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Miscellaneous - 350 SUMMER STREET 4/30/2018
N C) w O � v O y c o � - rn m O � jO M o m m I Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION .../. . This certifies that 6 eIv L���� Z has permission for gas installation . �.�,.e^.� .�_.............. in the buildings of... at ..... &6—b...&� . J/ , North Andover, Mass. Fee .�'.. Lic. No. i�... /may ................... .. . GASINSPECTOR Check # -/ 9 6 -' 8345 •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ��ici �� MA DATE 1 01— Z PERMIT # JOBSITE ADDRESS S8 Vrnyv- -2_ 5-�_- OWNER'S NAME G OWNER ADDRESS _ TEC�—FAX- TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL -U' CLEARLY NEW: RENOVATION: __ REPLACEMENT: -01 PLANS SUBMITTED: YESFII NOR APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 S 1 9 10 11 12 13 14 BOILER BOOSTER._.. CONVERSION BURNER - COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR w � 1. lI I_ --1 _I L .. E -.I -=__ I GRILLE L . _. - - _1 _ - (�--_- r-- INFRARED H EATER I� .-„_ LABORATORY COCKS r— MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST ----------- UNIT UNIT HEATER UNVENTED ROOM HEATER WATER HEATER > ! OTHER — _ - - --------IC_-- �i ----�._�1I 1—�_.I_ ._JI� �_.__ INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES J[J NOE] 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW y LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] BOND I I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 01 AGENT [��I SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true and c 'to t best of knowledge . and that all plumbing work and installations performed under the permit issued for this application will be in c e ent prov' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. CI)a PLUMB ER-GASFITTER NAME k�w� `� LICENSE # SIGNATURE MP ERIMGF � JP n J G F 0 LPGI __i CORPORATION # _ ( PARTNERSHIP Q#= LLC 0# COMPANY NAME: ADDRESS - CITY �-t -__ _.YAC V� _ � STATE[-__ ZIP ®1 6_ . TEL � _..- � -- -- _ FAX CELL. -REMAIL ,..__......� :� e --- - - ----- - ----- = - -- r -- - T-� _ o o z N ❑ } W IL Iii w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kvi 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/OrganizatiorAndividual): LA q TA! j Address: 94 ma4v. S k— City/State/Zip: k30ZL — e V,," Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 7 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] f employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Elec ' 1 repairs or additions 11. lumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other "Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: L_4- 4:V1 Tiel- A Policy # or Self -ins. Lic. #: tai/ �C4V_1_ / Expiration Date: Job Site Address: Sey),City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert un randp alties ofperjury that the information provided above is true and correct. Si ature (�Date: 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 #: I - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person.in the service of another under any contract of hire,. express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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 retained 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 permithicense number which will be used as a reference Dumber. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: , The Commonwealth of Massachusetts Department of Industrial .accidents Office ofInyestigatitons 6.00 Washington Street Boston, MA, 02111 Tel, # 617-727-4900 ext 406 or 1-877:MASS.A.BB Revised 5-26-05 Fax # 617-727.7749 www.ntass.gov/dia Af *:r `COMMONWEALTH OF MASSACHUSETTS P► UMBERS AND GASFITTERS LICENSED AS A JOURNEYMAN. PLUMBER+ � ISSUES THE ABOVE LICENSE TO: ' t i 4�.LLLIa.:M. E GROVER JR s� l ,I t.9`.: 3aLEM ST W 1.$URN MA 01801-3119 I . _ 18514 05/01/14 164294 ' Fold, Then Detach Along All Perforations �I w COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS LICENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: I WILLIAM E GROVER JR 7.59 SALEM ST WOBUR_N MA 01801-3119 9.436 05/01/14 164293 Fold, Then Detach Along All Perforation4 w LOCATI^:: " --- — ONLY. A A6C: WILL AF n -11RE AN INSTRUMENT VEY- L�1� �'rV ;EfA;`.�� i i 1 l 0. _-T �E Scale: 40 •�S `s '� CP .� LoT cD/-\A a TOWN OF NORTH ANDOVER. PERMIT FOR WIRING This certifies that. ir—:TP� s?�,?�Q-- L'/�'P�'`'r'' /....... . has permission to perform /'`— wiring in the building of . �l! .? �' "� A! ..................... at ....... .Gi, ! ...... , N"INSPECTOR Fee .�.`-� .tic, No.. ELECTRICAL Check# 33 .l Cansnwruuoahle of Ra33achadoUd Official Use Only tt�� cc77 Permit NO. .1Jefrarfnu�f� o�:.fira �oruicfsi ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11071 (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)7V RVK OR TTP. City or Town of: IZ By this application the undersigned g Location (Street & Number) Owner or Tenant Owner's Address LOTION) Date: �P _00V — To the Inspector of Tfl fres: or her in tion to rform the electrical work described: below. Is this permit in conjunction with a buildini permit? Yes Purpose of Building - �` 1c1 1v4�� Uti Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Telephone No.W5 3 7" 64,19 No ff (Ch eeltAppropriate Box) Iity Authorization No. Undgrd ❑ No. of McCcrs Undgrd ❑ No. of Meters ` -I. No. of Recessed :Luminaires No. of CeiI.-Susp. (Paddle) Finns N°. of ; Tatal Transformers IfVA.' No, ofLuminaire Outlets No. of Hot Tubs Generators I ICVA No. ofLurainaires Above ln- Swimming Pool rad. � nd. ❑ n. -o +mergency ig Eng: Bane ` Units No. of Receptacle -Outlets No. of Oil.Burners FIRE ALARMS No..of Zones No, of•Switches No. of Gas Burners No, ofsDetection and , InitiatingDevices ' No. of Ranges .. .. No. of Air Cond. Total Tons No. of Alerting Devices <, g No. of Wnste Disposers IieatPump Totals: umber Tons K o. of elf- ontained Detection/AlertingDevices No, of Dishwashers Space/Area Heating ICW unicipnl Local ❑ ❑ Other Connection No. of Dryers Heating Appliances Icy Security Systems: No. of Devices or E uivalent No. of Water ICVY Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromossage Bathtubs No. of Motors Total HP Telecommunications Wiringg:: No. of Devices or E uivalent . OTHER: 11 oath additional detail if desired, or as required by fife Inspectorof fJ ires. 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: --Unlesswaived-by-the-owner no -permit for -tile -performance of electrical work -may -issue unless the Iicensee provides proof of liability insurance including "completed -operation" coverage or its substantial equivalent:- The undersigned certifies that such cove ge is in -force, and has exhibited proof of same to IH6 permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I cert 1, under tlfe pa trs afrd penalties of perjury. , tltaf the infanitation this op 11 canon s true anti coMplete If'IRM NAMI;cServicesLIC. NO. A-5217 -Licensee:. Pasquale A. Ahbrandi Signature LIC. NO4. (Ifapplicable, erffer " »p " in �e !ic se r un er nQ.1 Bus. Tel. No.. q78 47 s1 Address:. 70 refile ve oar , A,illerica MA 01862, Alt. Tel No.: *Per M.G.L. a. 147, s. 57-61, security work requires Department of Public Safety '`S" License: Lic. Tto. OWNER'S'INSURANCE WAIVER: I am aware that the Licensee does not tante the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check; one) ❑ owner ❑ owner's a eat. Owner/Agent PERMIT FEE. S Signature Telephone No. I -TZ Oe'y WOOP Lo—r- i I A LOCATI.C': _7 BASED 'C ONLY. A WILL RFOUIRF AN INSTRUME Jut- LAU�2EETIA-": — f-2. -:�-�'T F" I—e-1- 1. 'k L\. Scale: ('1 — 4d J J Q IY O O J L� 0 Z N LL) V) O Z C� z_ H X w 0 0 0 U O O c0 � (9) 'j Fes- W N Q O V) O LLLI x U N z Q C7 = Z F- H _N N O X --3 w w Z D Q w w V) O C.7 Z F= X w I 00 U N w X O Clf J N- J w0NQ 0 F- z 00®w �= :0 W J ~ a Jm� MOM nww0 Q cr- w a_ (n Q F-. O Qf C) J 0- W z r') O C� O w Z N > O V) 0 c N fy_ w Q Z N O O N N N cr w m w U w 0 2 D - Z O o>3 Z s U) O C) o Z U O } Q W O - W (0 afm w V) w LLO Ow H ,ZL U� V)w Oa Z_ U 0 0 z g0w Q N C7 = z Ld V) . OfLLI w i z n w x� 00 w 00 NWS N W LO L'i N Z LLI J X J 73: N Ln U3: 0 0 0 U O O c0 � (9) 'j Fes- W N Q O V) O LLLI x U N z Q C7 = Z F- H _N N O X --3 w w Z D Q w w V) O C.7 Z F= X w I 00 U N w X O Clf J N- J w0NQ 0 F- z 00®w �= :0 W J ~ a Jm� MOM nww0 Q cr- w a_ (n Q F-. O Qf C) J 0- W z r') O C� O w Z N > O V) 0 c N fy_ w Q Z N O O N N N cr w m w U w 0 2 D - Z O o>3 Z s Location ,350 No. -3 C) 5 4` Date 10 — 5- U -'- TOWN TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 33 0 Foundation Permit Fee $ Other Permit Fee TOTAL Check # 5-5 4 T- 330 --- Check 30 --- 16056 0 M` � Building Inspector 1• X !, O z M go O ic r v M r r z Q TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING .. t § ./i a -: e�ayV•�y,,,����, 'i/1YC ,tet [ W �i:�Ila ,�"gz�v�- OWN BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: Building Commissioner/In r of Buildings Date SECTION 1- SITE INFORMATION . 1.1 Property Address: Q SO $% W, 1-7NDuvdA1 1.2 Assessors Map and Parcel Number: Map Number Parcel Number ��yew46ti 1.3 Zoning Information: +- * Zoning District Proposed Use ✓����,: 1.4 Property Dimensions: 5ez, $-g6 2 W. 1Sd Lot Areas Frontage fI 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided e., /Z7 1.7 Water Supply M.G.L.C.40. 54) Public n( Private ❑ 1.5. Flood Zone Information: Zone Outside Flood Zone 1.8 Sewerage Disposal System: / Municipal ❑ On Site Disposal System H SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Address for Service Signature Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: i�d f�?>I1Lr.� Q ES tvtc�,✓9 Licensed Construction Supervisor: i 3/yPL�la7 I /. ,yG. Address S gnatur �f,-Do&I-ti mil , d/,fYS� Telephone Not Applicable ❑ CS, 07AY87 License Number Expiration Dat 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 1• X !, O z M go O ic r v M r r z Q SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......0 No...... A SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t�'X/�Ariio✓ O �11l�oc*,✓r /r�y� / f j't0&A SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant b"FFICIAI «rs USE` (3NI Y " 1. Building ;Z S 0'no -V� (a) Building Permit Fee Multiplier 2 Electrical o2'Poo. W (b) Estimated Total Cost of Construction 3, v ©O° / 3 Plumbing Soo ao Building Permit fee ($) X (b) 33 4 Mechanical HVAC coo. C,® 5 Fire Protection zs"�. 