m V J d 6. W W d ' z O H V W IL df z J Q Z LL i a 0 Q ' O I 6 N. Z a 0 Date X. 11 .'. W/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that1%.. has permission to perform ... plumbing in the buildings of .!�l.t'��%. �..f.��✓.s���/... Me.......... North Andover, Mass. Fee ./z �. Lic. No. � ��%.�/� . ............................. . PLUMBING INSPECTOR Check H 584J" 0' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) /np �tt e\I� Mass. Date �� .0 ��/ " r BuOwnees Name iL-04 Type of Occupancy New O Renovation p Replacement 12� Pians Submitted: Yes O No G FIXTURES ^ check Ofei ceffificate Insallmg""•+a7�s�C ��GO� <� p corpWation Address 54W - �o , AP%no Ct p Partnership <0, d.zv FirrNC;o. Business Telephone I - -- Name of Licensed Plumber p >�xnrr INSURANCE COVERAGE 1 have a currant liability policy or its substantial equivalent which meets tate requirements of MGL Ch. 142 c�he If you have Cced yes, Please indicate the type coverage by checking the appropriate boot, A liability insurance policy Other type of indemnity p gam( p OWNERS INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. Ceres! Laws, and that my signature on this permit applimltion waives this requirement, Check one: SWadute of Owner or Owners Agent Owner p Agent p I hereby certify that all of the details and information I have submitted (or enter" in above Vlftlibw are true and axumte to the best of my knowledge and that all pkrnrbing work and ir:stailatiorrs or under pemyt fthis application will be in compfianoe with all pertinent provisions of the �� of the GeneYal Laws Signimm Of LKWSW PNimber Type of L cetsc Mastw Journeyman L License Number - • � K ^ check Ofei ceffificate Insallmg""•+a7�s�C ��GO� <� p corpWation Address 54W - �o , AP%no Ct p Partnership <0, d.zv FirrNC;o. Business Telephone I - -- Name of Licensed Plumber p >�xnrr INSURANCE COVERAGE 1 have a currant liability policy or its substantial equivalent which meets tate requirements of MGL Ch. 142 c�he If you have Cced yes, Please indicate the type coverage by checking the appropriate boot, A liability insurance policy Other type of indemnity p gam( p OWNERS INSURANCE WAIVER: l am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. Ceres! Laws, and that my signature on this permit applimltion waives this requirement, Check one: SWadute of Owner or Owners Agent Owner p Agent p I hereby certify that all of the details and information I have submitted (or enter" in above Vlftlibw are true and axumte to the best of my knowledge and that all pkrnrbing work and ir:stailatiorrs or under pemyt fthis application will be in compfianoe with all pertinent provisions of the �� of the GeneYal Laws Signimm Of LKWSW PNimber Type of L cetsc Mastw Journeyman L License Number - r7 Location I, -t t R/C No. Date ,10RTM TOWN OF NORTH ANDOVER ' 0 aciAmmmisdi-OLLp Certificate of Occupancy $ • Building/Frame Permit Fee $ �sJAcH Foundation Permit Fee $ 14 f,_ � w�Qther Permit Fee t��.' !� $ i Sewe pnection Fee $ Afater Conn 6'16n Fee $ ToTA6' $ ('�0 Building Inspector P Div. Public Works PERMIT NO. ,aP APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. '/ PAGE MAP +40. I LOT NO. 2 RECORD OF OWNERSHIP ;DATE ;PAGE ZONE SUB DIV. LOT NO. h m Imo— I '�\�, (BOOK 1 LOCATION 35 W reI i1 �� I` �R A-�/� Y PURPOSE OF BUILDING I 1 24 1.I.