00 6 Total 1+2+3+4+5 © Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, 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 Signature of Owner/A ent Date Im IBM_ NO. OF STORIES SIZE 1,2, A BASEMENT OR SLAB J✓ '' re 4,0 se Jr 6aw. SIZE OF FLOOR TIMBERS is 2:k 2NU 3 RD SPAN DIMENSIONS OF SILLS 0jr6" DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS — HEIGHT OF FOUNDATION i.cozf m.Aot THICKNESS IeA' SIZE OF FOOTING U '" X �o " X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ef £S FORM U — LOT RELEASE FORM 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,/I�/�,✓� PHONE 6 qac -GYP LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET J SG ST. NUMBER �!� ************************************OFFICIAL USE ONLY*********************************** I RECOMMEfVD zCONSERV ION COMMENTS TOWN PLANNER COMMENTS F D INSPEC OR -HEALTH I `'^4� ENTS: IATOR DATE APPROVED/ /, DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED k DATE REJECTED COMMENTS C D PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9\97 jm TE 172:0' LOT 104 EXISTING FOUNDATION TOP OF FOUNDATION ELEV. = 109.6' w LOT I �rA v in SEE PLAN N.E.R.D. 7879 FOUNDATION LOCA TION PLAN CLIENT: MESSINA. DEVELOPMENT THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. . LOCATION: LOT 10A SUMMER, STREET NORTH ANDOVER, MA. LOT 9AA 1.3' •� e tj CAR G e-Aj- 1 lT� t� 31.1' 95.9 23•09MER STREET SSM I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMEN73 OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CER77FICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS, WETLANDS,EASEMENTS ORDERS OF COND1T10NSETC) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOV£.EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISRANSEN A• SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MA17ON CONTAINED HEREON. SCALE: 1" = 60' DATE: OCTOBER 16, 1995 CHRISTIANSEN 9,SERGI PROFAND SURVEYORS 160 SUMMER Sr. HAVERHIL L MA. 01830 TEL 508-373-0310 @1994 BY CHRIS77ANSEN & SERGI INC. 33 ti � . J•f DRA WING No. 95033001 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name `�9�7'fN�r✓ QUI®,�� Location: City Na AN -00&'5A 011 Phone # �7��6�S�29s1 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City Phone #: Insurance Co. 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 fine up to $1,500.00 and/or one years' imprisonment_as welLas-civil,penattiesjnlhelmn d -a -STOP WORK.ORDER..and_a fine.of.(.$1-00.OA)-a-day against -me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pgyjond penalties of perjury that the information provided above is true and correct. Print name P_hone.# ?7,F-6- ,2951 Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing El Building Dept ❑Check if immediate response is required Q Licensing Board p Selectman's Office Contact person: Phone #. Health Department Other I:9 0 BOARD OF BUILDING REG License ; yCONSTRUCTION SUPERVISOR „3" NumbeF GS 072487 Trimo:19067 '' Adr�inisttator . North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11,S150A. The debris will be disposed of in: ,�'aA,44✓r-P" �itiucG �CL.Cj Q<�(�Orf,4L — o4ler®L,_/ r9 (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector 7 0 �¢ w W a( w° TO V) a C/) 9 w z r.o a w° T E U w 04 � ao' ro w aw, U W g2 cis m w � coG w w a G m o cin o cn /6 .5 0 M� c Z CD L co co ts VY V V C ' O C m E a m ,moo m N W m jqC m O O ' ev m o 0 CD V v1y��CD 44 LA = o on CQ Qcoa :mor m �>Z o :evow Q, t5 i 0 CL c Q m c o = m :CDN o� m z COD c o Im NL= O C Z `r o •N O LAJ u CD oma= Va s _i m� O� 2ca m C, rA O a._... m i a CO O co O V Z O d O y o ICID o, � O CD CD CL co O O O m O d CL CMa H C � � C cv 'a O o Z c. LD CIO C CL CA LL) 0 LLJ W W w Location 31-0 �V wafer No. 71r Date 1>16 NORTH TOWN OF NORTH ANDOVER Certificate Occupancy $ of ��ss•►cMusE Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ a Check # 15677 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING --:,:.y ..:• •�' >rF.. ., ,ray$, i�i..> �£T.``.• Y�Y .. '"�'k BUILDING PERMIT NUMBER: DATE ISSUED: C� SIGNATURE: Building Commissioneo to of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: S �50 SUry�'e2. sr 101A (o 2 - Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use LA Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Rapred Provided Recmired Provided 7 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSIUVAUTHORIZED AGENT 2.1 Owner of Record ,r•.�ie S�- Name (Print) Address for Service &82 —0 F Y gr Sign re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES - 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 6s, 0-7.2 :K k % License Number Address ' �5ate� y Expiration Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Si nature Telephone ou M X ic z O J� i l e r 90 O onr M z^ YI SECTION 4 - WORKERS COMPENSATION (M.G.L. C 152 6 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 rmit. Signed affidavit Attached Yes .......❑ No ........ ❑ SECTION 5 Description of Proposed Work check all applicable) New Construction [IExisting Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition [I Accessory Bldg. ❑ Demolition ❑ Other Specify 64-fj/„d0,1 1,✓,rsR-Cca9r;0✓ ' �AJFev�rf Brief Description of Proposed Work: 71rIY611/4- ek'XE4 /s/Q�Iry� O.✓� �.Yf� [+vA`G y Jf9¢e r3.'re XA.10 0"e -"-(A;` , 'rvl t�/eC tl7�c''t tiaei ,�iA' ,�yN.,r��.✓G SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost Dollar to be (Dollar) Completed by permit applicant ICIAI; USE ONLY 1. Building Spa, ep (a) BuildingPermitFee Multiplier 2 Electrical SoG, °a (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a) X (b) �- 4 Mechanical HVAC^ 5 Fire Protection 6 Total 1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZAT ON TO BE COMPLETED WHEN OWgN�E�RS AGENT OR OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 9 y A N C— A4 _k as Owner/Authorized Agent of subject property Hereby_ authorize "ATT-- L3 M t? D to act on My b i, in all matters relative to work authorized by this building permit application. Sigiireofoer 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 I'JA1JC.-/ nL1 (VgfUtur6) Pi Name , Si ature caner/A ent NO. OF STORIES Date �e SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DRAENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHRANEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ;t" i D. Robert Nicetta .Building Commissioner (978) 688-9545 (978) 688-9542 Fax Please print DA Town of North Andover Building Department 27 Charles Street North Andover, MA. 0184, HOMEOWNER UCENSE EXEMPTION JOB LOCATION Number Street Address -17A I IG2 Map / 1 t "HOMEOWNER �c {,� fJ N G `f e3 -CA Yob � _l73- 67 1-M Name Home Phone Work Phone PRESENT MAILING ADDRESS City Town State— Zip Code The current exemption for "homeowners" was extended to include owner-cccupied dwellings of 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 Budding Code Section 108.3.5.1) .DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is irrtended to be, a one or two family dwelling, attached or detached structures ac- cessory 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. 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 No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements t HOMEOWNER'S SIGNATURE T - APPROVAL OF BUILDING OFFICIAL Q s? asr.I.•i° Gz OU -a O w cu Cl)v v v) O A '10r.a r.�, p w O w C U w � U w p u: G w" O W u a W O w y cn G w O z d O c4 m G w W A a w\ c 7 cn z i cn o v o cn o `m c o O N C O V V 67. C R e0 := O o e m Ea c 1r r m O Q.ct rUS 0 4D :CD E m �. O N s 6m 0.5 N C �: c 0 s cO Em o_ V m m ' IM = 0 C" mit �• N 60.1 H Z O .: c CCL o c CL.— 0O2 3 N Z r r co* a = C •c Z =r .0 COO L3 COD•m` 0 10 O CM F¢� 6A CL m - O � _ � ` h �� O 1— t dwm �lm O O O 0 c crisZ is H MA E ct CD C 0 w cc CO) O V H cc C _cc �. h cm mm Q co 3 'O co CL L LC. Q C. Q: Q C *"It C Z CID co C. CO2 C 0 cl). LLl U) w w WLLJ Location 3�5-© :Sv isi ko-er '54- No. 5 -No. SR Date NORTH TOWN OF NORTH ANDOVER O�"'O :•,ti0 Certificate of Occupancy $ Building/Frame Permit Fee $ SwC Mus Foundation Permit Fee $ Other Permit Fee -Pvo) $ ! `� TOTAL $ Check # 151G/ zg /i'i c�^" Building Inspector I 77, TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING This Section for Offi d -Use Oil '' BUILDING PERMIT NUMBER: 5 Cx� DATE ISSUED: oa00/ SIGNATURE: 1116eu �C-'— Building Commissioner/1for of Buildings Date SECTION I- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: a?ld l47 h141 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area (sf) Frontage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided 1.7 Water Supply .1t.G.L.C.30. SJ) I.S. Flood Zo Woruution: 1.8 S:7c Disposal System: Public i private 7 Zone Outside Flood Zone ❑ Municipal � On Site Disposal System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record z 0116 Name (Print) Address for Service : 7 a O nate Telephone 1 9'7�-5 2.2 Owner of Recor Name Pritt Address for Service: Signature Telephone SECTIO43 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Con truct n Supervisor: License Number Address �% t T,/i:�I, Expiration Date Sign re Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ 6a-�ll� cl. �irie �— Company Name Registration Number % Address Expiration Date ture Telephone rn X z O m t O z MMrn 7� O D r Cv G rn _r ^Z 0 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 a Kcable New Construction ❑ Existing Building ❑. Repair(s) ❑ Alterations(s) ❑ Addition ❑ . Accessory Bldg. ❑ Demolition ❑ Other Specify Brief Description of Proposed Work: Ile SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant OMCIAL USE ONLY . 1. Building (a) Building Permit Fee�r®�4 Multiplier � ®p 2 Electrical (b) Estimated Total Cost of Construction ! etc) D 3 Plumbing Building Permit fee (a) x (b) �. 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) 7 O Check Number SECTION 7a OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Oorized Agent of subject property I i%%1 J73� e3� q wner/A Hereby authorize /l�f ���/ 45 to act on My be it f 1 matters r lative o work authorized by this building permit application. SiSi natt�lt Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION as Owner/ uthorized Age of subject property Herehv declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief yam/ J Print Name Q /J d.3 EI 7AZ0 0 Si at e Ow r A ent Date —� NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 1 ST2ND 3RD SPAN DIMENSIONS OF SILLS DIN ENSIGNS OF POSTS DIN ENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CFENINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM - U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICAN �% Ax PHONE ASSESSORS MAP NUMBER LOT NUMBER /r1714 6110 l SUBDIVISION LOT NUMBER !� STREET`/'i1s J� STREET NUMBER. OFFICIAL USE ONLY ftECOMNMNDATIONS OF TOWN AGENTS YDATE APPROVED It, -)115161 CONSERVATION AD STRATOR DATE REJECTED COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECCTTO'R'- HEALTH DATE REJECTED /f DATE APPROVED -,3/-,/!7 o i TAC INSPECTOR - HEALTH 1 DATE REJECTED I - COMMENTS D��I zs - o /'`' 102cJ O KCL Sfis� t PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE 17?= LOT 11A -s SEE PLAN N.E.R.D. 7879 FOUNDATION LOCATION PLAN CLIENT. MESSINA DEVELOPMENT THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: LOT 10A SUMMER, STREET NORTH ANDOVER, MA. LOT 9AA 31.1' 95.9 EET S 23•0 SUMMER TR I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMEN73 OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CER71FICATION DOES NOT CONSIDER ANY OTHER RESTRIC77ONS SUCH AS COVENANTS, WETLANDS.EASEMENTS ORDERS OF CONDITIONS.ETC) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE.EXCEPT W17H THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIB1TED.CHRIS77ANSEN A• SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MA77ON CONTAINED HEREON. SCALE: 1" = 60' DATE. OCTOBER 16, 1995 CHRISTIANSEN SERGI PROFESSIONAL ENGIN ERS LAND SUR160 SUMMER Sr. HAVERHILL.MA. 01830 TEL 508-373-0310 © 1994 BY CHRISTIANSEN A: SERGI INC. 133 1a1 ","'-DRAWING No. 95033001 Z 4 o +ct h i v l ! a J V n"F i. • ;.••'r' • • .� ;:� ',�;f ti";� Vii, A ,, 1•� �/ 1 ' E�IJ !k• tl • • w' t olI �y V n"F Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Mr � nr•atinn• � J 11 (/�1�96.'11�,. �i i" / C. .t�/�''' �G�%dJ'�/ City/'�' %�'✓` dr y J XA . Phone �� � �3y— %d�3 am a homeowner performing all work myself. �1 am a sole proprietor and have no one working in any capacity I am an employer iproviding workers' commp�ensation for y employees working on this job_ compgny name: Address Ci Phone#: 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 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a rine of ($100.00) a day against me. t 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 the pains and penalties of perjury that the infonnalion provided above is true and correct Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' Building Dept DCbeck if immediate response is required Building Dept 0 Licensing Board 0 Selectman's Office Contact person:_ Phone #: 0 Health Department 11 Other FORM WORKMAN'S COMPENSATIOM ACORD CERTIFICATE OF LIABILITY INSURANCE *� DATE / 03/166 /200200 1 PRODUCER :(603)893-9450 FAX (603)893-9480 Lakeside Insurance Agency, Inc. 88 Stil e,s Road Salem, NH 03079 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURED South " Shore Gunite Pools 7 Progress 'Avenue- Chelmsford, MA 01824 1 .. INSURER A: Valley Forge - INSURERB: Transcontinental INSURER C: Transportation INSURER D: American Home Assurance. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD/YY LIMITS GENERAL LIABILITY C143430331 04/01/2000 04/01/2001 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $ 100,000 CLAIMS MADE ® OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 A X B7 kt Addl Ins GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY017R0 PRO LOC AUTOMOBILE LIABILITY 1057229951 04/01/2000 04/01/2001 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 BODILY INJURY - -$- - ALL OWNED AUTOS B X SCHEDULED AUTOS - (Perperson) _ BODILY INJURY X HIREDAUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE - $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS LIABILITY 182102948 04/01/2000 04/01/2001 EACH OCCURRENCE $ 1,000,000 OCCUR FICLAIMS MADE AGGREGATE $ 1,000,000 C $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 0652-00-02 04/01/2000 04/01/2001 TORY LIMITS X ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Covering Installation of Swimming Pools and related operations of the insured during the policy period t: Szypszak Residence-t�SO—Summer_Street,_NortFi Andover, MA VCR I Iris m I C nuLUCR ADDITIONAL INSURED; INSURER LETTER: VPIIYVCLLA I IUP1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Town of North Andover 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Attn • Building Inspector BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 27 Charles Street OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Jose h Rossetti/USER39 ACORD 25-S (7/97) UAV- iG7Q'%cQQ_0Cd1 ©ACORD CORPORATION 1988 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. cc w ox.. LoLL ®o L Op s � - 1 w Q _O 1— 7 0 chi • V \NG� 0 O��" —� CO W W Q Z U-) z W 0) m ti c*� o _ ao CD 0Q W O 0000 2v� JW�� ��xco �� W O w W Y mz Y mZ o> Q W O �=Zamo J Zy U- W O J LL - Z Z Z, O0 Z JOzogow s� Q Q Q»»» X31.10'-�. Z F- _ �zzzzzz �1. F- 90 0 0 l W ZW U ER S -T P'ee 0 z Q aco OU z w o v E Uw i O a m w W w w W ao' vi m w O w C7 :jn a0' ' W w G cc z cn v o cn C 0.— W O 0 O O •E m m CD 0 CD O O O O O d o- a ca O CrL-+ CcC v J •O •O. OCD� c Z v CO) � C Q. 0 U) LLJ0 w W crW o m c Z c C2 c` : O H ' O v u d C � ea eD O � E Q �► im m .o H O cc w, �E m m �: am. C �• a m c c ea 2: A m CD � c m "m'z o. o� Zoao es CO)MD Z •go U O cc E d= C 0-00H Z o v m` cmc g CO) a m� Z eya _ ` HBO c =A CL.- CIO :10 C 0.— W O 0 O O •E m m CD 0 CD O O O O O d o- a ca O CrL-+ CcC v J •O •O. OCD� c Z v CO) � C Q. 0 U) LLJ0 w W crW v s v. f rA O t-o�, O z O r� r �C C 'F' .m r wt O cc 0 CM< O h -p N O_ C , O C Cc V V f v �t fl, c . O W WCD m C ••+yr s`. Z v N EQ D. m f V C .. m c N j.:Ec i� O E CIO w� E > co Q L C CL v x} 0 v w p w ca 1 1 w A r J z" Wcc z` Q x v E A a � a � � ,� .. ,, ,tea o u� �- Q as u bcz O v O O Cp C p' v C C's p C p O w cn w r� U w n' w cn ii w w w cn cn O z O r� r �C C 'F' .m r wt O cc 0 CM< O h -p N O_ C , O C Cc V V f v �t fl, c . O W WCD m C ••+yr s`. Z v N EQ D. m f V C .. m c N j.:Ec i� O E CIO w� E > O z O r� r �C C r Oi ui cc 0 CM< W W I� h -p (� h , O C Cc I� II f v J 'aw+ , WCD 9 N! CO . Z v D. f V C c i� E co Q L C CL 0 CD cm a? o c ca 1 1 r J Wcc O z O r� r �C C r Oi ui cc 0 CM< W W I� h -p (� h , O C Cc I� II f v J 'aw+ , co 9 N! CO . Z v D. f V C c C �C C d 0 C GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW , POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps k Damproofing Foundation drain - pipe/stone/fabric filter/cover and outlet connection. FRAME- Fireblock - over girts/plates,between floor joist Penetrations for plumbing, heat, elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing, at rafter cuts. Hip and Valley rafters - watch bearing at walls. 'Ridge & Hip - Provide proper`connections. Cathedral roof rafters provide proper connections and use "Hurricane Clips" tie to plate. Stair stringers - watch cuts and h4� ,'support. • .Joist hangers - fully nailed w/ hangar nails. Sill plates 2-2X6 (1 PT) w/sill seal Girts'= solid brick or steel plate bearing at,foundations Y " air space at sides in foundation pockets. Lateral bracing at ends, Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers%Beams etc. Check headroom clearances -stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0° clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: , Natural tight equal to 8% of floor area. '/ of required glazing shall, be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents.. Firecode under stairs if used for storage FIREPLACES: Separate permit required" Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. /y DECKS: Separate permit required: ` Lag to house, provide flashing. i Rails min. 36" high, Baluster max space 5" on center. Over,.8' above grade, use 6x6 posts w/lateral bracing. ' Lag all posts and rails. • ,„ • Pier footings down 48", Conc. pad at stair base. . FINISH: Handrails returned to wall/newall post. °y p Guardrails required alongside open- cellar. stairs. Exterior grading complete. , Certificate or occupancy required prior -Jo occupying -structure. * $ �. Temporary Stairs required for inspection. I .fi Re -inspection fee - $25.00 (Be Ready) Zertikate of occupan6V.regiuin@d prior tA,o&upyinQ stfubtti f,fi �r" - ,: �� , fir' ,�a,� • , .� 1. v , - Lateral bracing at ends, Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers%Beams etc. Check headroom clearances -stairways, under beams Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "0° clearance fireplaces & stoves Window Schedule or Every Habitable Room Must Have: , Natural tight equal to 8% of floor area. '/ of required glazing shall, be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents.. Firecode under stairs if used for storage FIREPLACES: Separate permit required" Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf. /y DECKS: Separate permit required: ` Lag to house, provide flashing. i Rails min. 36" high, Baluster max space 5" on center. Over,.8' above grade, use 6x6 posts w/lateral bracing. ' Lag all posts and rails. • ,„ • Pier footings down 48", Conc. pad at stair base. . FINISH: Handrails returned to wall/newall post. °y p Guardrails required alongside open- cellar. stairs. Exterior grading complete. , Certificate or occupancy required prior -Jo occupying -structure. * $ �. Temporary Stairs required for inspection. I .fi Re -inspection fee - $25.00 (Be Ready) Zertikate of occupan6V.regiuin@d prior tA,o&upyinQ stfubtti f,fi �r" - ,: �� , fir' ,�a,� • , .