�oo 1 OWNER'S NAME i NO. OF STORIES SIZE OWNER'S ADDRESS ( BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND RD SPAN M DIMENSIONS OF SILLS S} - POSTS 1 BUILDER'S NAMEod 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 N SIZE OF FOOTING X IS BUILDING ADDITION )�� 7 MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE yes IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION, IF ANY `w` IS BUILDING CONNECTED TO TOWN SEWER y� IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES EST. BLDG. COST PAGE I FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED S �3 lea I BOARD OF HEALTH SIN TUBE OF OWNER OR AUTH(64IZED AGENT r--" It) YVLWV-3L_ A YYVI.%-f OWNERTEL.# °�- F E E Wl o 4!!j� CONTR. TEL. # CONTR. LIC. # PLANNING BOARD PERMIT GRANTED y� >A 19 9 BOARD OF SELECTMEN t `JNIIV3H ON _I P'E I +tI p -Z 1.W.9 �IN1�313 110 SWOON dO SVO S831V3H 11N11 EJ.1.H 1NVIOVd ONINOI110N0:) 81V _ S83ldV8 OOOM aOdVA 80 8,1.M lOH 'S10D B 'SW9 1331S WV31S _ 'S10D T 'SW9 a39W11 Nand 81V lOH 09:MOA 3JVN8n3 SS313dld 1SIOf OOOM ONIIV3H 11 I ONIWVNd 9 'NV1d lO1d S30V ld3U SIHl 'a3SOdWlH3dnS '013 'S30VU -VV 'S3HOMOd H11M 'S9NIa11n8 d0 SNOMN3Wia 10VX3 aNV S3N11 101 WONA 30NV1Sla aNV 101 JOSNOISN3Wla 10VX3 MOHS1SnW NO1103S SIHl ZI 01OD3b JNiaiina _ SHn1X13 M300W t.)NIJUUC Hue 83MOHS 11VIS 13AV0 8 8y1 ON19Wnld ON 31V1S ANIS N3HJ11X S30NIHS DOOM A801VAV1 S319NIHS 11VHdSV 13S01D 831VM 03HS 1Vld ('Xld ZI W8 131101 08VSNVW FT13ME) 29 X13 E H1V9 I dIH 319VO ONI9Wf11d Ol do0a 5 3 800d �I dOlb daS 3WV8d NO 3NO1S ONINIM ABNOSVW NO 3NO1S X19 MNID 80 ':)NO:) 3WVa3 NO XOIH —I 80014 8 'S81S D111V ABNOSVW NO XDI89 I 3WV83 NO O:)On1S f NONJWOD ONIOIS SO1S39SV O.mGdVH ONMIS 11VHdSV H18V3 S310NIHS DOOM E 1 9 313dDNOJ ONIGIS S(]dVO9doaa j VlD SNOOK 6 II S11VM b N3HD11X N83(J0W WOOM OV3H S3:)Vld 32113 1.W 9 ON V38V DI11V 'Nld '/i 1/1 71 V38V.1.W,9 'N13 lln, V38V 1N3W3SV9 E N13Nn llVM AaO 831SV1d sa31d Cl M08VH 3NO1S 80 XD189 3NId 'X.19 3138:)N0:) E I L i E I_ 3138JN0� HSINid 801831NI 9 NOI1VGNf10d Z N0110nUISNOO S1N3W18VdV 531330 —_ A11wvd 111nw 53180!S AlIWV3 310NIS AONvdn00o CQ CIQ z 0 m PM4 Q 0 ~ V IIJ C6 z W 0 W Z z cc u 06 CA Z u i a 0 W W Ck 0 m m L C a m ..� L oc u W C U IA L c .: Y co � U ii it ii c (r U)ii O Q ii L 030 O it m cr w CL z w w oc 0 �cc a NZ V) O uJ o � �w 6r W 0 00 C �C 0 N w 0 0 F Q 04 0 V) W J ZD .Jcoto OLIN r` O Z a .=CL E a w 4 L c c O � L O O. � O C C •— C. O �� V 0 O Z Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption (Please print) - JOB LOCATION SS Cl i1 -V Number Street ress :'.'HOMEOWNER' %L orna,\ r'15�_ f' idle- -USS-' Name Home Phone PRESENT MAILING ADDRESS f\ becti.on of Work Phone town N , Q Mit din City Town State Zip code The current exemption for "homeowners" was extended to include owner ,-occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided X -hat the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: ' Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use and/or farm .,structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit .to the Building Official, on a form acceptable to the Bulding Official, that he/she shall be responsible for all such work performed under the `'building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules. and regulations. The undersigned "homeowner" certifies that he/she understands the Town of ,North Andover Building Department minimum inspection procedures and ,.'requirements and that he/she will comply with said procedures and requirements. -HOMEOWNER'S SIGNATURE .(% APPROVAL OF BUILDING OFFICIAL-__.. Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. ..,,. »«�## :3 CDS n2��/ RCD CD Cl) / EE0�� % Cl) /o (n 7 000 0 . ■C -2-0r\) \k$%� ƒ/ Cl) &@ /CL b� @/ � �- m (n � . i m { � I � 1 ®m e#s ® _ fƒ■n /§� , ):§M ` -Q 2}k «ems Al \\% k(§ � 9- ' ..,,. »«�## :3 CDS n2��/ RCD CD Cl) / EE0�� % Cl) /o (n 7 000 0 . ■C -2-0r\) \k$%� ƒ/ Cl) &@ /CL b� @/ � �- m (n 17 Lo � b li ` Y I'fl 5=13 b� 131f- r0 IOI-O" 9 ULW5T-EA5 q $ALL. I1., 9 r m� \ CN z o \ kAn 70 Dr � O 11 v Nil Q O -4 70 (� N 0 0 _ � w • P .o N r;, r� F W 14 'BALLv5TER5 w 7'3'/%11 := 3 £S x 7 Lh ol p In "o16 ��Ys I �r i o rJ ni axe ,� l I 1 � Vo O 3 t o rn In m -Ti N N b: N H IW In Y � n, x i I .p• c,l X LA 6'rA T D 7A ID � � � N r rn 3'm 70 1 � Vo O i VAR15 N b: N k H � n, x i I .p• c,l X LA 6'rA T D m � � Vo N k H � n, x m � � � \Cli STT I =1 4 r £ Fq u Zo Z \ D O m _ 4 „ rn r � N U �► 7. 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G + ; ; Certificate of Occupancy $ �� s'••• E<� Building/Frame Permit Fee $ ACMUS Foundation Permit Fee $ Other Permit Fee TOTAL Check # 18'14 L}. `--Building Ins}ector 1.1 Property Address: Max - 1.2 Assessors Map and Parcel Number: 35(), r 'a � � N -e_ I3 K1 / 4) q y-)&\kr ,Ji lo� Map Numbfr Parcel Number 2�t Owner of Record: 1.3 Zoning Information: ^ 1.4 Property Dimensions: t Name PriAddress for Service: P -1 — — Signature Telephone Zoning District Proposed Use Lot Area (sf) Frontage ft 1.6 BUIIDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide R red Provided Re red Provided Expiration Date Vddress V t 22 —,3 /cl ure Telephone 1.7 W S ly M.G.L.C.40.154) 1.5. Flood Zone Infomution: Zone Outside Flood Zone ❑ 1.8 Municipal Se Overage Disposal System: On Site Disposal System ❑ Public Private ❑ Not Applicable ❑ Company Name SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Max - 2.1 Owner of Record Name (Print) Address for Service: '"t LG tgnature Telephone 2�t Owner of Record: ^ t Name PriAddress for Service: 2) Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number (J (�J`��L��, A`LL �.�����,�—��o� a Expiration Date Vddress V t 22 —,3 /cl ure Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone MU rn z 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 .......0 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: `� �-IJ�IT/d a�i74 41,,3 4^-(-< ® vim I SECTION 6 - ESTIMATRD CONSTRUCTTON COCTC I Item Estimated Cost (Dollar) to be Completed by permit applicant OMit A)Cr USE ONLY _ .:..:. 1. Building.: C�0. 000 _ Q (a) Building Permit Fee Multiplier DIMENSIONS OF POSTS 2 Electrical DIMENSIONS OF GMDERS (b) Estimated Total Cost of Construction HEIGHT OF FOUNDATION SIZE OF FOOTING 3 Plumbing�p Q Building Permit fee tat X (b) --- D 4 Mechanical HVAC 0 Q z 0 5 Fire Protection ,? ` (� 0 6 Total1+2+3+4+5 ,'� , (� Check Number or.%.,llul\ /a VVV1VrAAUln%Jxl/.AIA.U11 1V Dr, (,UMrLhIr U WALK OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize_'3-0�-)1/1to act on My be It', in all matte re ative to work authorized y this builduig permit application. 1 iature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Ln1e and accurate, to the best of my knowledge and belief pso Print ame (� 1 NO. OF STORIES BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST c 'SPAN DIMENSIONS OF SILLS pZ (Q DIMENSIONS OF POSTS stJ� DIMENSIONS OF GMDERS �Il HEIGHT OF FOUNDATION SIZE OF FOOTING � �^/(��_�_ 4 (� MATERIAL OF CHIMNEY N IS .BUILDING ON SOLID OR FILLED LAND _ IS BUILDING CONNECTED TO NATURAL GAS LINE &C-1 Date k SIZE d THICKNESS X I 12/10/2004 10:00 17815935291 TOWN HOUSE PAGE 02 . DKID '04 08=40 f90d AURORA, IiPb ING TECHNOLOGY 9789768980 fir: . - WK: T-994• P.8242 F-042 1 ecrt on mf�y�l' � �; i?0i 1'C�S' � 11M01'id11� 011 tht6 jc�b.AddrawL -p ■dAararrywrw� In����,p.o��nm.