� sMioM oilgnd nip _ �oloadsu� 6uip�ing Qltld 00'4LS`t BSS /£4 -- Q S $ ldlol $ aad uoijoouuoo Jo}eM r $ and uoijoauuoo James $ aad IiwJad a9y30 , $ aad ;iwJad uoilepunod aad Iiwiad awead�6uippEl c°t; . ' o .-� $ �(ouedn000 }o a}eoilipao ......... U3AOaNd HIHON AO NMOL , 'ON aped S L Location Su, rn t Vi' No 'U::� Ll�� �� Date F°*Tpf TOWN OF NORTH ANDOVER °L F pCertificate of Occupancy $ �o Building/Frame Permit Fee $ 5 • tl 'ss„CHUSE<h -Foundation Permit Fee $ l'✓ m f - 4 erWFee $ Q `Sewer Connection Fee $ Water Connection Fee $ TOTAL $ aZ3 vC, 017 %/ Building Inspector C v 54 1 Div. Public Works. ~ Location. No: Date iN°"Th TOWN OF NORTH ANDOVER o?o. Certificate of Occupancy $ r Building/Frame Permit Fee $ Foundation Permit Fee $ Q� 4." �, sAGMUs - 3 Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $JZ) Building Inspector 29/13<io 150.00' . PA ID $810 Div. Public Works Location Date. TOWN OF NORTH ANDOVER - A _ Certificate of Occupancy $ * # Building/Frame Permit Fee $ a. SSACMtiSi Foundation Permit Fee. `" $ - Other Permit Fee $ Sewer Connection Fee $ g Water Connection Fee $ TOTAL $ r ding I spec 09/28/95 �,3 11, 1.077.50 PAID !k -'j Div. 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C4 cn U. S J Q Izuj O Y r P O J Q Co _z LL- LmF— O c G O s U V `D uj Z Q ' ^ C4 C Oca LAJ O Q1 O W ca � ¢ LU LU m d W m C yC� ' �_ m LU z w > i co LU cr- D m : =Q p �c E pm. �mm a i Co O N Cf O O N cyy o Q o ! L = co N m O O m ea o J Q D -J Z •a c a� �• L '= O CA c Z ul V�/: CA pC L •C 0 VN O i CD C.3 CL tj O R C H• ¢ m fy O C C m mL 3 N CIO CD N m r0+ �••' m ev L m W W C �....�_-. .., c O m = N N R 0= O.L _ Z � E m 9: � o 40== Z z CA = Q' R m O q H 0 Z LU w G. «L. CO Y r P O J Q O E _z LL- LmF— _C V uj Z Q � Oca O Q1 O W LU yC� ' �_ m LU z w > i O co LU cr- C13 O � O i Co O Q i cyy o Q co O {-' c J Q cv -J Z •a c a� c Z ul z 0 CD C.3 CL R C cr_- w y co Z z � Z LU w Cly FORM U - LOT RELEASE FORM 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 local or state law, regulations or requirements. ****************Applicant fills out this seection***************** APPLICANT: CSS/ (/ CD,,eJ Phone 470'99TZ, LOCATION: Assessor's Map Number _Z0.12h4 Parcel Subdivision F A-V -A Lot (s) /4 14 Street SLA m me )2 Si1<�r- T' St. Number 5.6 ************************Official Use Only************************ RECOMMENDATIONS O� AGENTS: Conservation Admin�is``trator Ir Comments v f) 1 G1� Town Planner Comments Food Inspector -Health C O' Septic Inspector -Health Comments Date Approved I,-- Date Rejected Date Approved qS- Date Rejected TA I Date Approved Date Rejected Date Approved Date Rejected Public Works - sewer/water connections -IZJ--W g'�^�l - driveway permit '17�bc) 9-6 45 Fire Department y, Received? by Building Inspector SEP 7 1995 Date ,4*1� LOT 1 1A N 959 REEL, 23.09 UMME.R S? SEE PLAN N.E. R. D. 7879 S . STRUCTURE SWN -FOUNDATION LOCATION PLAN THE HTORIZONTALFY THATTHE SE78ACKPRIARY REQUIREMEN73 OF THE LOCALRMS TO APPLICABLE ZONING BY—LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY 07HER RESTRICTIONS SUCH AS COVENANTS, WETLANDSEASEMEN7S, CLIENT. MESSINA DEVELOPMENT ORDERS OF CONDITIONS,ErC.) HIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY THIS CERTIFICATION IS MADE AND LIMITED PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT WITH THE . WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. TO THE ABOVE CLIENT. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBI7ED.CHRIS77ANSEN A• SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR— MA77ON CONTAINED HEREON. LOCATION. LOT 10A SUMMER, STREET NORTH ANDOVER, MA. �H Of Stgs J9 va SCALE. 1" = 60' DATE. OCTOBER 16, 1995 0� M AEI. J. RGI E, • CHRIS TIA NSEN rK SERGI PROFESSIONAL ENGINEERS — LAND-SURVEYORS _ 160 SUMMER Sr. HAVERHILL,MA. 01830 TEL 508-373-0310 © 1994 BY CHRIS77ANSEN .d• SERGI INC. DRAWING No. 95033001 - .� 104_ . . J i.. t - ' 31' LIMIT. OF .EXCAVATION TOP SOIL AND-SUBSOI! 5,_ AROUND LEACHING Z5 25'36D-EOX, it :.\ ;•,. .'.a '��� ;.\.000,,�- ',,\ . \ \,, \ •� 6. _ TP i at Ole N � .'r \~. F�. 1 3Gr .�OR 0 WA TER •.zs ' _ t SERVICE 9 2 59 k.. 02.52 F,, RE:N H.P. NELSON Dirmor BCILDI.\G CONSERVATION HE aLT14 PLANNING I _ =Town-of __ - -: NORTH ANDOVER •�•�j OIV6IO:t OF - - PL NNING & C0NB1 i%= DEVELOP'.YIENT i . to 120 Main Street. 01845 (508) 682-6433 CHTMMY APPLICATION AND PERMIT DATE %/tel PERMIT T LOCATIONe �T OWNER'S NI AI.1E' �v-� ��� iAJ A bf A� BUILDER'S NAME ( o 6 M /J 14 MAS ON I S NAME --g p rl tQ AA S :Fl e L 10 ML�_cON I S ADDRESS H NE INTERIOR C 7-:2idEY GIc EXTERIOR C ._:LVET �✓ /L!C.IGi� Nt: i t .- R ii: i D S i'r E �i' i T:i=C:C':ESS OF will have C\ T.T LJn 1 or f' =-e re��ireents c� t e cede a -d rules and e=_. -eceivec 12-fy- SIG�:ATURE OF 1AASON O COivTR. LIC. 042,_; 1 EST'. CONSTRliC:10i7 C^S PER:• . GRANTED RCBE RT NICV77' , BU:. -,;S.:,: = �c yi REMARKS THIS P-,.--tMIT. 'MIUS7 BE DISPLAYED ON THE PR=IS-S �` N CERTIFICATE OF USE &OCCUPANCY . , Town of North Andover Building Permit Number 458 (1995 ) THIS CERTIFIES THAT Date MAY 28, 1996 THE BUILDING LOCATED ON 350 Summer Street (Lot #10A) MAY BE OCCUPIED AS Single family dwelling w/2 car IN ACCORDANCE garage WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. CERTIFICATE ISSUED TO Messina Dev. . Co. 44 Great Pond Dr. Boxford, MA ADDRESS ildin Inspector 0 z 4 CD V. ti CO c p vi co := z cc c D �v Z� L RR�m c V� :CD o �C VR0CCD~� CD g g .. EQ W= ,m. C W r m o e �CD :tea ^^^ SN EE n wJ s mm a L � c �, T ✓.CD N c� CD J N C_ :c = C C y R O N m � c N m ; c, •j AY�� c :o Lam: C y a 'acs � row m c-, C5Cc 0 Z o F- m y c C m = m c� C N F- o o F- m LJJ G •0 + �V! cc F- N oc �E V V N o V i cv= c a o Z eyo - .0 H O r- $ CL, m � �_] H O U 0 :z Q U) �• pG � cb Q u� apA E aG cn D m e °�° 'O a `� U 14 �+ �� O Q w z v o n O v w cn p w U w coo W 5 �, cn w rL v O w cn co ti CO c p vi co := z cc c D �v Z� L RR�m c V� :CD o �C VR0CCD~� CD g g .. EQ W= ,m. C W r m o e �CD :tea ^^^ SN EE n wJ s mm a L � c �, T ✓.CD N c� CD J N C_ :c = C C y R O N m � c N m ; c, •j AY�� c :o Lam: C y a 'acs � row m c-, C5Cc 0 Z o F- m y c C m = m c� C N F- o o F- m LJJ G •0 + �V! cc F- N oc �E V V N o V i cv= c a o Z eyo - .0 H O r- $ CL, m � �_] H O U 0 :z Q coo T Cc O Z {Q.. w Cc , o y �. } c z F- cm o LL CO)ICD c o _ > cr Q H m m u z > CD o CD C) c co O � co coQ L o Q co C -p o cc Q •p_ y Q CO Z V Q LL c CD CO) �z cc Q Ca m _ LL Q CO) C3 a z z cr- Z Q LL ri.cr Location - y 4 .�..` No.� V Date i 4 a Check # 15452 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �' / Building inspect Ir/ —.10 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: D DATE ISSUED: A / y� SIGNATURE: Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Map Number Number: Parcel Number ` "C ! `� J lJ Address for Service 1.3 Zoning Information: Zoning District Pr Use 1.4 Property Dimensions: Lot Area . Frontage ft 1.6 BUILDING SETBACKS ft 2.2 Owner of Record: Front Yard Side Yard Name Print Rear Yard Required I Provide Re4aired Provided Re Fred Provided 3.1 Licensed Construction Supervisor: 1.7 Water Supply M.G LC.40. § 54) Public ❑ Private ❑ Zone 1.5. Flood Zone Information: outside Flood Zone ❑ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSFIIP/AUTHORIZED AGENT 2.1 Owner of Record e (Print) Address for Service Si re Telephone 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone SECTION 4 - WORKERS COMPENSATION (11LG.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 ....... D SECTION 5 Description of Proposed Work check atl a licable' New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: CL) c-+ ;2Ck N rv, obi. 0 ?Ile I SECTION 6 - ESTIMATED CONSTRUCTION^COSTS I Item Estimated Cost (Dollar) to be Completed by permit applicant (a) Building Permit Fee Multi lien 1. Building O C r 2 'Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee (a).x (b) ` ^�- r 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number. SECTION 7a O,WNER AUTHORIZATION TO BE COMPLETED WHEN I OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behaalh in l matters lativgqb work authorized by this building permit application. Date 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 Signature of Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS IST 2 ND 3 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 I FORM - U -1 LOT RELEASE FORM S �� s .q_9_© INSTRUCTIONS: This form is used to verify that all -necessary approval/ permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance With any applicable requirements. Nossi is i.iils•/'i■-!!MINE ■a.i■ wags iias:■•'i!/!!a/.Now a i-s,swas -!/. WON MEN ass sii i i i a/!/i■ APPLICANT PHONE ASSESSORS MAP NUMBER LOTNUMBER SUBDIVISION LOT NUMBER STREET � `� - STREET NUMBER 3 O ��l■'i/!/.s•.1///■'a/.■•iississi■■■i.issaisiasi:IIsi-iii■aiiiiisiii■■i!/■'iiiii■■■■i'■ OFFICIAL USE ONLY .lil,isissii■i/../aii'iiii/a.■iaa■'!.■..Bassoons *noses M..iii.aaa i aia i/a.i/ i a a■■ iii l i.i s• RECOMMENDATION OF TOWN AGENTS //•aa■' a!'■islali/ •iii:iiiI/ LAZ&k T�� ).iii.fa.a//./s//Aa-■■.ii!/.///■!■/■lis/■i• ■■i■ /i■//■ DATE APPROVED Z e 7 KD CON VAT1ON AD TRATOR DATE REJECTED. COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED COMIVIQITS FOOD INSPECTOR - HEALTH ` SEPTIC INSPECTOR - HEALTH CONIlyIE1VTB PUBLIC WORDS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT CONIMIIVTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED RECEIVED BY BUILDING INSPECTOR DATE ea I r� CO) h r .r C 0 a� v co CL ey CL H _ 0 .a CO) .c.. O V m O co CL CO3 C ti c c m c o c p (� C N O �V V c d � d c c m CA= E E a,A "'11 o m y N • tom pG W Q o T a " .2 7 °�° T E m w 0, azo X. W a�' ci w U a z V °�° c�G w d A rr m O cn o cn CO) h r .r C 0 a� v co CL ey CL H _ 0 .a CO) .c.. O V m O co CL CO3 C ti c c m c o c p (� C N O �V V c d � d c c m CA= E E a,A "'11 o m y N • tom Q m�C,� y O: H C C �ce E CD cm CLL) cm CD 2 i = O o Of c cm v•�Z o r C G C F- Q m O O. y m C m_+ p Q = H p d O H m N W •+ G y m � iv Z m .+7t L .r •Go t C d C yCM Z o a 0-0 0 ti 0— z ca 4-a�m� CO) h r .r C 0 a� v co CL ey CL H _ 0 .a CO) .c.. O V m O co CL CO3 C ti 3400 Date .. �/:./ Z.-. G :... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies thatc( C-.�- r �? .... / ,� �% ............ . has permission for gas installation .../D. !\ .............. in the buildings of .....�........................ at ...... , ,North Andover, Mass. Fee. .�... Lic. No... ``7 l ....JAI- ....�..J �..... . INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00':. FiTT1N� (Print or Type) _ NORTH ANDOVER Mass. Date " wilding L6cation."�"5"0 Su.o,m er- St✓ Owners New -� ''1 Renovati��=Tj°Replacement FIXT(.CRFc `PlansLtllitted �j: ti r f - ME MEN N. EMENSEM N �■��0on�oon�s�■�■�oa■���� Ad 'a40 LU v; m r SEEN M MENSEMEMEMERNMEEN z No x 1 < to W 8TH FLOOR (Print or Type) Check one. Certificate Installing Company Name ANDOVER P, HG. & -HTG. C0 jN1% ,Corp. 2199 Address 20 AiEGEAN;'.DR. UNIT # 10 L] . Partner. METHUEN, NA. 01844 Firm/Co. Business Telephone: 978-685-8383 Name of Licensed Plumber or Gas Fitter GFORGF I AROSF Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [5;�j Other type of indemnity:ET Bond 0 Insurance Waiver: I, the undersigned, have been made ;awaFe that the. licensee. of this application does not have any one of the above tlit=ee'�insurance coverages. Signature of owner agent of property Owner : Agent 1 hcteby certify that III of the deuihs and information !hare submitted (or rntcrcd) to aboYe appttcattop atetrue a" acewate to the bat of my knowtedge and that aQ ptumbiq; work aW Inmilations yalotmc4 hdct'ratttit issued for this a pi+liotkttswW be is atip s vtith all rctO=t provisions or the h4ssachusetts State Cas We attd Mapta 142 of the General Laws, By Title City/Town: APPROVED (OFFICE use oNLY)' TYPE LICENSE:_ P er. Gasftter Master Journeyman re of Licensed )er or'Gasfitter ME MEN EMENSEM �■��0on�oon�s�■�■�oa■���� SEEN M MENSEMEMEMERNMEEN No 8TH FLOOR (Print or Type) Check one. Certificate Installing Company Name ANDOVER P, HG. & -HTG. C0 jN1% ,Corp. 2199 Address 20 AiEGEAN;'.DR. UNIT # 10 L] . Partner. METHUEN, NA. 01844 Firm/Co. Business Telephone: 978-685-8383 Name of Licensed Plumber or Gas Fitter GFORGF I AROSF Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy [5;�j Other type of indemnity:ET Bond 0 Insurance Waiver: I, the undersigned, have been made ;awaFe that the. licensee. of this application does not have any one of the above tlit=ee'�insurance coverages. Signature of owner agent of property Owner : Agent 1 hcteby certify that III of the deuihs and information !hare submitted (or rntcrcd) to aboYe appttcattop atetrue a" acewate to the bat of my knowtedge and that aQ ptumbiq; work aW Inmilations yalotmc4 hdct'ratttit issued for this a pi+liotkttswW be is atip s vtith all rctO=t provisions or the h4ssachusetts State Cas We attd Mapta 142 of the General Laws, By Title City/Town: APPROVED (OFFICE use oNLY)' TYPE LICENSE:_ P er. Gasftter Master Journeyman re of Licensed )er or'Gasfitter 3725 Date..`.? - /,-? - 1 2-- ........................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING CI :lr�/ I !, AIL This certifies that ................................00-........................................................... 7 has permission to perform ............. wiring in the building of ... ...... v� .......... ....................... . North Andover, Mass. Fee..�� . .. . ....... Lic. No . ............. ........ ...................... ....... ... ..... ELECTRICAL INSPECTOR Check # "�"• TBFC0W0]VWE4LTHOFM4MaJJ SEM Office vac ori •�• DFMPARIA F OFXXIXS9FEIY r BOAkDOFFIREPREV M7Olt/ Permit No. �' a`7 WAD Rx�z4rronssr�c.�lzmOccuancy & Fees Checked PUCAHONFOR PERMIT TO PERFORMELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WMi THE MASSACHU5S M ELE.CMCAL CODE, 527 CMR 1200 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover The undersigned applies for a permit to perform the electrical w described bel To the Inspector of Wires: Location (Street & Number) Owner or Tenant Owner's Address 's this permit in conjunction with a 'urpose ofBuilding / permit: Yes® No (Check Appropriate Box) /, 0 ;xisting Service Amps/ Volts 'ew Service Amps / Volts umber of Feeders and Ampacity )cation and Nature of Proposed Electrical Work Io. of Lighting Outlets No. of Hot Tubs Utility Authorization No. Overhead Ur>dergrnund No of Meters Overhead Q Underground No: ofMetas /'r t S �( '^L )fLigbtiog.Fixttm Swimming PodAbove gem. Gakti. K: if Receptacle Outlets No. of til Burners ground K, Na of ft-gmcy Lighting Battery [huts f Switch Outlets No. of Gas Burners P Ranges No. of Air Cond. Total FIRE ALARMS Disp°sals TOM of ZoaEs , No. of Heat TOW Toffs Total Na dIIetedicr3satd Dishwashers Space Area Heating _ W l Devic" Nix 0500 ding Devices • Na of$drCm"i ted.'. dyers' Mater Heaters Heating.DevicesKw KW i mom' $Devices Local Maoniicdw O � No. ofCone No. of Iro Massage Tuffs Si No. of Motors Bailasis Total HP elvert c --S 12 i ll�SIJRANC� W . AkTdNn AfVFR; Iatna►�atethattheldnes not$�ei�'a@ecritss>eqt>ralatas>e�bj'�dase!$(,ata-�lLaws a►�penr� � � leek one) Owner Agent Telephone No. �� PERMIT FEE � �_� N2 3428 Date./ . - �7 -'fq/ .. ........................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ . ......... has permission to perform ............................................... wiring in the building at .':7� ..'2..... ` ..... ............ . North Andover, Mass. Fee -5 � ..................... Lic. ..................... ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer 1tIC Wlt✓IIVlul ywr-ALl" Ur IYlf L"AL11UJCl 1J urrfce v5c uIrry DEPARTALENTOFPUBLICS9FE77 Permit No. 3y� U%A BOARDOFMEPREYEVHONRWUMTIOAS527CMR12:(XI Occupancy &Fees Checked PPUCATION FOR PERMIT TO PERFORM ELECMCAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date-- Town at Town of North Andover I The undersigned applies for a permit to perform the electrical woll described below. A Location (Street l Owner or Tenant Owner's Address To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [—] No (Check Appropriate Box) Purpose of Building /�j.,$/ p r- C Utility Authorization No. Existing Service Amps Volts Overhead Underground No. of Meters New Service Amps / Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work G'- i/r �.� /!s %ICo vK 6 No. of Lighting Outlets No. of Hot Tubs No. of Transformers 7 Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground El 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 Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER hWar=C,O aC a Ptast1t1Dthetegt� xnlsofN1as d mxra1Laws IhaveaomalLmxldyhmuxePblicygrludTCar C maWoritsskstriale#yalat YES ED NO Ihmest�btn&edmWptoofofsarne1DtheOffioe YESFJ IfjwhawdodWYES,pimemdc*thetA)Cof ovwWbyd�tgthe wsLJRAr ® BUID MIER (PmSpe*) ���►� Estin*dvahteical Wcdc $ walkos t 1 — 7"O / IrrpechrnD*Rawested Rough Fatal SigtW uaxi3�&RMhies of HRMNAME 2�`�i4/ATE. & Lam•• .7c-lw. sign to y� t lioa l'b d::9/0.9 s/z. / BtlsatasTCL Na �1�- �f/J B'i30 ate„ 70 f�iC��� L'D1/�. ��• &illi/jC.✓ 10V _ AI.TeLNa �/•3 / OWNER'SPOJRANCEWAIVER;I.amatkethattheL awdbe not etheitutrattoecaerageoritss> ialecglivaiec�astegtmEdbyNf tdgsetisGa>eraiLaws aoddvtmysiguWrrcttthispem>ga m thisMW*ZW YL (Please check one) Owner E3 AgentEl �-• Telephone No. PERMIT FEE $ p _ Town of - tC.aRW� H.P. NELSON . ��,• _---:-_:' _` . NORTH ANDOVER COsSE� :aTays.-a`t of IU� - HEALT ?LVNNI{NG PLANNING & CONMUNITY DE'V'ELOP.NMNT Cgj'�'ic i XPPLI CATION AND PER'KZT 160 :Y1= StrL-w 01845 . (5O8) 682-6483 DA'T 7� 1 ��� PERMIT T LCCA: ICN C(1 �,t �✓t f'� J �. CWS' S V�,:? /l, 1=� C ! A, S ADDRESS \ /J 0: C =:rte:= _ /'� l �! �' /�;' •-k' `f _..,,..� C D:•fI;E � � t �I� =.t'='�_.=cR C==='TVE= L'��"-i C 1�_ will cr have rales and DA - 5_�_ C?-- - �J C REMARRS cz THIS PRR:--- :•?T.:-- _= DIS??�Y.D GV TH' _=:tIS ., 07 �1� ���� T it-L4L4,5-q/� � CL6 H � /� ���� O Us-arg 0i he ` ammou Jl it4 of sa> � Permit No. 2'1 `�'Z r 1hvmttnrw of Vubrm Enfau Occupancy Fee Checked e3�s.G� TION REGUI ATIONS 527 VJR 12:00 0 peeve blantcf BOARD OF FlAE PREVEN APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacrusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Mi)r or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit to perform the electrical work described below. Location (Street S Owner or Tenant Owner's Address Is this permit in conjunction with a building perrrttt: Yes _1! No L_ (Check Ap rco Purccse of Buiidina �� e ` c `7 Utility Authorization N :� Existing Service AmoYtits Overhead '_Undgrnd r No. of Meter s New Service s Amos Ji Voits Cvernead -T----- Uncgrnc No. of Meters Numoer of Feeders and Ampacity Locaticn and Nature of Preeosed Electrical Ncrx I — No. cf �ansformers Total No. of Lignang Outlets I No. c. Hct .ccs 1 K`,A No. of Lignttng Fixtures No. of Recectacie Cutlets No. of Swttcn Outlets arra. '— Generators KVA No. of Ranges No. of Disocsals No. of Cisnwasners No. of Dryers No. of `Nater Heaters No. Hvcro Massage Tucs OTHE=t: At;over— 'n- Swimming P=ct rr.c _ y arra. '— Generators KVA No. of Emergency Lighting No. of Cit Surners I Sacery Units jNo. or GasBurners FIFE ALARMS No. of Zones ,o:ai No. of Cetec:ion ant No. ct Air C.:rc_ c-5 Inttiaung Cavices Heat Tc:at Total i No.cf Z s ons 1:! No. of Souncing Devices No. of Sed Containee ScacetArea -ea-mg K:/ Detec::on/Sounetng Devices Heating Cewces (.V Muntcioai --Other Local IT. Cannec:;on No. of No. of I Low vcttage KN I Signs Satiascs Wirnc ` No. of Mctcrs 7c,, a; INSURANCE CCVERAGE: Pursuant :o the reeutrements of ' :assacr::set s ;ererai Laws — NO = ! I have a current Liaotiity Insurance Polic/ e�e inc!uctng Ccm_.c Cceraucns Coverage or its sucs:antial ecutvatent. YES _ have sucmtttea valid prcot of same to the Office. YES T" NO _ if ycu nave checxec YES. please inaicate the type of coverage my checxtng the aoprae to Cox - INSURANCE 3CNO = OTHER = (P!ease 8cerf•.+) (Exotranon Date) Es-ttmatea value of E!,c:n i WorK _ N Inscecaon Date Recuestea: Rou gn (�f L F nal Crx .o Start Signea uncer mg-of-perlury: _ b LIC. NO. s 2 Z-� F;Rht NAME —� C. NO. __-__—.-- Licensee r� S.gra::re taus. Tel. No. 1 Ll�� Z 8'Y a f i e( 2.Q U d A/ l S -/--4w -e—/lil /� _ Alt. Tei. NO. Address d OWNER'S INSURANCE WAIVER! I am aware that the t.