�•d.�]Alp�c��ratriaasigl�i�rr.p�rt�. � w"4ww"0*a,-4watolls .at dtri brew gift-emmagelm Imdit=AIV wlllcaft. rmc��� ✓ _ _ �tlor��Jkknr� vZ 1d a 7 .Mmmh go= warm► coo nacwms ena eabd compwe� �xana�awa an�onr CRY a T f3chwk fmmw&bams:h:.r#qu sd E C�OR[AGta011k Nl�orm _ -- � DRPWbrAW 12/10/2004 10:00 17815935291 TOWN HOUSE PAGE 01 DEC 1'0 '04 96:69 FRMAURiORA MIR Yl:6NNOLOGY 9799755030 !Borth Andover Building Departm. ent DEWS QISP43AL FORM T-003 P.02/02 f-942 Tal, 978-68843545 In acwManc a vvith thp. provision of .MGL c 40 354., a oorndition of Building Permit Number_ .. _ Is mat. the debris resulting from this work ahail be• disposed of in a proWy licensed solid waste disposal facility as.def"ined.by MGL c I I, 5150 A. The debris MR be disposed of In: rJ6aq`/4 6wolo d&Q.- /0 f-JOL"r- RD 0 01 q_�,r (Location of Facility) Signature of Permit Applicant Dam NOTE: Demolition permit From the Town -of North Andover must be•obtainod for this project through the Qffice of the Building 3nspWor Q) OD C- 0 r Z "M "0 1%, C/) Ram- om (n 0 -T 0 m X r. ;u > z F) (D 0., 0 @ z 0 14 0 0 Lq V - z- 0 = . z ( cm 0 0 m OD N) 0 0 m z CF) 1%, MORTGAGE IAN LOCA LOCATED IN: _ Mo.eTtiA/ )y --k- /` i /t DEED BK. 9412 PG._ c2eq BUYER: AA A16 t -,c/ PLAN SCALE: Z".314, BK. PG. DATE: Doter. /4, 2�,� INV. NO. l OO� 67 r,48 i3, S so . m . /7'! 35 i �I _ I To: 6�lN�c,t/�j,e7y All(. and He We Insurers: I hereby certifythat I have examined premises and that all bulld/ngs are located on the _#pround as shown, and that they do ( t. conform to the zoning by—lows when conhvcted or are exempt from vlolallon enforcement acqap under Moss. G.L TTtie WI, Chirpier 4W, Section 7, unless otherwIse noted. I o/so certify that this property Is CV67-) located In the flood hazard area. NOTE. This certlflcoBon Is based on the survey marks of others, and does not represent an actual flehf survey. It R for mortgage purposes only, and no boundary determinations are to be mode by this plan. J, NORTHSTAR LAND SURVEYSEERVICES *# THE TANNERY"=SuiTE 13 P.O. BOX 1 31 — NEW8URYPORT,.MA 01950 TEL. : (978) 465-2940 FAx :(978) 465-1017 C C4 C aqua Lf ��zr FORM U - LOT RELEASE FORM /1 o�cQ�� /�'•' INSTRUCTIONS. This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION****** APPLICANT�u`�,n �n f i < ✓n PHONE q- p c**SECTION"'""'"'***SECTION"'""'"'* - LOCATION: Assessor's Map Number 3 PARCEL 173 SUBDIVISION LOT (S) STREET k ST. NUMBER-c� USE A ' ff,LIM W i CONSERVATION ADMINISTRATOR DATE APPROVED` I I di DATE REJECTED I Z TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9\97 jm "D W .TJ Gn u ::E O ;7 m � o= DD �< om iz o� Z S -15A" x 4'-91/4" 3046 -D W ;u of 0::E ox m � 0 = vy om oc zm D F- c c K z c c� c m Ncu*x 4600 '000 Orno n0�� c �C)(/) � m DcC(/) mmoo (n -< -i, 0 G) m m z r� z (n V) _ 0 C 9 _ 71 0)m .. —I r z m C7 -a z omc D m m U xv K: fel ODo z �r �l U) C: O O -P z C5 c) DP. c n D F- c c K z c c� c m Ncu*x 4600 '000 Orno n0�� c �C)(/) � m DcC(/) mmoo (n -< -i, 0 G) m m z r� r N (n 0 x 9 71 0)m .. —I m z D F- c c K z c c� c m Ncu*x 4600 '000 Orno n0�� c �C)(/) � m DcC(/) mmoo (n -< -i, 0 G) m m z FIO n O z cnC w 00 a?