-censee toes not have the insurance coverage or its suostanttai eeutvaient as re- Qutreo by Massachusetts General Laws. ane that -my signature on ::.:s =err -.tit aopticatton waives this reoutrement. Owner Agent tP!ease cnecx ones V 'etecrone No. PERMIT FEE 3 (Signature of Owner or Agents %-6=a5 Date .lz Z9 2797 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING 4L This certifies that .... A ........... .............................. ..................... has permission to perform O."Y ............ wiring in the building of ....................................... at ...................... ,North Andover, Mass. Fl..98. ......... Lic. No2.Z-?Z4-,0 ............................................................... ELECTRICAL INSPECTOR 7 I � 04/916 5,42 385.00 PAID WHITE: Applicant CANARY: Building Dept. PINK Treasurer GOLD: File r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITT H (Print or Type) NORTH ANDOVER Mass. Date Y' uildin k 9 Location '152 �u�.6�i ��'f- • PermAt # 3 �'%- __ • -- •� Owners Name -` New Renovation D Replacement p Plans Submitted _ _FI_XTUR_E5 (Print or Type) Installing Company Name,- , Address Business Telephone:5 Name of Licensed Plumber or Gas Fitter Check one: Certificate Q Corp. Partner._ rn Firm/Co. i������u�ii��■iiiiiil �i son ENNEEMENNEEN MENEEMONEENEEMEMENEEMEMENE (Print or Type) Installing Company Name,- , Address Business Telephone:5 Name of Licensed Plumber or Gas Fitter Check one: Certificate Q Corp. Insurance Coverage: Indicate the type of insuranc'e' coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Ej Insurance Waiver: I, the bzAersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. ignature of owner/agent of property Owner F] Agent M i hereby certify that all of the detaUs and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that aU plumbing work and inswUations performed under Permit issued for this application will -be In compliance with all patlnent provisions of the Massachusetts State Cas Cade and C4apter 14: of the General laws. By Title City/Town: APPROVED (oFFicrz use ONLY) ---.. TYPE LICENSE: Plumber Gasf itter Master Journeyman Signature of Licensed Plumber or Gasfitter O - ___ License Number'. Partner._ rn Firm/Co. Insurance Coverage: Indicate the type of insuranc'e' coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Q Bond Ej Insurance Waiver: I, the bzAersigned, have been made aware that the licensee of this application does not have any one of the above three insurance coverages. ignature of owner/agent of property Owner F] Agent M i hereby certify that all of the detaUs and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that aU plumbing work and inswUations performed under Permit issued for this application will -be In compliance with all patlnent provisions of the Massachusetts State Cas Cade and C4apter 14: of the General laws. By Title City/Town: APPROVED (oFFicrz use ONLY) ---.. TYPE LICENSE: Plumber Gasf itter Master Journeyman Signature of Licensed Plumber or Gasfitter O - ___ License Number'. -Y'^.w--w!1'"H�fi�.o-xrW �.r-.c..'au'�'•. ^..�,.�. -v �,r p u••1•�r yay£id. y..,��..ya. _- `—�,. ._rte.-�y-4+�8s/'�[r. s 'a 2038 Date. . r: r, of Ho RT",�ti TOWN OF NORTH ANDOVER, : q •q °o p PERMIT FOR GA& INSTALLATION . a.. rc: SSACMUSE t This certifies�I . ,S ,h .f that.. . : has permission for gas installation�-�- in the buildings of ..!2L�.a! u. ... .. , atth Andover, Mase Fee ?5,.' Lic. No:. t z o G CO .. ~ GAS INS PECT WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File . r - , 7a r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTIN* G ( Print or Type) , C NORTH ANDOVER Mass. Date -2 >uildin Location j r6 , 5 t�v - g r 'I "' Perms # �Ozlj r z Owners Name %r% ss, v, A, ? New II Replacement �] Plans Submitted D ~' S FIXTLiocc I (Print or Type) Check one: Certificate Installing Company Name i ,% Q Corp. Address 73 S 6✓ ,(.JJT- Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Joti �od i%(� Insurance Coverage: Indicate t` e type of insurance coverage by checking the appropriate box: Liability insurance policy ZE�Other type of indemnity Q Bond Insurance Waiver: I, the undersicned, 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 1= Agent LJ I heteby certify that all of the devils and information I :tare submitted (or entered) in above application are true and accurate to the best of my knowledge and that aQ plumbing work and lnicAdations ;crformcd under rumit issred for this appiicatioo wW be In compliance with an pertinent provisions or the Massachusetts State Gas Cade and f3aptes I4'- of the Ge-netai Laws. • .. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: luirtber ` 7' Gasfitte` Signature of Licensed Master Plumber or Gasfitter ourneyman y 3 �l License I3umber - as C V H< a m m F- m C Z O us 6 G O = O `" Y tt LII y W Q W —_ w _ O F- N d = W y 4 w z_ ", G °' 1 4 Q o c H w W c7 ju F- /fl 2 1 J < G W G w O Q O tL ? tL W t- W _t C2 G w = d W G W C t Y- V! m O Z G O>us N UA G O CZ t. O O t1 1 U G[ y Q n. F- O BASEMENT I 10 Ll I/ I I I I I I I I I I I IST FLOOR 2HO FLOOR 3RQ FLOOR 4TH FLOOR I I I f I I I I I I I STH FLOOR 6TH FLOOR 7Tx FLOOR I I I I I I 1 I! 1 I STH FLOOR ( I I I I (Print or Type) Check one: Certificate Installing Company Name i ,% Q Corp. Address 73 S 6✓ ,(.JJT- Partner. Firm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter Joti �od i%(� Insurance Coverage: Indicate t` e type of insurance coverage by checking the appropriate box: Liability insurance policy ZE�Other type of indemnity Q Bond Insurance Waiver: I, the undersicned, 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 1= Agent LJ I heteby certify that all of the devils and information I :tare submitted (or entered) in above application are true and accurate to the best of my knowledge and that aQ plumbing work and lnicAdations ;crformcd under rumit issred for this appiicatioo wW be In compliance with an pertinent provisions or the Massachusetts State Gas Cade and f3aptes I4'- of the Ge-netai Laws. • .. By Title City/Town: APPROVED (OFFICE USE ONLY) TYPE LICENSE: luirtber ` 7' Gasfitte` Signature of Licensed Master Plumber or Gasfitter ourneyman y 3 �l License I3umber r z8 �a � 3g � �) This o has pe. in the at Fee 74 ZA J- .. v WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File:. Date. ° TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION a This certifies that .. ��`... �,. .. - a" ?�.......... . has permission for gas installation - .... . ...�.......... . in the buildin gs of .. ...•. '� -c 1!LG!?,:.�``.............. at 1.2.` <t'.. �'��� �`� _'a ?� . ..r ... North Andover, Mass. ,5 Fee '. Lic. Nociv% _. r,"-�-....... . -GAS INSPECTOR Check # /? ��` `�l� 4015 MASSACHUSETTS UNIFORM APPLICATON FORPERIVIlT TO DO GASFITTING (Type or :print) NORTH ANDOVER, MASSACHUSETTS Building Locations New Replacement Date n Permit # 'h Amount $ Plans Submitted (Print or tym) (Print or type) Installing Com Address { C'1�� C_hg& ane- Certificate Installing Company ,�Ua,�7czU� Check one: Certificate Name �. rt)rt JJ` (U 1:1 Corp. 7 n S j U/' ► i� t�� M l �i1:1 Partner. y 7 S -S E] Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurancd coverage by checia Liability insurance cy ❑ Other type of indemnity Insu ' e , ' e I, the undersigned, have been made aware that the I hereby certify that all of the details and information I hdLe submitted nt best of my knowledge and that all plumbing work and'in all ' o rfo ed .� compliance with all pertinent provisions of the Massaclius �s ate Plu ing By: e ff°°� ��icc n um er Type`ef'Plumbing License appropriate box: Bond ❑ of this application does not have any one of the above Agent 11 ered) in above application are true and accurate to the under Permit Issued for this application will be in Code and Chapter 142 of the General Laws. Title 1� s'" 1 -) , City/Town icense uri er Master ❑ Journeyman APPROVED (OFFICE USE ONLY I AOR7q j O F . Date..'.."�'.� . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ../V, /. F-.... C``�fi.�-��� �f f .......... has permission to perform .... /? C. !i4 .& ............. plumbing in the buildings of ............... at. ....... , North Andover, Mass. Fee .1- 7 .' .. Lic. No. 2. .......... . , .. . P WING INSPECTOR Check # 5286 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO P^LUMBIING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date Building Location 3Y6 S u u,,( y,i /� S / , Permit # n , � Amount v Owner / dL Gk C I/ Q1 L i >'i r,, �.c_ / New ® Renovation ® Replacement 1:1 Plans Submitted Yes 1:1 No ❑ (Print or type) Check one: Certificate Installing Company Name'94 11 Corp. nPartner. Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy -0 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 El Agent F1 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 Massachus s Stgte Plu rinnd Chapter 142 of th eneral Laws. By Signature oT 1-1censeu rIUMDer Type of Plumbing License Title /.7 In/ City/Townil—cenlseM•um er Master � Journeyman ❑ APPROVED (OFFICE USE ONLY >3927 • Date...........!... f NORTH 1 TOWN OF NORTH ANDOVER olp PERMIT FOR WIRING This certifies that ....... ..�'L.T�./cI? /.. ... ....... /..::7:1**C C........ has permission to perform l� i........... ....................................... wiring in the building of I /jjc„� J S w... Su '??.?. ° ... - .................... orth Andover Mass. �t .................. ..... ee... �..!!/U Lic. No. / �f� ..,�, .� ...r� .......... .. ........ LECPRICAL INSPECTOR Check # �/ Jul 08 02 08:38a IES Service Dept 8786719402 p.1 lir is ti: �4:'vl'LZ•: �:�F tle1. �I1t : wnp .1 WR;:: TI• II: LC7t07R1..0 ,.7 ::;:LUt C:..n1.. .�:iJi [:1_ Pi3532CRL"S3iu=1..Cu^....il :.-pR., it\..-..�..ivQ: �gv i 7_0-77 11'\r _1� vl _ _ ti _ _ .1' ✓:d.:�•1.`:T .:i�7,1 .'zE-_�.' t _:vzn nrz acs c_ „s a-'rer +atpnor. tc r l.,�r_L C . Ln.c4E'iJ� ic5ts !V ?C .I, er Or Tenant ?S `thL'S Fermit'a CoP11l?kt- i� 0� iv .y ? �P98a^.�� D,-:j;;L.4 A'., 01%,mfase of5"06inz SlCwL^s :t0 4?C^ API ros t dDtts ItiUn,her o , each. n ac _=a.ma3ci.Y _a moatEnd I:r:o> a o_ 71sopused, J<<m_" f_. ww;l unt .._. C;. -Ib lie r war3B: i C.'tift'L r�f9e9 i^i :t7lDP lVED. +al:erbead ����r5 !_ IvZ i1 licce_zb "ON?,7itilt)n 61`?i'?e TGIfmVu;P;t70i? mm' ,�_ WQlv2u pptli? IP.'peCTpr i7:"j1 ire= T':.' . I .1114Cn lJGQlt1O?G/ fe!Dii jj Q^.SIr8C. !J' a: required in the 1t:.^aeCtOr a! h'tr?S. .ills waived y tl'.e ovmtr, n0 t^e:?nIi SOr the D,'•r"o- an.^.- 0f ei-_ct:1Cai W8r1: Iilc'� ::SllC UTI. tSS tRe iicArs6e770V,c_S =00fl CT liabillr✓ l:nsi anot Inziudin_ +'Co',l'ID.eTed, ooerfiTior." mversp O - its subsmitiai eQ_I1t8ierit. lr,e lind.rs;Pcd C_:?iileS irat 5110'1 cove=z Is in force. and has e.-hibized Drool 0, ame to Th2 mcm, it ?.sU. Qillce. CHE:E_-K_ ONE: INSUFLAIv 30ND ❑ 0 iER ❑ ;�pecii}:l (J:plrai. rn Due) stimaied Value of �iectrical VJori,: �. ®y {Pv"n.n reouired by nullcipa) puiiml.) Wark to Start: inspections to be requested in accordan^w with ,i+iEC RL, it, i 0. and upan completion. 1-ernry, «{ azr file pains 6t ctue4 DJ Perjuly, ihcf IPt c L1Ffit.-'Yi 8/tOlt Otf iftl; [/ D1JC6:/UDP CS i; J;� radr COP PpE�I_, I'l i0IT*7S�i�iE: 1A%B1"5t�t �,o tri ^�l She L^ ?'17. LIC. NO.. Z_= iCe@3_e: A c 11dIc A t, .Z i'i�rdTlC3i St*,T2ilaSSi��.I°1Q., (f oapiicabYe, enter "exempt" in the iic nse nun?oer line.i ori R `'rV= i 01 8 C b6F 1'ef.:vo.: OVIMER'S DiSUR6NC'Z V-lA_IVz-R: i am aware thaT the'' cznsse uve; no, hm,c til: iiatiii it), ins.irance c.lv_-,?- nc-•�•-11v re0v1[reCi by !aw. 0, inn sic:? 7-tt below, i heret7�' 'waivt this reni.lirelnent. ' ai, t}2` (CiI:CiC Gile.l � Owner � I CIVFTi."''i °. o'"i:. Sa arum bore No. � P�.hd1 T_ I .o, C' ' e:k'i+3ai^. i, := `u4dd.,a,+0. 0: Tara! �tiatSFQraMS A)t_ INC. of ue.lidmC CJt:Itiets !No. a_ ant �'alos I Sewer.YCo.a i II<io. of Li2hifitaa Fi-, res Son is m ZmoE g'x�p e I I ws. 07 ��a= .aucef tarp _ laar, arnd. Matter, Units �_+ia. as F c—eptacie tra tiee flea. a{ Gil Burue>rs 11-11211L ALARMS INN. ofzones 4 o. o� strza"laes No. of Gas Buroen c. of eteclon ana ! Aillfiatmg !l e� ees Ilya. ofom �Eg.s Nob of Air Cased. ion i _ of lemma Devices �",No. �?Na. of vsles*e Disposers I is I '+umber" To—asIM ToralS: Nc. of Ge;_l..00'taimeo �&}QrscCtoa�A::[�ag INo,af,'Ciis���sscceas I ISSp22QI'4rea ae-afiog KwlYauoaeilaai 3eevee�^ E E tJ- �,�• o_ � Lncad � ti,oaic�o>F �d�_: Tic. of DT vers ��r�ataaf� m aances A.. a__ li ir�t S:T+s�,ceems: !VCs, ax dt'am' .. �C. Ot No. o1 _ I Ido. at D_-.zice, or �Sea:t.!Mienf I ea®as. z:f .� Sb�aas l?iaAi35L5 ! Lataisiata No. I of F^_C5 a!'L@aJaS'mmi: I Na. F-vd •Rllfltnssaim 1CnthtubsI Q. O:r�aOLQtG,. tmIIi3 x k -_Co WIzR,:2E3@3as 'iSin"' _ I fgI0. of, Devices or 1,,guiy?Aeli I .1114Cn lJGQlt1O?G/ fe!Dii jj Q^.SIr8C. !J' a: required in the 1t:.^aeCtOr a! h'tr?S. .ills waived y tl'.e ovmtr, n0 t^e:?nIi SOr the D,'•r"o- an.^.- 0f ei-_ct:1Cai W8r1: Iilc'� ::SllC UTI. tSS tRe iicArs6e770V,c_S =00fl CT liabillr✓ l:nsi anot Inziudin_ +'Co',l'ID.eTed, ooerfiTior." mversp O - its subsmitiai eQ_I1t8ierit. lr,e lind.rs;Pcd C_:?iileS irat 5110'1 cove=z Is in force. and has e.-hibized Drool 0, ame to Th2 mcm, it ?.sU. Qillce. CHE:E_-K_ ONE: INSUFLAIv 30ND ❑ 0 iER ❑ ;�pecii}:l (J:plrai. rn Due) stimaied Value of �iectrical VJori,: �. ®y {Pv"n.n reouired by nullcipa) puiiml.) Wark to Start: inspections to be requested in accordan^w with ,i+iEC RL, it, i 0. and upan completion. 1-ernry, «{ azr file pains 6t ctue4 DJ Perjuly, ihcf IPt c L1Ffit.-'Yi 8/tOlt Otf iftl; [/ D1JC6:/UDP CS i; J;� radr COP PpE�I_, I'l i0IT*7S�i�iE: 1A%B1"5t�t �,o tri ^�l She L^ ?'17. LIC. NO.. Z_= iCe@3_e: A c 11dIc A t, .Z i'i�rdTlC3i St*,T2ilaSSi��.I°1Q., (f oapiicabYe, enter "exempt" in the iic nse nun?oer line.i ori R `'rV= i 01 8 C b6F 1'ef.:vo.: OVIMER'S DiSUR6NC'Z V-lA_IVz-R: i am aware thaT the'' cznsse uve; no, hm,c til: iiatiii it), ins.irance c.lv_-,?- nc-•�•-11v re0v1[reCi by !aw. 0, inn sic:? 7-tt below, i heret7�' 'waivt this reni.lirelnent. ' ai, t}2` (CiI:CiC Gile.l � Owner � I CIVFTi."''i °. o'"i:. Sa arum bore No. � P�.hd1 T_ Jul 00 02 00:398 IES Service Dept 9786719402 Wrstt Electrical Services Effective 1/02/0i through 1/02/04 Department of Code Inspectors Wiring Divisions ' Attention: s ` Reference: Gentlemen: Electra, cal Department Inspector Corporate Signaduxes p.2 Int 0MTa te)M a r f ac N u:i a tU inteltate Network Systems Interstate Controls NaTmvnodExecutive Pak 70TrtcleCovr: Aced h, Bilierica, MA 01 E62 Phon;.;70-667.5700 Fax. 579-547-8L"9 interstate)Northern New England interstote Network Systems 1 ` Ccce Lane Bedford. NH 0-- 110 Phwre:603-52'-�23U =ax:603-6.%_?480 Irterstate/Southam Now England 58 Kent Avenue Warwick, FA 02em Phan=:4] ; _rl•6700 Fara 40 ; _x.7,611: ww d7,i nterstatae lectriea Lw m The following is a list of corporate signatu,,z that arc acceptahle at Interstate. Electrical Services Corporation for permit applications. > Pat Alibrandi, Chairmen (Master License *A921 ) ➢ James Alibrandi, President Robert Parker, Vice President of Engineering ➢ Alan Tiezri, Vice President of C.oxtsira-lion Thoirla.s O'Toole, Chief Financial Officer > John Sloane, Vice President Service r Note: Af other _hceme numbers are a vailable U'Pon.mquosr If you should have any comments, questions, or require additional infon p ortratilease feel free to contact me at this office. Sincerely, MUM TATE ELEC`lid1ICAZ 1 FRVICES CORP. J di Pat Alihrandi Chairman :LU C,iN.'fp Cvh'iv� I Jul 08 02 08:398 IES Service Dept 9786719402 p.3 Fo:tl. Then Denf_h Along All Paitorat. \\ lM COMM0NWEAL.TH OF MASSACHUSEU 1S� BOARD OF ELECTRICIANS EL REGISTERED MAS7M ELECTRICIAN i ISSLES TKS LICENSE TO i'YPE INTERSTATE ELEC-- :SERV CORP PASQUALE A. AL.DBRRM-N-DI. � -A 70 TREBLE' GONE'_.; R:D'_--� Pio BiLLERIGA. .-M.A, 0'1.862-2208 331738 5217 A 07/311/04 331738 Fold, Then Gata.•.h Along AN Parioramne i i Fdd, Thin oei=i Along NJ Pe..or-BUMS CONTROL ;# D ©Q 0 v 1 IMPORTANT If this license is !cst or destroyed, notify your Hoard at the Division of Professional Lio=aure, 229 Causeway St., 1 5th Floor, BorAon, MA 02114. It your name or address shown is changed, notify your ooard of correct name or address to insure proper mailing cf, ripe. Renewal Application. Always refer to your license number. This license is subject to the provisions of ha General Laws as amended. It is a Personal privilege, and mus- not be loaned or assigned to any otner person. Keso this license on your person or posted as required by law. Feld, Then Gateeb Along All Perfoiwwrt5 Jul 00 02 00:39a FmU� [78jJ 6$I-veSE FAnT Barry Driscoll irlG Ag --y, Irrc 600 Longwater Drive P.O. Boz 9120 Norwell, MA 02061 i5UREDInterst8te CIeCt^TCcI Se..^V 70 Treble Cuve Road North Billerica, MA' 01862 IES Service Dept 9706719402 Dl- LIAbI ! ! Y IN6URANCE DATE(MM,DrrrY, �781Z 6$;-no"86S to1D/0',' .A I 'S AI' n 0 1 F-07MAI N ONLY AND CONFERS NO RIGHT S UPON THE CER1lF7.^.A T E HOLDER. THIS C ERTIPICATE DOES NOT AMEND, EXTEND CR A'_TERTHE COVERAGE AFFogoZD gyT}m pOUwIES BELOTN. IWURERS AFFORDING COVERAGE TC:rS CvrFlaraTTan Y+suaegA: Transcontinental insurance Co. INtAJ9ERE: ONTO C_sualty Insurance Co. n;sl-I�sn c: — INSUReR D: msuaca E THE POLICIES 0" INSURANCE LISTED BELOW HAVE BE?v ISSUECTO THE INSUREONAMED ASO YE FOR THE POLICY P_RIpD INDICATED. NOTWITXSTANDING ANY. REQumaliNT, TERM OR CONDTTION OF ANY CONTRACT OR OTHER OOCUAgEh17 Wn R._PECTTO WHOH T}!IS CERTIFICATE MAY BE ISSUED OR MA.`. m.fiAAl.ttfEWBURANCEAPFOROED8YTHEPOLIVESD'CSCR!3EDHERSPI[BsuFMTTOALLTHETER POLICIE=. AQ(3RE KTE LIMITS SHCWN MAY NEN AVE BEREDUCED By PAID CLAIMS, h15,E}iCL'J9i0N3A14DCCNUPIONSOFUCH 1H TYPE OF INSURANCE POLI CYNUMBER L r LATE AMDCNYI OA iMM1DD/YY1 LWTTg �AmaALuaeILlTv �i07445487i 09/3012001 09/30/2002 vFA;He WRRtNC js l ODO COMM04CALGENERALUABILJTY , CLAMS MACE 1 OC:i1F FIRE OAMAGE jMy cne iitai I S 5DD ,Q ' MED EYP Any ok pum nj I g $ FERfANAL 5 ADV INJiJPY c uEN'Ln.G3REGATEUMITAFPUPFFEq.. GENFkALAGGREGAT'E IF 2,000 F JCY � FRO' v LOC 'n L"'. •�MP*P ACG F 2.000 • t1rCMOsq.ELIA3lLITY 10 799 5 4 89 4 tAgpj 09130/2DOi 09/30/2002 X AW AUTO 07777 Y 1i 2 (OTHER STA. i Es) 09Z31)/2001 09/ 30/2002 A EDN( UMf S Ca amis>r�p ALL OWNED AII'T08 • , =AEDUl£O&jros BOOILYIN'VRY A Perperovj S WRED AUTOS _±7- NONCWNED AUTOS 8:70:LY 1N.lURY fear er�0ert; F I PROPERTY DAMAGE2 ff (.A.RAGi:JABLLnY' ! (Pa ea9�errj ANY AUTO AUTO ONLY -EA ACCIDF_A'T ; t1THETr THAN Ell ACC 8 __ I exceasuaetLrrr 61LOSZ779963 AUTO ONLY. AGG S 09130/2DOT D930/200:2 1E O=S=Aftsm-eff 14BREI LA FORM11 1 EAD axuPRlaNce a 10, ODD, B AGGASCATF s 10,000 OEOt1CT:eLE S �lENT1gN S I wa�N ns DcweNsanoMAvc D79954380s EMPLOYERS'1LABIU7Y 05�'30(2DD1 05/30/=002 ToryUM ER A I EL. EACM ACCIDENT EL 0 SEABE - EA SMPLOYF SIDO , EL DSEASE-POUCY Um- I F SOD A otsfial�atiT�n Floater 1079354877 0!3J30/2001I OW/30%2002 3100,000 Any one site $200,0DD Transit $100.000 Tomo. Storage :Eit9lPTION Oz OPEFAT10t1SlL f},^.ATt S/VEHI :Ls,SJES(CLUSIOtQS ADDED BY E1VUOR5EMENTWE10At PFiOMSONS The Notice of C,111cellation provision is 30 days except 10 days for non-payment oP premium. Evidence of insurance for work performed Within the insureds scope of nornaai business operations, :r:FMFICATEHOLDER INSURED;INSURERLEETTER• CANCELLATION 1 SMOULDANYOFTHE ABOSEDEs:3mgo0OUC'S9E^ANCM.LEDBEFOREJ-fM W'UT1ON DAT: THEREOF. THE MSUING =APANYwP„L EMi'AVOR TO MAIL 30 DAYS WRITIP4Nm'IG MTjtcERT;FIDA-m- •jcLDEr;NAM2TOTHELEPT, j BITFAILURETO MAL sucm,y ncz SHALL WOSE NCOBLIOA'nCNOR UABILfiY OF ANY KIND UPON TT'E COMPAVY, ITG AGMJTS OR REPREsmcATVE5. i AUTHORIi c� REPRES6NTATIYE ^� i B, Dr15C011 /BM? fir. p.4 C?fig O } = FA h ca CV 0 p �'C p y"a� m m t C c Z • m =r -o 3 H O ^w O O�Q • '- CD n .Z y O• CL �. m r Ory OG x .9 a o G1 � rCD ;L7 C =r m .n►�ot m p ,y ®' ' n .-►' C2 , CD mCD •� _ �` U) CL I-r1 CD C/). f Er .� 0 ' CD O CD M M C CD CO) CL CD CO3 CD I CO)CD 0 O CSD CD , CD C?fig O -• CA t Qa = y h ca ;z 0 p �'C p y"a� m m c Z • m =r -o 3 H O ^w O O�Q • '- O' ., O• ra �-► p '••� O h m Ory OG x .9 a o G1 � rCD ;L7 b ^ ^) =r m .n►�ot m p y o 0 -40 y oa 0 cot .-►' p in n Jr d CD Om rter^^17 �p mmq ® "` r npaCD A•.�I y . - !'• O 0rN j e rte. 