�Om S o a�' Sa y -� : C c") O to �c Z =r -O y =roasm m �O m � o N -�1 O =r • _ c"♦ o Cj 6"CD G C�r1 a ay % CL :t m ors::� � O N CID W. a RAlaw OH:� 'D y ad -a• cr CL o P A y w N O c m y . Voo:�:fin m o :h ZCA CD 7� CD si , :�• O m� a 3 uo �CIO ;?am'f o ?j�m go to: 0 o :'_ : G o 0 — m o '0O CD 5z Z CA o C36 �• qd T co D.O Y; m b r CO) mCD 'o m X CD n� m c d CD CD o CD C CD CO). CL v CO) UM CD FIO n O z cnC w 00 a?�Om S o a�' Sa y -� : C c") O to �c Z =r -O y =roasm m �O m � o N -�1 O =r • _ c"♦ o Cj 6"CD G C�r1 a ay % CL :t m ors::� � O N CID W. a RAlaw OH:� 'D y ad -a• cr CL o P A y w N O c m y . Voo:�:fin m o :h ZCA CD 7� CD si , :�• O m� a 3 uo �CIO ;?am'f o ?j�m go to: 0 o :'_ : G o 0 cncn °�N GJ y tt� 7d o mit ^D � h qd T VF I ^� Y; ;o cncn P tt� 7d ►h qd T r g:n ;o b r n 7y T tz c� � qr M A ° 1 O C ►s d Date..- . /-A�....... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ... tt,-+-r �r '`.. 1! �. a! ............ has permission for gas installation �'1. �- �?- :........ . in the buildings of . , at . � .t'�. . ................... North Andover, Mass. Fee ' . ` .. ii, c. No—..A9 %6 ... �., .......... Check # GAS INR C` � MASSACHUSEIIS UNIFORM (Type or print) NORTH ANDOVER, MASSA Building Locations 3; New ❑ Renovation Ey TON FOR PEMU TO DO GAS FTITING Owner's Name ❑ Plans Submitted Date �qay Permit # ' V,41 Amount $ ,�.Sz (Print or type) V Check one: Certificate Installing Company Name Lto rQ Corp. Address /� f % v�� A(le% e�= ,u �� �10 C>l?a� Partner. Business Telephone •7kl S' 6 . 3 1_ C Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: 13 I have a current liability Insurance policy or it's substantial equivalent. Yes 13No If you have checked yes, please indicate the type coverage by checking the appropriate box. 13Liability insurance policy (�j " Other type of indemnity 0 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 13 Agent 1 I hereby certify that all of the details and information 1 have subrrnttea kor emerea) in aoove appncauun arc uuc dnU accUlalc w nM best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S k�Gas Code r1,Chrter 142 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 7—f-65,( rl Gas Fitter Icense um er 0 Master 12 Journeyman X Wj U U z c aJ-4 0Wx z c �— c o "w w 0 G0 z� Z ac7 ww w U a a WW z 5 U 0 oG > a F O 1 SUB-BASEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) V Check one: Certificate Installing Company Name Lto rQ Corp. Address /� f % v�� A(le% e�= ,u �� �10 C>l?a� Partner. Business Telephone •7kl S' 6 . 3 1_ C Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: 13 I have a current liability Insurance policy or it's substantial equivalent. Yes 13No If you have checked yes, please indicate the type coverage by checking the appropriate box. 13Liability insurance policy (�j " Other type of indemnity 0 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 13 Agent 1 I hereby certify that all of the details and information 1 have subrrnttea kor emerea) in aoove appncauun arc uuc dnU accUlalc w nM best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S k�Gas Code r1,Chrter 142 of the General Laws. APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 7—f-65,( rl Gas Fitter Icense um er 0 Master 12 Journeyman Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............ e ........ W ........... �t�iY .............................................. has permission to perform ...... jowl ... �r . ai � . . ......................................... ...... ....... .... ......... wiring in the building of.............................................................. %,' 14 . ...../. /,4,v S ; at ...... 