'Co. -c - O a m: O c _ cn CD �...oP" coo YCD . / mcn lqb 3 _ oir o M,w:♦ m �nrl G en t F • j► 00 m CD s . r:CD Gn7 a, O ' x r+ O l Y 0 CD rA... t � ' E a ;z PO 171 O m O :; O ^w O O�Q • '- O' ., � t" 00 w 0.7 OC a- "ti � Ory OG x .9 a o G1 � rCD ;L7 b ^ ^) 0 Q. x y E a GENERAL BUILDING MOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT (COPY OK)..or no inspections INSPECTIONS: (Minimum) Excavation, Footing, Foundation, Frame, Insulation, Final. . FOOTINGS: Continuous Full 2x4 Keyway _ { Continuous strip footings for interior columns FOUNDATION: Rebar as required ' M Anchor bolts or straps +^ _ Damproofing A q Foundation drain - pipe/stone/fabric filter/cover and outlet connection. drFRAME: Fireblock over girts/plates between floor joist ,. Penetratioris for plumbing, heat; elec,.etc. f t r Walls at stair. stringers. ^ . s , - Windbrace corners and center bearing partitions. ` Size ridge to provide full bearing at rafter cuts. Hip and Valley'ralters'--watch bearing at walls. Ridge & Hip " provide proper. connections. k •;• x �� Cathedral roof raftersprovide proper connections.end .use "Hurricane Clips" tie to plate. ' x Stair stringers - watch cuts and heal support. '•Joist hangers 7•fully nailed w/ hanger nails. Sill plates•2-2X6 (1 PT) w/sill seal. ' Girts - solid brick orsteel plate bearing at foundations '/ " air` space at sides in foundation pockets. ,..` Lateral.bracing at ends'. ' -Certified calculations. required for,Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. . 4 " . "Check headroom clearances - stairways; under beams ;.. Attic Access. (min. 22x30 w/3' headroom above). Crawl space access. (min. 18x24). ' w Bath exhaust fans to have metal duct to exterior (not in soffit). Firecode S/R wood frame of "O" clearance fireplaces & stoves . Window Schedule or Every Habitable Room Must Have: Natural light equal to 8% of floor area. '/ of required glazing shall be openable. Bedrooms required min. 20x24 egress window or door. Vent attic spaces - "proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing - Smoke Chamber - Finish Smooth parging, clean joints, 8" solid @ combust. Surf • ` r�;DECKS: Separate permit required: .. Lag to house, provide flashing. Rails min. 36" high, Baluster max space 5" on center. u- Over 8' above grade, use 6x6 posts w/lateral bracing,. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Han returned to wall/newall post. *• - ` Guardrails required alongside open cellar stairs. Exterior grading complete. ,. Certificate or occupancy required prior,to occupying structure..- Temporary, Stairs required for inspection. - .. - Reinspection fee.., $25.00 (Be Ready).. Certificate of :occupancy required'prior to occupying structure. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Ii. ..................................... This certifies that ............. ........................................... has permission to perform...: :'+ .......... .................... ................................. wiring in the buildingof..... . at ... --------- ............. . North Andover, Mass. �� - 65� Fee.... ... Iq m fV ........ Lic. No . ............. ... ........................ ................. ELECTRICALINSPECTOR Check # 4330 THE CO1VMONWF.AUHOFMASSACHUSENS Office Use only DEPARTAfl IOFPUXATCS4FE7Y Permit No. BOARD OFFIREPREVF. MONREGULA7YONS527CM l2. -01D Occupancy & Fees Checked APPLICATIONFOR PERMIT TO PERFORMELECTRICAL WORK j ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date 3 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work escribed below. Location (Street & Number)�� Owner or Tenant Owner's Address Is this permit in conjunction with a building pe it: Yes M No r (Check Appropriate Box) . n Purpose of Building �'� jQ Utility Authorization No. Existing Service O 0 Amps4Z/ Volts Overhead Underground No. of Meters % New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work -�f 4c— e-, A*W-412 Oezoy 4". �d No. of Lighting Outlets 7 No. of Hot Tubs No. o ransformers Total No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground E3 ground No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges j No. of Air Cond. Total FIRE ALARMS No. of Zones / Tons No. of Disposals No. of Heat Total Total No. of Detection and Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sou_nding Devices No. of Dryers Heating Devices KW Local Municipal Other Connections �. No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP ;. n F ERw L Q �Lt� /e) r D:tt _ f 149 C"s� i G LC d It 1'f� 7t>Sut =Cored P tDthereWEMO iSofMaada>�Currall mvs IhaNcaamalLiaAtyhmua=Fblicyuxhx¢>gC Co ar&st> alegxvaht YES NO IbavesubmiWdvandpmofcfmmtotheQffm YES (�i� IfyvuhavedEckEdYES,plt i&atethetypeofmvemgE�by Fs M9,dValueofEkhicaiWotic $ WC&IDStalt `% s a3 bSPeWMDaCRec Rough Final le KU. ecl<lp Li=WNo. --4t7=--&=39',0t57217 [ice f/ Signue Lioe=No�— Bugt>essTelNo xo- '00166219-- Alt TeL No. DWNER'SNSURANCEWAIVIIt;IamavvatethattheLicros(-doesnothavetheinstnartoecovetageoritsatmntialecpvalertasiegmedbyMassacbLisczC nedLaws uidthatmysigo&ueonthispetrmtaThcMonvvmvesthisregtmmmL r 1 Please check one) Owner ® Agent ® �f V Telephone No. PERMIT FEE $76,-,5 Signature o wner or gen Date.';�'.0 3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ? 5i ... GA.). P4 r, C'. o U � has permission to perform ... U-.'?.V� P ct Q plumbing in the buildings of .. A.1 -1'e. U.' P.c` '. J. 4 ............. at ... S.� L. . 1/.. k �" fi... , North Andover, Mass. ................... // Fee ...3� . Lic. No..1.01 J .� . :�, ) Q2 �.i. J. AkP t ... . PLUMBING INSPECTOR Check # 3 (' S 6 5515 MASSACHUSETTS UNIFORM APPLICATION FOR (Type or print) NORTH ANDOVER, MASSACHUSETTS Building TO DO PLUMING Date 07 573 Permit # Amount Type of Occupancy New Renovation0 Replacement Plans Submitted Yes. No Ea 0 . 1:1 (Print or type) Check one: Certificate Installing Company Name 4:!- e 12 L,,-,( A ez- 14 to 11 Corp. Address P o 0 Y_ �7n- 41 0 Partner. Y02 C 1,4 BusihOssi one Tele'h '7' 12- 7 - FnMVCo. p Name of Licensed.Plumber: r_ to VC -0 LZ x Insurance Coverage: Indicate.the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity Bond 0 Insurance Waiv 1, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner El Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Slra�e Plumingfflode/wj "ter 142 of the General Laws. , - Type of Plumbing License - =e MUMMY .Master D (OFFICE USE ONLY Journeyman F1 Date .. 5: 'rye ° TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This Certifies that .. CN.'........�.. v v has permission for gas installation �R w, ° J. ` ..'........... . �e Ciin the buildings of ... . � . .."....�. a " t. f S D S V wt wt le r S� at .... ......................... . , North Andover, Mass. Fee..... Lic. No. GAS INSPE TOR Check # (0 58 4293 MASSACHUSETTS UNIFORM APPLICATON FOR PERNIIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Owner's Name New ❑ Renovation ® Replacement ❑ Date ,,Z— /9 — 0-3 e Permit # Z �� Amount $ 0 /A- Lj &,,-K 411 u Plans Submitted ❑ (Print or type) CAeck one: Certificate Installing Company Name %LI C _ ca c s,c.i o 4 : co F-1 Corp. Address b /3 a X Partner. '7— Business Business Telephone Finr/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy V9 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 I hereby cer►ity that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my ldidwledge 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 SUq Gas Code # Cl�erX ofthe General Laws. ICity/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber A:52 9 / i ❑ Gas Fitter License NUMber Master ❑ Journeyman TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that. %:y. �/' ;f!.. /?.`I/`. . r' .+a t .U........ has permission for gas installation .. 4�. s . . . . � g.7........ . in the buildings of.,�. `1. /I' A /? o. %: � c .......................... at . ss .(�...? .(--� 1:. �.-r................... North Andover, Mass Fee. Lic. No........... .......................... GAS INSPECTOR Check # 11_/% # 1 � MASSACHUSETTS UNIFORM APPUCATON FOR PERNIIT TO DO GAS FITTING (Type or print) Date' - �- NORTH ANDOVER, MASSACHUSETTS L Building Locations 3S C) 5 0 r,-) Yy-ve- -f-` � Permit # 1, 3 Y Amount $- Owner's Name P - 62A") New Renovation ❑ Replacement ❑ Plans Submitted ❑ (Print or type) Check one: Certificate Installing Company Name 4'� �-� 0 V �' 6 \ ❑ Corp. ddres1s O ULk S 1 (` L ❑ Partner. Business Tele -phone >'r I 7 A�i ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �l� �1-o�Lj 6hc,a V CV INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noo' If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Ma i afore on this permit application waives this requirement. Check one: Si tore of OvAer oi•-e ner's A e . Owner ❑ Agent ❑ I hereby certify -that all of the details and information I have subm' (or tered) m' abo plication are true and accurate to 1 best of my knowledge and that all plumbing work and installat �rs�p, cr ed and Permit Is ued for this application will be in compliance with all pertinent provisions ofthe Massachuse TED (OFFICE USE ONLY) I Signature of 0 Plumber4j ❑ Gas Fitter ❑ Master ❑. Journeyman ed PIAOr Gas Fitter 'J, S" f p-.- Icense um er • (Print or type) Check one: Certificate Installing Company Name 4'� �-� 0 V �' 6 \ ❑ Corp. ddres1s O ULk S 1 (` L ❑ Partner. Business Tele -phone >'r I 7 A�i ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter �l� �1-o�Lj 6hc,a V CV INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ❑ Noo' If you have checked M, please indicate the type coverage by checking the appropriate box. Liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Ma i afore on this permit application waives this requirement. Check one: Si tore of OvAer oi•-e ner's A e . Owner ❑ Agent ❑ I hereby certify -that all of the details and information I have subm' (or tered) m' abo plication are true and accurate to 1 best of my knowledge and that all plumbing work and installat �rs�p, cr ed and Permit Is ued for this application will be in compliance with all pertinent provisions ofthe Massachuse TED (OFFICE USE ONLY) I Signature of 0 Plumber4j ❑ Gas Fitter ❑ Master ❑. Journeyman ed PIAOr Gas Fitter 'J, S" f p-.- Icense um er