3-5 ..... V9.1 ...... .............. , North �Andover, Mas. P!%y14(,L, Fee....O�..... Lac. NoX.:ZX.� .......... .......I...1..................iEMICAL INSPECTOR Check# 49'5 C/ 5711-05 Commonwealth of Massachusetts Of Use Only (/ Department of Fi/ee Permit No. BOARD OF FIRE PREVENTIONS Occupancy and Fee Checked d [Rev. 11/99] (leave blank APPLICATION FOR PPERFORM ELECTRICAL WORK All work to be performed in aMassachusetts Electrical Code ( C), 527 12.00 (PLEASE PRINTINIIVK OR TYPE LINFO Date:City or Town of. _ jZTo the Inspector of Wire.: By this application the undersigned give notice of hi or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant <" Owner's Address Is this permit in conjunction with a Purpose of Building Existing Service 1 Amps 6V Wolts New Service QQ Amps 6J/ a6volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Telephone No. Yes ❑ No ❑ Building Permit# Utility Authorization No. Overhead ml-- Undgrd ❑ Overhead ba"' Undgrd ❑ Lot: No. of Meters No. of Meters 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 S1.wimming Pool Above ❑ In- ❑ o. o Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets NG. of Qil Burners FIRE ALARMS No. of Zones No. of Switches 1 No. of Gas Burners ^ �� No. of Detection and /—/ Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices. g No. of Waste Disposers Heat Pump Number I Tons KW I No. of Self -Contained rj I Totals: Detection/Alerting Devices 7J No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances gam, Security Systems: No. of Water No. of No. No. of Devices or Equivalent Heaters' of Signs Ballasts Data Wiring: No. of Devices or E uiwlent 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. 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 D BOND ❑ OTHER ❑ (Specify:) Estimated Value of Electrical Work: (Expiration Date) (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC. NO.: Licensee: Signature 42 LIC. NO.: as e us. Tel. No.: I>kzAddress:/ Alt. Tel. No.: !?G7rl� / �,�1✓ OWNER'S INSURANCE'WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required bylaw. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Over/Agent Signature Telephone No. PERMIT FEE: $ Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ...!.....-",,,,,,,,,,,,,,, has permission to perform ................ plumbing in the buildings of .. at .... .... - .................... , North Andover, Mass. Fee'.��/-7 .. Lic. Na b S' .. :! �.. /! PLU�Nf� INSPECTOR Check 6443 MASSACHUSETTS UNIFORM (Type or print) NORTH ANDOVER, MASSACHUSETTS � - J/- Building Location 3T f �O Hers ame ��Su 5 Tvpe oLclpancy .517' TION FOR PERMIT TO DO PLUMBING Date /T,/q"y y_ Permit #--!2 Amount New 1:1 Renovation a Replacer�4t 0 Plans Submitted Yes ❑ FIIXTURES (Print or type) Check one: Certificate Installing Company Name(r' Lo) -e- S �I Corp. Address rrl r/I' /.Yc'r'� �y`�^a af�dc��f El Partner. Business Telephone % �' S-yL 3 7( Firm/Co. Name of Licensed Plumber:-)y1f'a4 jej Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policyEll Other type of indemnity Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachu-atts State P b'ng Code and Chapter 142 of the General Laws. 1�7'1,Gi2 Uli� By: Signa ure o icense um er ltuc City/Town APPROVED (OFFICE USE ONLY Type of Plumbing License ?— F4 %-, rcense um er Master Journeyman